Opinions on "P=MD"

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

MedPR

Membership Revoked
Removed
10+ Year Member
Joined
Dec 1, 2011
Messages
18,579
Reaction score
57
All opinions welcome, but primarily looking for opinions from M4s and beyond since they're the only ones who can actually say how the "P=MD" mentality worked out for them or their colleagues. Kind of similar to how M1-M2s tell pre-meds they have no idea what they're talking about, an M2 saying "P=MD is the truth" doesn't know what they're talking about either since they haven't interviewed, matched or even taken Step 1. Not trying to offend anyone; just being real.

Looking for opinions about "P=MD". It's obvious that technically it is true, but do you think it creates a mentality that just skating by during pre-clinicals is all that's necessary to get where you want to be? And what's your overall take on it?

Members don't see this ad.
 
Last edited:
whats your question?

Looking for opinions about "P=MD". It's obvious that technically it is true, but do you think it creates a mentality that just skating by during pre-clinicals is all that's necessary to get where you want to be? And what's your overall take on it?
 
Members don't see this ad :)
Interesting question... I'm going to guess the reason behind a particular person's assigned value on "P=MD" likely offers a honest insight into if they are "slackers" or not...

Person A: "Awesome, now that I can just skate by, I can focus more on Step1 and research without stressing minutiae!"

Person B: "Awesome, now that I can just skate by, I can play more video games and smoke more weed without stressing course minutiae!"

Not saying one person is better than the other, they're just different.
 
There's no daily new thread quota to fill just because HughMyron is on hold. :smuggrin:
 
I'm also interested in getting some opinions on this, but in regard to graded schools. I've only been accepted to a letter-graded school right now. At this point at least, I'm aiming for a top peds residency. I don't know if I should be okay with getting B's and C's, or if I should really put in the extra effort (and stress) to try to get as many A's as I can. There are PD surveys that say that preclinical grades are on the lower end of their list, but that's on average and not representative of the most competitive residencies.

(Sorry, not trying to hijack the thread, but the topic seemed similar enough)
 
I'm also interested in getting some opinions on this, but in regard to graded schools. I've only been accepted to a letter-graded school right now. At this point at least, I'm aiming for a top peds residency. I don't know if I should be okay with getting B's and C's, or if I should really put in the extra effort (and stress) to try to get as many A's as I can.

(Sorry, not trying to hijack the thread, but the topic seemed similar enough)

I never understood this. Why wouldn't you ALWAYS aim for As? You might change your mind about peds, so why put yourself at a premature disadvantage?
 
All opinions welcome, but primarily looking for opinions from M4s and beyond since they're the only ones who can actually say how the "P=MD" mentality worked out for them or their colleagues. Kind of similar to how M1-M2s tell pre-meds they have no idea what they're talking about, an M2 saying "P=MD is the truth" doesn't know what they're talking about either since they haven't interviewed, matched or even taken Step 1. Not trying to offend anyone; just being real.

Looking for opinions about "P=MD". It's obvious that technically it is true, but do you think it creates a mentality that just skating by during pre-clinicals is all that's necessary to get where you want to be? And what's your overall take on it?

The majority of M4s have not matched yet. Wait another month unless you only want to hear from all the future urologists and ophthalmologists. I applied to general surgery, which is not the most competitive specialty, so others who applied for those residencies like ortho, plastics, derm, etc. might have a different answer.

P=MD is only for the pre-clinical years. I prefer it this way because it really does take a lot of pressure off. I go to a 5 point school (H/HP/P/LP/F), so I still felt that drive to better myself to get a higher actual grade than just a P. There were definitely some people who took full advantage of P=MD. I definitely liked the fact that not getting a perfect score was not devastating, as many pre-meds believe. There is no way to possibly learn everything in medical school and you WILL get questions wrong. As far as Step 1, I don't think a P=MD mentality will hurt you. Most of Step studying is not based on what you learned during the first two years, but rather on recalling information, cross-referencing between subjects and being able to recognize clues and patterns to answer questions. Most people take about a month of prep and study time before taking the exam, which is so far beyond what you do for a regular exam that they aren't truly comparable. Of course, if you do well in pre-clinical years you will set yourself up to do better on the Step.

Once you get to the clinical years, as far as I know, every school uses a 5 point system. This is because these courses are taken by all students and the majority take the shelf exam at the end. If it was P/F, residencies would have no clue how you actually did in the field you are interested in.

Having gone through the application and interview process, I can tell you that I did not get asked a single question about my pre-clinic grades. I think I had one question about my clinical grades - got an Honors in peds and the interviewer was like "Oh, so it looks like you really did well on pediatrics. Why aren't you going into that?" :confused: Otherwise it seemed that no one was interested in those grades.

Edit: Asked an ortho friend, and he said that his mentality has been P=FM.
 
I never understood this. Why wouldn't you ALWAYS aim for As? You might change your mind about peds, so why put yourself at a premature disadvantage?

I was thinking maybe it would be better for me just to focus on the most important material to get by on the lecture exams so I can put more study time toward actual boards material. If the Step 1 is more important than preclinicals, I'd rather try to prepare for it than spend so much time learning minutiae for class exams..
 
Last edited:
When you start the pre-clinical years, you will realize how much of it is a complete and utter waste of time that will have exactly zero bearing on your ability as a physician in the future. Your girlfriend is a M3 IIRC - why don't you ask her how much of the stuff she learned for step 1 she actually remembers and, even better, uses with any sort of regularity in a clinical context. Comments from M4s and attendings (the ones that aren't teaching a course) about material that we might be learning at the time are also pretty telling.

I'm not saying that the pre-clinical years are a complete waste of time, but as I'm nearing the completion of our pre-clinical curriculum it's become apparent how useless it really is. I have quite a bit of book knowledge up in that head of mine, yet I still know very little about the nitty gritty details of "practicing medicine." Obviously the basic information is critical as without it you'll be totally clueless, but thinking that you're going to be a better or more qualified physician because you scored a 95 on an exam when the average was an 80 is a complete joke. 90% of the people saying that are probably people that got 95s.

If medical school were sufficient preparation for being a physician, medical school part II - aka residency, which in many cases is as long as IF NOT LONGER THAN medical school proper - would not be necessary.
 
Interesting question... I'm going to guess the reason behind a particular person's assigned value on "P=MD" likely offers a honest insight into if they are "slackers" or not...

Person A: "Awesome, now that I can just skate by, I can focus more on Step1 and research without stressing minutiae!"

Person B: "Awesome, now that I can just skate by, I can play more video games and smoke more weed without stressing course minutiae!"

Not saying one person is better than the other, they're just different.

Yea that is essentially why I asked. My guess is that at least some of the "P=MD" proponents are people who struggled to do better than pass during M1 or parts of M1 and merely adopted the mentality as a defense mechanism.

The majority of M4s have not matched yet. Wait another month unless you only want to hear from all the future urologists and ophthalmologists. I applied to general surgery, which is not the most competitive specialty, so others who applied for those residencies like ortho, plastics, derm, etc. might have a different answer.

P=MD is only for the pre-clinical years. I prefer it this way because it really does take a lot of pressure off. I go to a 5 point school (H/HP/P/LP/F), so I still felt that drive to better myself to get a higher actual grade than just a P. There were definitely some people who took full advantage of P=MD. I definitely liked the fact that not getting a perfect score was not devastating, as many pre-meds believe. There is no way to possibly learn everything in medical school and you WILL get questions wrong. As far as Step 1, I don't think a P=MD mentality will hurt you. Most of Step studying is not based on what you learned during the first two years, but rather on recalling information, cross-referencing between subjects and being able to recognize clues and patterns to answer questions. Most people take about a month of prep and study time before taking the exam, which is so far beyond what you do for a regular exam that they aren't truly comparable. Of course, if you do well in pre-clinical years you will set yourself up to do better on the Step.

Once you get to the clinical years, as far as I know, every school uses a 5 point system. This is because these courses are taken by all students and the majority take the shelf exam at the end. If it was P/F, residencies would have no clue how you actually did in the field you are interested in.

Having gone through the application and interview process, I can tell you that I did not get asked a single question about my pre-clinic grades. I think I had one question about my clinical grades - got an Honors in peds and the interviewer was like "Oh, so it looks like you really did well on pediatrics. Why aren't you going into that?" :confused: Otherwise it seemed that no one was interested in those grades.

Edit: Asked an ortho friend, and he said that his mentality has been P=FM.

Thanks for the input. Lol @ the bold :laugh:
 
Members don't see this ad :)
When you start the pre-clinical years, you will realize how much of it is a complete and utter waste of time that will have exactly zero bearing on your ability as a physician in the future. Your girlfriend is a M3 IIRC - why don't you ask her how much of the stuff she learned for step 1 she actually remembers and, even better, uses with any sort of regularity in a clinical context. Comments from M4s and attendings (the ones that aren't teaching a course) about material that we might be learning at the time are also pretty telling.

I'm not saying that the pre-clinical years are a complete waste of time, but as I'm nearing the completion of our pre-clinical curriculum it's become apparent how useless it really is. I have quite a bit of book knowledge up in that head of mine, yet I still know very little about the nitty gritty details of "practicing medicine." Obviously the basic information is critical as without it you'll be totally clueless, but thinking that you're going to be a better or more qualified physician because you scored a 95 on an exam when the average was an 80 is a complete joke. 90% of the people saying that are probably people that got 95s.

If medical school were sufficient preparation for being a physician, medical school part II - aka residency, which in many cases is as long as IF NOT LONGER THAN medical school proper - would not be necessary.


I have talked to her about the whole P=MD thing and she doesn't agree with approaching pre-clin that way. Just to add a bit of perspective, her step 1 = 257 and she has honored all of her clerkships so far (surg, neuro, psych, medicine). You're right that she doesn't remember a lot of the minutiae from pre-clin, but she thinks that what she has retained really helped her on Step 1 and also helps her stand out during rotations. Also, she was the type that studied 6-8 hours per day during pre-clin. Oh, and her school is P/F. So even though she isn't a proponent of the P=MD mentality, she does admit that learning all the minutiae is low yield. However, she thinks low yield is better than no yield and I'm inclined to agree.


All that said, it's an n=1 and I know many med students do just as well (or better) on step 1 and clerkships without putting a lot of emphasis on minutiae.

As for the rest of your post, surely I agree that getting higher scores in pre-clin doesn't necessarily mean you're going to be a better physician. At the same time, the stuff students do that result in lower grades (video games, partying, etc) won't make them better physicians either and that's the problem I have with the whole argument. To me it seems like a lot of med students use it as an excuse to not study as much because "it won't make me a better doctor anyway".

So yeah, I'm a pre-med and I know my perception could completely change over the next couple of years, but I think the whole "it's not necessary to get high pre-clinical grades because it won't make me a better doctor so why bother?" mentality is ridiculous and I know current M3s and M4s who feel the same way.

Edit: In addition, I know it's not the analogy but why is the relationship between pre-clin and step 1 any different than pre-reqs and MCAT? Most people would tell a pre-med to learn everything as well as possible in pre-reqs because it will help on the MCAT. I've never once seen a med student tell a pre-med to "learn the bare minimum for an A since nothing you learn in pre-reqs will help you be a better med student and the MCAT doesn't test the details that are tested in your pre-med classes anyway".
 
Looking for opinions about "P=MD". It's obvious that technically it is true, but do you think it creates a mentality that just skating by during pre-clinicals is all that's necessary to get where you want to be? And what's your overall take on it?

Depends where you want to be. If you just pass all of your pre-clinical courses, boards, and rotations, but aren't able to match into the specialty of your choice, are you content with your MD and all the work you put into it? I feel like most people would be happy in a few different specialties, but I would be kicking myself later if I went through school with a "P=MD" mentality and ended up rejected from my desired specialty goal, even though I don't have one in mind right now. But then again I'm a lowly premed, so ask me again this fall if I still feel this way :laugh:

I think this thread is really a round-about way of comparing pre-clinical grading (P/F vs grades)...
 
Just to add a bit of perspective, her step 1 = 257 and she has honored all of her clerkships so far (surg, neuro, psych, medicine).

Wood wife.

What is she thinking hanging around a lowly pre-med anyway? :naughty:
 
P = MD can be misleading because for some, it can imply that it's ok to skate by with a barely passing score and not put in effort. However, having P/F schools are awesome because you either pass or fail. You can focus on learning the material, and not pull your hair out if you only get "B's" in every test, or get mad because you were one percentage away from an A.

Step 1 scores are vastly more important than pre-clinical grades. In a school with Honors/High Pass/Pass or A/B/C/F, it's very possible for people with a Pass or a C to destroy Step 1. It's also very possible for people who get Honors and A's to barely pass Step 1. It comes down to knowing the material, and buckling down at the end of second year. Noone is gonna care if you get all Passes in pre-clinicals if you kick butt in Step 1. Likewise, noone will care that you got all Honors if you failed Step 1.
 
Wood wife.

What is she thinking hanging around a lowly pre-med anyway? :naughty:

23d.gif
 
a lot is person dependent. For me, I wish there was more of a pass/fail system, mainly because when you are graded on and +/- graded system, it is easy to feel horrible when you get a 75 and the average was 85. It is easy to feel horrible when you get an 82 and the average is 85. But you don't feel proportionately awesome when you get a 95 and the average is 85.

you also have to determine what you are giving up. i know a 2nd year who said her biggest regret was shooting so hard for As in the first year and now she is a straight B student and loves her life. As a father, I am not about to give up time with my kids in order get As. I know plenty of single people that get to the library at 730am each day and walk out at 9pm every single day including the weekends. for them, they are happy studying that much. I also know people that study less and are devastated because med school takes all their time.

the problem is that when you are a premed, you are going to be like everyone else and say "straight As for me, going ortho." and you may be like that. or you may get into the grind and say, "you know, i am done studying and watching a movie."

to be honest though. if i had enough confidence in myself to learn enough and do well on my boards, i would shoot for C- every time.
 
So wait, do I need to know this formula for the MCAT?

*memorizes every possible algebraic rearrangement*

P = MD

M = P/D

D = P/M

log(P) = log(M) + log(D)

etc.

I won't even be starting med school until this fall, but I'd like to add that I'm very happy to be attending a P/F school. From college, I learned that whenever the institution takes the pressure off, I feel more confident in my study habits. For example, whenever a professor told the class beforehand that the exam will be curved (I realize that P/F does not equal curved) I tended to feel very comfortable, which led to better studying. It's kind of like shooting a basketball...if you know you have to make 9/10 free-throws to get an "A," it can make you nervous. But if you shoot free-throws thinking "I only need to make 6/10, and anything better than that is just a bonus" you are perhaps more likely to make 9/10. I am, at least.
 
I won't even be starting med school until this fall, but I'd like to add that I'm very happy to be attending a P/F school. From college, I learned that whenever the institution takes the pressure off, I feel more confident in my study habits. For example, whenever a professor told the class beforehand that the exam will be curved (I realize that P/F does not equal curved) I tended to feel very comfortable, which led to better studying. It's kind of like shooting a basketball...if you know you have to make 9/10 free-throws to get an "A," it can make you nervous. But if you shoot free-throws thinking "I only need to make 6/10, and anything better than that is just a bonus" you are perhaps more likely to make 9/10. I am, at least.

Be careful with this philosophy. Many P/F schools don't use cut offs (e.g <60%) as the mark for failing. They use standard deviations. From what I remember from my med school interviews a lot seemed to use a cut off of around 2.5 SD from the mean. Getting an 80% might seem like a pass, but if the average was 90% with an SD of 3%, you just failed. Also, by definition a program that is Pass/Fail MUST have someone fail each year. Programs that use the 5 point system do not have this requirement.
 
I haven't matriculated yet, so I don't know too much, but I do have many friends who are either currently in medical school or just started their residency. When I asked each of them what I should be looking for in a school, without fail each one told me that I had to go somewhere that was P/F for the pre-clinical years. Every person. One even went so far as to say that if he had gotten into only two schools: one was a graded top-10 school and the other was a P/F lower-mid tier, he'd choose the P/F school every time.

This isn't to say that my friends are lazy, because they definitely aren't. Those that have taken the Step 1 have scored above 240, one of which got above 260. They basically stated, as others have stated previously, that having P/F allows you to focus on killing the Step1, doing research, shadow, etc (basically all the stuff that you need to do to match into a competitive residency that you just won't have time for if you're focused on acing every single exam). The friend with the 260+ started studying for Step1 right at the start of MS2. He never went to lecture and very very rarely studied for specific classes. He figured out that if he just focused on doing practice board questions on the topic of the class for crazy hours he could kill two birds with one stone (I believe he used Gunner Training). This covered enough material for him to be able to pass his exams and he was essentially able to study for Step1 for nine months at a high level.

His method obviously isn't for everyone as he is dead set on matching ortho at HSS. Some people will use that extra time not spent on the nitty gritty details to study for boards, some will use it to spend extra time in student clinics, some will use it to relax and spend time with friends/family and some will still use it to get the highest score on every exam simply because that's the mindset they've always had. It totally depends on what your goals are, but the good thing about P/F is that it gives you the option.
 
What exactly is clerkship that someone mentioned earlier?
 
So yeah, I'm a pre-med and I know my perception could completely change over the next couple of years, but I think the whole "it's not necessary to get high pre-clinical grades because it won't make me a better doctor so why bother?" mentality is ridiculous and I know current M3s and M4s who feel the same way.

Edit: In addition, I know it's not the analogy but why is the relationship between pre-clin and step 1 any different than pre-reqs and MCAT? Most people would tell a pre-med to learn everything as well as possible in pre-reqs because it will help on the MCAT. I've never once seen a med student tell a pre-med to "learn the bare minimum for an A since nothing you learn in pre-reqs will help you be a better med student and the MCAT doesn't test the details that are tested in your pre-med classes anyway"

It depends I suppose. I got into this debate in the allo board to no avail, but I slacked off quite a bit for all of M1 and about half of M2 and am perfectly comfortable with my performance on qbanks. I consistently scored below average on every single exam in M1 and most of M2. In many cases I had a pretty small margin between my score and the passing threshold. Despite that, I'm still learning a lot and am doing well considering the point at which I am in my preparation (I would expect anywhere from a 210-230 if I were to take it today; obviously that's not anything to write home about, but considering that includes zero review of M1 material - much of which I'm getting <50% of the questions correct - I'm pretty happy with that).

Obviously you should put forth the effort necessary to achieve at a level you're comfortable with. However, the argument that you must do well in your courses to do well on step 1 is nonsense. It also varies from school to school and even class to class. In my current course, doing well absolutely means you will be prepared for step 1. The course is taught very well, and while it at times goes off on tangents that may not be all that useful to you outside of random interest, for the most part everything is clinically relevant and will be useful in the future. Contrast that to, say, the final we took for our pharm course, which was a complete joke and an absolutely dismal measure of your mastery of the material.

"But if you don't learn it now you're never going to learn it!!!1111" you might say. Perhaps, but that's not the opinion that I've gotten from MANY people - from M3s to current residents. Most of that knowledge is gone, never to be relearned. Most of the remainder, however, will be relearned but in a clinical context. It might be hard to believe, but it's extremely difficult to translate the knowledge you learn from books and lectures into the clinical arena. Acing exams in the classroom absolutely does not mean you will be a good clinician. It certainly may give you a good foundation, but by all accounts it's not necessary to do well, and there are plenty of people that kill M1/M2 and then suck ass in M3 and beyond.

As far as MCAT vs. step 1, it's not even comparable. The primary difference is that the MCAT tests a fairly small amount of content and a large amount of "critical thinking" skills. In other words, simply knowing the material is not sufficient to do well on the MCAT; you must be able to apply it in new ways and, in many cases, use the knowledge you already know to make inferences about things you don't. This requires a very deep and thorough understanding of the material (imagine answering questions on a MCAT passage discussing reaction equilibrium while only memorizing, and not understanding, what equilibrium expressions are). Step 1 is the complete opposite. There is almost zero critical thinking, and your performance is largely based on how many facts you learned and how good you are at remembering them in response to a question. Just look at how you prepare for the exams: for the MCAT, AAMC FLs are absolutely essential. You would be a fool not to use them. For step 1, practice exams aren't critical. Some people even say to save the money. Instead, qbanks - i.e., going through as much of the content as possible - is critical. There are many people that don't take ANY NBME exams prior to taking step 1.

Ultimately I've learned this is one of those things where people believe either one way or the other. I'm not going to try and convince you otherwise. However, you are a fool if you think strong class performance is NECESSARY - necessary being the key word - to good step 1 performance or being an excellent physician. There are simply too many exceptions for that to even be remotely true.
 
Last edited:
What exactly is clerkship that someone mentioned earlier?

Clerkships = rotations = time spent in a particular specialty working on a team in that specialty. Your entire third year and a good chunk of the fourth year are spent completing a variety of clerkships. They're essentially the clinical side of the medical school curriculum.
 
It's true, P=MD

However, P may also be low step 1, poor study habits for clinical years, ineligibility for certain scholarships/AOA, not matching into your desired residency location/program, and/or not practicing your desired specialty. AOA is one of those things they didn't stress much for us the first two years of med school, but some specialties really care about. Not sure if it is true for all schools, but some P/F schools still keep track of your class rank which will go into your deans letter and help determine your AOA eligibility.

Also, I'll be the first to admit that much of the M1/M2 curriculum is extraneous information, but not all of it, and that early in your training, you can't make an entirely accurate prediction of what is and isn't relevant. So don't kill yourself or your relationships to get the A, but if you're choosing video games or booze over a higher grade, you may want to reorganize priorities to prevent any regrets when you apply for residency.
 
Step 1 is the complete opposite. There is almost zero critical thinking, and your performance is largely based on how many facts you learned and how good you are at remembering them in response to a question.

This is not true, there is quite a bit of critical thinking and application of knowledge on step 1. You'll see. Moreso for step 2 though.
 
This is not true, there is quite a bit of critical thinking and application of knowledge on step 1. You'll see. Moreso for step 2 though.

In what subject? Because just about the most critical thinky I've come across is physio, which is a joke. Occasionally there are questions that require you to know some kind of association - i.e., presents a case that you need to diagnose and then asks you about, say, a symptom of a disease commonly associated with disease #1 or an important side effect of the first-line therapy for disease #1. I do 46-question blocks, and maybe 5-10 of those will actually not be a rote memorization question. The remainder are largely, "hey, did you pick up on that little factoid we mentioned in the stem?!" type questions, which are hardly critical thinking. This is after doing roughly 1200 qbank questions. Maybe by chance I've managed to avoid them, but I'm highly skeptical.

Contrast that to, say, getting an orgo reaction on the MCAT that you have never seen or heard of before and being asked a question about it. If you know the foundational material well enough, you should be able to answer it. I've yet to see anything remotely similar to something like that for step 1.
 
Be careful with this philosophy. Many P/F schools don't use cut offs (e.g <60%) as the mark for failing. They use standard deviations. From what I remember from my med school interviews a lot seemed to use a cut off of around 2.5 SD from the mean. Getting an 80% might seem like a pass, but if the average was 90% with an SD of 3%, you just failed. Also, by definition a program that is Pass/Fail MUST have someone fail each year. Programs that use the 5 point system do not have this requirement.

Right, I see. So unfortunately, it's like the scenario where 3 friends encounter a bear in the woods. You don't have to outrun the bear, you just have to outrun your friends. It doesn't seem ethical, but I'm sure in a 5 point system, more than 1 person per semester usually fails anyway? The medical school I'll be attending has only 80 students per incoming class. At least one of us is going to fail the first year?
 
In what subject? Because just about the most critical thinky I've come across is physio, which is a joke. Occasionally there are questions that require you to know some kind of association - i.e., presents a case that you need to diagnose and then asks you about, say, a symptom of a disease commonly associated with disease #1 or an important side effect of the first-line therapy for disease #1. I do 46-question blocks, and maybe 5-10 of those will actually not be a rote memorization question. The remainder are largely, "hey, did you pick up on that little factoid we mentioned in the stem?!" type questions, which are hardly critical thinking. This is after doing roughly 1200 qbank questions. Maybe by chance I've managed to avoid them, but I'm highly skeptical.

Contrast that to, say, getting an orgo reaction on the MCAT that you have never seen or heard of before and being asked a question about it. If you know the foundational material well enough, you should be able to answer it. I've yet to see anything remotely similar to something like that for step 1.

Like I said, you'll see it on game day. I'm surprised the q banks havent adjusted for this
 
The friend with the 260+ started studying for Step1 right at the start of MS2. He never went to lecture and very very rarely studied for specific classes. He figured out that if he just focused on doing practice board questions on the topic of the class for crazy hours he could kill two birds with one stone (I believe he used Gunner Training). This covered enough material for him to be able to pass his exams and he was essentially able to study for Step1 for nine months at a high level.

Since much of the minute details from preclinical years are neither helpful for real-life practice or obtaining a good residency placement, would it be a possible strategy to heavily study for Step 1 during preclinical years using various review books to follow along with lecture topics and do lots of practice questions from USMLE World or Gunner Training, and just learning enough class material to pass? Is this a popular strategy for medical students who aim for very high Step 1 scores? Would it be tough to pass classes if I focused on Step 1 prep instead? Would I run out of practice questions too soon, since every questions bank only has 2000 questions or so?
 
It depends I suppose. I got into this debate in the allo board to no avail, but I slacked off quite a bit for all of M1 and about half of M2 and am perfectly comfortable with my performance on qbanks. I consistently scored below average on every single exam in M1 and most of M2. In many cases I had a pretty small margin between my score and the passing threshold. Despite that, I'm still learning a lot and am doing well considering the point at which I am in my preparation (I would expect anywhere from a 210-230 if I were to take it today; obviously that's not anything to write home about, but considering that includes zero review of M1 material - much of which I'm getting <50% of the questions correct - I'm pretty happy with that).

Obviously you should put forth the effort necessary to achieve at a level you're comfortable with. However, the argument that you must do well in your courses to do well on step 1 is nonsense. It also varies from school to school and even class to class. In my current course, doing well absolutely means you will be prepared for step 1. The course is taught very well, and while it at times goes off on tangents that may not be all that useful to you outside of random interest, for the most part everything is clinically relevant and will be useful in the future. Contrast that to, say, the final we took for our pharm course, which was a complete joke and an absolutely dismal measure of your mastery of the material.

"But if you don't learn it now you're never going to learn it!!!1111" you might say. Perhaps, but that's not the opinion that I've gotten from MANY people - from M3s to current residents. Most of that knowledge is gone, never to be relearned. Most of the remainder, however, will be relearned but in a clinical context. It might be hard to believe, but it's extremely difficult to translate the knowledge you learn from books and lectures into the clinical arena. Acing exams in the classroom absolutely does not mean you will be a good clinician. It certainly may give you a good foundation, but by all accounts it's not necessary to do well, and there are plenty of people that kill M1/M2 and then suck ass in M3 and beyond.

As far as MCAT vs. step 1, it's not even comparable. The primary difference is that the MCAT tests a fairly small amount of content and a large amount of "critical thinking" skills. In other words, simply knowing the material is not sufficient to do well on the MCAT; you must be able to apply it in new ways and, in many cases, use the knowledge you already know to make inferences about things you don't. This requires a very deep and thorough understanding of the material (imagine answering questions on a MCAT passage discussing reaction equilibrium while only memorizing, and not understanding, what equilibrium expressions are). Step 1 is the complete opposite. There is almost zero critical thinking, and your performance is largely based on how many facts you learned and how good you are at remembering them in response to a question. Just look at how you prepare for the exams: for the MCAT, AAMC FLs are absolutely essential. You would be a fool not to use them. For step 1, practice exams aren't critical. Some people even say to save the money. Instead, qbanks - i.e., going through as much of the content as possible - is critical. There are many people that don't take ANY NBME exams prior to taking step 1.

Ultimately I've learned this is one of those things where people believe either one way or the other. I'm not going to try and convince you otherwise. However, you are a fool if you think strong class performance is NECESSARY - necessary being the key word - to good step 1 performance or being an excellent physician. There are simply too many exceptions for that to even be remotely true.

Sounds like the MCAT requires more in-depth knowledge, while Step 1 requires a larger breadth of knowledge (at least based on your post).
 
Be careful with this philosophy. Many P/F schools don't use cut offs (e.g <60%) as the mark for failing. They use standard deviations. From what I remember from my med school interviews a lot seemed to use a cut off of around 2.5 SD from the mean. Getting an 80% might seem like a pass, but if the average was 90% with an SD of 3%, you just failed. Also, by definition a program that is Pass/Fail MUST have someone fail each year. Programs that use the 5 point system do not have this requirement.

OK, gotcha. So it's like the classic scenario where you and 2 friends encounter a hungry bear in the woods. You don't have to outrun the bear, you just have to outrun your friends. While P/F creates collaboration by reducing the sense of competition, it is still there? My entering class will be approximately 80 students. Even if all of us are hard working students, and nobody drops out for personal reasons, at least one of us will fail first year? This seems unfair. :(
 
Preclinical grades simply do not matter for most specialties. Sure, if you want to do dermaneurosurgery at Johns Hopkins, then everything matters, including school rank. However, for the vast majority of specialties and instituitions, your pre-clinical grades do not matter.

The difference between getting a B (or high pass) and an A is literally studying stupid minutia that has no bearing on clinical practice. For example, on the last physio test, there were about 3 questions that were lifted from a single slide that itself was talking about the latest basic science research. Those 3 questions would be the difference between an A and a B since the entire test was only 30-odd questions. Every single test has been like that. Off the top of my head, knowing the molecular weight of the anion exporter, knowing the precise functional amino acid differences between HbA and HbF, knowing the signalling molecules involved in limb development in the developing embryo. Do any of these questions have any bearing on Step I or clinical practice? Nope. They are simply grade gates to see whether or not you have the stamina to memorize stupid minutia that the school thinks warrants a higher grade.

There's the P=MD mentality and then there's knowing that pre-clinical grades do not matter and to concentrate your efforts on the boards. Pre-clinical years come down to "yep, I know the material and I'm not going to stress because that histo answer was really B instead of A because the glands stained purple instead of deep blue" not "I can skirt by knowing the bare minimum".
 
I'm also interested in getting some opinions on this, but in regard to graded schools. I've only been accepted to a letter-graded school right now. At this point at least, I'm aiming for a top peds residency. I don't know if I should be okay with getting B's and C's, or if I should really put in the extra effort (and stress) to try to get as many A's as I can. There are PD surveys that say that preclinical grades are on the lower end of their list, but that's on average and not representative of the most competitive residencies.

(Sorry, not trying to hijack the thread, but the topic seemed similar enough)

I'm a pediatrician -- the top peds residencies are not as competitive as the other "competitive" fields (surgery, derm, etc) but you still need a STRONG academic performance in med school to match.

Basically if you are happy with a noncompetitive primary care field AND you dont want a top notch academic residency program, then yes I would agree that "P = MD"
 
Preclinical grades simply do not matter for most specialties. Sure, if you want to do dermaneurosurgery at Johns Hopkins, then everything matters, including school rank. However, for the vast majority of specialties and instituitions, your pre-clinical grades do not matter.

The difference between getting a B (or high pass) and an A is literally studying stupid minutia that has no bearing on clinical practice. For example, on the last physio test, there were about 3 questions that were lifted from a single slide that itself was talking about the latest basic science research. Those 3 questions would be the difference between an A and a B since the entire test was only 30-odd questions. Every single test has been like that. Off the top of my head, knowing the molecular weight of the anion exporter, knowing the precise functional amino acid differences between HbA and HbF, knowing the signalling molecules involved in limb development in the developing embryo. Do any of these questions have any bearing on Step I or clinical practice? Nope. They are simply grade gates to see whether or not you have the stamina to memorize stupid minutia that the school thinks warrants a higher grade.

There's the P=MD mentality and then there's knowing that pre-clinical grades do not matter and to concentrate your efforts on the boards. Pre-clinical years come down to "yep, I know the material and I'm not going to stress because that histo answer was really B instead of A because the glands stained purple instead of deep blue" not "I can skirt by knowing the bare minimum".

True story.

Most med school profs have this lovely habit of testing the most useless, non-relevant minutiae. The few things you really do need to know and should be tested on during the pre-clinical years are often nowhere to be found on exams.
 
Preclinical grades simply do not matter for most specialties. Sure, if you want to do dermaneurosurgery at Johns Hopkins, then everything matters, including school rank. However, for the vast majority of specialties and instituitions, your pre-clinical grades do not matter.

The difference between getting a B (or high pass) and an A is literally studying stupid minutia that has no bearing on clinical practice. For example, on the last physio test, there were about 3 questions that were lifted from a single slide that itself was talking about the latest basic science research. Those 3 questions would be the difference between an A and a B since the entire test was only 30-odd questions. Every single test has been like that. Off the top of my head, knowing the molecular weight of the anion exporter, knowing the precise functional amino acid differences between HbA and HbF, knowing the signalling molecules involved in limb development in the developing embryo. Do any of these questions have any bearing on Step I or clinical practice? Nope. They are simply grade gates to see whether or not you have the stamina to memorize stupid minutia that the school thinks warrants a higher grade.

There's the P=MD mentality and then there's knowing that pre-clinical grades do not matter and to concentrate your efforts on the boards. Pre-clinical years come down to "yep, I know the material and I'm not going to stress because that histo answer was really B instead of A because the glands stained purple instead of deep blue" not "I can skirt by knowing the bare minimum".

This. The :rolleyes:-inducing grade grubbers and people freaking out over one little question doesn't exist in med school as it did in some parts of undergrad.
 
I'm a pediatrician -- the top peds residencies are not as competitive as the other "competitive" fields (surgery, derm, etc) but you still need a STRONG academic performance in med school to match.

Basically if you are happy with a noncompetitive primary care field AND you dont want a top notch academic residency program, then yes I would agree that "P = MD"

This is exactly what I've been looking for. Thank you so much. Don't mean to get into specifics here, but I was referring to the "near" top peds residencies, i.e. not MGH, CHOP, or Colorado, but a little bit lower down the rank, like Emory or Texas Children's. Should I worry about trying to get all A's for these places as well, or would I be okay with mostly B's?

Thanks again!
 
Preclinical grades simply do not matter for most specialties. Sure, if you want to do dermaneurosurgery at Johns Hopkins, then everything matters, including school rank.

Do most schools include preclinical internal ranking as a part of the class rank for residency applications? I thought that it was only a very very small portion of the final rank, like 10, if it's included at all, and most often it's not.
 
Do most schools include preclinical internal ranking as a part of the class rank for residency applications? I thought that it was only a very very small portion of the final rank, like 10, if it's included at all, and most often it's not.

To answer this question accurately one would need to know the grading system of every school across the country. It's not something you should worry about until you are deciding where to matriculate.

Sent from my SGH-T999 using SDN Mobile
 
I matched to ophtho in January.

What does P/F really mean? What does Honors/Near Honors/Satisfactory etc really mean?

In the end, residencies don't care about your grades, they care about your class rank. And at most schools, (or my school, at least) your pre-clinical grades will account for 1/3 of your GPA and third year will account for 2/3.

That matters when the time comes to determine class rank or quartile. It's also matters when the time comes for AOA, which is a giant gold star that catches the eye of residency programs, as only the top 10-15% are eligible for such a distinction. (Varies by school). There are top notch places in certain specialties that only invite AOA residency candidates to come interview.

Programs directors are too busy to figure out the grading scale and system at every school. Most P/F schools will still rank you in the end on your transcript or on your dean's letter. Residency programs care about this.

So how much does your GPA matter? Somewhat. It's behind things like Step 1 and LORs, but above things like research, and volunteer experiences. (There's a paper on this out there, somewhere.)

When you start the pre-clinical years, you will realize how much of it is a complete and utter waste of time that will have exactly zero bearing on your ability as a physician in the future. Your girlfriend is a M3 IIRC - why don't you ask her how much of the stuff she learned for step 1 she actually remembers and, even better, uses with any sort of regularity in a clinical context. Comments from M4s and attendings (the ones that aren't teaching a course) about material that we might be learning at the time are also pretty telling.

I'm not saying that the pre-clinical years are a complete waste of time, but as I'm nearing the completion of our pre-clinical curriculum it's become apparent how useless it really is. I have quite a bit of book knowledge up in that head of mine, yet I still know very little about the nitty gritty details of "practicing medicine." Obviously the basic information is critical as without it you'll be totally clueless, but thinking that you're going to be a better or more qualified physician because you scored a 95 on an exam when the average was an 80 is a complete joke. 90% of the people saying that are probably people that got 95s.

If medical school were sufficient preparation for being a physician, medical school part II - aka residency, which in many cases is as long as IF NOT LONGER THAN medical school proper - would not be necessary.

You're right that the coursework doesn't matter relatively as much. But the grades do matter.
 
I have talked to her about the whole P=MD thing and she doesn't agree with approaching pre-clin that way. Just to add a bit of perspective, her step 1 = 257 and she has honored all of her clerkships so far (surg, neuro, psych, medicine). You're right that she doesn't remember a lot of the minutiae from pre-clin, but she thinks that what she has retained really helped her on Step 1 and also helps her stand out during rotations. Also, she was the type that studied 6-8 hours per day during pre-clin. Oh, and her school is P/F. So even though she isn't a proponent of the P=MD mentality, she does admit that learning all the minutiae is low yield. However, she thinks low yield is better than no yield and I'm inclined to agree.


All that said, it's an n=1 and I know many med students do just as well (or better) on step 1 and clerkships without putting a lot of emphasis on minutiae.

As for the rest of your post, surely I agree that getting higher scores in pre-clin doesn't necessarily mean you're going to be a better physician. At the same time, the stuff students do that result in lower grades (video games, partying, etc) won't make them better physicians either and that's the problem I have with the whole argument. To me it seems like a lot of med students use it as an excuse to not study as much because "it won't make me a better doctor anyway".

So yeah, I'm a pre-med and I know my perception could completely change over the next couple of years, but I think the whole "it's not necessary to get high pre-clinical grades because it won't make me a better doctor so why bother?" mentality is ridiculous and I know current M3s and M4s who feel the same way.

Edit: In addition, I know it's not the analogy but why is the relationship between pre-clin and step 1 any different than pre-reqs and MCAT? Most people would tell a pre-med to learn everything as well as possible in pre-reqs because it will help on the MCAT. I've never once seen a med student tell a pre-med to "learn the bare minimum for an A since nothing you learn in pre-reqs will help you be a better med student and the MCAT doesn't test the details that are tested in your pre-med classes anyway".

What may be helping your girlfriend in her USMLE and her rotations now may not even help her later on (ex. all the neurology minuta you learned won't help much if you want to do cardiology) . So what is the point of learning it really? Plus human memory has its limits and it is extremely hard to learn every bit of detail and recall it years later. So again what is the point in learning that minuta, when it can be looked up in this case?

Humans have limits and we have to realize that going beyond those limits will not help us but hinder us. Our hunter gather ancestor only used their muscles when they needed to because anything extra was a waste of energy. It is really difficult to retain vast amounts of information even when there is no time limit. Thus it is much more efficient to know "where to look it up" than it is to "sit there and memorize it over and over again." Memorizing every small detail is a waste of time and energy.
 
Last edited:
The thing about class rank though...is that the vast majority of people won't be in the top portion(which is something that people might not be used to in undergrad). Depending on how it's worded in the Dean's Letter(or the criteria for AOA), only a tiny portion(15-20%) would benefit from this. Everyone else won't, which makes up the bulk of med students. It isn't a negative thing to not be in the top percentile or have AOA. If it is, well there would be thousands of unranked US med students :scared:

On the contrary, for extremely competitive specialties, things like that do matter. Fields like derm, NS, optho sorta self-select anyway...
 
The thing about class rank though...is that the vast majority of people won't be in the top portion(which is something that people might not be used to in undergrad). Depending on how it's worded in the Dean's Letter(or the criteria for AOA), only a tiny portion(15-20%) would benefit from this. Everyone else won't, which makes up the bulk of med students. It isn't a negative thing to not be in the top percentile or have AOA. If it is, well there would be thousands of unranked US med students :scared:

On the contrary, for extremely competitive specialties, things like that do matter. Then again, less than 10% of a class would be going for derm, NS, optho, etc.

While not a deal breaker, it still matters on some level. I think most programs across most specialties will distinguish between a candidate with a class rank in the 70th percentile and one with a rank in the 10th.
 
What may be helping your girlfriend in her USMLE and her rotations now may not even help her later on (ex. all the neurology minuta you learned won't help much if you want to do cardiology) . So what is the point of learning it really? Plus human memory has its limits and it is extremely hard to learn every bit of detail and recall it years later. So again what is the point in learning that minuta, when it can be looked up in this case?

Humans have limits and we have to realize that going beyond those limits will not help us but hinder us. Our hunter gather ancestor only used their muscles when they needed to because anything extra was a waste of energy. It is really difficult to retain vast amounts of information even when there is no time limit. Thus it is much more efficient to know "where to look it up" than it is to "sit there and memorize it over and over again." Memorizing every small detail is a waste of time and energy.

I understand that, but if it helped her get a great step 1 score and honor most clerkships then it was worth it considering those are among the most important parts of your residency application.

Sent from my SGH-T999 using SDN Mobile
 
I matched to ophtho in January.

What does P/F really mean? What does Honors/Near Honors/Satisfactory etc really mean?

In the end, residencies don't care about your grades, they care about your class rank. And at most schools, (or my school, at least) your pre-clinical grades will account for 1/3 of your GPA and third year will account for 2/3.

That matters when the time comes to determine class rank or quartile. It's also matters when the time comes for AOA, which is a giant gold star that catches the eye of residency programs, as only the top 10-15% are eligible for such a distinction. (Varies by school). There are top notch places in certain specialties that only invite AOA residency candidates to come interview.

Programs directors are too busy to figure out the grading scale and system at every school. Most P/F schools will still rank you in the end on your transcript or on your dean's letter. Residency programs care about this.

So how much does your GPA matter? Somewhat. It's behind things like Step 1 and LORs, but above things like research, and volunteer experiences. (There's a paper on this out there, somewhere.)



You're right that the coursework doesn't matter relatively as much. But the grades do matter.

What if you go to a school that doesn't rank?
 
Top