Most Important Things When Choosing a Medical School...

[username456789]

I go to an H/P/F school, straight-passed every class for 2 years while learning the important stuff for Step 1

From another thread (I'm not trying to be a dick, I was just quickly searching your post history out of curiosity to find out what specialty you applied for):

Only honored 2 of my pre-clinical classes. Decent (240-250) Step 1, honors in all clinical rotations except Ob/Gyn including sub-Is and aways, reasonable research

Applied to 34 residencies, got interviews at 31, including all top-20 programs I applied to.

Pre-clinical grades don't matter.

UPDATE: I matched at my #1 choice, a top 5 program

So which is it?

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[Dbate]

I had a question about Match Lists.

People have commented that one should look at match lists and use it as a factor when determining which medical schools to apply to and attend.

But from the ones I have seen, they all just appear to be regionally biased. That is, most people do residency at their home institution or institutions in the state (more so because I am looking at Texas match lists).

What are the important things to look for? And why does it even matter?

 

[bollywoodlover]

Agree with a lot of people. True p/f
Schools are rare. Most have internal rankings and most have aoa. Guess what ? You have to be at least top 25% if you want to qualify for aoa. It's still ranked. If your not in the aoa at these true p/f schools then your not going to fool a derm or ortho program that your in the top 10 percent.

I've talked to docs about p/f schools and was saying how these students have less stress, but they all say not really because its internally ranked. I guess if you don't believe you being ranked and you strive just to pass you'll prob end up near the bottom. I wouldn't want that mentality. In the deans letter they will still say you performed top quartile or whatever I'm sure to distinguish the people who are trying hard. I'm sure they wouldn't say you were at the bottom if you were but would stress the positives, but if they didn't mention you were at the top I'd think that would imply you were bottom 50 percent.

My school doesn't curve. So if you work hard for an A or honors you get it no matter how many students already got As which I think is a positive even though my school has letter grades.

 

[gravitywave]

I see multiple problems here, especially for an accepted pre-med trying to ask these questions...

15 things to look for in 3rd year:

1) Most if not all rotations have residency programs (esp in the fields you're considering)
Disagree. Many of the best rotations don't have residents. Surgery can be a much more powerful experience when the student is first-assisting everything.
2) Most if not all rotations have weekly conferences and grand rounds
OK, but shouldn't be the second question you ask. Passive learning of this kind is a marker for a strong academic environment, but is incredibly low yield, especially as a med student.
3) Low student to faculty ratio on rotations
no Argument here
4) Faculty and residents that love to teach and learn. Essentially, does the hospital have a culture of the residents/med students being there to work (bad) or being there to learn (good)? (bad = malignant)
If you could ask one question, this should be it. Culture is key.
5) Clinical faculty who are leaders in their field
Important, but so few schools are connected with leaders in every field that I feel this is a poor weedout question for a pre-med. Don't pick a school on the basis of the Ortho dept, even if you think you know right now you are going into Ortho. You probably aren't.
6) Med students are protected from scut
Getting a real answer on this will be incredibly difficult. Scutwork is grossly overreported at most places
7) Med students are responsible for their own patients and have a large "scope of practice." You learn best by doing, not watching. (You should be writing real SOAP notes, coming up w/ a DDx, ordering Dx tests, planning and discussing Tx options w/ your resident/attending as part of a team, and then assisting in surgery or helping to perform medical procedures)
This is a good question. Even the places with the very best clinical education struggle to do this for every student on every rotation. But it is the gold standard.
8) Med students have a list of procedures that should be done during each rotation.
No, this isn't helpful. Too easy to work around if you are lazy or on a rotation that you aren't engaged in. Culture is far more important, see above
9) Med students have a list of learning objectives for each rotation
OK. I'm still not convinced that having these truly drives clinical education though
10) Med students get exposure to both university and community hospitals
Yes, helpful.
11) Standardized grading rubric for rotations.
Yes, helpful
12) No limit on number of Honors given out per rotation.
Nope. PDs know who the schools are that do this and it really dilutes the strength of an excellent-appearing transcript from that school. A set ratio of Honors is far more helpful.
13) Ability to do 3rd year electives and away rotations.
yes, or a curriculum that completes third year early and allows for more elective time prior to ERAS (aka a longer fourth year)
14) The hospital(s) are busy w/ lots of diverse pathology and see enough patients so you're not just sitting around all day doing nothing.
sure, but it's not like you can't end up sitting around all day doing nothing at such a hospital
15) The hospital(s) have a primarily low and middle income patient population that is open to letting med students take an active role in their care (many rich patients often only want to see attendings).
I'm actually not sure what this means. I think it's more apochryphal than anything else

the answers you'll get to most of these questions are going be (sorry) very difficult to interpret as a pre-med. even as one with lots of clinical experience. The single most important question is something along the lines of "what was the teaching culture like?" or "how happy are you with the clinical education you got?" Schools should be willing to give you some data out of their AAMC Graduate Questionnaire, which asks all this kind of stuff.
Preclinicals are important, too. Basically, you're going to want the maximum amount of flexibility. OPs list is a good one. True P/F remains rare. Match lists are impossible to interpret in a meaningful way. Ditto for USMLE scores, although you should make sure the school gives at least six weeks for study.

 

[alpinism]

I see multiple problems here, especially for an accepted pre-med trying to ask these questions...



the answers you'll get to most of these questions are going be (sorry) very difficult to interpret as a pre-med. even as one with lots of clinical experience. The single most important question is something along the lines of "what was the teaching culture like?" or "how happy are you with the clinical education you got?" Schools should be willing to give you some data out of their AAMC Graduate Questionnaire, which asks all this kind of stuff.
Preclinicals are important, too. Basically, you're going to want the maximum amount of flexibility. OPs list is a good one. True P/F remains rare. Match lists are impossible to interpret in a meaningful way. Ditto for USMLE scores, although you should make sure the school gives at least six weeks for study.

Per #1 there are definitely pros to not having residents on rotations like you mentioned (esp in surgery). At the same time, there are also multiple downsides. It will be much harder to find mentors who you can relate to and get advice about things like submitting ERAS, choosing where to apply and what programs to rank, figuring out electives/away rotations, and learning about a resident's day to day life, etc... They were just in your shoes a few years ago and most have tons of helpful advice on preparing for and surviving internship. Good residents should also add to your education more than they take away from it. Its much harder to figure stuff out if you're just working with attendings who graduated residency 20yrs ago and aren't involved w/ GME (they're often out of the loop or misinformed). Its also helpful to go over your application with your home program's PD (even if you're not applying there).

Per #12 either way, not honoring a rotation in the field you're applying will weaken your application. If you're at a quota school and work your a** off only to get a high pass, you're gonna look worse than someone with honors almost every time. This is because even if the PD knows the schools without quotas, they still don't know if you deserved that grade or not, but they have to assume you did. I agree, school reputation does play a role, but its mostly only for top programs. For the vast majority of med students, the better you're chances of getting honors, the better off you'll be when applying for residency.

The list wasn't meant to be in any particular order w/ reference to importance. Just some things to consider when comparing the clinical years of 2 schools.

 

[gravitywave]

re: residents, I can see where you're coming from but I just don't feel it's a very good weedout question for someone trying to decide. It probably is true that more residency programs affliated with your school means a higher caliber educational environment, but I'm not sure that's going to be a great discriminator for most people when it comes to how they end up feeling about their education on Graduation Day. Most people aren't going into academic medicine. Most people aren't going into Rad Onc or ENT or plastics and so not having a program in those fields won't make much difference to them.

re: grades, this is a debate that could have its own thread. Schools with better reputation have an easier time with this issue and can more easily afford to do things like give lots of Honors, no Honors, or not grade people at all. Most places though have to be able to sort their students by academic performance in an internally valid way. We see things differently, probably because we're at different schools.

Overall it's very very difficult for someone to get good answers to any questions they could ask about the clinical years. I honestly feel that issues that are more easily assessed are the ones that people should think of first. like location, cost, curriculum structure, amount of PBL, etc.

Per #1 there are definitely pros to not having residents on rotations like you mentioned (esp in surgery). At the same time, there are also multiple downsides. It will be much harder to find mentors who you can relate to and get advice about things like submitting ERAS, choosing where to apply and what programs to rank, figuring out electives/away rotations, and learning about a resident's day to day life, etc... They were just in your shoes a few years ago and most have tons of helpful advice on preparing for and surviving internship. Good residents should also add to your education more than they take away from it. Its much harder to figure stuff out if you're just working with attendings who graduated residency 20yrs ago and aren't involved w/ GME (they're often out of the loop or misinformed). Its also helpful to go over your application with your home program's PD (even if you're not applying there).

Per #12 either way, not honoring a rotation in the field you're applying will weaken your application. If you're at a quota school and work your a** off only to get a high pass, you're gonna look worse than someone with honors almost every time. This is because even if the PD knows the schools without quotas, they still don't know if you deserved that grade or not, but they have to assume you did. I agree, school reputation does play a role, but its mostly only for top programs. For the vast majority of med students, the better you're chances of getting honors, the better off you'll be when applying for residency.

The list wasn't meant to be in any particular order w/ reference to importance. Just some things to consider when comparing the clinical years of 2 schools.

 

[aloepathic]

From another thread (I'm not trying to be a dick, I was just quickly searching your post history out of curiosity to find out what specialty you applied for):



So which is it?

Honored Endocrinology and Doctoring II, out of roughly 20 preclinical courses. For all intents and purposes I abbreviate that to straight-pass.

 

[Lady Netter]

1. cost
2. location - not in the sense of what you'll be doing in the city, but more in proximity to family (if that's important)
3. curriculum set up - is it discipline based (biochem class, histology class, anatomy, etc) or by system? mostly lecture-style or mostly PBL-style? This matters A LOTTTTTT. Make sure your learning style matches the curriculum style.
4. can you see yourself getting along with the people there? most cannot do med school alone. you'll need friends and a support system.
5. research opportunities

 

[Lady Netter]

I had a question about Match Lists.

People have commented that one should look at match lists and use it as a factor when determining which medical schools to apply to and attend.

But from the ones I have seen, they all just appear to be regionally biased. That is, most people do residency at their home institution or institutions in the state (more so because I am looking at Texas match lists).

What are the important things to look for? And why does it even matter?

Match lists should only be used after you have assessed every other factor and cannot decide between 2 schools. Match lists are hard to interpret because most do not understand which programs are actually good and you also don't know why the people applied to where they applied. What if a person applied to a lower-tiered program and it was their first choice because they needed to be in that location for family reasons?

I would be worried if the schools cannot match students into competitive specialties, but in terms of actual programs, I think that's hard to judge as a premed.

 

[aloepathic]

What he said.



Also, did you get a sense of the importance of AOA from the program directors you talked to? I know this has been discussed at length on SDN so I don't want to start another debate. I just want to know your opinion on the matter since you seem to have done well in terms of securing your desired residency (presumably) w/out being AOA.

Sorry, never meant to imply that I wasn't AOA. I actually did get AOA, but here the results don't come out until after the early match is over so it didn't help me much. AOA at most school emphasizes the same things that residency program directors do (Step 1, clinical grades, evaluations, research or significant extra-curricular experience as a tiebreaker). As is consistent with previous posters (and posts of mine), pre-clinical classes are only important inasmuch as they build a foundation for what actually matters. One sentence in your dean's letter, <1-5% of AOA criteria.

In terms of importance, I think being the type of candidate who is going to get AOA will obviously make you more competitive since the criteria so closely align with the NRMP Residency Director Survey's higher rated qualities. Only one residency that I know of (Hopkins) actually screened on AOA and they made exceptions. Statistically a significant people who match into even competitive fields are not AOA.

 

[aloepathic]

As a followup, the percentage of people matching into the competitive specialties who are AOA is as follows (note: Urology and Ophtho are not NRMP specialties so they aren't included, but anecdotally they're probably somewhere in the 30-40 range):

51: Dermatology
46: Plastics
42: ENT
31: Rad-Onc
27: Ortho
26: Rads
25: Neurosurg
24: Med-Peds
15: Medicine

And down from there

Source: https://docs.google.com/viewer?url=http://www.nrmp.org/data/chartingoutcomes2011.pdf

(really great data source for all things match)

 

[nychila]

pre-clinical classes are only important inasmuch as they build a foundation for what actually matters. One sentence in your dean's letter, <1-5% of AOA criteria.

Most of the SDN posts that I've read said somewhere around 20% of AOA criteria is preclinical grades?

Also, would it be much harder to get AOA from a top school than a lower-tier school, since each school can only select the top 1/6 of their class?

 

[Planes2Doc]

Hey I have a request... So I realized that even as a current medical student, I still don't know what to look for in regards to the clinical years! I've never seen it addressed before in this forum until now. I was wondering if we can compile a master list so I can stick it onto the original post? I don't think it's fair to rule out half of the education since that's misleading! Any thoughts?

 

[Geebeejay]

Hey I have a request... So I realized that even as a current medical student, I still don't know what to look for in regards to the clinical years! I've never seen it addressed before in this forum until now. I was wondering if we can compile a master list so I can stick it onto the original post? I don't think it's fair to rule out half of the education since that's misleading! Any thoughts?

+1 This is something that is incredibly important to me, but isn't really discussed very often in Pre-Allo

 

[Black Mamba24]

Sorry, never meant to imply that I wasn't AOA. I actually did get AOA, but here the results don't come out until after the early match is over so it didn't help me much. AOA at most school emphasizes the same things that residency program directors do (Step 1, clinical grades, evaluations, research or significant extra-curricular experience as a tiebreaker). As is consistent with previous posters (and posts of mine), pre-clinical classes are only important inasmuch as they build a foundation for what actually matters. One sentence in your dean's letter, <1-5% of AOA criteria.

In terms of importance, I think being the type of candidate who is going to get AOA will obviously make you more competitive since the criteria so closely align with the NRMP Residency Director Survey's higher rated qualities. Only one residency that I know of (Hopkins) actually screened on AOA and they made exceptions. Statistically a significant people who match into even competitive fields are not AOA.

Oh, my mistake. Thanks for the helpful info!

Hey I have a request... So I realized that even as a current medical student, I still don't know what to look for in regards to the clinical years! I've never seen it addressed before in this forum until now. I was wondering if we can compile a master list so I can stick it onto the original post? I don't think it's fair to rule out half of the education since that's misleading! Any thoughts?

+1 Great idea

 

[PACERS14]

the name recognition (effectively usnews top 25) will make a LARGE impact when you are applying for residencies. If you are set on matching at a top-notch program or in a competitive field (ie plastics/radonc/etc) then you will make your life MUCH easier by going to a well-known school.

Whether this is worth higher tuition/turning down scholarships/location/etc. is up to you to decide. I feel like there's a strong sentiment of "where you go wont matter for the match" which is FAR from the truth.

 

[Twinnering]

the name recognition (effectively usnews top 25) will make a LARGE impact when you are applying for residencies. If you are set on matching at a top-notch program or in a competitive field (ie plastics/radonc/etc) then you will make your life MUCH easier by going to a well-known school.

Whether this is worth higher tuition/turning down scholarships/location/etc. is up to you to decide. I feel like there's a strong sentiment of "where you go wont matter for the match" which is FAR from the truth.

If you dont mind, could you elaborate on this advice in terms of why the last sentiment is far from the truth? For instance, is this coming from program directors and such?

 

[Wordead]

If you dont mind, could you elaborate on this advice in terms of why the last sentiment is far from the truth? For instance, is this coming from program directors and such?

I don't know if it's actually the truth or not and to what degree it matters, but I will share that the M4s who applied to the ultra-selective specialties (ENT, Plastics, Derm, Radonc) did say that they felt a bit out of place because everyone was coming from Stanford, Hopkins, Harvard, etc etc.

Also, if you take a look at the allo match lists....well, it's fairly obvious that the schools with good reputations tend to match people into residencies with good reputations.

 

[Xenops]

I have a question; where do I find out if a med school's classes have mandatory attendance? I find their curriculum websites confusing to navigate.

 

[Planes2Doc]

I have a question; where do I find out if a med school's classes have mandatory attendance? I find their curriculum websites confusing to navigate.

A majority of schools are not mandatory. The only school I can think of off the top of my head with mandatory attendance is Mayo. It also has a tiny class, so professors would notice. Other than that, I don't know a good source to find this.

Another incredibly important thing to actually look up in this regard is the PBL curriculum. Those are typically all mandatory, and are a huge pain if you have no intention of ever going to lecture.

 

[sinombre]

UC Irvine has mandatory attendance as well.

 

[Planes2Doc]

UC Irvine has mandatory attendance as well.

Well that sucks. I'm also guessing that some schools have "mandatory attendance" as well, but it's actually not enforced. We had a couple classes at my school where attending lecture was supposedly mandatory. It definitely wasn't.

 

[sinombre]

Well that sucks. I'm also guessing that some schools have "mandatory attendance" as well, but it's actually not enforced. We had a couple classes at my school where attending lecture was supposedly mandatory. It definitely wasn't.

Hmm, I think it's a new thing at Irvine, so I guess I'll have to wait and see how it pans out. As far as I can tell this policy is actually enforced there. If I have to deal with this I'll probably just study other stuff while in lecture.

 

[alpinism]

I have a question; where do I find out if a med school's classes have mandatory attendance? I find their curriculum websites confusing to navigate.

AFAIK the following schools either have mandatory lectures or don't record their lectures.
(some of the info is about 3yrs old and might be out of date)

Mayo
UCI
Rochester (no recorded lectures)
LECOM Erie (lecture pathway)
Western (mandatory clicker questions at the beginning of class)
AZCOM (no recorded lectures)
KYCOM
KCUMB
RVUCOM (some mandatory lectures)
VCOM
VCOM-CC
UMDNJ (officially mandatory, but often not enforced)
Utah
CCLCM
OUWB
NYMC (no recorded lectures)
Wake Forest
U Washington (M1 year only)
Indiana

If anyone has any new or updated schools, feel free to add to the list.

 

[Planes2Doc]

Hmm, I think it's a new thing at Irvine, so I guess I'll have to wait and see how it pans out. As far as I can tell this policy is actually enforced there. If I have to deal with this I'll probably just study other stuff while in lecture.

Ah I see. Yeah, when I used to go to lecture (which ended pretty quickly), I usually see people on Facebook or doing something else with their computers. I wonder why they even go to lecture in the first place!

As for labs, which of course are mandatory, the penalty for unexcused absences is clearly outlined in our syllabus. I wonder if something is written in the syllabus regarding lecture as well. Otherwise, there are classes at my school that have "mandatory lecture," which ends up being completely meaningless.

At my undergrad, there were some classes that used clickers at the beginning of class to take attendance. I was reading course reviews for one of them, and a respondent wrote that you can just have a friend use your clicker for you. Someone seriously wrote that, I kid you not. That's a very risky way of skipping class if clickers are used, and can have serious consequences if you're caught.

 

[3838]

What is good in your clinical years: Being able to be an active member of the team. Carrying multiple patients in your ward rotations. Being able to write notes vs. writing "fake" notes that aren't checked or critiqued. If interested in surgery/OB: adequate OR exposure & L+D exposure. Although I would argue everyone should learn how to deliver a baby.

What is bad in your clinical years: Shadowing. 3rd year isn't supposed to be passive. You don't need to be working 15 hours a day but you basically need a good amount of experience so PDs won't raise their eyebrows and question if this kid can handle intern year.

Variable: Required rotations. Is there a lot of focus on rural rotations? Are sub-internships required? Are there rotations in the field you want vs. doing away rotations? The last question is probably not a good one for me to mention....since people change their mind all the time...my bad.

Scut protection. This one is hard to ask med students because they might not want to say it's that bad. There is a difference between real scut("get me coffee!" "fax 100 papers") vs. fake scut("go ask this patient XXX question" "you should go see this consult"). Yes, there was a student who rolled her eyes at seeing consults.

I know this is an old post, but how would you suggest we get in contact with said M3's and M4's?

 

[mvenus929]

I know this is an old post, but how would you suggest we get in contact with said M3's and M4's?

Once you're admitted, ask the admissions office for emails of third and fourth year students.

 

[alpinism]

Once you're admitted, ask the admissions office for emails of third and fourth year students.

Yep. Every admitted applicant trying to decide between 2 schools they really like should talk to a few M4s from each school
(married vs. single and those going into primary care vs. competitive specialties).

 

[wiloghby]

AFAIK the following schools either have mandatory lectures or don't record their lectures.
(some of the info is about 3yrs old and might be out of date)


UMDNJ (officially mandatory, but often not enforced)


If anyone has any new or updated schools, feel free to add to the list.

UMDNJ had 3 different medical schools. NJMS and RWJMS are now part of Rutgers, and the School of Osteopathic Medicine is now at Rowan University. So what you have posted may be true for one or two of those schools, I do not know. But I can tell you that NJMS absolutely does not have mandatory attendance. They have a designated student who is in charge of filming the lectures and uploading to the class dropbox. I have been told ~60% of the class uses these instead of attending class.

I know you alluded to that with your qualification that it is "often not enforced", but I wanted to elaborate for anyone considering the school. Attendance really is optional at this point. I can't speak for RWJMS or the SOM at Rowan.

The same courses at NJMS, when offered through the graduate school in Newark, (for the MS or SMP programs) frequently require students to attend and use attendance as part of the final grade. But I am pretty certain that the medical school preclinicals do not require attendance.

 

[SunsFun]

Can someone elaborate on PBL? How much time does it usually take? The schools I am considering have it twice a week. Does it basically mean that every week I will have to do tons of "independent research" trying to find relevant info in the library and then prepare a presentation? Sort of like a project/presentation we do in undergrad but on steroids. How bad is it for those who are thorough and prefer do more rather than less when unsure how much is enough?

 

[amvet70]

Getting back to OP: as almost 3 out of 5 med school applicants do not get accepted anywhere, I think the primary thing one should be thinking about is broadly applying to schools where you might have a reasonable chance to get an interview initially considering your GPA/MCAT. The MSAR could be a helpful starting point. I’m not saying you can’t give any reach schools a shot but don’t just ignore a school because of its grading system or mandatory lectures requirement. These are reasons to ignore a school when you haven’t been accepted anywhere? Really? Maybe these or other reasons become more important once you have multiple offers in hand, but if you’re not at that point yet, you may want to rethink your strategy about the narrowing down of med school choices.

Cost is definitely important. Location could be important for family considerations or if you live in states like California where there are few med schools and they have boat loads full of qualified applicants, and so you will need to consider out of state options. Before you get an offer, you’ll be interviewed. You may want to consider a med school’s mission statement especially if your some out of state student trying to explain to an interviewer how you match up with the school’s mission.

Do not use match lists as a guide. Med students pick residencies for other reasons than reputation or research opportunities. Many med school graduates will not be involved in research post med school. Some grew up in small towns and just want to go back to where their or their spouse’s families are. Some have significant others who are still in school (a PhD program, a MS2 student, etc.) or are both MS4’s trying to couples match and so they select residencies in order to stay close. Furthermore, one MS4 may be at top of class where their significant other MS4 is at the bottom so that could determine their match outcomes. The point is you do not know the back stories of the matched students so relying on a match list is not particularly helpful.

If you can get into a well med school, congrats, but according to the NRMP survey of residency program directors (PD), the most important factors in their decision making is how the student performed while in med school (especially MS3 year, letters of rec, Dean’s letter, Step 1, etc.). The preclinical years and the name at the top of the diploma are less important in the PD’s decision making process, so why do you?. According to the surveyed PDs, the fact that the name at the top of the diploma is from any US med school is more important than whether the med school is well known. You can get to where you want to go post med school from any US med school. All US med schools are good. Do not ignore med schools just because US News doesn’t rank them high.

Mandatory lectures?. This is a concern, really? If you go to class at least you'll have heard the material one time before the test. If you’re relying on tapes, is everyone going to be diligently on top of the material every day, please? Or will people think, I’m tired, I listen to the tapes tomorrow. And then what happens is that it’s two days before the test and you have to digest a week’s worth of tapes. Instead of locking yourself into your apartment, get up and go to class. The fresh air will do you some good. As residents you’ll be in hospitals from 6AM to 6-8PM, 5-6 days a week. Going to class will help get you into practice. And since you’ll be with classmates, maybe you’ll improve your ability to interact with others.

Clinical years (especially third year rotations): a lot of variables in experiences (what attendings, residents, fellows you work with, what patients happen to come in on day you’re in a surgery or a psych or a neuro clerkship etc., weight of shelf exams etc. MS3 is the single most important year. MS4 tends to be electives and what one takes tends to be a function of interest and working around residency traveling, interviews, etc. For all clinical years, very difficult to assign meaning to these years to someone who hasn’t been accepted to any med school or to even a MS1, MS2 because of uniqueness of each med student experiences during these years.

Grading system: as pointed out above, “People tend to obsess about this, but ultimately it doesn't make a huge difference.”

AOA questions: some med schools do not have AOA chapters (I think Stanford, UCSD and some others). So AOA certainly makes a residency application stronger, but it may not have any bearing depending on one’s med school. Whether or not a med school has an AOA chapter should play no role in choosing med school. If your med school has a chapter, you’ll need to study hard from get go as only a few get elected.

Big shot faculty: when you apply electronically, residency programs will tend to use screening filters meaning if you don’t have a high enough GPA and Step 1 score, your application will probably be sent to the reject pile despite your research or connections. And just because you have some “big shot” faculty at med school, I think this is a greatly overblown factor. Not every med student is going to make a connection with some big shot while in med school. Also don’t these big shots have some integrity or do they just write rec letters for everyone? I’m not saying a letter from some big shot is worthless, I just do not think it’s widespread, especially when you’re talking about competitive residencies, and certainly not a meaningful factor in choosing a med school.

Bottom line: You can get to where you want to go post med school from any US med school. All US med schools are good. Within reason, apply broadly.

 

[chickensoupdr]

Can someone elaborate on PBL? How much time does it usually take? The schools I am considering have it twice a week. Does it basically mean that every week I will have to do tons of "independent research" trying to find relevant info in the library and then prepare a presentation? Sort of like a project/presentation we do in undergrad but on steroids. How bad is it for those who are thorough and prefer do more rather than less when unsure how much is enough?

From what I've heard from current medical school students, you get as much as you put into it. Unfortunately, not everyone in the group puts in the effort, which can be frustrating but understandable at the same time since different people learn differently. I guess it depends on your group, the facilitators, and how you study best.

 

[mvenus929]

Can someone elaborate on PBL? How much time does it usually take? The schools I am considering have it twice a week. Does it basically mean that every week I will have to do tons of "independent research" trying to find relevant info in the library and then prepare a presentation? Sort of like a project/presentation we do in undergrad but on steroids. How bad is it for those who are thorough and prefer do more rather than less when unsure how much is enough?

My school has case-based PBL once per week. We spend 1-2 hours going through a case, and then the following week, at least one person in the group has a 5-10 minute presentation on something related to that case. The presentations took like 10-20 minutes to put together. But, I recognize that this is not how most schools do PBL, so YMMV.

 

[chronicidal]

Re: grades. A multi-institutional study demonstrated that preclinical grading makes a bigger difference to student well-being than other aspects of the curriculum such as the frequency of testing, the number of lecture hours, and the amount of clinical exposure. (Reference: Reed DA et al. Acad Med 2011, 86, 1367-73.) Two interval grading (i.e. P/F or its equivalent) was associated with significantly higher well-being compared to multi-tier grading systems in that study and others (see Bloodgood RA et al. Acad Med 2009, 84, 655-62; and Rohe DE et al. Mayo Clin Proc 2006, 81, 1443-8.) By well-being I mean various measures of burnout, anxiety, stress, thoughts of dropping out, depersonalization, emotional exhaustion. Students at multi-tier graded schools have twice the odds of feeling burnout and serious drop-out contemplation.

There will always be people who will tell you anecdotally that grading system doesn't make a difference, that it wasn't that bad for them in retrospect. In fact at schools where M3s and M4s were surveyed on their opinion of retaining a multi-tier system vs. changing to P/F, a majority (50-65%) typically support the status quo and oppose a change. This was certainly the case at Pitt and Hopkins, before they changed to P/F in the last five years. When you have people invest a large amount of energy and time (thousands of hours) working towards some goal (grades), our minds are naturally inclined to place more value on that achievement and the system that permitted it than might be ascribed to it objectively (what is the real value of having a discriminating grading system during the preclinical years anyway?). When you have people go through an experience that may have had somewhat negative transient effects on their well-being, but they make it out ok, they tend to minimize the negative aspects in their memory. When you have people who were only exposed to one system (e.g. a graded system), they will tend to comment on that system more favorably than other systems they are less familiar with.

These schools like Pitt and Hopkins changed to P/F despite not having the overwhelming support of all the clinical-years students. I'd like to think it's because the curriculum committees of relevance were sufficiently persuaded by the empiric evidence in the literature for a benefit in student well-being, non-inferiority for board scores and other academic outcomes, and residency survey data showing that programs don't care much about preclinical grades. They also may have had enough confidence in the quality of students at that school to not have to need the extrinsic motivation of Honors grades to self-regulate and strive for excellence in learning (see White and Fantone, Adv Health Sci Educ 2009, 15, 469-77).

If I were a premed, I would look to a P/F system as one of many indicators for a higher likelihood of good well-being throughout the preclinical years. It's neither sensitive nor specific, but useful nonetheless. I would also look at a recent change from multi-tier grades to P/F as a positive marker of the institution, its educational philosophy and culture, and the faculty and administrators -- they're student-focused, they're intent on developing students into self-motivated lifelong learners, they're in touch with and willing to roll with the national trends in medical education (even the AMA has policy now recognizing the benefits of two-interval grading in the non-clinical curriculum), they're not stagnant in their policies, they consider student input, they value evidence-based decision-making.

 

[cs24]

Mandatory lectures?. This is a concern, really? If you go to class at least you'll have heard the material one time before the test. If you’re relying on tapes, is everyone going to be diligently on top of the material every day, please? Or will people think, I’m tired, I listen to the tapes tomorrow. And then what happens is that it’s two days before the test and you have to digest a week’s worth of tapes. Instead of locking yourself into your apartment, get up and go to class. The fresh air will do you some good. As residents you’ll be in hospitals from 6AM to 6-8PM, 5-6 days a week. Going to class will help get you into practice. And since you’ll be with classmates, maybe you’ll improve your ability to interact with others.

Most of your post is pretty good, but as far as the above I have to strongly disagree. Yes, there are a great deal of students that keep up with the streamed lectures on a daily basis. Of course if you get behind it is going to be bad, but for me to go to a lecture, not retain information, and then go home to review the "tapes" after I've inefficiently used 4 hours of my day is a struggle. I greatly prefer sleeping in to a more reasonable hour, watching my lectures at 2x to get a sense of what was focused on, then doing a review later. That way, in the same 4 hours that the 20% of my class who actually attends lecture used on lectures, I have gone through the material twice, once at my own pace with reinforcement from useful outside resources online and in board review books.

Maybe going to lecture worked great for you, but don't assume that you know what's best for all pre-meds. If they have a choice I highly recommend nonmandatory recorded lectures, and this is coming from someone who never missed a class in undergrad. I started out going to class and my life has been so much better since I stopped. You don't have to just lock yourself in your apartment and study, studying from home is what gives me time to get outside of my house in the evenings and pursue my hobbies. Also, I think it's better to use your free time now when you have it rather than getting up to go to lecture so you will be prepared for 3/4th year when attendance is obviously required. Do you also recommend getting up at 4:30am every morning so you will be prepared for early rounding when/if you are exposed to it? Some things you should just adjust to as they come instead of frantically and inefficiently preparing for (eg prestudying before med school).

 

[DermViser]

Re: grades. A multi-institutional study demonstrated that preclinical grading makes a bigger difference to student well-being than other aspects of the curriculum such as the frequency of testing, the number of lecture hours, and the amount of clinical exposure. (Reference: Reed DA et al. Acad Med 2011, 86, 1367-73.) Two interval grading (i.e. P/F or its equivalent) was associated with significantly higher well-being compared to multi-tier grading systems in that study and others (see Bloodgood RA et al. Acad Med 2009, 84, 655-62; and Rohe DE et al. Mayo Clin Proc 2006, 81, 1443-8.) By well-being I mean various measures of burnout, anxiety, stress, thoughts of dropping out, depersonalization, emotional exhaustion. Students at multi-tier graded schools have twice the odds of feeling burnout and serious drop-out contemplation.

There will always be people who will tell you anecdotally that grading system doesn't make a difference, that it wasn't that bad for them in retrospect. In fact at schools where M3s and M4s were surveyed on their opinion of retaining a multi-tier system vs. changing to P/F, a majority (50-65%) typically support the status quo and oppose a change. This was certainly the case at Pitt and Hopkins, before they changed to P/F in the last five years. When you have people invest a large amount of energy and time (thousands of hours) working towards some goal (grades), our minds are naturally inclined to place more value on that achievement and the system that permitted it than might be ascribed to it objectively (what is the real value of having a discriminating grading system during the preclinical years anyway?). When you have people go through an experience that may have had somewhat negative transient effects on their well-being, but they make it out ok, they tend to minimize the negative aspects in their memory. When you have people who were only exposed to one system (e.g. a graded system), they will tend to comment on that system more favorably than other systems they are less familiar with.

These schools like Pitt and Hopkins changed to P/F despite not having the overwhelming support of all the clinical-years students. I'd like to think it's because the curriculum committees of relevance were sufficiently persuaded by the empiric evidence in the literature for a benefit in student well-being, non-inferiority for board scores and other academic outcomes, and residency survey data showing that programs don't care much about preclinical grades. They also may have had enough confidence in the quality of students at that school to not have to need the extrinsic motivation of Honors grades to self-regulate and strive for excellence in learning (see White and Fantone, Adv Health Sci Educ 2009, 15, 469-77).

If I were a premed, I would look to a P/F system as one of many indicators for a higher likelihood of good well-being throughout the preclinical years. It's neither sensitive nor specific, but useful nonetheless. I would also look at a recent change from multi-tier grades to P/F as a positive marker of the institution, its educational philosophy and culture, and the faculty and administrators -- they're student-focused, they're intent on developing students into self-motivated lifelong learners, they're in touch with and willing to roll with the national trends in medical education (even the AMA has policy now recognizing the benefits of two-interval grading in the non-clinical curriculum), they're not stagnant in their policies, they consider student input, they value evidence-based decision-making.

There's a reason why schools, have difficulty switching to Pass/Fail systems for preclinical years. Many of your fellow students in your class are going for highly competitive specialties such as Dermatology. This specialty for example, one's rank and AOA status are very important to getting interviews and the number of interviews. You can bet top of the class students who want those competitive specialties will want every chance to demonstrate that they are top in comparison to everyone else, as this is then put in the Dean's letter. These are people who thrive on competition. To put it simply, those gunning and lucky enough to be competitive for these competitive specialties WANT the system as it is now. They don't want the change, to what you want - even if it results in better mental health and cooperation in your class, and the many other benefits of complete P/F preclinical grading, that many other schools have already figured out. It's the same ones who follow this credo: http://weknowmemes.com/2011/10/its-not-enough-that-i-should-succeed-others-should-fail/

I disagree that residencies just look at Step 1. Class ranking is just as important. Many gunner students who are great when it comes to being in a classroom and taking exams (something premeds have done all our lives and mastered), may not do so hot in the clinical years when a large part of your grade is a subjective opinion regarding your competence (a.k.a. what people in "normal" jobs have to deal with). Many but not all of these types, also have a very low EQ as well, which makes rotations very painful with them. It's much easier to get an "Honors" in a basic science course, then it is to get an "Honors" in Surgery. By taking away all basic science grading, everyone starts off on the same footing entering MS-3 (excluding Step 1 score). So in calculating AOA, everyone would be essentially ranked based on Step 1 (a 1 day test) and clinical grades (high subjective component grading). I think that schools that have a high emphasis on GPA and MCAT when it comes to their matriculating students it's not at all surprising that they are not amenable to changing their grading paradigm. Just as in science, many of your administrators believe competition is good, even if it means weeding out the weak, so to speak.

 

[chronicidal]

I think that schools that have a high emphasis on GPA and MCAT when it comes to their matriculating students it's not at all surprising that they are not amenable to changing their grading paradigm. Just as in science, many of your administrators believe competition is good, even if it means weeding out the weak, so to speak.

This is likely to be true, so long as the admission dean has enough power to influence the decisions regarding curriculum policy. That depends on the school.

 

[DermViser]

This is likely to be true, so long as the admission dean has enough power to influence the decisions regarding curriculum policy. That depends on the school.

Yes, but realize that your admissions dean is not some nobody. He/she is most likely someone from the medical school clinical faculty who in turn is greatly influenced by basic science faculty (who get their little feelings hurt when people don't come to class and thus may feel that P/F grading will make it worse) and clinical science faculty, some of whom are program directors [and thus want to differentiate the top from the bottom], who are conservative and VERY resistant to change, esp. if they are alumni of your institution (the "if I had it bad, so will they" mentality).

Remember that in the paper regarding UVA's P/F grading, they didn't heavily start researching the topic UNTIL they realized they were losing students to better schools bc of their grading system (i.e. when their institution's admissions game was greatly affected), as they realized from the answers on their post-acceptance surveys.

 

[mvenus929]

Remember that in the paper regarding UVA's P/F grading, they didn't heavily start researching the topic UNTIL they realized they were losing students to better schools bc of their grading system (i.e. when their institution's admissions game was greatly affected), as they realized from the answers on their post-acceptance surveys.

So in calculating AOA, everyone would be essentially ranked based on Step 1 (a 1 day test) and clinical grades (high subjective component grading).

So UVA still maintains class rank, but it's internal rank only. It's used to hand out awards at the end of second year (top person in each basic science class), and for Junior AOA nomination (because you have to be in the top 25% to qualify for AOA), but we also use other things for AOA nomination--during transition week into third year, the class actually nominates like 10 people each that they believe fulfill the goals of AOA. Step 1 scores, AFAIK, do not factor into AOA nomination here. Senior AOA, the same thing happens, but third year grades are included in the class rank determination.

The rank is not mentioned anywhere in our Dean's letter, even by ambiguous language (we're allowed to read our Dean's letters). The histogram that they include for third year grades pretty much tells where you are in the class, at least for clerkships, anyway.

 

[DermViser]

So UVA still maintains class rank, but it's internal rank only. It's used to hand out awards at the end of second year (top person in each basic science class), and for Junior AOA nomination (because you have to be in the top 25% to qualify for AOA), but we also use other things for AOA nomination--during transition week into third year, the class actually nominates like 10 people each that they believe fulfill the goals of AOA. Step 1 scores, AFAIK, do not factor into AOA nomination here. Senior AOA, the same thing happens, but third year grades are included in the class rank determination.

The rank is not mentioned anywhere in our Dean's letter, even by ambiguous language (we're allowed to read our Dean's letters). The histogram that they include for third year grades pretty much tells where you are in the class, at least for clerkships, anyway.

I was only referring to the UVA study, due to the REASON why they inquired about P/F grading in the first place. They did it bc it was greatly affecting their ability to recruit top notch applicants. There are schools that are truly P/F in the first 2 years with no internal ranking in those 2 years.

 

[KnuxNole]

Going to class is pointless for some people. I know for me, there is nothing of benefit that was gained with powerpoint lectures. I would stay home, memorize the notes and sometimes use books to supplement, rinse and repeat. A lot of basic science is work ethic and studying a large chunk of material.

I wouldn't tell everyone that they need to go to class, since that makes no sense. Some people learn by listening, some people don't. I know I would be playing video games in class if I was forced to go.