How much does class ranking matter?

[CrimsonMirage]

Hello!

Our school doesn't tell you where you're ranked (in an attempt to reduce the competitiveness, I suppose). But in the end, we found out where we're ranked when we apply to residencies. Residencies and deans can see our ranks, and our dean's letters will surely hint at what our class rank is (or explicitly state it).

How much does this rank matter, especially for competitive residencies? Does it matter if someone is in the bottom vs top half of the class? I've heard that if you're in the top 10-20 people, class rank matters b/c it leads to AOA, but otherwise everyone is the same. Is this true?

Thanks!

---

Members don't see this ad.

 

[SoundofSilver]

I would guess class ranking is one of the more important factors when it comes to applying for residency. But perhaps someone with more knowledge on the issue can elaborate.

 

[tfc]

Our school doesn't tell you where you're ranked (in an attempt to reduce the competitiveness, I suppose). But in the end, we found out where we're ranked when we apply to residencies.

What school is this? Sounds like a disingenuous policy. These are your grades, why shouldn't you know where you are ranked? They don't have to be public, but you should know your own rank.

 

[equinsu ocha]

I heard this quite a bit on the interview trail this year. Many schools don't reveal your class rank but it does show up in the dean's letter for residencies. Doesn't make a whole lot of sense to me.

 

[TwoSandwiches]

On the interview trail and talking to my dean, here's what I've learned about what residencies in general look at. After getting past a step-score automatic cutoff algorithm, the most important thing when your app is physically looked at by programs is your MSPE (dean's letter), which includes your grades/class rank (sometimes specific, such as 43rd out of 150 or sometimes quartile, sometimes generic phrases like 'in top 20 students) AOA status, and comments from attendings on the wards.

After that comes your CV (research, extracirriculars), LOR's, and your personal statement.

 

[gravitywave]

we aren't ranked

 

[KnuxNole]

Class rank could be a hindrance for MOST medical students, since a lot of people are naturally bottom half of the pack.

 

[JackShephard MD]

Hello!

Our school doesn't tell you where you're ranked (in an attempt to reduce the competitiveness, I suppose). But in the end, we found out where we're ranked when we apply to residencies. Residencies and deans can see our ranks, and our dean's letters will surely hint at what our class rank is (or explicitly state it).

How much does this rank matter, especially for competitive residencies? Does it matter if someone is in the bottom vs top half of the class? I've heard that if you're in the top 10-20 people, class rank matters b/c it leads to AOA, but otherwise everyone is the same. Is this true?

Thanks!

It definitely matters for the top handful of specialties. Why don't you take some time and research these documents:

Results of the 2010 NRMP Program Director Survey
http://www.nrmp.org/data/programresultsbyspecialty2010v3.pdf

Charting Outcomes in The Match, 2011: Characteristics of Applicants Who Matched to Their Preferred Specialty in the 2011 NRMP Main Residency Match
http://www.nrmp.org/data/chartingoutcomes2011.pdf

I would guess class ranking is one of the more important factors when it comes to applying for residency. But perhaps someone with more knowledge on the issue can elaborate.

This is off base.

 

[tfc]

On the interview trail and talking to my dean, here's what I've learned about what residencies in general look at. After getting past a step-score automatic cutoff algorithm, the most important thing when your app is physically looked at by programs is your MSPE (dean's letter), which includes your grades/class rank (sometimes specific, such as 43rd out of 150 or sometimes quartile, sometimes generic phrases like 'in top 20 students) AOA status, and comments from attendings on the wards.

After that comes your CV (research, extracirriculars), LOR's, and your personal statement.

How do these schools compare applicants, one from a school that ranks and one that doesn't? Or one from a school that does P/F and another that has grades?

 

[Butler]

How do these schools compare applicants, one from a school that ranks and one that doesn't? Or one from a school that does P/F and another that has grades?

To my knowledge, all schools continue to give grades for their clinical years even if the preclinical years are P/F. Clinical grades are much more important. This topic has been beaten to death all over this forum, but the general importance ranking for applying to residency is this:

1. Step I
2. Clinical Grades
3. LOR
4. AOA [preclinical grades/ranking sometimes play a role here], Step II, Research (specific order changes depending on what specialty you are applying to).
5. School prestige (...some would argue this is more important. Take that with a grain of salt).
6. Everything else
7. Volunteering

 

[Phyozo]

You can't talk about class rank without talking about academic pedigree. A lot of upper level schools would still prefer to take a 50% percentile from harvard than a 95%tile from joe-shmoe-medical school in south dakota. From what our own aPDs tell me, no one wants the bottom 10%tile from anywhere.

 

[Mr RADical]

1. Step I
2. Clinical Grades
3. LOR
4. AOA [preclinical grades/ranking sometimes play a role here], Step II, Research (specific order changes depending on what specialty you are applying to).
5. School prestige (...some would argue this is more important. Take that with a grain of salt).
6. Everything else
7. Volunteering

In many fields, including most small competitive ones, letters of rec and phone calls made from program directors and chairs are more important that Step 1 scores.

 

[Butler]

In many fields, including most small competitive ones, letters of rec and phone calls made from program directors and chairs are more important that Step 1 scores.

Obviously "who you know" is more important than "what you do." That is a given, but you usually don't pick a med school based on some PD working there that is famous for some specialty that you haven't even decided on yet.

 

[ppfizenm]

You can't talk about class rank without talking about academic pedigree. A lot of upper level schools would still prefer to take a 50% percentile from harvard than a 95%tile from joe-shmoe-medical school in south dakota. From what our own aPDs tell me, no one wants the bottom 10%tile from anywhere.

Off topic. Have fun moving on.

 

[username456789]

Off topic. Have fun moving on.

It was actually pretty on-topic, even if it wasn't what you wanted to hear.

 

[gravitywave]

Off topic. Have fun moving on.

i don't think the influence is as great as that poster was making it out to be, but it is real.

 

[Phyozo]

Off topic. Have fun moving on.

Yes a post about class rank on a thread about class rank. Very off topic </sarcasm>

 

[ijn]

In many fields, including most small competitive ones, letters of rec and phone calls made from program directors and chairs are more important that Step 1 scores.

Calls maybe will get through, but your letter of rec from our Lord Christ Jesus himself isn't going to get read by anyone if the program has an automatic STEP 1 screen of X and you are X-1.

 

[CaptainSSO]

///

 

[JackShephard MD]

Calls maybe will get through, but your letter of rec from our Lord Christ Jesus himself isn't going to get read by anyone if the program has an automatic STEP 1 screen of X and you are X-1.

Connections >>>> Step 1 cut offs (especially < 10 points).

 

[Deferoxamine]

To my knowledge, all schools continue to give grades for their clinical years even if the preclinical years are P/F. Clinical grades are much more important. This topic has been beaten to death all over this forum, but the general importance ranking for applying to residency is this:

1. Step I
2. Clinical Grades
3. LOR
4. AOA [preclinical grades/ranking sometimes play a role here], Step II, Research (specific order changes depending on what specialty you are applying to).
5. School prestige (...some would argue this is more important. Take that with a grain of salt).
6. Everything else
7. Volunteering

False.
Number 6 belongs much higher in the people-oriented specialties.
Number 1 is a myth. Few people really care that you can lock yourself in a room for a month and memorize a few audiotapes.
Numbers 2, 3, and 5 probably matter the most.
Jury's still out on Number 4.

 

[zherussianbear]

No, it could be a hindrance for exactly half of med students

 

[SAvoodoo]

If you're not first, you're last.

/shake and bake

 

[tfc]

If you're not first, you're last.

/shake and bake

Second place is just the first to lose.

 

[ijn]

Connections >>>> Step 1 cut offs (especially < 10 points).

Nope. That's a silly dream that people who do poorly on the STEP 1 hold onto. No ortho residency is going to start taking 220s just because the program director is ****ing your mother.

 

[mmmcdowe]

Nope. That's a silly dream that people who do poorly on the STEP 1 hold onto. No ortho residency is going to start taking 220s just because the program director is ****ing your mother.

I'm inclined to agree that it would take some serious hookups to overcome serious deficits. The neurosurgery PD was asked to clarify this after stating the approximate cutoff was 240, though "they'd look" at people from 220-240. His response was "If you have a 235 and you landed a plane in the Hudson, we'd interview you".

 

[tfc]

I'm inclined to agree that it would take some serious hookups to overcome serious deficits. The neurosurgery PD was asked to clarify this after stating the approximate cutoff was 240, though "they'd look" at people from 220-240. His response was "If you have a 235 and you landed a plane in the Hudson, we'd interview you".

Most epic post I've read so far.

 

[MilkmanAl]

False.
Number 6 belongs much higher in the people-oriented specialties.
Number 1 is a myth. Few people really care that you can lock yourself in a room for a month and memorize a few audiotapes.
Numbers 2, 3, and 5 probably matter the most.
Jury's still out on Number 4.

That's a bit of a misleading breakdown. From everything I've heard and experienced (and according to all the surveys I've ever seen) Step 1 is clearly the most important factor in getting residency interviews. As I've mentioned before, I had 8 interviews before anything other than my Step score was even released (given that my CV was essentially blank). Its importance may wane a bit post-interview, but I'm not sure I can recall any data on that. At the very least I'd say it's quite a bit more important than school prestige and probably on par with clinical grades and rec letters, unless you have some really amazing recs.

The "everything else" category sure seems pretty unimportant in every specialty, as far as interview selection goes. That said, I did talk an awful lot about building a computer, cooking, and the other things I listed as hobbies during my interviews.

Anyway, I doubt you'll ever get a hard answer on this topic, OP, but I think we can all agree that class rank is somewhere in the land of middling to above-average importance in this application game. How much it matters is going to change by program, specialty, blah, blah, blah, but it's not something to get either really excited or really upset about.

 

[Mr RADical]

Connections >>>> Step 1 cut offs (especially < 10 points).

Agree I know several people who got interviews / got in with step 1 scores well below what the "average" appears to be for a given program. This of course is all anecdotal, but I do know one person who was rejected - had a call made - then interviewed.

 

[SAvoodoo]

serious response:

http://journals.lww.com/academicmed..._Criteria_for_Residency__Results_of_a.24.aspx

this one has class rank as 7 (clerkship grades as 1, step 1 as second). survey's done in 2006, results released in 2009.

if you want to get hardcore on it here's the nmrp pdf with the info. I really don't feel like typing up all the results but basically everything in terms of medical performance ranks ahead of class rank with the exception of honors in basic sciences, consistency of grades and honors in clerkships (tied). a ton of other stuff ranks ahead of class rank in other categories including every single aspect of the interview. then it breaks it down by specialty...enjoy

EDIT: to reinforce what MilkmanAl said, see page 6 of the nmrp pdf. also note class rank falls below every letter of rec, grades, both step 1 and 2, and your personal statement...
http://www.nrmp.org/data/programresultsbyspecialty.pdf

 

[ArcGurren]

False.
Number 6 belongs much higher in the people-oriented specialties.
Number 1 is a myth. Few people really care that you can lock yourself in a room for a month and memorize a few audiotapes.
Numbers 2, 3, and 5 probably matter the most.
Jury's still out on Number 4.

That sounds like a lot of wishful thinking. Every single PD I've talked to regarding specialty selection (and this is across the board for most specialties) has shown to rank Step 1 as the most important factor in granting interviews. It's tough, but true.

LORs and Clinical Grades are probably the next most important, followed by AOA and class rank. Extracurriculars are only really considered heavily at academic programs if they involve leadership and/or research. These kinds of things (as well as doing externships etc) can certainly make up for a weaker Step 1 score but almost all programs definitely screen using both step 1 score and clinical grades.

 

[gravitywave]

False.
Number 6 belongs much higher in the people-oriented specialties.
Number 1 is a myth. Few people really care that you can lock yourself in a room for a month and memorize a few audiotapes.
Numbers 2, 3, and 5 probably matter the most.
Jury's still out on Number 4.

"people-oriented specialities"? you mean, like, all of them???

anyway. no, most in peds and psych aren't super interested in the difference between 250 and 270. guess what? most anywhere in anything aren't interested in the difference between 250 and 270.

number 6 matters everywhere on interview day.

Letters might be the most variable factor. They matter a lot more in plastics than in gas, for example.

most people seem to say Step 1 matters most, but that's because it functions an awful lot like the MCAT did for med school. lets face it, an awful lot of places aren't even going to bother with a 190. get past the threshold and everything else is part of the picture. but nobody gets to see your picture if you never got past the door.

 

[gravitywave]

Calls maybe will get through, but your letter of rec from our Lord Christ Jesus himself isn't going to get read by anyone if the program has an automatic STEP 1 screen of X and you are X-1.

Nope. That's a silly dream that people who do poorly on the STEP 1 hold onto. No ortho residency is going to start taking 220s just because the program director is ****ing your mother.

lolz no. that's not what's being discussed. we're talking about when your mentor and the PD at your #1 were in residency together.

ortho residencies do take 220s btw. how do you think that happens?

 

[SteinUmStein]

lolz no. that's not what's being discussed. we're talking about when your mentor and the PD at your #1 were in residency together.

ortho residencies do take 220s btw. how do you think that happens?

Just curious, how do things play out if you go to med school at your #1 residency choice? Just try to impress the PD and the big-time attendings who may know the PD?

 

[MilkmanAl]

Just curious, how do things play out if you go to med school at your #1 residency choice? Just try to impress the PD and the big-time attendings who may know the PD?

I'm not sure how the rec letter thing works, but I know the interviews are a bit odd. Depending on how well you know and get along with the interviewers, it can either be a nice conversation or supremely awkward since a lot of the interview time is there for you to ask questions about the program. That is, if you can keep a good conversation going, it'll be great, but if you already know everything about the place, you set yourself up for a lot of dead air if you can't find common ground.

For some supreme home program awkwardness, I was interviewed by one of my friends and by an attending I'd spent quite a lot of time around, and they both just read off scripted questions instead of talking with me. Strange.

 

[SteinUmStein]

I'm not sure how the rec letter thing works, but I know the interviews are a bit odd. Depending on how well you know and get along with the interviewers, it can either be a nice conversation or supremely awkward since a lot of the interview time is there for you to ask questions about the program. That is, if you can keep a good conversation going, it'll be great, but if you already know everything about the place, you set yourself up for a lot of dead air if you can't find common ground.

For some supreme home program awkwardness, I was interviewed by one of my friends and by an attending I'd spent quite a lot of time around, and they both just read off scripted questions instead of talking with me. Strange.

What kind of home-field advantage can we expect (if any) when it comes time for our program to rank us? Or do we just get awkwardness as our bonus?

 

[SlickNickMD]

smh you can tell you bombed step 1 in some of these posts, with that being said everything matters so try to dominate every aspect of you application-If you are below avg in one aspect try to make up for it in another

IMO the only thing in med school that WILL completely close a lot of doors is a poor step 1 score, but a great step 1 does not guarantee anything

 

[MilkmanAl]

What kind of home-field advantage can we expect (if any) when it comes time for our program to rank us? Or do we just get awkwardness as our bonus?

As with everything, it depends on your specialty and school. For competitive specialties at competitive schools, you probably shouldn't expect much of a boost at all. On the other end of the spectrum, you'll probably be almost guaranteed a spot, assuming they don't hate you. Generally, I'd say you have a significant advantage at your home program.

 

[b-real]

What kind of home-field advantage can we expect (if any) when it comes time for our program to rank us? Or do we just get awkwardness as our bonus?

May be different everywhere, but it was strongly hinted that a position was mine if I wanted it. Obviously, this is influenced by how you do during your home rotation and how well you get along with the department, but there is home field advantage in this game.

 

[SteinUmStein]

Thanks for the info, I'm taking Step 1 soon and anything that can ease the anxiety of needing a high score helps. I'm not interested in anything particularly competitive, so hopefully my home program will keep me around.

 

[JackShephard MD]

Nope. That's a silly dream that people who do poorly on the STEP 1 hold onto. No ortho residency is going to start taking 220s just because the program director is ****ing your mother.

It's clear you don't understand how the business world or politics work.

I figured I'd offer a real world example (Dermatology match statistics):

Let's face it, George Bush didn't get into Yale because of an SAT score or a fabulous essay.

Just because you mentioned ortho, below shows orthopedics matches with scores in the 220's or less:

Nope. That's a silly dream that people who do poorly on the STEP 1 hold onto. No ortho residency is going to start taking 220s just because the program director is ****ing your mother.

 

[Phyozo]

What kind of home-field advantage can we expect (if any) when it comes time for our program to rank us? Or do we just get awkwardness as our bonus?

Obviously extremely variable, but i would argue that the advantage is a double-edged sword. Do well and impress everyone and of course you'll be their top pick. Do poorly or be average and people might prefer to hedge their bets with someone else with similar numbers. Also, if a lot of people want to stay at the home program, you'll be competing with those students to stay.

On a personal note, my decision was easy: I met with my PD to test the waters and realized he had cherry picked his favorites already when he encouraged me to leave...So I did (as did those that were cherry picked, much to the PD's dismay).

 

[Phyozo]

Nope. That's a silly dream that people who do poorly on the STEP 1 hold onto. No ortho residency is going to start taking 220s just because the program director is ****ing your mother.

It's clear you don't understand how the business world or politics work.

He meant taking 200s...give the PD some credit, they have standards too

 

[JackShephard MD]

He meant taking 200s...give the PD some credit, they have standards too

I understand, which is why I said in my original post that missing the cutoff by <10 points is much less important than quality connections.

lolz no. that's not what's being discussed. we're talking about when your mentor and the PD at your #1 were in residency together.

ortho residencies do take 220s btw. how do you think that happens?

Exactly.

It's hard for young career academics (i.e. most medical students) to understand the pivotal role of business and politics in medicine.

 

[SteinUmStein]

Obviously extremely variable, but i would argue that the advantage is a double-edged sword. Do well and impress everyone and of course you'll be their top pick. Do poorly or be average and people might prefer to hedge their bets with someone else with similar numbers. Also, if a lot of people want to stay at the home program, you'll be competing with those students to stay.

On a personal note, my decision was easy: I met with my PD to test the waters and realized he had cherry picked his favorites already when he encouraged me to leave...So I did (as did those that were cherry picked, much to the PD's dismay).

Ugh, I don't know what I would do if my PD told me to get out of town. I'd still probably rank my home program first. I have (very) strong geographic incentives to stay where I am now, I guess if I knew I didn't have much shot at staying I would look at community programs within a commutable distance...

I'd say about 1/3 of the residents in the program I'm interested in are from here, so it's pretty significant but not like people are elbowing each other out to stay.

 

[ijn]

It's clear you don't understand how the business world or politics work.

So you're saying the rejection rate for future dermatologists who do well on the STEP 1 (>260) is 0% and the rejection rate for the nepotists (220 and lower) is 56%. Nope, STEP 1 still is way more important than who your mother ****s.

 

[Phyozo]

Ugh, I don't know what I would do if my PD told me to get out of town. I'd still probably rank my home program first. I have (very) strong geographic incentives to stay where I am now, I guess if I knew I didn't have much shot at staying I would look at community programs within a commutable distance...

I'd say about 1/3 of the residents in the program I'm interested in are from here, so it's pretty significant but not like people are elbowing each other out to stay.

I know some people have very good reasons to stay, but a lot of my classmates initially wanted to stay because they hadn't really looked elsewhere...it wasn't until after interview season that they realized their opportunities to go to elsewhere didn't seem so bad.

 

[Phyozo]

So you're saying the rejection rate for future dermatologists who do well on the STEP 1 (>260) is 0% and the rejection rate for the nepotists (220 and lower) is 56%. Nope, STEP 1 still is way more important than who your mother ****s.

Usually it's hard to separate great clinicians from nepotism. Med students aren't idiots and even if they have an "in" they'd still work their butt if they wanted a competitive field. Those cases of allowing in a more unqualified student solely because of their connections are more rare. You can't say which is more important...they both are and you'd be stupid not to use every advantage you have to achieve your goals.

 

[ppfizenm]

Yes a post about class rank on a thread about class rank. Very off topic </sarcasm>

On a thread about intra-class rank you feel the need to discuss the class ranks between different schools. The OP didn't ask how will it look if I am top of my class here as opposed to middle of the pack at a top ten. He also didn't ask you to provide a loose ranking system for all med students. So yes, off topic.

Basically the whole thread doesn't even relate to what was originally being talked about anymore anyway so whatever.

It was actually pretty on-topic, even if it wasn't what you wanted to hear.

I clicked on the link to hear about what I say above. Not to hear another discussion on pedigree.

 

[username456789]

On a thread about intra-class rank you feel the need to discuss the class ranks between different schools. The OP didn't ask how will it look if I am top of my class here as opposed to middle of the pack at a top ten. He also didn't ask you to provide a loose ranking system for all med students. So yes, off topic.

Once again, you're wrong. This thread is discussing class rank and it's potential importance and influence on students' aspirations. He pointed out that this influence is not standardized across the board, and the implications it has may vary with a school's pedigree.

He was 100% on topic, and I can't figure out why you refuse to accept this, unless you simply are in denial with regards to his post.