My pre-clinical grades are horrible, am I in trouble?

[BRBeta]

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I'm a 2nd year, and I have horrible grades (I've failed one of my basic science courses - cardio/pulmonary/endo/ENT core, which I will be remediating this summer). My class rank is subsequently pretty low.

While I've yet to take Step 1, I've always had this pattern of sub-par grades and extremely high scores on standardized tests (always >90th %ile, including the MCAT). This has been true since junior high and carried me into medical school. I taught Kaplan so I know there is a pretty high correlation between MCAT and USMLE scores, and so on, so I figure I have a fair shot, with appropriate preparation, to score above average on Step 1. From my friends who are M3's and M4's they've told me that largely clerkship grades at my school place more importance on how well you interact with the team, that you care for your patients, that you show a willingness to learn, and not necessarily how much you know (other than the shelf exams, which are still important - but again, standardized tests I tend to do well on).

I'm 100% sure that whatever I go into I want to work with pediatric populations and I'm 95% sure that I want to go into a pediatric residency, and eventually a fellowship. My main concern is getting a fellowship - how competitive are they in pediatrics? Assuming that I have even just above average USMLE scores on all steps, will my pre-clinical grades matter?

I've searched the forums, and saw some of the data that suggests that other than EM, most fellowship fields have fewer US applicants than spots, so it would seem that would be an advantage. I'm most interested in cardio right now, but that can and probably will change over the next two years.

Any help would be appreciated. Thanks!

 

[lla252]

It sounds like you are thinking maybe a little bit too far ahead- so many things can change between your pre-clinical years (I assume you are in either your first or second year since you haven't taken Step 1 yet) and 4th year. If you do well on Step1 and in your clinical years, your chance of getting a strong residency is high. Although you might be asked about your difficulties in your pre-clinical years, if you don't continue to have such problems you are unlikely to be affected much by those grades in your residency application process.

Then, when it comes to fellowship, it is my understanding (I'm only a 4th year student so take this with a grain of salt) that your residency record will be much more relevant to getting a good fellowship than your med school record. Where you go to residency may impact your ability to match in a peds cardiology fellowship - a few programs that I interviewed at had residents who were quite afraid of not matching in cards. So going to a top-tier residency program is obviously helpful in getting a strong fellowship.

However, like I said, you're awfully early to be worrying about whether you will get into fellowship- most people in your position don't have a clue what specialty they are going to match in let alone are considering a fellowship. I am impressed that you are thinking so far ahead, but I feel like the best thing for you to do is probably focus on the next year or two, keep a good academic record (were you able to correct the reason why you were having academic difficulty?), and try out different specialties to see what you like during your 3rd year. I hope this was helpful! Good luck with your classes- I'm very excited about peds so I'm glad you're already so interested!!!

 

[14022]

MCAT scores definately do NOT correlate with USMLE scores. It is a completely different test. The MCAT uniquely has a reading comprehension section that does not require any previous knowledge. The USMLE exams test purely medical knowledge. It would be extremely naive to think you will score >95th percentile based on your MCAT performance. Keep in mind for the USMLE, you are being compared only to those that did well on your MCAT and got into medical school. Those that did poorly on the MCAT are not likely in medical school and thus do not take the USMLE. Thus, most people that made it into medical school have a history of doing well on standardized tests if they got to that point and not all do well on the USMLE exams. I would think you are at pretty high risk of failing step 1 based on your preclinical performance and would take the USMLE very seriously, rather than assuming you will do well based on your ability to take standardized tests. So please study hard for step 1.

That being said, fellowship is most highly dependent on where you do residency and your performance in residency. Your residency placement is most dependent on your performance in medical school. For pediatrics, your clinical performance your third and fourth year will be much more important in getting you a good residency. Outstanding clinical performance can make up for weak preclinical performance. However, failing a course is more of a red flag than just doing poorly (yet passing). You will likely have to explain this in your application, indicate how you overcame this barrier, what you did specifically to pass the second time, what you learned from the experience, and how you came out better in the end. I agree you are looking way too far ahead. Right now, you should spend more time trying to do as well as you can in your coursework. If you fail another course, it is going to be that much harder to get a good residency. Best of luck!

 

[WatchingWaiting]

MCAT scores definately do NOT correlate with USMLE scores. It is a completely different test. The MCAT uniquely has a reading comprehension section that does not require any previous knowledge. The USMLE exams test purely medical knowledge. It would be extremely naive to think you will score >95th percentile based on your MCAT performance. Keep in mind for the USMLE, you are being compared only to those that did well on your MCAT and got into medical school. Those that did poorly on the MCAT are not likely in medical school and thus do not take the USMLE. Thus, most people that made it into medical school have a history of doing well on standardized tests if they got to that point and not all do well on the USMLE exams. I would think you are at pretty high risk of failing step 1 based on your preclinical performance and would take the USMLE very seriously, rather than assuming you will do well based on your ability to take standardized tests. So please study hard for step 1.

Do you do reserach or just utter things that sound good with no evidence? Why do you think med schools rely so much on MCAT scores in making admissions decisions? For fun? For ***ts and giggles?

The MCAT score correlates better with Step 1 scores, Step 2 scores, and even with clerkship grades than does undergraduate gpa. In fact, it's the best single predictor of med school performance. You can go to the aamc website, and there are ten or fifteen studies that have examined this question. The correlation with Step 1 is like .65 for grades, .69 for MCAT scores, and .71 for the two together.

If someone is failing classes, it certainly does indicate high-risk of not doing well on Step 1, but then again, given that passes on med school exams are often set at 70-75% and often based on very small minutiae that the particular instructors felt important, which may or may not correlate with what is actually important, it is possible that this person has a problem with rote memorization and short-term regurg, but has a good long term memory and good comprehension which will serve him well on the Step 1.

 

[siempre595]

I think the bottomline here is that pre-clinical grades are not really what make or break you in getting a decent peds residency. Remediate the class and pass it, start studying and get a decent score on step 1 and don't fail anything else. Fellowships are, as someone else said, largely determined by resdiency, and I highly doubt very many fellowship programs even look at pre-clinical grades from med school with much interest. You're not in that bad of a position at all to still get a good peds residency spot, just fix the problem and don't create anymore big problems to fix in the future.

 

[Pedialyte]

I think you can still do great! My friend and classmate failed one pre-clinical class and she's now doing emergency medicine (surprised me, too). I think a strong Step 1 might reassure programs about your pre-clinical goof up. In general, I think Peds programs really like strong clinical grades, but that just seems to be my experience. You could also talk to a Peds advisor and see what they say. Hope this cheers you up a bit!

 

[14022]

Let me clarify. Of course, in general, the better you do on the MCAT, the more likely you will do well on USMLE. However, in the most simplest terms, a 0.69 correlation would mean that 31% of those that do well on the MCAT dont do well on the USMLE or vice versa. Not great correlation in my opinion. BRBeta, I am not saying by any means that you cannot do well on step 1. All I was trying to say is that do not assume that you will do well based on your previous perfromance. Step 1 is tough and takes a lot of preparation. If you put in the effort, you will likely do well. I think siempre said it best. Fix the current problem and do not create any new ones, and you will be fine. Best of luck!