No honors 3rd year

[superdoc2.0]

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"We don't want honors, but we do expect you to do triathlons, auction your professional level oil painting to charity, play violin in a local symphony, and also get up at 4am every morning to surf."

Im sure you are joking, but do I resent the expectation that people have cool hobbies. Maintaining a time-intensive hobby at a high level and doing well in school is just another way to find the brilliant people who are smart enough to balance both. Also, everyone in my class who has a cool hobby has the money to sustain it. They came from money and still have family support to buy their really expensive camera, roadbike, climbing gear, or whatever. I grew up relatively poor and in a rural area, and I truly think hobbies are something that the upperclass has time and money for. Same with traveling. I'd love to talk about how I backpacked across Europe, but where is the money going to come from? Privilege and money yield a lot of interesting talking points on an application.

I feel ya there. Being poor is definitely a disadvantage in life. At least our children will have the time for hobbies.

 

[charmiedermie]

How absolutely useless.

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

Someone else getting an Honors grade in a clerkship doesn't make your Honors grade any less worthy or less special, even if it is earned by a large segment of the class.

 

[PhillyMed777]

Med school is far from little league people. First of all, step 1 is an equalizer; average is around 230 these days. Grade is normalized/curved. You either beat other people or you don't. Even in my classes I'd estimate 10-15% get Honors. No one is getting any ribbons without work. Heck i've been doing really well, and I haven't gotten anything to show for it. A crumbling application will easily preclude you from many post-grad residencies and/or specialties.

I'd argue its even more competitive. Its an arms race. Everyone is racking up publications. The step score is being driven up each year, making it harder to shine.

 

[username456789]

Someone else getting an Honors grade in a clerkship doesn't make your Honors grade any less worthy or less special, even if it is earned by a large segment of the class.

It absolutely does. It's the academic equivalent of giving everyone a trophy for showing up to tee ball.

 

[username456789]

Even in my classes I'd estimate 10-15% get Honors.

The whole issue at hand is that there are schools that give out ~30-40% "Honors" grades which I think we can all agree is pretty absurd, and defeats the purpose of having such a designation.

On a side note, you sound like you could use a beer or two to relax.

 

[masaraksh]

Med school is far from little league people. First of all, step 1 is an equalizer; average is around 230 these days. Grade is normalized/curved. You either beat other people or you don't. Even in my classes I'd estimate 10-15% get Honors. No one is getting any ribbons without work. Heck i've been doing really well, and I haven't gotten anything to show for it. A crumbling application will easily preclude you from many post-grad residencies and/or specialties.

I'd argue its even more competitive. Its an arms race. Everyone is racking up publications. The step score is being driven up each year, making it harder to shine.

That doesn't make sense. If you're doing well, isn't that what you have to show for it? 😵

It absolutely does. It's the academic equivalent of giving everyone a trophy for showing up to tee ball.

I would be really curious about the amount of "grade inflation" in medical school over the past few decades. I actually am not sure how much of it comes simply from 'giving out more honors' (aka making the tests less ambiguous and the questions more clear so that it is easier for more people to honor) and how much of it has to do with student culture getting more 'gunnery' as a whole... with the increases in tuition, tight competition for certain specialties, etc. driving students to study harder as a group.


Really interesting stuff. I know I'm glad to be at a strong US MD school right now since otherwise it may be a rough road.

 

[masaraksh]

The whole issue at hand is that there are schools that give out ~30-40% "Honors" grades which I think we can all agree is pretty absurd, and defeats the purpose of having such a designation.

On a side note, you sound like you could use a beer or two to relax.

That is a little absurd. However, what if you set the cutoff for honors at the top 10% of the class, and the lowest in the top 10% gets something like a 96.5% .. but then there is a solid 10% of the class between 94% and 96.5%... now these guys don't honor?

At that point it becomes more of a lottery of who guesses best on the tough questions and doesn't fill in the wrong bubble on an easy question than actual ranking by merit.

 

[Slack3r]

Someone else getting an Honors grade in a clerkship doesn't make your Honors grade any less worthy or less special, even if it is earned by a large segment of the class.

If everyone gets Honors it reduces the quality of that grade (not that anyone will notice) because you have no way to stratify students.

 

[charmiedermie]

It absolutely does. It's the academic equivalent of giving everyone a trophy for showing up to tee ball.

Why is your assumption automatically that because 30% of the class got Honors on a rotation, that students are getting a trophy for just showing up? I don't see how after working hard, presenting well, doing well on the shelf, and earning Honors, suddenly because you happen to know, long after the fact, the percentage of people who got Honors (which you don't even find out till you look on the MSPE), that somehow changes things entirely. At what cutoff are students no longer getting a trophy? 20%? 15%? 10% 5%?

See @masaraksh's example. At some point the line between Honors and High Pass is very arbitrary if not even significant in reality.

Sorry, but it just sounds like either sour grapes or something a gunner or a hypercompetitive person might say just because they no longer feel special (not talking about you, personally).

If everyone gets Honors it reduces the quality of that grade (not that anyone will notice) because you have no way to stratify students.

No one is talking about "everyone" getting Honors - see above. Reduces the "quality" of that grade to you in what way? Psychologically? So you learned less or didn't put as much effort because you found out later that 30% of your class got Honors, which would have been different if it was only 10%? If it's not noticed then what difference does it make?

You can stratify med students on anything - that doesn't make it necessarily meaningful. See @caffeinemia's comment on getting Honors on Surgery.

 

[username456789]

No one is talking about "everyone" getting Honors - see above. Reduces the "quality" of that grade to you in what way? Psychologically? So you learned less or didn't put as much effort because you found out later that 30% of your class got Honors, which would have been different if it was only 10%? If it's not noticed then what difference does it make?

In this case, what's the difference to you, then, in having 30% get honors or only one kid get honors? No difference in the amount the people involved learned. So why not decrease the number of "Honors" grades given out so that it actually retains some useful meaning and doesn't continue to get diluted/inflated.

The difference here is that, at my school at least, a grade of Honors is an honor that a select few are honored to receive. It's not meant to placate the masses, it's meant to recognize the people who truly are a cut above the rest.

You guys are being bizarrely literal and concrete in your thinking with regards to the little league analogy. The point is that everyone shows up and works very hard at baseline. That alone should not earn you a grade of Honors.

There's a reason millenials are referred to as The Entitlement Generation.

 

[Mad Jack]

If everyone gets Honors it reduces the quality of that grade (not that anyone will notice) because you have no way to stratify students.

It could conversely be argued that some schools simply have better students. Honors at Yale are probably more difficult to earn than honors at Meharry, so Meharry giving out honors to students that wouldn't have earned them at Yale reduces the quality of the grades awarded by Yale.

 

[notbobtrustme]

In this case, what's the difference to you, then, in having 30% get honors or only one kid get honors? No difference in the amount the people involved learned. So why not decrease the number of "Honors" grades given out so that it actually retains some useful meaning and doesn't continue to get diluted/inflated.

The difference here is that, at my school at least, a grade of Honors is an honor that a select few are honored to receive. It's not meant to placate the masses, it's meant to recognize the people who truly are a cut above the rest.

You guys are being bizarrely literal and concrete in your thinking with regards to the little league analogy. The point is that everyone shows up and works very hard at baseline. That alone should not earn you a grade of Honors.

There's a reason millenials are referred to as The Entitlement Generation.

Students aren't setting the grading policy, the administration is. A school like WashU that gives out 50-70% honors/rotation is not the fault of the student, it's the administration.

It could conversely be argued that some schools simply have better students. Honors at Yale are probably more difficult to earn than honors at Meharry, so Meharry giving out honors to students that wouldn't have earned them at Yale reduces the quality of the grades awarded by Yale.

Unless you've poured over each school's policy on 3rd year grading, there's no way you can say this. 3rd year grading runs the gamut from "honors for showing up and passing the shelf" to ">75th percentile on shelf exam AND honors evaluations from attendings". And even then, it's extremely variable. There are attendings who give out honors for just knowing what an ACE-inhibitor is while other attendings simply don't give out honors, no matter how well you perform.

And fwiw, Yale has a strict no grading policy and every student is unranked even after the clinical years. Of course, it's Yale, so they can do this without impacting their students' careers.

 

[username456789]

Students aren't setting the grading policy, the administration is. A school like WashU that gives out 50-70% honors/rotation is not the fault of the student, it's the administration.

I didn't blame the students for creating administrative policy.

I do blame the people (some students included) who would defend such a silly practice, however.

 

[Mad Jack]

Students aren't setting the grading policy, the administration is. A school like WashU that gives out 50-70% honors/rotation is not the fault of the student, it's the administration.



Unless you've poured over each school's policy on 3rd year grading, there's no way you can say this. 3rd year grading runs the gamut from "honors for showing up and passing the shelf" to ">75th percentile on shelf exam AND honors evaluations from attendings". And even then, it's extremely variable. There are attendings who give out honors for just knowing what an ACE-inhibitor is while other attendings simply don't give out honors, no matter how well you perform.

And fwiw, Yale has a strict no grading policy and every student is unranked even after the clinical years. Of course, it's Yale, so they can do this without impacting their students' careers.

https://medicine.yale.edu/education/admissions/education/yalesystem.aspx

They're graded in the clinical years, just not pre-clinical. In regard to what these grades amount to, they have a no ranking policy, not a no grading policy.

As to the original point, I was kind of saying the same thing as you, just illustrating it in a roundabout way- grades are meaningless because they're different at each school. They can really only be used to compare students from the same school and are a useless metric for comparing students from one school with another.

 

[charmiedermie]

In this case, what's the difference to you, then, in having 30% get honors or only one kid get honors? No difference in the amount the people involved learned. So why not decrease the number of "Honors" grades given out so that it actually retains some useful meaning and doesn't continue to get diluted/inflated.

The difference here is that, at my school at least, a grade of Honors is an honor that a select few are honored to receive. It's not meant to placate the masses, it's meant to recognize the people who truly are a cut above the rest.

You guys are being bizarrely literal and concrete in your thinking with regards to the little league analogy. The point is that everyone shows up and works very hard at baseline. That alone should not earn you a grade of Honors.

There's a reason millenials are referred to as The Entitlement Generation.

For me, it doesn't make a difference at all what the percentages are. It obviously makes a difference to Slackr, which is why he said the quality is reduced, and which is why I asked him how exactly the quality of the grade/clerkship is reduced, just because he finds out several months to a year later on his MSPE that 30% of students got Honors on a clerkship. Decreasing the number of "Honors" grades given out doesn't magically change anything about how good or bad that clerkship was -- same attendings, same residents, same shelf, same observed H&P, same turning in of a written H&P, etc. and doesn't tell you anything about actual performance.

I was being slightly tongue-in-cheek, not literal, with my question to you, but you felt that at a certain large percentage of the class receiving Honors, it becomes more of a "trophy for showing up to tee ball" thing. So I'll reword my genuine question to you: At what percentage or range does that Honors grade start to retain useful meaning for you, and is not diluted/inflated? Or if you were a residency faculty member reading a MSPE, at what percentage/range of the class would you want a clerkship director to reduce Honors to, to have that grade in front of you retain useful meaning and not be diluted/inflated?

Honors is the name given to a clerkship grade - the highest clerkship grade, it's not an award. It's a grade given once a certain competency level has been reached. We use the RIME (Reporter, Interpreter, Manager, Educator) at our school. It's no different than in a basic science class where it's clearly defined at the beginning what the exact cutoffs are for each grade: 90 or greater = Honors, 80-89 = High Pass, etc. based solely on individual performance, not based on whether you're in an overall smarter or dumber class. You want grades to be assigned based on your performance as relative to other classmates, and not whether certain abilities have been achieved, which doesn't change with the specific class or with time. It has nothing to do with feeling "entitled" to get Honors.

If your view of grades was adopted, it would play into and legitimately justify the views of gunners and hypercompetitive medical student classmates who believe their grade is assigned based on where they fall relative to their classmates and not to a set of behaviors and actions.

 

[username456789]

For me, it doesn't make a difference at all what the percentages are. It obviously makes a difference to Slackr, which is why he said the quality is reduced, and which is why I asked him how exactly the quality of the grade/clerkship is reduced, just because he finds out several months to a year later on his MSPE that 30% of students got Honors on a clerkship. Decreasing the number of "Honors" grades given out doesn't magically change anything about how good or bad that clerkship was -- same attendings, same residents, same shelf, same observed H&P, same turning in of a written H&P, etc. and doesn't tell you anything about actual performance.

I was being slightly tongue-in-cheek, not literal, with my question to you, but you felt that at a certain large percentage of the class receiving Honors, it becomes more of a "trophy for showing up to tee ball" thing. So I'll reword my genuine question to you: At what percentage or range does that Honors grade start to retain useful meaning for you, and is not diluted/inflated? Or if you were a residency faculty member reading a MSPE, at what percentage/range of the class would you want a clerkship director to reduce Honors to, to have that grade in front of you retain useful meaning and not be diluted/inflated?

Honors is the name given to a clerkship grade - the highest clerkship grade, it's not an award. It's a grade given once a certain competency level has been reached. We use the RIME (Reporter, Interpreter, Manager, Educator) at our school. It's no different than in a basic science class where it's clearly defined at the beginning what the exact cutoffs are for each grade: 90 or greater = Honors, 80-89 = High Pass, etc. based solely on individual performance, not based on whether you're in an overall smarter or dumber class. You want grades to be assigned based on your performance as relative to other classmates, and not whether certain abilities have been achieved, which doesn't change with the specific class or with time. It has nothing to do with feeling "entitled" to get Honors.

If your view of grades was adopted, it would play into and legitimately justify the views of gunners and hypercompetitive medical student classmates who believe their grade is assigned based on where they fall relative to their classmates and not to a set of behaviors and actions.

My medical school was ABCDF grading, with honors not being a normal grade you achieve, but a special designation for not only achieving an A, but for being in the top 10%. If you did A work, you got an A. Honors is an honorary designation beyond that. I guess if your school chooses to dilute it and use it as just a surrogate for an A, the discussion is a little different. But, in my opinion, that really defeats the purpose of the designation, and also illustrates the uselessness it represents in trying to compare applicants based on this metric.

To answer your question, I would surmise that somewhere in the neighborhood of 15% approaches the limit of utility in viewing honors as a special designation versus just another grade.

When all [this is an exaggeration] students get honors, no students get honors.

 

[camedstudent23]

I have been told by several PD's that if you are at a top 20 school and have honored few clerkships, as long as you have good comments on your MSPE, you will get the benefit of the doubt. They will just assume you had the disadvantage of competing with the best of the best. If you have few honors and below average comments on your MSPE, they will assume you're smart (to have gotten into that med school) but a slacker and not look highly of you.

 

[Greenberg702]

I have been told by several PD's that if you are at a top 20 school and have honored few clerkships, as long as you have good comments on your MSPE, you will get the benefit of the doubt. They will just assume you had the disadvantage of competing with the best of the best. If you have few honors and below average comments on your MSPE, they will assume you're smart (to have gotten into that med school) but a slacker and not look highly of you.

Which I'm sure most people will probably find frustrating since top 20 schools also give out the largest proportion of honors. So attending a lower ranked school is essentially a double whammy, fewer people get honors AND if you don't, you also look a lot worse/don't get the benefit of the doubt.

 

[TwinsFan]

Not all top schools give a lot of honors. Mine certainly has a reputation for being stingy with them. And your peers are generally are some of the top students out there, seems like a double whammy to me...

 

[camedstudent23]

Not all top schools give a lot of honors. Mine certainly has a reputation for being stingy with them. And your peers are generally are some of the top students out there, seems like a double whammy to me...

Yup, mine is 10% H, 30% HP, 60% P, MP if you failed the shelf or had professionalism issues.

 

[Greenberg702]

Yup, mine is 10% H, 30% HP, 60% P, MP if you failed the shelf or had professionalism issues.

That's pretty strict. Mine is 25% H, 25% HP, and 50% P. Conditional if you failed the shelf.

 

[charmiedermie]

My medical school was ABCDF grading, with honors not being a normal grade you achieve, but a special designation for not only achieving an A, but for being in the top 10%. If you did A work, you got an A. Honors is an honorary designation beyond that. I guess if your school chooses to dilute it and use it as just a surrogate for an A, the discussion is a little different. But, in my opinion, that really defeats the purpose of the designation, and also illustrates the uselessness it represents in trying to compare applicants based on this metric.

To answer your question, I would surmise that somewhere in the neighborhood of 15% approaches the limit of utility in viewing honors as a special designation versus just another grade.

When all [this is an exaggeration] students get honors, no students get honors.

Most med schools grade third year either ABCDF or Honors/High Pass/Pass/Fail, with the highest grade being either an A or an Honors, respectively. I think your school is very much in the minority in terms of taking the highest clerkship grade earned, A, in your case, and then stratifying it even further. At some point, stratifying things further, just for the sake of stratification, won't give you any more useful information about the applicant, and inflating students' huge egos isn't a good enough of a reason to do it.

Now, if your med school purposefully wishes to breed neurotics, gunners, and hypercompetitiveness in its student body, then that's a different story.

 

[charmiedermie]

Which I'm sure most people will probably find frustrating since top 20 schools also give out the largest proportion of honors. So attending a lower ranked school is essentially a double whammy, fewer people get honors AND if you don't, you also look a lot worse/don't get the benefit of the doubt.

And also cleverly disguise where a student falls in their MSPE, unlike a lower ranked school, which won't hide it.

 

[username456789]

And also cleverly disguise where a student falls in their MSPE, unlike a lower ranked school, which won't hide it.

Once again since you can't seem to understand or are purposely ignoring the previous explanations, top schools aren't hiding anything any more than other schools in the MSPE.

 

[username456789]

Now, if your med school purposefully wishes to breed neurotics, gunners, and hypercompetitiveness in its student body, then that's a different story.

Our student body was amazing. The hilarious grades = gunners" paranoia on SDN had actually begun to get old by now.

 

[charmiedermie]

Our student body was amazing. The hilarious grades = gunners" paranoia on SDN had actually begun to get old by now.

You left out the other 2 categories of students I mentioned when it came to your school taking the highest clerkship grade of A, and then chopping it up even further. Unless Honors is just some extra award, with no AOA or class rank importance, then it does have the potential to breed hypercompetitive feelings, regardless of how amazing you may have thought of your class. Talk to people who ended up in the middle and towards the bottom or just missed Honors at your school by a smidgen. Gunners, I'm not as concerned about, since actual sabotage on clerkships, doesn't really happen much.

Once again since you can't seem to understand or are purposely ignoring the previous explanations, top schools aren't hiding anything any more than other schools in the MSPE.

I realize that the entirety of the MSPE can not be limited down only to an overall MSPE adjective (which is defined). But if you look at the link that was previously posted: http://www.jacr.org/article/S1546-1440(13)00767-9/addons, top schools make it more difficult for someone glancing at their MSPE comparison information to figure out where that person falls in their class looking at that alone. You really have to hunt for it by looking at several MSPEs from students from the same school or go through all the histograms at the end to get a better idea. Either all schools should hide better or no schools should hide it at all.

Examples, although these are extremes:

Stanford - "Clearly stated in the first page of the MSPE and repeated in italics above the deans' signatures is the statement, 'No grades or narrative summaries are available and there are no class rankings.' This is true. They offer no comparative data concerning their students in the summary paragraph."

Medical College of Georgia - "There is a quintile ranking system. The last sentence of the summary paragraph relates the student's quintile."

Clearly, one school is hiding, which needs further hunting, and one is not, on this particular part of the MSPE, although its not the only part looked at overall, which I acknowledged.

 

[username456789]

This is actually a great point.

There is a lot of ceiling effect in medical school, and when you set cutoffs at strict percentile based criterion in a closely bunched group, you effectively lose the ability to discriminate between levels of performance.

It's been so long since I was in school that I can't remember the exact criterion used at my school, but it was sort of a blended percentile vs absolute performance. One of those things where theoretically everyone in the class could get honors, but based on historic benchmarking the threshold for honors was set at a % level

You have to have a cutoff somewhere. Getting honors or just missing honors in a given course may come down to what seems like chance at times . . . establishing a pattern of getting honors in every class/rotation clearly does not.

 

[Psai]

You have to have a cutoff somewhere. Getting honors or just missing honors in a given course may come down to what seems like chance at times . . . establishing a pattern of getting honors in every class/rotation clearly does not.

I'm consistently at the edge of honors so my transcript is going to end up being basically 50/50. Depends on my condition on the day of the exam I suppose because it's always a matter of 1 or 2 questions

 

[username456789]

I'm consistently at the edge of honors so my transcript is going to end up being basically 50/50. Depends on my condition on the day of the exam I suppose because it's always a matter of 1 or 2 questions

Exactly. This will represent a good approximation of your overall performance.

 

[charmiedermie]

Exactly. This will represent a good approximation of your overall performance.

How is it a good approximation of @Psai's overall performance when the difference between Honors and High Pass was 1-2 shelf questions?

 

[PhillyMed777]

How is it a good approximation of @Psai's overall performance when the difference between Honors and High Pass was 1-2 shelf questions?

i think he meant that if he gets 50:50 as his honors:HP ratio, then it reflects that he was on this border.
idk, just my thoughts

 

[username456789]

How is it a good approximation of @Psai's overall performance when the difference between Honors and High Pass was 1-2 shelf questions?

He was skirting the border between honors and not honors throughout the year. He was not consistently performing at obviously-honors level. People who consistently get honors are consistently outperforming him. That's why it's an honor to get honors.

How is this difficult to understand? You get what you earn, despite the wussified upbringing many people in our generation have had.

Here's a helpful tip: the difference between honors and high pass is always going to be just a few questions, by definition. If you want to avoid worrying about this, get more questions correct.

 

[username456789]

i think he meant that if he gets 50:50 as his honors:HP ratio, then it reflects that he was on this border.
idk, just my thoughts

Correct.

 

[Slack3r]

Arguing with this is more fruitful that arguing with charmiedermie:

 

[charmiedermie]

He was skirting the border between honors and not honors throughout the year. He was not consistently performing at obviously-honors level. People who consistently get honors are consistently outperforming him. That's why it's an honor to get honors.

How is this difficult to understand? You get what you earn, despite the wussified upbringing many people in our generation have had.

Here's a helpful tip: the difference between honors and high pass is always going to be just a few questions, by definition. If you want to avoid worrying about this, get more questions correct.

What you seem to have difficulty understanding is the difference between a grade of Honors vs. High Pass on a clerkship is usually due to the shelf, not because of clinical performance. One could have every single check box on clinical evals checked off for Honors and still not get Honors, solely because you didn't get the specific raw score on the shelf. That's fine if you're not even close, but I know you don't believe a 1-2 question difference truly makes a difference in terms of a real tangible difference in performance.

To give you an alternate scenario, one could get straight High Passes on clinical evals, get the shelf raw score required for Honors, and thus end up getting Honors overall, even though they didn't consistently perform at obviously-honors level clinically.

So, no, @Psai could be performing clinically as a med student at Honors level and still not get Honors. If you think 1-2 shelf questions truly differentiates a medical student who performs clinically as an Honors student vs. a med student who performs clinically as a High Pass student, then no amount of reasoning will convince you otherwise.

Here's a helpful tip: A little more empathy goes a long way.

 

[username456789]

What you seem to have difficulty understanding is the difference between a grade of Honors vs. High Pass on a clerkship is usually due to the shelf, not because of clinical performance. One could have every single check box on clinical evals checked off for Honors and still not get Honors, solely because you didn't get the specific raw score on the shelf. That's fine if you're not even close, but I know you don't believe a 1-2 question difference truly makes a difference in terms of a real tangible difference in performance.

To give you an alternate scenario, one could get straight High Passes on clinical evals, get the shelf raw score required for Honors, and thus end up getting Honors overall, even though they didn't consistently perform at obviously-honors level clinically.

So, no, @Psai could be performing clinically as a med student at Honors level and still not get Honors. If you think 1-2 shelf questions truly differentiates a medical student who performs clinically as an Honors student vs. a med student who performs clinically as a High Pass student, then no amount of reasoning will convince you otherwise.

Here's a helpful tip: A little more empathy goes a long way.

The charmiedermie approach: if you're losing the argument, change the argument.

I'm not having difficulty understanding anything. Clinical knowledge is part of overall evaluation. Eventually, you have to have a cutoff for who gets what grades. You've spent your whole life with cutoffs like this (one question being the difference between an 89 and a 90 on an exam, for instance), so why is this any different? To boot, if I'm not mistaken Psai is a preclinical student (I may have him confused with another poster), and my statement absolutely applies to preclinical education (we can certainly agree that the importance of preclinical grades is up for debate, of course).

And if I'm wrong and Psai is a third year, if he is consistently walking the line between Honors and High Pass, that's because he's consistently performing close to but not always at the level of Honors work. Whether that work is more heavily or less heavily weighted towards the shelf exam is not the issue here - go whine to your office of medical education if you think your particular school does it unfairly. But that was not the hair we were splitting here.

I am empathetic. But I am also just a teensie weensie bit tired of hearing medical students always whine about how honors is hard to get and it's unfair that you have to, like, do really really well to get honors.

 

[charmiedermie]

Arguing with this is more fruitful that arguing with charmiedermie:

There is no arguing. If you truly think 1-2 shelf questions right makes a real-life tangible difference in the performance of an Honors student vs. a High Pass student, then your mind won't be convinced otherwise to reality.

Considering you thought most people gunning for psych are aiming for cash-pay purely outpatient gigs, reality isn't your strong suit.

 

[username456789]

There is no arguing. If you truly think 1-2 shelf questions right makes a real-life tangible difference in the performance of an Honors student vs. a High Pass student, then your mind won't be convinced otherwise to reality.

There is ALWAYS going to be a cutoff. At some point you say "ok, I'm going to draw the line here." Your third grade teacher did this. Your high school history teacher did this. Your college professors did this. Medical school does this.

I will say this again: someone doesn't honor all their classes on a fluke. If you're honoring everything, you're performing at an honors level (however your school defines that) consistently. If you're sorta close to honors a lot of the time but not always performing up to honors standards, then a 50/50 breakdown of H/HP accurately represents your body of work.

Like I said, if you're that person who is constantly missing Honors by 1-2 questions, you either have to accept that you're just not Honors material, or you have to get more questions correct so you're not always on the precipice.

 

[charmiedermie]

The charmiedermie approach: if you're losing the argument, change the argument.

I'm not having difficulty understanding anything. Clinical knowledge is part of overall evaluation. Eventually, you have to have a cutoff for who gets what grades. You've spent your whole life with cutoffs like this (one question being the difference between an 89 and a 90 on an exam, for instance), so why is this any different? To boot, if I'm not mistaken Psai is a preclinical student (I may have him confused with another poster), and my statement absolutely applies to preclinical education (we can certainly agree that the importance of preclinical grades is up for debate, of course).

And if I'm wrong and Psai is a third year, if he is consistently walking the line between Honors and High Pass, that's because he's consistently performing close to but not always at the level of Honors work. Whether that work is more heavily or less heavily weighted towards the shelf exam is not the issue here - go whine to your office of medical education if you think your particular school does it unfairly. But that was not the hair we were splitting here.

I am empathetic. But I am also just a teensie weensie bit tired of hearing medical students always whine about how honors is hard to get and it's unfair that you have to, like, do really really well to get honors.

I'm referring to Honors, the grade, not the award like it is at your school dicing up the top grade.

No one here is talking about preclinical education in which your entire grade at the end is based on an average of a series of exams, so 1-2 questions on 1 exam isn't an issue. This thread is about Honors in third year, so I'm assuming his 50:50 ratio is referring to third year (I could be wrong on this though).

Like I said, he could be performing at all Honors clinically, but the shelf makes the difference, which is why he said "depends on my condition on the day of the exam I suppose because it's always a matter of 1 or 2 questions." See my alternate scenario of all HPs but a H level shelf which gets you Honors overall.

We get it, you easily get Honors in every thing you touch and grace with your presence, and you do well in everything you attempt, so it's easy for you to label them as "whining" or entitled, that they just can't buck up and get Honors like you do, no matter how valid their concern - see @masaraksh's point and SouthernSurgeon's response. That's a lot of things but don't confuse it with being empathetic.

 

[Psai]

I'm a third year. I'm also actually skirting the line of honors clinically as well, basically half and half. I'm comfortable where I'm at and most of the people who honor everything definitely deserve it. I'm of the opinion that honors should be something special and difficult to achieve, not a participation prize. We all know the people who got one or two good grades on an easy rotation because of a nice attending but generally grades seem to be rather good at gauging someone's overall competence from what I've seen

 

[sobored]

There is ALWAYS going to be a cutoff. At some point you say "ok, I'm going to draw the line here." Your third grade teacher did this. Your high school history teacher did this. Your college professors did this. Medical school does this.

I will say this again: someone doesn't honor all their classes on a fluke. If you're honoring everything, you're performing at an honors level (however your school defines that) consistently. If you're sorta close to honors a lot of the time but not always performing up to honors standards, then a 50/50 breakdown of H/HP accurately represents your body of work.

Like I said, if you're that person who is constantly missing Honors by 1-2 questions, you either have to accept that you're just not Honors material, or you have to get more questions correct so you're not always on the precipice.

I generally agree with what you're saying. I think the problem is that there is a huge perception difference between honors and high pass/pass, even if it does only come down to a question or two on the shelf that determines this distinction. A student who got a question over what was required for honors, vs a student who got one lower and is now a high pass, well there's not a whole lot of difference between these two students. But to someone who doesn't know them, like a PD, it looks like a huge difference between the two. This may not be fair, but it is what it is. Maybe a better way to report grades is to report an actual percentage earned in each clerkship to put a little more context behind each grade. Either way, this doesn't really affect me anymore so whatever.

 

[username456789]

I generally agree with what you're saying. I think the problem is that there is a huge perception difference between honors and high pass/pass, even if it does only come down to a question or two on the shelf that determines this distinction. A student who got a question over what was required for honors, vs a student who got one lower and is now a high pass, well there's not a whole lot of difference between these two students. But to someone who doesn't know them, like a PD, it looks like a huge difference between the two. This may not be fair, but it is what it is. Maybe a better way to report grades is to report an actual percentage earned in each clerkship to put a little more context behind each grade. Either way, this doesn't really affect me anymore so whatever.

I mean, in a way it's a bit of a shame, but this is the nature of any grading system since elementary school, and will continue to be the case. There is always going to have to be a cut off. Students on this site constantly whine about how classic grading systems are terrible and the devil, and heavily push for pass/fail, but then get upset when the subtle nuances in their scores are not reflected on their transcripts.

You can't have your cake and eat it too.

 

[username456789]

I will also restate my previous argument, which is to say that if you are always missing honors by one or two questions, then it is clear you are not a slamdunk case for an honors student. The people who always or usually get honors in their courses and rotations are clearly performing at a consistently higher/superior level to those who feel they are always borderline. Missing honors in one course because of one or two questions is a shame. Missing it by one or two questions on every rotation is a clear pattern.

Inb4 charmiedermie enters the thread to argue about the definition of performing. Yes, I understand that it seems silly that if you have slacked off all rotation and then demolish the shelf one can get honors. That's not what we're arguing about here, and is unfortunately intrinsic to your specific school. If you want the policy changed, get involved.

 

[charmiedermie]

I will also restate my previous argument, which is to say that if you are always missing honors by one or two questions, then it is clear you are not a slamdunk case for an honors student. The people who always or usually get honors in their courses and rotations are clearly performing at a consistently higher/superior level to those who feel they are always borderline. Missing honors in one course because of one or two questions is a shame. Missing it by one or two questions on every rotation is a clear pattern.

Inb4 charmiedermie enters the thread to argue about the definition of performing. Yes, I understand that it seems silly that if you have slacked off all rotation and then demolish the shelf one can get honors. That's not what we're arguing about here, and is unfortunately intrinsic to your specific school. If you want the policy changed, get involved.

People arguing for Pass/Fail are arguing it only for the preclinical years, not third year. And that's because they've concluded that PDs don't care about preclinical grades. If PDs said tomorrow they really do care about preclinical grades when it came to interview and matching, then students would want it graded. In any preclinical class, your overall grade is determined by several exams and the math calculation is clear on how you get to that grade. You know exactly where you stand from test to test. You get to review exam questions, your answer sheet, and the answer key and see why you got what you got right and wrong. It's not like you're taking one basic science shelf the entire year. It's as fair as you're going to get in terms of being transparent. That's why there aren't as many complaints in terms of grade calculation, even if you are on the edge because it's clear throughout, as has been the case since elementary school.

The problem is the grading in third year is quite murky. You don't know where you stand clinically throughout the rotation in terms of whether you're at Honors/High Pass, until long after evaluations are turned in. You have no idea where you stand officially in terms of the clinical evaluation part, when you go into the shelf on the very last day of the rotation. By the time you get your overall grade, you're on another rotation, so if you want to see how exactly it was calculated, you have to take time off your current rotation to go through all your clerkship components assuming they'll even let you have access to it in the first place. Even then, as a student, you don't get to see the exact formula in how evals, shelf, and anything else are calculated to come together to get that final grade, as @NickNaylor alluded to.

My HP clinical eval + H shelf scenario, is an unintended side effect of this system, and it's not just intrinsic to my school either, it's pretty much at every school, because the shelf is given so much importance even though it's only a set and lower percentage of the overall grade. Even grading of the shelf is inconsistent (raw score, percentile, scaled score, scaled percentile etc.) as @sazerac mentioned. If PDs want an Honors grade to hinge on 1-2 questions on a shelf, then that's fine, but I doubt that's their intention when they're trying to select potential residents for interview or to match in their field - see @sobored's post.

 

[masaraksh]

To clarify, my post was specifically in response to @masaraksh 's post - in the context of ceiling effect.

This is like education theory 101. When everyone is scoring near perfect scores, you lose the ability to effectively discriminate between individual performance.

This is a criticism of school level test design, which is often poor (i.e. it's a PhD researcher writing the test who doesn't really know or care about this kind of stuff). It happened in my med school M1 year biochem course - the class average was usually like a 96 out of a 100 (true score, I mean, not curved).

The shelf exams don't have a problem with ceiling effect, as they are a nationally standardized exam and actually have a good distribution and, I would assume, have a number of internal consistency checks performed on them.

Funny thing is, one or two questions can actually meaningfully distinguish performance if they have good item discrimination (i.e. the top 10% of test takers consistently get these one or two questions right that everyone else misses with high frequency).

Very true, there are questions that act as discriminators in that way. I'm am just in first year, but the questions on our exams definitely vary. Coming in to an exam, there are the "guaranteed points questions" (as in the questions that if you get wrong you shouldn't be allowed a prescription pad), the middle of the pack questions, and then the tougher questions. There are always some questions that are minutia in a sense because they require recall of something that was maybe only briefly mentioned in lecture, notes, etc.

 

[medstar2330]

I will also restate my previous argument, which is to say that if you are always missing honors by one or two questions, then it is clear you are not a slamdunk case for an honors student. The people who always or usually get honors in their courses and rotations are clearly performing at a consistently higher/superior level to those who feel they are always borderline. Missing honors in one course because of one or two questions is a shame. Missing it by one or two questions on every rotation is a clear pattern.

Inb4 charmiedermie enters the thread to argue about the definition of performing. Yes, I understand that it seems silly that if you have slacked off all rotation and then demolish the shelf one can get honors. That's not what we're arguing about here, and is unfortunately intrinsic to your specific school. If you want the policy changed, get involved.

You make some good points, but I don't fully agree with some of what you're saying.

Depending on the grading system of the school in question, I don't think it's at all possible to say that a student usually getting Honors is necessarily better than someone getting H. My school utilizes a "two pronged" approach - you have to get a certain number of Honors clinical evals and a certain grade on the shelf - failure to hit either results in getting the lower of the two grades. Thus, someone could just squeak by the Honors evals requirement, and get a 90 on the shelf and thus get H; meanwhile another could fantastically dominate clinically and get glowing evals with near unanimous Honors; however if they ended up with an 89 on the shelf they've got HP. With the way grades are reported in the MPSE, there's absolutely no way to tell exactly what portion of your evals were Honors or what you got on the shelf; thus the second student is absolutely a victim to the system here. You tell me - who in this scenario would you more like to have as your co-resident?

That brings me to what I think is the biggest problem with the grading system - it's not at all standardized. Some schools require a 75 on the shelf for H while others require 90th percentile - a huge difference. That's not fair at all. I realistically could do better on every rotation in every way than someone from another school and come out looking much worse because of my school's standards. Different schools weigh things differently or not at all. The evals are worded differently.

And to the point about being consistently borderline, you do make some good points. You can definitely extrapolate that someone getting one or two questions is probably consistently a better test taker. However, to say that getting one or two questions more right on an exam meaningfully makes a difference in terms of future clinical performance (or makes a meaningful statement of their aptitude over 8 weeks of day in and day out work) is not something with which I agree, especially given the scenario I described above.

 

[tco]

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.

I'm pretty sure we had this exact discussion a couple of years ago.

At my school, honors was 15% of the class. It seemed as though shelf scores were largely irrelevant. The people who played the game correctly and puckered up to the right people honored, and those who scored in the upper 90th percentiles often didn't. I'm not saying that holds true for every person who honored, but it was a pretty striking trend.

To answer the OP's question: I matched in Radiology last year. Personally, did not honor anything during third year. I also was not AOA. I did not interview at all of the places I wanted to (applied to the south - Duke, Emory, and Vandy were notable exclusions), but I was very happy with the selection I had available (far more interview offers than I could attend) and ended up matching at my number 1 choice.

 

[Dave89]

I will also restate my previous argument, which is to say that if you are always missing honors by one or two questions, then it is clear you are not a slamdunk case for an honors student. The people who always or usually get honors in their courses and rotations are clearly performing at a consistently higher/superior level to those who feel they are always borderline. Missing honors in one course because of one or two questions is a shame. Missing it by one or two questions on every rotation is a clear pattern.

Inb4 charmiedermie enters the thread to argue about the definition of performing. Yes, I understand that it seems silly that if you have slacked off all rotation and then demolish the shelf one can get honors. That's not what we're arguing about here, and is unfortunately intrinsic to your specific school. If you want the policy changed, get involved.

This is a completely legitimate point.

Not every Honors student jut manages to garner a 93.001% final grade. A number of them get 95-97% or the like.

With that said, if I were a course director and one of my students had missed the cutoff by 1% or less, I would look for excuses to bump him or her up.