How much do preclinical grades/class rank matter?

[PatchAdams25]

How much do class rank/preclinical grades matter for matching into competitive specialties?

From my understanding the only thing that matters is Step 1, clinical grades, and research. AOA is a plus. Reasoning being that some schools don't even rank students, so it is hard to standardize it in the residency process. Is this true?

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[Shark7500]

Everything matters. Just do your best.

 

[Redpancreas]

How much do class rank/preclinical grades matter for matching into competitive specialties?

From my understanding the only thing that matters is Step 1, clinical grades, and research. AOA is a plus. Reasoning being that some schools don't even rank students, so it is hard to standardize it in the residency process. Is this true?

What you've said is more or less the conventional SDN wisdom I agree with, but I'm not sure how many schools outside of top-tiers ones don't rank. So many people don't realize schools rank candidates, but don't tell them that until you learn what the Dean's Letter is. The issue, however, comes when you ask yourself what you really want because all desirable things are hard to achieve. 90% of med students don't want to just graduate, but go to a solid residency in their field. For Internal Medicine for example, no one will tell you that you need to be AOA but being AOA/250+/top-of-your-class are selection criteria employed by brand-name residencies which set students who go to those residencies up nicely for a competitive GI or Cardiology fellowship down the road. I'd imagine things would be similar for General Surgery and perhaps Pediatrics.

EDIT: Also, class rank is pretty important and pre-clinical grades factor in pretty heavily there.

 

[PatchAdams25]

I understand the goal is to do the best you can; however, is someone really gonna get knocked for having lower than average preclinical grades but a step>250 and good clinical grades? The whole point of preclinical is to give you a medical basis so that you can do well on step/show that you can do well on boards in the future. The goal of clinical years is to make sure you will be a good clinician.

 

[SpecializedSurgeon]

For us, the preclinical grades themselves aren't critically important, but class rank is (they kindof go hand-in-hand).
That said, at plenty (most? not sure) of schools you can have mediocre grades in the first couple of years and crush the clinical rotations and your class rank will shoot up.
So yes, "everything matters", but you are correct in that if you have a high step 1 score and your class rank is high, few programs will focus on how you got there.

 

[Donald Juan]

I understand the goal is to do the best you can; however, is someone really gonna get knocked for having lower than average preclinical grades but a step>250 and good clinical grades? The whole point of preclinical is to give you a medical basis so that you can do well on step/show that you can do well on boards in the future. The goal of clinical years is to make sure you will be a good clinician.

If you make above 250, honor all your clinical grades, then outside of multiple failures/repeating a year your preclinical grades will likely not hold you back from any specialty. It obviously doesn't help you either if you miss AOA or have a lower class rank due to your preclinical grades.

The reason people are weary to answer this question, is because you keep asking the question over and over again until people confirm to you that they don't matter. The only reason I can guess you are doing so is to confirm to yourself that you don't need to work as hard the first two years, which is a poor mindset to have. It's like asking if I can eat fast food all day in January and February, then work out every day and eat perfectly in march through May and still have a nice summer body.

 

[Lannister]

is someone really gonna get knocked for having lower than average preclinical grades but a step>250 and good clinical grades?

Well okay but the stuff you learn in pre-clinicals is what's covered on step. Obviously there are people who do poorly during M1/M2 and rock step, but I'd imagine there's probably a correlation between pre-clinicals and step score.

 

[PatchAdams25]

If you make above 250, honor all your clinical grades, then outside of multiple failures/repeating a year your preclinical grades will likely not hold you back from any specialty. It obviously doesn't help you either if you miss AOA or have a lower class rank due to your preclinical grades.

The reason people are weary to answer this question, is because you keep asking the question over and over again until people confirm to you that they don't matter. The only reason I can guess you are doing so is to confirm to yourself that you don't need to work as hard the first two years, which is a poor mindset to have. It's like asking if I can eat fast food all day in January and February, then work out every day and eat perfectly in march through May and still have a nice summer body.

Doesn't matter when you start the diet as long as you end with the nice beach bod right

In all seriousness, the reason I am asking is not to "confirm that I don't need to work as hard." Of course I know you have to work. That is not at all the mindset I am trying to have. I am going to work my butt off and see where the cards fall. I am more so reaffirming that I do not need to stress about every little point or being slightly below average in some classes. I have also heard many conflicting things when it comes to preclinical grades from residents/attendings so I was hoping for some clarity

In most schools crushing clinical year will outweigh preclinical performance anyway when it comes to classrank, so most of this is a moot point.

 

[Jabbed]

Fwiw most people who crush clinicals are the same ones who crushed pre-clinicals.

Great quote from @operaman

Yes, it's important. Are there other things that are more important? Sure. Does that make first year any less important? No.

I don't know if people ask this question because they don't like studying as hard as it takes to do well or because they just hate the material or because they are doing poorly and need some solace, but no matter the reason, the fact remains that everything is actually important and there really aren't any shortcuts. People talk about this year or that year as more or less important, but the not-so-subtle presumption is that someone who does poorly in one year has the ability to do well in all the others. Sure, other things are valued more by PDs and other subjects are more likely to appear on boards, but the guy who can just squeak by one year and then crush it the next probably rides to class on a flying unicorn.

Be very careful not to construe the advice aimed at fourth year students as applying to first years. There's a huge difference between saying XYZ doesn't matter to a fourth year who has already demonstrated he did well in pretty much everything else, and a first year doing badly currently who may or may not actually turn things around. What I have seen typically goes like this:

1) Ms1 starts getting behind and getting lower grades; decides first year material isn't high yield enough to matter; plans to step it up Ms2
2) Ms2 guns hard for the first exam but does a lot worse than he thought (what, we were supposed to remember all that physio?), so decides M2 classes don't matter and plans to focus solely on Step 1
3) Assuming Ms2 passes his classes, he gets to study period and finds himself plateauing a good bit lower than he hoped.
4) Finally takes step 1 and does so-so on it. Decides he'll kill it 3rd year, take CK early, and maybe do some research to compensate.
5) Ms3 year starts and he treads water for a couple of weeks until he realizes that he can't manage to balance the shelf study with clinical time; misses honors either because of the shelf or because of evals; decides that only IM and Surgery really matter since they're the big ones everyone looks at.
6) Still ends up P/HP in IM and Surg
7) That research he planned to do really isn't going anywhere either, but he'll start working on that later....

I could go on and on. The point I'm beating to death is that importance is probably best talked about only in retrospect. For now, assume that everything matters.

 

[Goro]

How much do class rank/preclinical grades matter for matching into competitive specialties?

From my understanding the only thing that matters is Step 1, clinical grades, and research. AOA is a plus. Reasoning being that some schools don't even rank students, so it is hard to standardize it in the residency process. Is this true?

Take a look at this:

 

[PatchAdams25]

Fwiw most people who crush clinicals are the same ones who crushed pre-clinicals.

Great quote from @operaman

One of the best responses I have ever seen on this site. Good to see that progression this early in M1. Let's hope I don't follow that path