Discussion in 'Allopathic' started by NRAI2001, Mar 17, 2008.
How big of a factor do basic science grades in medical school play when applying to residencies?
Very little, for the most part.
Obviously you want to get a good foundation for Step 1, but it's really more important to do well on Step 1, your clinical rotations, and get good letters of recommendation.
Agreed. One of my mentors calls it the "dirty little secret" of med school -- students stress over first and second year grades because they have no other benchmark and they are still in the undergrad grade oriented mindset, only to find out that they barely matter. Your step grade and rotation grades and evals are going to be of huge weight, dwarfing almost everything else by comparison.
When interviewing for interns, we usually ignore any grades before 3rd year (unless you actually fail something, but even then, if you rock 3rd year, who cares). If these are used at your school for determining AOA, then it would matter for that. Again though, great grades in 3rd year, great letters and a sweet Step 1, = very competitive.
PS: + ability to interview well. Have seen "perfect candidates" get thrown off the rank list completely for coming off as a punk (also hitting on a resident's wife at the meetngreet. oops.).
Okay. I know this is off-topic, but this is really annoying me and some of my classmates.
When it comes to letters of recommendation, how important are they?
For OB/gyn, I've heard everything from "I've never read a letter that was anything other than glowing - so I never read letters anymore; I just trash them," to "Letters are EXTREMELY important, because they are assessments of your capabilities from actual physicians!"
One of my classmates is going into general surgery, and she has heard the exact same mix of opinions.
So which is it? Does it vary by program and by specialty?
Hmmm...didn't realize there was such a disparity between the various fields!
IMHO, it goes:
Step 1 > MS-III > LOR > research
Step 2 is somewhere in the middle of that spectrum, assuming you did as well (or better) than Step 1 (which should be the only reason you take it early!).
MS-I and MS-II grades would be towards the end.
In and of themself, they're pretty much not important. The only times they matter is if you did A) Incredibly good or B) Incredibly bad. If you're in the middle 90-95% like the majority of medical students, no one cares.
However, they are somewhat useful in that they touch on other things. Doing well first and second year is very helpful to doing well on Step 1. However, this is more a test of knowledge vs. grade, so consider that. Also class rank can be important for AOA, but once again that goes to being "incredibly good".
What if you don't Rock the Boards? Our school maintains that students who get good grades do well on the boards and that they have in house research that shows a correlation. So, if you are in the bottom 1/2 of the class and don't rock the boards....where does that leave you? Forced into a specialty that you don't want to go into?
There is a pretty good variety within the less competitive fields, so it's not like you are forced into a particular one. But yes, your choices will be limited to the handful of fields that traditionally take folks with your stats. Might mean you are deciding between FP, OB, PM&R, Peds and Psych, instead of between derm and optho. That's just the way it works. Best to have an open mind and be able to get excited about something that ultimately ends up attainable. If you only see yourself happy in one of the specialties you aren't going to get, it's going to be a rough awakening.
Step 1 is only one part of the equation. Residencies will look at the whole picture including grades, LORs, research, other activities/degrees etc.
If you are a poor test taker and want to go into a competitive specialty, while harder, it is not impossible. As with many things in life, sometimes who you know matters far more than what you know (or what some test says you know). A powerful mentor can open many doors. Persistence is the key to success in any field.
I didn't say those were my grades, although I'm around the middle of the pack and am only an M1 so Step 1 is over a year away. But, I don't expect to rock the boards...I had only a lowly 30 on the MCAT and am hit or miss on standardized exams (did fairly well on the GMAT, only average on the LSAT). I just don't know what to expect...always thought Cariology would be interesting, but don't know if I could get into it without doing well on USMLE 1, etc. (not quite sure how that all works anyway). I have heard that if I do an IM residency here at my school, that they would prefer me for the cardiology fellow here....but that may only be hearsay (shrug).
Just to give you some personal advice, Internal Medicine, as a whole, is not a competitive specialty. However, if you're interested in a competitive fellowship out of it (Cards, GI) it behooves you to go to the best program you can. And some of those programs can be quite competitive. Thus, you're not going to be running into "I won't match" but "I want to match as best as I can". People match into Cardiology from no name community programs, but it's MUCH easier from big name university programs.
Also, don't sell yourself short on Step 1. One of the top scorers in my class was an "average" Pre-med, who busted his *** (especially second year, when the material matters most).
I'm sure it does vary to some extent by program and specialty. But it's obviously safe to say that great letters can only help you, so try to get them.
I have heard from one peds program director that she will pay more attention to the dean's letter than individual letters, as it is supposed to be reflective of all of your clinical evaluations. But does everyone do this? Who knows.
The medicine and peds program directors I've spoken with have framed it similarly:
3rd Year Performance > Letters of Rec > USMLE Step 1 > Everything else (like years 1 and 2, extracurriculars)
I don't think I've talked to anyone who has emphasized the importance of preclinical grades for residency, aside from the fact failing a bunch of courses would be a bad idea. I've actually heard some top former PDs say that Step 1 hardly matters for the non-competitive fields, but I'm sure not every program feels that way. Obviously research can play a role too, depending on the candidate and program. I know our school stresses the importance of the Dean's letter.... someone on this thread said something similar.
Can't speak for medicine or peds, but my meagre experience feels Dean's letter= charmin extra soft triple ply (unless someone has been disciplined for some reason- it would be in there). They are almost uniformly glowing...only reason to look at it is to get a sense of class rank if it isn't elsewhere.
LOR's on the other hand can be useful if...
1) the author shows that they've actually interacted with the student (or they trust the people who have).
2) they state they would be interested in keeping the student at their institution (a good thing)
So to get letters like these, don't be shy about telling attendings you're interested in their field (while not kissing *ss), and work your tail off on the service or sub-I.
Dean's letters are all going to be glowing, no doubt, but they use standard terminology (at least at my school) to rank students more objectively and try to help programs separate out student performance in the classroom and on clerkships. They might use "good," "very good," "ëxcellent," and "outstanding," for example, in lieu of "below average," "average," "above average," and "great." Rotation directors do the same, and this is reflected in the comments section of the dean's letter. Also, student grades in preclinical and clinical courses are noted on a graph showing the total distribution of final grades within that course, which might help programs to identify the best students. There's definitely some useful information beyond the extra soft triply-ply exterior.
Maybe various schools do the dean's letter differently then. I know at mine, it's essentially a cut-and-paste of your third-year evaluations. And while they will, sometimes, not include an outlying negative comment, they won't "charmin extra soft triple ply" over more than a couple of them. Thus it is a more complete picture than the three attendings who loved you that you pick to write letters.
But if everyone does these differently, then that's just one more reason why you can't make a hard and fast rule as to what part of the application means more to who. I think we can all agree that the clinical years mean a lot more than the first two. So survive the basic science, read first aid to ace step 1, then work really hard as an MS3 & 4 which will get you good grades, evaluations, and all the preparation you need for Step 2.
I would be interested to see how well the correlation used by your school fits. Do they actually show you the data and statistics or just say "we've run our own in-house research and can show you success in class correlates with success on Step I?"
The AAMC studied predictors for success on USMLE Step I and the MCAT had the strongest predictive value (r^2 ~80) for Step I success whereas 1st and 2nd year grades had a far lower predictive value. This is largely part of why the MCAT continued to be used as a medical school admission standard.
I've often wondered, but what can you do? Pull the BS flag on the Assoc. Dean when he says it?
MSIII clinical evaluations are so random, I dunno how you all deal. I know some departments that just hate students. I'm just not looking forward to it.
Just work as hard as you can for Step I, and don't let you "lowly 30" haunt you as a limiting factor
On another note, I've given up on grades at this point and have just tried to learn the material as best I can. So far it's working alright, because I feel like when I approach boards, I'll have a (false?) sense of confidence that I knew the material at some point, even if it maybe have been in a different context or taught in a different style AND I'm still doing above average. I guess just trying to learn for the sake of learning isn't that bad....
Agreed. I love doing well as much as the next guy, but there have been sections where I focused more on learning the material at the expense of specific test preparation. One would think that one should equal/lead to the other, but the strategies can be quite different.
This echoes an earlier post, but if you are a poor standardized test taker but Honor (A's) all of your pre-clinical courses it provides a way to "prove" that you can perform but truly have trouble with standardized tests. Everyone always asks about what they need to do to match and the canned answer is do the best you can. Working hard in the preclin years will make preping for step 1 easier, much like doing well in the premed classes makes getting ready for the MCAT easier.
I know everyone says that 3rd year grades matter most, but that's hard to believe given their subjectivity. Residency directors probably just look for red flags in terms of grades and comments. Grading criteria differs too much between schools.
Step 1 is the only objective thing they have, so it HAS to be #1, unless the program is desperate and can't fill their spots if they screen step 1 scores.
This has been very hotly debated on SDN before.
There was also an article on SDN that talked about this.
No one is ever going to agree, I think. The best thing to do is just do the best you can on each part of your application.
While it is true that third year grades are subjective, many schools also include data in their dean's letter about the percentage of students receiving each respective grade in that course so the programs can get a feel for whether an honors is really an honors or if they give it out to everyone.
For emergency medicine, I have been told that the order of importance:
Performance in EM clerkship(s)> LORs> Third year overall> Step I > leadership/research> Years 1&2.
I know that some residency directors at competitive schools do look at pre-clinical grades. In neuorosurgery at Hopkins, for example, I have heard attendings say that they specifically look at the pre-clinical anatomy grade. Other residency directors have said that they do glance through the pre-clinical grades to get an overall sense of the student. I think that the answer definitely varies with the program and the person evaluating the application. There may not be a blanket answer or a uniform policy.
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