No honors 3rd year

Discussion in 'Medical Students - MD' started by Al Pacino, May 1, 2004.

  1. Al Pacino

    Al Pacino Senior Member
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    My school's 3rd year grading policy is either Pass or Honors; there's nothing in between. Only 25% of the class gets Honors in every rotation; everybody else gets a Pass. The competition for honors is extremely fierce, and as the year is ending, I've realized that some of those who racked up the Honors did so in a less than honorable way.

    My question: How does it look if I don't have a single Honor my third year?
     
  2. mellantro

    mellantro Senior Member
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    this is a good question and one that I have wondered about as well.

    anyone have any thoughts? it seems like clinical grades are so key in landing a sweet residency, but if a person only passes internal med and/or surgery, is that gonna kill them for any kind of competitive residency?

    I know, my wording is a bit overdramatic, but you know what i mean :)
     
  3. Jaded Soul

    Jaded Soul Proloxil > Zoloft
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    I hope that residency admission committees know about this grading system at your school. If 25% of people honor each rotation, it buffs their transcripts and makes them look better than they are in comparison to students from other schools. I think it's more typical for around 10% to honor a rotation, which is how it is at my school. We also have the intermediate category between called "high pass."

    Anyway, I'm going to go out on a limb and say it wouldn't look great if you don't honor anything because it's relatively "easier" for you to do it than if you were at another school. But that's just my opinion--you need to hear from someone who goes to a school that also doesn't have a category between honors and pass.
     
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  4. 8744

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    I think you just shouldn't worry about it. First, because the die is cast, so to speak, and it is impossible now for you to honor anything in third year. Fourth year for us is all pass/fail and if it is for you the only way you can change you class rank now is for the worse by failing a fourth year rotation.

    My class rank is not that high. I'm planning on taking a month off in October to study for Step 2 to ensure that I get a good grade. (I did well on Step 1) My advisor says this will go a long way towards negating the negative effect of low class rank.

    I don't know into what specialty you want to match so I'm just giving you philosophical advice and moral support.

    How exactly do people "honor" in less than honorable ways? Do they cheat on the shelf exams? Hack into the gradebook?
     
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  5. doc05

    doc05 2K Member
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    dude, 25% is a lot. but not everyone can get honors. so lighten up, and play with the cards you've been dealt.
     
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  6. musicman1991

    musicman1991 Senior Member
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    Residency programs get a histogram of your schools grade distributions. That's too bad your school didn't at least have High pass to seperate those group a bit. I wouldn't worry about it. Also what speciality are you applying for? If you did well on step 1 & 2 that should make up for it.
     
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  7. Goober

    Goober Senior Member
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    It doesn't matter if you are applying to a noncompetitive specialty. If you want something that is difficult to match in, you are going to have a hard time unless the rep of your school is very high. All you can do at thsi point is do your best on the USMLEs, get good LORs and do some relevant EC stuff.
     
  8. Al Pacino

    Al Pacino Senior Member
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    OK, thanks for all the responses. I'm coming from a top 30 med school. Many of my friends are going to end the year with ZERO honors for third year. It's actually a common phenomomenon among classmates, but one doesn't hear about this problem so much on SDN. I guess most people go to schools where there is a high pass which softens the blow of not getting honors.

    To honor requires more image than substance, at least at my school. At most rotations, your evaluation is weighted 70% clinical performance and 30% shelf exam. I have a problem with this distribution. I'm consistently in the top of the class, in terms of shelf exam i.e 99%ile, which is no easy feat for those of you who have taken the NBME's bastard exams. However, in terms of clinical evaluation, my school has this ****ty rule where only 20% can honor the CLINICAL PERFORMANCE.

    Hence, I'll maximize the 30% of my score on the shelf exam, but because I don't get honors on the clinical performace, my final score is a pass.

    What pisses me off is that I'm a lot smarter than those people who are honoring their clinical performace, but I'm just a not good schmoozer or as good-looking as those people. With teams of attendings and residents changing so fast and so often, the schmoozers with their pitiful fund of knowledge have no problem flirting and ass-kissing their way to the top. It's sickening to me watch how some of the male residents are all over the good-looking female students. These students get extra teaching, attention, and most likely a higher grade.

    BTW, I'm applying for radiology :D
     
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  9. scootad.

    scootad. Senior Member
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    Yeah, its unfortunate but so much of one's success depends on the way you look.

    Its also interested to me that a field like radiology w/ minimal pt contact that has become pretty competitive in recent years now requires good grades in your clinical years. Of course while being hot may give you those "good" clinical grades I cant see how being hot will help one become a better radiologist where one spends 90+% of one's time staring at a computer.
     
  10. Goober

    Goober Senior Member
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    Well if you are scoring in the 99% on the shelf exams you should score above 250 on the USMLEs, in which case you won't have any problem matching into radiology coming from a top 30 school as long as you apply to a broad range of programs.
     
  11. Seaglass

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    Just to offer a different point of view, have you considered that perhaps the most important part of medicine, besides being able to find the information you need, is personality? You need to convince your patients to do what you want them too, you just can't order them to, and that takes personality. In my opinion it's a good thing that clinicals are weighted so heavily because that reflects the skills you need to change patient behavior. Of course I was/am a schmoozer so . . .

    C
     
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  12. Al Pacino

    Al Pacino Senior Member
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    Don't extropolate more than there is--I have no problem taking care of patients. Patients like me as a student and as a person. My written evaluations will say something to the effect that I have good rapport with patients. On a few occasions, I have received small gifts from patients that I've taken care of such as box of chocolates or a fruit basket.

    Clinical grades do NOT judge how you "change patient behaviour." If clinical grades were based on that criteria, most of us would fail right away. As those who have gone through medical school, medicine does not heal people. When was the last you cured someone? When was the last time you "healed" someone?

    I'll tell you what clinical grades measure: they measure how well one measures up to the IMAGE of what a doctor should look like. It doesn't matter that if below this image, there's no substance of medical knowledge.

    Attendings who spend a few minutes with the team each day can't see beyond the surface and deep inside the different students. What they see is superficial and can be cultivated.

    People tell me that's how the real world is. I agree, and I'm resigned to that fact. People tell me to worry about taking care of patients, which I do. But that doesn't mean I have to accept it.

    At least your honest and thanks for showing your true colors as to the meaning of third year grading :smuggrin:
     
  13. chef

    chef Senior Member
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  14. irlandesa

    irlandesa Senior Member
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    So in a relatively non-competitive specialty like IM, what would qualify as "something difficult to match in"? I know that BWH, MGH, Duke, Penn, etc. for IM are completely out of the question for someone with a couple of Passes on their record (on the H/HP/P/F scale) or anything below Honors in Medicine; but what other types of residency programs (i.e. academic, community, mixed programs in IM or FP) would be inappropriate for an "average" or "below average" clinical students (but with at least an HP, very pref. higher in their specialty of choice) with otherwise strong credentials (including nice written comments from clinical evals to go in the Dean's Letter, LOR's, USMLE scores, etc.)? I know I haven't always gotten along great with everyone on here, but I really don't want to waste my time applying to programs that are out of my league. Please be honest but nice; I swear I don't care about the IMG thing anymore, I was mistaken, mea culpa.
     
  15. praying4MD

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    How do you know you are a lot smarter than "those people who are honoring their clinical performance"? That's a rather bold statment don't you think?? To assume that those who are honoring do not earn their grades but only get them because they are good looking, ass-kissing, etc.? Wow. And not only that, but to assume that they have a pitiful fund of knowledge is rather presumptious.

    [MY TESTIMONY:]
    I am someone who does not do well in a heavy pimping environment, not because I do not know the information, but often because I get very flustered in front of a crowd of upper levels. So someone, like yourself, would look at my pimping performance and say that I have a "pitiful fund of knowledge." However, my upper level, [at least on my last rotation,] was also kind enough to allow me to shine in other ways. I do rather well on One-on-one pimp sessions instead of ones in a group, so I showed my knowledge there and also, where it really counts-- in DOING stuff in the OR [it was a surgery rotation.] He respected that while I may not know the exact mechanism of action of a particular drug ON THE SPOT, that I was willing to look it up, pull an article on it and apply it use to my patients; also, while the book stuff comes a little harder to me, the day to day necessary skills were second nature to me: tying knots, op notes, taking care of paperwork, etc.

    In addition, I like to think I got along exceptionally well with my upper levels - [and yes, i would consider myself good looking-- so what??] I definitely think that my sense of humor and ability to talk to them as if they were my friends helped me a LOT. That is not schmoozing to me-- that is being NORMAL and is indicative of who I am-- someone that likes to interact with people.

    And these things are what *really* matter-- because I have learned something that I won't forget now [by getting the pimp question wrong] AND we were able to get through the day while laughing. And he respected me more for that I think and for the fact that I really wanted to learn.

    As for the good looking girls comment-- 1) they will get their payback on OB/GYN & you will likely get preferential treatment because you have a penis. It all evens out in the end-- I was treated like shi* on OB/GYN and I have no doubt it is because a) I am a woman. b) I am reasonably good looking and take pride in my appearance.

    2) Don't hate us because we're beautiful AND have a great sense of humor. :D
     
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  16. daisygirl

    daisygirl woof
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    Praying4md-

    Great post :) . I miss your posts in the everyone forum :( That forum isn't what it used to be :(
     
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  17. praying4MD

    praying4MD 2K Member
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    Aww, thanks daisygirl. Good to see you around too. :) How's life been treatin' ya? I know about that Everyone forum-- I've lurked a little here and there and it has gotten pretty out of hand and rather immature I think. Not like the good ol' days at all. But thanks for the sweet compliment anyway. :) Take care.
     
  18. StupidRoo

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    I realize this is a dead thread, but I would like to provide an update to avoid misinformation. Things may have changed over the years. Research has been done and 25% is not a lot. In fact, it may be a bit below average. A top 10 program in my area apparently awards 60% honors. Now that is ridiculous, but it is reality. My program gives about 25%, so I felt the need to investigate the issue because I felt like it has still been relatively tricky to honor a rotation though I have managed to get about half H half NH. I think it is a disservice to students to offer a system with no gradient. There should always be an intermediate grade to show that you performed above average even if it wasn't at the honors level. Here is a link if you are interested. http://skepticalscalpel.blogspot.com/2012/10/medical-school-grading-and-t-ball.html?m=1

    I will add that it certainly sucks when people who nearly fail the shelf get honors when you do well on the shelf and get near honors. I learned that in certain rotations, stating that you were going into the field would result in a perfect eval even if you were average. I never did this, but it was definitely a technique employed by classmates. Graded standardized encounters would be the best way to eliminate this subjectivity, but it seems like they are underutilized in medical schools in general. Just my thoughts.
     
  19. Psai

    Psai Snitches get zero vicryl
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    stop bumping threads because you're mad about not getting honors

    graded standardized encounters are the worst thing to happen to medical education since the flexner report
     
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  20. Tired

    Tired Fading away
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    #20 Tired, Apr 26, 2015
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  21. Jabbed

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    Ya, ****ing Flexner. Taking all the snake oils out of our pre-clinical lectures since 1910.
     
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  22. Tired

    Tired Fading away
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    #22 Tired, Apr 26, 2015
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  23. Jabbed

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    I think Flexner specifically referred to alternative medicine as "charlatanism" in his report.
     
  24. username456789

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  25. username456789

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    I think the take home point here is not that "more students should get honors", but rather "too many schools are giving out way too many honors."

    It completely dilutes the meaning or honor of achieving it.
     
  26. NickNaylor

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    At my institution honors was awarded to 40-50% of students on average depending on the rotation. With very few exceptions everyone did well on clinical evals, so the primary determinant of your final grade was the shelf score.
     
  27. 194342

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    dude, wtf. Seriously wtf. There is a strict 10% cutoff for honors, 20% for high pass at my school. It blew.
     
  28. NickNaylor

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    That's unfortunate. At my school, it was essentially known among the students that high pass is the default grade, and getting honors or pass required doing notably well or notably poorly. Honors/high pass accounted for 80-90% of the grades for most rotations.
     
  29. alpinism

    alpinism Give Em' the Jet Fuel
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    Wow. For us it was usually only the top 10 to 20%. Not only that but you had to honor both the clinical grade and the shelf grade.

    Most rotations it was 60% pass, 30% high pass, 10% honors.
     
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  30. Psai

    Psai Snitches get zero vicryl
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    for us it's just basically if you honor the shelf you get honors
    it's a little more complicated than that pretty much need a 75th percentile to honor
     
  31. NickNaylor

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    That was the annoying thing about our rotations: shelf exams usually took up a large component of the clerkship grade (25-33%) but very seldom were there actual guidelines with respect to how well you had to score in order to achieve certain "grades" on the shelf. It was altogether very vague and mysterious.
     
  32. sazerac

    sazerac rye sense of humor
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    It gets even more vague and mysterious because there are multiple ways to grade a shelf. I was in an orientation, I think it was neurology, when they announced that you needed a 70 on the shelf to get some kind of grade. I asked what the 70 represented... a percent correct? a percentile? raw score? scaled score? scaled percentile?

    The response was an eye roll and an exasperated "I SAID... you need a 70" and they moved on to the next topic. Yeah... thanks for the clarification!

    I honestly don't think they knew the answer.
     
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  33. username456789

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    How absolutely useless.

    Medical schools have now become Little League teams, where everybody gets a ****ing ribbon or a trophy.
     
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  34. Psai

    Psai Snitches get zero vicryl
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    honestly i think they should just scrap half of medical school and start residency sooner because medical school is turning into **** with all this team-based nonsense, simulations, etc.
     
  35. MedSchoolSurvivor

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    Third year can be very frustrating because of the grading. Schools attempt to place an objective score on something that's largely subjectively based. In my school, you could get a scaled score of 99 on the shelf and still do mediocre if an attending saw the evaluation as just another piece of pesky paperwork to be filled out as fast as possible and ended up giving straight 3's. Or in other cases, one student may have to get the nobel prize to get a perfect evaluation while another student with a different attending will get a perfect eval just for showing up. The most frustrating aspect is when an attending seems to give out good marks or poor marks based on how much they "like" the student.

    One of my attendings was on his third wife who was about 20-30 years younger than him. The two attractive girls that went before me and received perfect evals, while me and my friend (both guys), walked away with perfectly mediocre evaluations despite my asking for constructive criticism and him telling me, "You're doing great."

    Just do your best and try to learn something, and try to not let the third year subjective unfairness get to you.
     
  36. StupidRoo

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    I've done that on all, but one rotation at my school. That being said, I've gotten mostly honors, so maybe that is just the way it pans out. I'm not mad about not getting honors, but I feel like there is a lot of misinformation on these threads, so I figured I would post some research.
     
  37. Ismet

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    My school has completely different criteria for each rotation, which gets really frustrating. We don't have a cutoff for how many people can get honors, but what you have to do to get honors is quite variable among each clerkship, with internal medicine being the most convoluted (In order to get high pass, you have to have high pass and honors evals, with a certain shelf score cutoff. If you just have all high pass evals, you end up with a pass somehow). I don't understand why it's not more standardized.
     
  38. Ismet

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    I am not a fan of OSCEs either, but I have to admit it's great prep for CS (which I don't think should be a thing either, but it is, so...)

    We just had a practice CS exam and it was tough (bread and butter cases, but I ran out of time on the note in almost every station). I'm really glad they gave us an actual insight into what the day would be before we take it.
     
  39. superdoc2.0

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    Honors on your transcript isn't important, residency directors only care about your hobbies. I even heard that residency directors want applicants without honors because this shows their commitment to mediocrity.
     
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  40. qw098

    qw098 zyzzbrah
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    u wot m8 o_O
     
  41. notbobtrustme

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    ya but he also goes to a top 10. AFAIK, most top medical schools are like that. At WashU, something like 70% of the class honors their clinical rotations.

    Our school is something like 25%-65%-10%, honors, high pass, pass. You really got to earn that pass, if you know what I'm saying.
     
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  42. username456789

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    It's still idiotic.
     
  43. NickNaylor

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    I agree in that using clinical grades becomes somewhat useless since there's so little variation in the large number of students. On the other hand, I do think the grading scheme relieves some of the pressure of "outdoing" your peers, which I think is a productive change. In general I found students to be more supportive and helpful to one another rather than competitive. For most people the approach was to figure out how to make both students on a team look good rather than figuring out away to make myself look good, possibly at the expense of the other. I would much rather be in that kind of culture - it makes the learning more productive and I can focus on learning medicine than scheming to "look good."

    You're correct, though, that as a tool strictly used for evaluation it becomes useless and little more than a circus act.
     
  44. superdoc2.0

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    You heard me right brah!
     
  45. Dr Love

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    My school also gives a small number of evals, based primarily on subjective criteria. I agree with all the flaws in this approach that others have pointed out. Personally, I think clinical grades don't correlate with anything useful at all.

    To share my experience, I applied with almost all passes into internal medicine. Nonetheless I got interviews at most of the top programs, but not MGH, Brigham, Penn or Columbia. I matched at a top 10 program, which was my top choice all along.

    I would guess that as the program/specialty becomes more competitive they are more likely to use automatic grade cutoffs. I am almost certain that the residency programs I mentioned used an automatic cutoff.
     
  46. StupidRoo

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    I found this to be true as well. I generally feel pretty rushed, and I'm not the best at typing admittedly, so I would almost always leave the exam room early in order to have plenty of time for the note since that is what is graded for clinical competence anyway. On one of them, I believe we were expected to do a full neuro exam which is pretty ridiculous given how long that can take. I just did a partial and ran out to do my note.

    I don't feel the time constraints or the encounter is realistic, but I do feel that it forces you to really focus on relevant questions and such. I would argue also that it is pretty much the only way to evaluate your process. I don't think I've ever had an attending or resident watch me through a full evaluation of a patient. It seems ridiculous that subjective evaluations are primarily based on presentations. You can form a pretty solid presentation based on old notes and hx alone without actually having any clinical competence. I guess that is one reason I feel partial to OSCE's. Some students in my class are brilliant at reciting a full normal exam, and I am almost certain that no one would have the time in the morning to do a full exam on every patient, meaning that at least a portion of the presentation is bs anyway.
     
  47. Tired

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  48. NickNaylor

    NickNaylor Thank You for Smoking
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    This was the policy for students at my school.
     
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  50. Ismet

    Ismet PGY-almost done!
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    Most attendings I've worked with will call out students if they recite a full normal exam during morning rounds. You're right, no one is doing a full exam on the patient in the morning, they're just checking pertinents and most likely quick heart/lungs/belly, and the attending will call you out if they think you're reporting on something you didn't do. Same with the note. Not that that helps with assessing clinical competence, but at least it keeps people in check.
     

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