Is it okay if grades decline if Step score might go up?

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SquigglyQ

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My biggest scare in this is that while pre-clinical grades may not matter, "consistency of grades" is on the list of what residency directors look for and I did very well in M1 year, but do not have the stamina to be perfectly on top of the current material while reviewing M1 material as well.
 
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I always mention class rank when writing a LOR. I also looked at class rank when evaluating residency applicants. I completely agree that a high Step score can get you a look, but residencies also want someone they can live with for 3 or more years and is not afraid to work. An audition rotation and good LORs with emphasis on your work ethic and ability to get along with people can possibly make up for lower grades. I do not advocate board prep at the expense of pre clinical grades.
 
I always mention class rank when writing a LOR. I also looked at class rank when evaluating residency applicants. I completely agree that a high Step score can get you a look, but residencies also want someone they can live with for 3 or more years and is not afraid to work. An audition rotation and good LORs with emphasis on your work ethic and ability to get along with people can possibly make up for lower grades. I do not advocate board prep at the expense of pre clinical grades.

So you would prefer somebody who got 230 on their step1 with a few passes and honors during their preclinical grades over somebody who got a 260 and straight passes?

To everybody else reading this thread - the single most important factor when choosing to interview a candidate for residency as rated by a survey of PDs across the nation is step 1 scores.

If you are in a P/F preclinical then the most important thing you can do is focus on board prep while also passing classes. However, put much more effort into board studying.
 
So you would prefer somebody who got 230 on their step1 with a few passes and honors during their preclinical grades over somebody who got a 260 and straight passes?

I would read both applications and decide on ranking after the interview.

watermelon master said:
To everybody else reading this thread - the single most important factor when choosing to interview a candidate for residency as rated by a survey of PDs across the nation is step 1 scores.

It's the most cited factor. LORs are close and actually have a slightly higher rating (4.2 vs. 4.1). There are 5,000 different ways that program directors review applications, but it may be more accurate to say that your Step 1 score keeps you from getting screened out. An interview invite also takes into account LORs, the MSPE, Step 2 CK, clinical grades, etc.

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If you study for school smartly you can be studying for boards simultaneously, and cram last minute for any weird things the school wants you to know. It worked well for me, and kept me honest about keeping up with anki reviews before I even set foot into dedicated.

The answer also depends on what you are interested in, if it is derm and there are a glut of AOA candidates with 250+ and straight honors m1,m2, and m3. Compared to your 250+ missing those things , it might come down to that.

Everything matters in some specialties where the competition is fierce.
 
I would read both applications and decide on ranking after the interview.



It's the most cited factor. LORs are close and actually have a slightly higher rating (4.2 vs. 4.1). There are 5,000 different ways that program directors review applications, but it may be more accurate to say that your Step 1 score keeps you from getting screened out. An interview invite also takes into account LORs, the MSPE, Step 2 CK, clinical grades, etc.

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Would have been nice if you also quoted where preclinical grades lies on that list

Step score > preclinical grades
 
So you would prefer somebody who got 230 on their step1 with a few passes and honors during their preclinical grades over somebody who got a 260 and straight passes?

To everybody else reading this thread - the single most important factor when choosing to interview a candidate for residency as rated by a survey of PDs across the nation is step 1 scores.

If you are in a P/F preclinical then the most important thing you can do is focus on board prep while also passing classes. However, put much more effort into board studying.
To answer your narrowly framed question, the answer is ...depends.@ MedEd said it better than I could. As I mentioned in my post which you neglected to acknowledge, you have to live with this person for 3 or more years. LORs, auditions, boards, class rank, interview, all go into the decision to match someone.. Step score is important, and helps get you a look, but is not the defining element. Plenty of people have perfect SATs and dont get into Harvard.
 
To everybody else reading this thread - the single most important factor when choosing to interview a candidate for residency as rated by a survey of PDs across the nation is step 1 scores.
It's the single most important thing that prevents you from getting screened out, but that doesn't mean you're getting interviewed/ranked.

GPA + MCAT alone don't get you into med school, but they sure can keep you out.
 
It's the single most important thing that prevents you from getting screened out, but that doesn't mean you're getting interviewed/ranked.

GPA + MCAT alone don't get you into med school, but they sure can keep you out.

So do you advocate getting better preclinical grades at the expense of step 1 scores?
 
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Thank you, everyone. I averaged 92% across my M1 year classes (92% = H). But that will probably not land me AOA by any means, so I feel I will have nothing to show for my hard work except having set the bar a little too high for myself for the trickier M2 material.
 
Not to hijack the thread or anything but I’m an incoming M1. My preclinical years are P/F but they do keep quartile rankings that are put in your residency application. With that said for me should I be worried about my grades so I can get in a higher quartile or should I just focus on passing + high step score
 
Not to hijack the thread or anything but I’m an incoming M1. My preclinical years are P/F but they do keep quartile rankings that are put in your residency application. With that said for me should I be worried about my grades so I can get in a higher quartile or should I just focus on passing + high step score
focus on passing + high step score. Step 1 score is the most important factor when getting an interview
 
Not to hijack the thread or anything but I’m an incoming M1. My preclinical years are P/F but they do keep quartile rankings that are put in your residency application. With that said for me should I be worried about my grades so I can get in a higher quartile or should I just focus on passing + high step score

To reiterate, Step 1 is the most cited factor in offering an interview, but that does not necessarily make it the most important. Of the 13 factors shown below, Step 1's average rating is tied for #9:

Screen Shot 2019-07-14 at 5.30.57 PM.png


The quartile rankings you mention would go into the MSPE/Dean's Letter.

For many years the standard advice for doing well on Step 1 was to do well in the first two years of medical school, and at my institution (at least) there is a very strong correlation between pre-clinical and Step 1 performance. Saying you have to sacrifice one in service to the other is oftentimes a false choice.
 
What if your school is graded and not just P/F? is it still STEP > grades ?
 
What if your school is graded and not just P/F? is it still STEP > grades ?
It's always step > grades. But doing well in both is also an option...my school consistently shows that the factor they've found to correlate most with step 1 score is pre clinical performance.
 
It's always step > grades. But doing well in both is also an option...my school consistently shows that the factor they've found to correlate most with step 1 score is pre clinical performance.

They only say that to bait students into paying attention to their PhDs

why rely on a correlation and gamble with your future? Just study for step 1.
 
No one cares about grades
Untrue. When writing a LOR, I always include class rank. When I sat on a resident selection committee, it was also a determining factor. PD surveys indicate that Step is one of the foremost factors, no doubt about it. Who do you think the program takes? Someone with high step and top third class rank, or someone with high step and bottom third? The latter might indicate someone who is bright and lazy. A bad combination for a resident, who will be in the program for at least 3 years. Many factors go into deciding which applicant a program will rank.
 
They only say that to bait students into paying attention to their PhDs

why rely on a correlation and gamble with your future? Just study for step 1.

I've seen the data..it exists. To be fair..we are primarily PBL so there arent many lectures..so in a way we are learning the foundations ourselves from primary texts. But I dont see why people cant do well in both..top25% + 250+ is doable. You just have to plan for both ahead of time..and incorporate board study with your class material. Obviously if you have to choose 1..go with the standardized board exam..but you can focus and do well in both of you choose.
 
Why is there this notion that classes aren’t studying for step? Sure sometimes it deviates and theres dumb PhD research on it but Medicine is medicine. Supplement class lectures with boards. It isn’t that hard to balance and still do fine. Coming from someone who has actually taken it and isn’t advising to get through zanki before you even start (again which is terrible advice)
 
I've seen the data..it exists. To be fair..we are primarily PBL so there arent many lectures..so in a way we are learning the foundations ourselves from primary texts. But I dont see why people cant do well in both..top25% + 250+ is doable. You just have to plan for both ahead of time..and incorporate board study with your class material. Obviously if you have to choose 1..go with the standardized board exam..but you can focus and do well in both of you choose.

Why would I want to waste my time "incoroporating class material" when i could use that time to publish or learn clinically relevant clerkship material?
 
No, what school's offer is Medicine Lite. If you want Medicine Full Version you have to drop some additional coin.
Oh I know. I've always said supplement class material with board stuff. But completely ignoring it and not doing well in coursework really doesn't seem like the best idea
 
Why would I want to waste my time "incoroporating class material" when i could use that time to publish or learn clinically relevant clerkship material?
All of the PDs and actual physicians are saying step is only part of it and grades do matter (although not a ton). Why do you think you're more correct then people who have actually gone through the process? Haven't you not even taken step yet? I'm just wondering where you are getting the data to back up your horrendous advice to incoming first years.

Its a lot easier to start out trying to have everything at first then cut things out as you need to than to realize you've been ignoring school and fail a class
 
All of the PDs and actual physicians are saying step is only part of it and grades do matter (although not a ton). Why do you think you're more correct then people who have actually gone through the process? Haven't you not even taken step yet? I'm just wondering where you are getting the data to back up your horrendous advice to incoming first years.

Its a lot easier to start out trying to have everything at first then cut things out as you need to than to realize you've been ignoring school and fail a class

Of course other aspects matter. That is why I am emphasizing that you spend your extra time that you would have used to studying the PhD's research and instead use it for publications and clerkship preparedness (which do matter)
 
Untrue. When writing a LOR, I always include class rank. When I sat on a resident selection committee, it was also a determining factor. PD surveys indicate that Step is one of the foremost factors, no doubt about it. Who do you think the program takes? Someone with high step and top third class rank, or someone with high step and bottom third? The latter might indicate someone who is bright and lazy. A bad combination for a resident, who will be in the program for at least 3 years. Many factors go into deciding which applicant a program will rank.

Pretty sure AOA is far more important but a good class rank helps for that. Doesn't necessarily mean preclinical grades are important because how AOA is determined is school specific.
 
Untrue. When writing a LOR, I always include class rank. When I sat on a resident selection committee, it was also a determining factor. PD surveys indicate that Step is one of the foremost factors, no doubt about it. Who do you think the program takes? Someone with high step and top third class rank, or someone with high step and bottom third? The latter might indicate someone who is bright and lazy. A bad combination for a resident, who will be in the program for at least 3 years. Many factors go into deciding which applicant a program will rank.

pretty crazy if your program actually does that. Class rank (depending on how it is calcuated) is largely a function of subjective clerkships. i have classmates who were unfortunately placed with preceptors who never gave out honors for anyone. Others were placed with "cool" attendings who gave out honors like candy.
 
Pretty sure AOA is far more important but a good class rank helps for that. Doesn't necessarily mean preclinical grades are important because how AOA is determined is school specific.
Agreed, AOA is a scholastic honorary society looking at multiple factors, but you cant be AOA without high class rank. It is school specific as you said. At my Wife's school you had to be in the top 10% . Agreed, you could be top 10% and not be AOA, but most were in her class. So I will continue to maintain that class rank is an important factor when RANKING a candidate. As the PD survey indicates, Step 1 is probably the best indicator for granting an interview, but your whole app and your interview get you the spot. From reading some of these posts, I think some students believe that getting a good Step score is the only thing that matters.
 
In these discussions I feel like it really needs to be mentioned by what people mean by "let grades decline if score my go up." What "let grades decline" means is different in a lot of different scenarios. Based on how some of the administrators in these threads react it's obvious they are interpreting that to mean "barely passing," when a lot of people mean "instead of crushing 95%+ I'll get more 87-92% scores."

No one should "sacrifice grades" if it means you are going to start getting exam scores in the 70s. Honestly at that point I question your grasp on the material and can pretty much guarantee that you won't be crushing boards if you are barely passing class tests. However I suspect most people that post on SDN don't mean that and more often mean that instead of getting high A type scores they will be getting high B to low A type scores. Yes it is absolutely okay and honestly completely worth it do take a few percent dip in exam scores if it means more points added onto Step.

It's insane to me that programs would use rank/pre-clinical GPA in any sort of way when ranking applicants. I've seen the data my school has and the difference between someone ranked 50/100 and someone ranked 30/100 isn't much more than maybe 10ish exam questions spread out over any given semester.
 
pretty crazy if your program actually does that. Class rank (depending on how it is calcuated) is largely a function of subjective clerkships. i have classmates who were unfortunately placed with preceptors who never gave out honors for anyone. Others were placed with "cool" attendings who gave out honors like candy.
Not crazy at all. If you look at the PD survey above, 70% of PDs list class rank as a "citing factor" for granting an interview. So 70 % of programs look at class rank before granting an interview
 
Not crazy at all. If you look at the PD survey above, 705 of PDs list class rank as a "citing factor" for granting an interview. So 70 % of programs look at class rank before granting an interview

I've literally had ortho PDs say that their extent of "looking at class rank" is to make sure you aren't bottom 1/3rd. Using class rank as a way to split candidates is a poor way to do it, especially considering the variation from school to school.
 
Not crazy at all. If you look at the PD survey above, 70% of PDs list class rank as a "citing factor" for granting an interview. So 70 % of programs look at class rank before granting an interview
"look at class rank"

okay great, you aren't at the bottom of the class. next. oh wow what a great step score that is! much more important than the fact that you were ranked 75/150 and not 34/150 with a lower step 1 score.

additionally that's a full 30% that couldn't care less about class rank.
 
I've literally had ortho PDs say that their extent of "looking at class rank" is to make sure you aren't bottom 1/3rd. Using class rank as a way to split candidates is a poor way to do it, especially considering the variation from school to school.
Once again, you would be correct. My point is analogous to your point about what " let grades decline means" . Surely nobody splits candidates by top quarter or top third. As you point out, competetive programs look to see if your not in the bottom third. It is clearly a factor that more competetive programs consider. Just as there wont be a big distinction between getting 95% vs 87 to 92%. But if a high step score doesnt correlate with class rank, it makes one consider what's going on? Is the student shy? Have a poor work ethic? Too dogmatic and innefecient? Why did they excel in didactic work and not clinicals? This is all I'm trying to say. I think some read my comments that not being in the top third will exclude them from being ranked. In most cases this wont be true.
 
With a poor step score you will be autoscreened by a computer .

By having a poor class rank you may be screened by some PD who has a preference for class rank , or if there is another application with better or equivalent step score with no mention of class rank or a higher class rank.

Think of the first two years as training for step one. If you keep up with the pace and do well you have trained your self to learn the material and will be in good shape when dedicated arrives . Most of the people who had trouble with step were the same people who had trouble with med school exams and we're just writing them off by saying step one is all that matters.

Do the best you can.
 
Once again, you would be correct. My point is analogous to your point about what " let grades decline means" . Surely nobody splits candidates by top quarter or top third. As you point out, competetive programs look to see if your not in the bottom third. It is clearly a factor that more competetive programs consider. Just as there wont be a big distinction between getting 95% vs 87 to 92%. But if a high step score doesnt correlate with class rank, it makes one consider what's going on? Is the student shy? Have a poor work ethic? Too dogmatic and innefecient? Why did they excel in didactic work and not clinicals? This is all I'm trying to say. I think some read my comments that not being in the top third will exclude them from being ranked. In most cases this wont be true.
You and I are on the exact same page. 👍
 
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