just how bad is a P in medicine...

[Borrow]

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hello,

some background. i'm a very average u.s. md student. 231 step 1 score. P all preclinical year. 3 H and 1 HP thus far in third year. some research experience blah blah blah but heres the kicker...

problem is i'm getting only a P in medicine. unfortunately not because of my clinical performance or shelf score (both in H categories) but because i mistakenly missed some deadlines for other side assignments in the clerkship which automatically bump your grade down. it's completely unlike me and i am shocked. i take full responsibility, its completely my fault and i understand that. i already talked to people in my department and was assured that it wouldn't affect my LORs.

the problem is is that i not quite sure just how much this will affect me. i never really wanted to go to a major program but i would at least like to go a semi-respectable university hospital that would put me in a good position for whatever fellowship i may decide down the line (right now rheum is the front runner, but maybe pulm/cc)

i love programs such as uconn, umass, vermont, and maine medical etc. but not sure if they are still within reach or should i set me expectations more towards smaller community programs like danbury, stamford and norwalk (btw I am limited geographically to nonmajor cities in NE)

i know this may be a ridiculous question but there is such a lack of information on what individual programs admission requirements and statistics are that it makes it difficult to judge just how competitive you are

 

[NYDO2014]

since you are an american MD student, a 231 step 1, put you in a competitive position in program like Uconn, Umass, NJMS, Stony. As long as you do an early medicine sub-I, cardiology, or medicine electives, and get honor before the ERAS got turn in.

doing really well on step 2 ck exam and strong LORs, will also help with your application.

 

[gutonc]

It's bad, but not the end of the world by any stretch. Take your SubI in July and rock it. Take CK early and do at least 10 points better than you did on Step 1. Get great LORs. You'll be fine for the programs you're looking at.

 

[JoBreeze]

For the programs listed I'd say you'd be quite competitive.

 

[EMorIM]

I'm surprised to hear people say that it's so bad. At my school ten percent get honors, the next 15% get letters, and everyone else gets either pass or (rarely) fails.

Do you mean to say that 75% of my class is suddenly in bad shape for the match? Our step 1 average was something bananas like 240 so I imagine there are many folks with a P in medicine and otherwise outstanding applications.

 

[gutonc]

I'm surprised to hear people say that it's so bad. At my school ten percent get honors, the next 15% get letters, and everyone else gets either pass or (rarely) fails.

Do you mean to say that 75% of my class is suddenly in bad shape for the match? Our step 1 average was something bananas like 240 so I imagine there are many folks with a P in medicine and otherwise outstanding applications.

That's the sort of thing that will be on your MSPE so it will matter less. But yes, big picture, programs are looking for students who are strong in that specialty. Your IM clerkship (and SubI) grade, for better or worse, will be part of that.

 

[general admission]

That's the sort of thing that will be on your MSPE so it will matter less. But yes, big picture, programs are looking for students who are strong in that specialty. Your IM clerkship (and SubI) grade, for better or worse, will be part of that.

How closely do schools look at the actual shelf score? I received fantastic evals and got an 89th percentile on the shelf (which will be stated in my Dean's letter in the IM faculty comments), but will only end up with HP since H is 90th or more at my school...

 

[Raryn]

How closely do schools look at the actual shelf score? I received fantastic evals and got an 89th percentile on the shelf (which will be stated in my Dean's letter in the IM faculty comments), but will only end up with HP since H is 90th or more at my school...

Unless your school reports it on the deans letter for some reason the programs don't get a copy of the shelf score.

 

[general admission]

Unless your school reports it on the deans letter for some reason the programs don't get a copy of the shelf score.

It is actually reported in our Dean's letter at the end of the faculty comments.

 

[gutonc]

It is actually reported in our Dean's letter at the end of the faculty comments.

Your MSPE will wind up being about 8 pages long, the likelihood of somebody picking up on this, or caring that much, is pretty small.

 

[jdh71]

OP

It's life ENDING

/thread

 

[Borrow]

OP

It's life ENDING
t
/thread

i didnt ask if this was going to ruin my medical school career i was just trying to figure out how much of an impact this will have on my application and the programs i choose to apply to. there's not much objective data (aside from those pd surveys which aren't very scientific) regarding the importance of these clinical grades and just how much it means.

does a P in medicine mean i should be aiming more towards programs with an average step 1 score 10 points below mine, etc. of course no one knows for sure, but im just trying to gather others serious opinions

for example, do you think i am still competitive at programs like albany, baystate, uconn, lahey, mt auburn, or rochester?

 

[bashwell]

At the end of the day, isn't it just more money? Why not apply to all these programs and see if you get interviews? Sure, it's not ideal, but if it means a chance of getting an interview, then it may have been worth it. At least that's what I would do. Anyway, good luck, OP. I sincerely hope you get into your top choice!

 

[jdh71]

My advice is to get money.

 

[notbobtrustme]

Take CK early and do at least 10 points better than you did on Step 1.

Do PDs not know that Step 2's average is ~10-12 points higher than Step 1 to begin with? Going from a 231 Step 1 to a 241 Step 2 is basically expected; both are ~50th percentile. Doing better would be scoring 20 points above, which would show a significant percentile increase.

Or is that overanalyzing it and just doing 10 points better is enough of an "improvement" for programs?

 

[gutonc]

Do PDs not know that Step 2's average is ~10-12 points higher than Step 1 to begin with? Going from a 231 Step 1 to a 241 Step 2 is basically expected; both are ~50th percentile. Doing better would be scoring 20 points above, which would show a significant percentile increase.

Fun fact: your USMLE score reports, as seen by programs, do not include the mean, just your score.

 

[Beacopp665]

Do PDs not know that Step 2's average is ~10-12 points higher than Step 1 to begin with? Going from a 231 Step 1 to a 241 Step 2 is basically expected; both are ~50th percentile. Doing better would be scoring 20 points above, which would show a significant percentile increase.

Or is that overanalyzing it and just doing 10 points better is enough of an "improvement" for programs?

I'll also add here that NOT improving by at least 10 points indicates a "worse" performance, especially if they are aware of the means for each exam. Unless you're over 250 anyways I'd say that doing minimum 10pta higher is expected and looks poorly if that doesn't happen

 

[gutonc]

I'll also add here that NOT improving by at least 10 points indicates a "worse" performance, especially if they are aware of the means for each exam. Unless you're over 250 anyways I'd say that doing minimum 10pta higher is expected and looks poorly if that doesn't happen

And you've reviewed how many residency applications?

 

[Beacopp665]

And you've reviewed how many residency applications?

Just going by the way my PD thinks of scores and the advice he gave us before applying and scheduling exams. But you're right I have zero experience on the other end of things

 

[NotAProgDirector]

I'm surprised to hear people say that it's so bad. At my school ten percent get honors, the next 15% get letters, and everyone else gets either pass or (rarely) fails.

Do you mean to say that 75% of my class is suddenly in bad shape for the match? Our step 1 average was something bananas like 240 so I imagine there are many folks with a P in medicine and otherwise outstanding applications.

This is very school dependent. At UVM, 15% get Honors and everyone else gets pass, there is no high pass. At Tufts, only 5% get pass. So whether a Pass in IM is "bad" or not depends on the context. Although at top programs, you might need an H regardless of the grade distribution to compete.

Your MSPE will wind up being about 8 pages long, the likelihood of somebody picking up on this, or caring that much, is pretty small.

I'm going to disagree with this. We look quite closely at the MSPE and departmental letters looking for objective evidence of performance. YMMV.

Fun fact: your USMLE score reports, as seen by programs, do not include the mean, just your score.

Fun fact: we're not as dumb as you seem to think! We know quite well what the averages are. Google will happily tell me, and the minimum pass of 209 on Step 2 is a give away that the mean is much higher than Step 1.

 

[jhamaican]

Copy and Paste from another Thread I posted in:

I honored only 1 3rd year rotation and got only a HP in medicine. Got almost all programs outside of the "big 4" which I didn't even bother applying to. I did have terrific letters (from what my interviewers said...), good research, board scores 240+ (step 1+2) and come from a medicine powerhouse school...

So I might disagree a bit with what the PD posted above about needing H for the top schools. I think its really only for the elite 4 judging from (sample size of 1) my interview season experience...

 

[rd31]

Copy and Paste from another Thread I posted in:

I honored only 1 3rd year rotation and got only a HP in medicine. Got almost all programs outside of the "big 4" which I didn't even bother applying to. I did have terrific letters (from what my interviewers said...), good research, board scores 240+ (step 1+2) and come from a medicine powerhouse school...

So I might disagree a bit with what the PD posted above about needing H for the top schools. I think its really only for the elite 4 judging from (sample size of 1) my interview season experience...

Well I didn't honor medicine and this season I got interviews at 3 of the "big 4." I don't go to a top 20 med school, nor do I have a second degree, but I was AOA.

 

[general admission]

This is very school dependent. At UVM, 15% get Honors and everyone else gets pass, there is no high pass. At Tufts, only 5% get pass. So whether a Pass in IM is "bad" or not depends on the context. Although at top programs, you might need an H regardless of the grade distribution to compete.



I'm going to disagree with this. We look quite closely at the MSPE and departmental letters looking for objective evidence of performance. YMMV.

This is why is absolutely blows my mind that there is such a premium placed on clinical grades. To say only the final letter grade is looked at with nothing else is ridiculous to put it lightly, especially with situations like those described in this post. That's not saying anything about the general subjectivity and random circumstance of the third year. It's just nuts.


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[DrAwesomo]

not the end of the world

 

[wjs010]

Isn't P pass? Why is pass bad?

 

[bashwell]

Isn't P pass? Why is pass bad?

Because SDN.

On a serious note I think it depends on other factors in your app and what your goals are. Like if you're aiming for MGH, then a P might stand out like a sore thumb. But if you're aiming for a mid tier program and the rest of your app looks solid then it probably won't matter a whole lot. At least that's my thinking.

 

[rd31]

Isn't P pass? Why is pass bad?

Are you really a medical student?

 

[wjs010]

Are you really a medical student?

Yes, but I haven't researched much about third year yet.

 

[Mad Jack]

Because at a majority of medical schools, granted some exceptions like outlined above, a P is reserved for the bottom third or worse of the class.

People forget that in a clinical grading scheme of H, HP, P, F - despite allegedly being "pass/fail" that's basically a traditional grading system. H is the A students, HP is the B students, P is the C students.

Programs don't particularly love having people get C's in their supposed field of interest.

That really sucks. Like, >80% of students are getting Ps in classes at my school right now, because that's just how they grade. I'm hoping that trend doesn't hold into the clinical years.

 

[general admission]

Because at a majority of medical schools, granted some exceptions like outlined above, a P is reserved for the bottom third or worse of the class.

People forget that in a clinical grading scheme of H, HP, P, F - despite allegedly being "pass/fail" that's basically a traditional grading system. H is the A students, HP is the B students, P is the C students.

Programs don't particularly love having people get C's in their supposed field of interest.

I just hope (and suspect it's true) that medicine programs can and will see that the large majority of people in my class get P. Probably about 15-25% tops get HP and 5% H. They specifically word the P evals for evaluators that they could range from deficient to "very strong" students. Combined with shelf cut offs that are ridiculous, it's just really stacked against us. My HP at my school could easily get me H at many, if not most schools I bet.

Clinical grades in general just seem to vary too much based on factors out of peoples' control.


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[gutonc]

I just hope (and suspect it's true) that medicine programs can and will see that the large majority of people in my class get P. Probably about 15-25% tops get HP and 5% H. They specifically word the P evals for evaluators that they could range from deficient to "very strong" students. Combined with shelf cut offs that are ridiculous, it's just really stacked against us. My HP at my school could easily get me H at many, if not most schools I bet.

Clinical grades in general just seem to vary too much based on factors out of peoples' control.


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Your MSPE will include a comment about the grade distribution in each core rotation. That said, if 30% of your class is getting H or HP in your chosen field, and you're not, a program may look askance at that a bit. That's life. You need to accept that and move on.