MD P/f clinical years

[psych_hopeful123]

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Hello! I am currently choosing between a few medical schools and was wondering what everyone's take is on p/f core clerkships. How much should I be factoring these into my decision? They sound like they would reduce stress by a lot. Are there any drawbacks that I am overlooking? Would love to hear thoughts of people that have been through/are going through their core clerkships and how this might affect one's experience. Thanks!

 

[TheIllusionist]

If it is a super elite place, the name is enough to carry and let you do whatever likely at a similarly elite place, as long you are not a total screw up (only objective criteria is STEP and even if you screw that up, the name is enough). Recent match lists are showing this more and more.

between a bunch of average places, choose a place with clinical grades to distinguish yourself.

outside of aoa status, step1 is the preclinical surrogate marker so pick a place with no preclinical grades (true pass outside AOA and no hidden rankings), since they are mostly just a pain in the ass.

 

[psych_hopeful123]

I should mention that I have been very fortunate and am therefore choosing between a number of "elite" places

 

[plshelpvanxious]

At my mid/low tier school, it's pass/fail, and I think everyone is happy it's this way. If you get wonderful grades, you'll probably ace step anyways.
It cuts down on the cut-throat, competitive atmosphere that I had expected to experience in medical school. Students share study resources and encourage others to do well. Maybe my school is full of genuinely friendly people, but I think the grading system plays a big role

 

[longhaul3]

If they're all elite then go for it, especially if you're thinking psych. The drawback is that it's a disadvantage for students aiming for super competitive specialities because they can't distinguish themselves on the basis of their clinical work.

For that reason I would not want to go to a sub-elite (?) school with P/F clinical grading, but people from the top schools will match at top places no matter what. On top of that I wouldn't be surprised if a number of the top schools with grades switch to P/F by the time you reach clinical year anyway as that seems to be the way things are headed.

 

[psych_hopeful123]

Thanks all! What about if I feel one school with H/HP/P/F clerkship grades is a better fit but am worried about the added stress of grades? How big of a difference do you think grades would make as far as overall happiness as well as competitiveness for residency apps? I know that on the interview trail I was told by current students to pick p/f pre clinical schools first and foremost so I'm wondering if that holds for clerkship year.

Thanks again!

 

[longhaul3]

Go to the school that you like better. You wouldn't even be worried about grades if the other P/F school didn't exist. Generations of us have gone through the grading process—some complain more than others, but you'll get by. Show up on time, smile, and say yes, and you'll do fine.

I wrote this in another post somewhere the other day, but I think the pressure of grades makes you learn better. It definitely made me go the extra mile on my rotations, do the extra research, put the extra effort into the note/presentation/shelf. No way I would have learned as much or pushed myself as much if I knew from the start my grade was just going to be P.

Edit: To add, the pre-clinical phase is almost completely irrelevant, but you won't realize that until you finish your clinical year. The pre-clinical students who do the interview lunches, etc. don't have that perspective and put way too much emphasis on it. P/F pre-clinical is nice (mine was), but it would be far down my list of priorities if I were choosing a med school today.

 

[mehc012]

Go to the school that you like better. You wouldn't even be worried about grades if the other P/F school didn't exist. Generations of us have gone through the grading process—some complain more than others, but you'll get by. Show up on time, smile, and say yes, and you'll do fine.

I wrote this in another post somewhere the other day, but I think the pressure of grades makes you learn better. It definitely made me go the extra mile on my rotations, do the extra research, put the extra effort into the note/presentation/shelf. No way I would have learned as much or pushed myself as much if I knew from the start my grade was just going to be P.

Edit: To add, the pre-clinical phase is almost completely irrelevant, but you won't realize that until you finish your clinical year. The pre-clinical students who do the interview lunches, etc. don't have that perspective and put way too much emphasis on it. P/F pre-clinical is nice (mine was), but it would be far down my list of priorities if I were choosing a med school today.

Ehh, even as I'm moving into M4, I wouldn't agree with that last statement. P/F pre-clinical means you can learn things at your own pace, you get to actually know your classmates, and it just generally sets up a nice culture in med school. To me, that's more valuable than a so-minor-it-there-is-no-word-inconsequential-enough effect on eventual Match. Preclinical years dictate a lot of your experience of med school and can set you up for success...or not. So even if they're not listed as a deciding factor in residency apps, that doesn't mean they aren't important or don't have an impact on those other important aspects.

 

[differentiating]

Thanks all! What about if I feel one school with H/HP/P/F clerkship grades is a better fit but am worried about the added stress of grades? How big of a difference do you think grades would make as far as overall happiness as well as competitiveness for residency apps? I know that on the interview trail I was told by current students to pick p/f pre clinical schools first and foremost so I'm wondering if that holds for clerkship year.

Thanks again!

Grades are super stressful- especially in clerkships, where you have much less control over the grade you get. I’d pick H/HP/P/F over H/P/F, but a straight p/f ms3 would help turn that year from a miserable one to a decent one. There’d actually be time to learn things, for one. It just depends on how much better you think the fit is, and how much stress you can handle.

 

[psych_hopeful123]

Grades are super stressful- especially in clerkships, where you have much less control over the grade you get. I’d pick H/HP/P/F over H/P/F, but a straight p/f ms3 would help turn that year from a miserable one to a decent one. There’d actually be time to learn things, for one. It just depends on how much better you think the fit is, and how much stress you can handle.

I see. One school is in a super high COL area across the country from my family which would make it hard for me and my spouse to live in a decent apartment together, and the other school is in a much more affordable area near my family + I already know a couple of current students there which is nice. I did like the students I met at both schools and they are both really exceptional prestigious places so I have no concerns on those fronts.

I was thinking that one advantage of having clinical grades might be less of an emphasis on STEP 1. I'm a decent test taker but not exceptional so I was thinking perhaps clinical grades would give me more room to show my strengths should STEP 1 not go as well as I had hoped. Let me know if this line of thinking makes sense...

 

[differentiating]

I see. One school is in a super high COL area across the country from my family which would make it hard for me and my spouse to live in a decent apartment together, and the other school is in a much more affordable area near my family + I already know a couple of current students there which is nice. I did like the students I met at both schools and they are both really exceptional prestigious places so I have no concerns on those fronts.

I was thinking that one advantage of having clinical grades might be less of an emphasis on STEP 1. I'm a decent test taker but not exceptional so I was thinking perhaps clinical grades would give me more room to show my strengths should STEP 1 not go as well as I had hoped. Let me know if this line of thinking makes sense...

This will depend on whether or not you can actually get strong clerkship grades. Some schools weight shelf exams highly, so it’ll come down to test taking anyway. Some schools you have little to no control over what grade you get, which was my experience. I legitimately can’t tell you why I got honors in certain rotations and passes in others.

I’m not saying it’s something you should avoid at all costs, but I’d consider it as a factor in your decision.

 

[psych_hopeful123]

This will depend on whether or not you can actually get strong clerkship grades. Some schools weight shelf exams highly, so it’ll come down to test taking anyway. Some schools you have little to no control over what grade you get, which was my experience. I legitimately can’t tell you why I got honors in certain rotations and passes in others.

I’m not saying it’s something you should avoid at all costs, but I’d consider it as a factor in your decision.

Got it. Appreciate your advice! From speaking with students it looks like at the graded school shelf exams carry very low weight and it really comes down to evaluations, similar to what you experienced. Gah this decision is hard...

 

[psych_hopeful123]

I think the post above hit the nail on the head. It's hard to know in advance how you'll perform. Lots of people lament that the grading on their rotations is random, unpredictable, capricious, etc., but 1) some schools do use the shelf, so that makes it more predictable, and 2) in my evaluations people across the board picked up on the same positives and negatives in my performance all year, so it's not completely arbitrary. It's hard to know anything except your own experience, because evaluations are a private matter, and people tend to speak out only when they got a worse grade than they wanted. This is where I argue the differences between top and not-top schools are clearest: the top schools have the best faculty and house staff, who are the most competent in both teaching AND evaluating.

Do your school options have Step 1 before or after the clinical year? Looking back, if I were choosing a med school today, that would also play a minor role in my decision (favoring Step 1 after clerkships).

So the p/f school takes Step1 after clerkships while the graded school gives students the option of taking step 1 before, in the middle, or after clerkships. So it looks like I could take step 1 after clerkships at either school which is nice.

I have only been able to speak to one student who had completed her clinical years at the graded school and she did state that she did say she felt the grading was fair. She also mentioned that it is not curved in any way so there was no limit on how many students could get honors

 

[psych_hopeful123]

Interesting. In any case I would strongly recommend taking it after clerkships. My school administration changed all sorts of things between my first and fourth years, so there's no guarantee that what they're advertising now will stay that way. For that reason I'd advise you not to choose based on a single feature of either school. If both schools are of about equal reputation, I'd say go with whichever one makes you more excited—because of location, weather, family, school name, etc.

Got it, that makes sense. Thanks for your help!

 

[differentiating]

So the p/f school takes Step1 after clerkships while the graded school gives students the option of taking step 1 before, in the middle, or after clerkships. So it looks like I could take step 1 after clerkships at either school which is nice.

I have only been able to speak to one student who had completed her clinical years at the graded school and she did state that she did say she felt the grading was fair. She also mentioned that it is not curved in any way so there was no limit on how many students could get honors

This is a plus. My school was capped at 45% honors, which felt a little arbitrary at a top school where most people were performing well, and exacerbated the issues with the random grading.

I personally don't have an opinion on step 1 before/after clerkships. There are pros and cons to both: it might be helpful to see diseases in person during your clerkship years to supplement your learning, but you also start a bit behind on the wards because you don't have that knowledge yet & the first shelf can be a shock. I suspect that it won't have a huge impact on how well a particular student performs on Step 1 either way.

 

[kraskadva]

OP - you mentioned you were married...where does your spouse want to live for the next 4 years? I'd let their preference be the deciding factor here. Since you're at the point of just nitpicking differences between schools anyway, it becomes 6 of one, half dozen of the other between them. And as a married med student, I can say will 100% certainty that an unhappy spouse is more stressful than anything the school can throw at you, while a happy spouse can make it all bearable.

 

[psych_hopeful123]

OP - you mentioned you were married...where does your spouse want to live for the next 4 years? I'd let their preference be the deciding factor here. Since you're at the point of just nitpicking differences between schools anyway, it becomes 6 of one, half dozen of the other between them. And as a married med student, I can say will 100% certainty that an unhappy spouse is more stressful than anything the school can throw at you, while a happy spouse can make it all bearable.

This is definitely a factor I have been heavily considering, however my spouse is pretty split on both places. Luckily his work allows him geographic flexibility so from a professional standpoint they are equivalent. The high COL place is more exciting to him (and me) but we both recognize that the more affordable location would make finding a decent, affordable place to live much more doable. So he's kind of left it up to me to make the decision based on what school I like better!

 

[psych_hopeful123]

I would welcome any tips on being married to someone outside of medicine while in medical school but I should probably make a separate thread for that haha

 

[700825]

Edit: misread the post...ooopppss lol

 

[psych_hopeful123]

My spouse is not in medicine. It's an interesting dynamic during med school. There was a lot of focus on me—it was a big accomplishment to get in, we moved (to a high COL and far less comfortable living situation) because of me, the foreseeable future depended on my performance and choices in med school, etc.—but obviously I was not working, so my spouse was the breadwinner. Spouse felt like my work was the priority (which it definitely was at specific points), but I felt like she was the priority. In any case, it definitely turned out that my life was easier 90% of the time, and I'd feel guilty sometimes about dragging her around the country just to have all this free time. If you can keep your eye on the big picture it helps.

You will have a TON of free time in med school, probably way more than you and your spouse expect, so don't go in feeling like your spouse will need to pick up the slack for the swamped med student (the pre-med forum has a terrible idea of what daily life in med school is like). At times he will, like when you're on surgery, but most of the time it will be you looking out for him. You may need to study a lot, but you're going to be the one who has time to get the car inspected during the day, take the dog to the vet, etc. I know my wife appreciated that I realized that early on and it made her feel better about the sacrifices she's made.

Edit: It's doubly gratifying to see your hard work pay off knowing that the stakes are greater than just your own. Getting the high Step 1 score back, getting the honors in the clerkships you worked really hard in feels good when you know someone else has made big sacrifices for you and is counting on your success.

That's actually great to hear and contrary to what others have told me regarding free time. After holding a full time job where my time is totally monopolized during the day I'm excited to have some flexibility, especially during the pre-clinical years, and especially because my spouse largely works from home so that means that's time we could spend together.

Also, that's a great perspective on accomplishments! That's kind of how I felt getting into top medical schools when I totally didn't expect it, actually.

 

[psych_hopeful123]

Just my opinion, but as someone at a school with graded pre-clinical I would go to the P/F school hands down (unless there is some major cost/prestige difference). Good preclinical grades are not going to make up for a weak Step 1. However, bad preclinical grades can hurt an otherwise strong app (and your class rank). The cost-benefit is not good. And that's not considering the rather cut-throat culture and lack of sharing of study resources.

Luckily, all the schools I'm looking at are p/f with no internal ranking during preclinical years so this is not a factor for me!

 

[700825]

Luckily, all the schools I'm looking at are p/f with no internal ranking during preclinical years so this is not a factor for me!

Sorry misread your post. In that case I would say go with the school with graded clinical clerkships. Otherwise, your entire application would ride on your STEPs and letters which is kinda terrifying.

 

[mehc012]

This is a plus. My school was capped at 45% honors, which felt a little arbitrary at a top school where most people were performing well, and exacerbated the issues with the random grading.

I personally don't have an opinion on step 1 before/after clerkships. There are pros and cons to both: it might be helpful to see diseases in person during your clerkship years to supplement your learning, but you also start a bit behind on the wards because you don't have that knowledge yet & the first shelf can be a shock. I suspect that it won't have a huge impact on how well a particular student performs on Step 1 either way.

Yah, I'd say capped grading is a bigger issue than the grades themselves.

As for the shelf vs step thing, I went to a school that allowed you to choose before, middle, or after, and I ended up doing it after 1 rotation - IM. It was the best decision I could have made. For one, it really motivated me on shelf studying. For another, I got to take IM right after finishing preclinicals, so it didn't affect me there as much as people think. You need a dedicated period for all of the random minutiae that only show up on Step 1, but honestly for the wards you mostly need OME, which is true both before and after Step anyways.

However, for Step itself? My UW scores went up like 20% before and after my IM rotation, but didn't budge one damn iota during my 2mo of dedicated itself. Now, I was also kind of a crummy student during that time, but no more than most people end up, if they're being honest. I also think I burnt out less both in clinicals and on Step by staggering my clinical time and also my study time (aka not starting dedicated right after finals period in M2, and breaking up my rotations a bit).

Everyone I knew who chose to do a rotation before Step ended up hitting honors threshold on their Shelf except one. It seemed to have no effect on clinical evals. Not sure about those who waited until the end (or at least more than halfway through) yet, since most are still finding out.

 

[aldol16]

True P/F clerkships could go either way. On the one hand, they're great as a student because you don't feel that constant stress to honor or high-pass a clerkship. On the other hand, it's much harder for PDs to distinguish students from your school and to compare you to students across the country. This is less of an issue if it's an elite school and your Step score is phenomenal but may become more of an issue if your Step score is less than stellar. P/F is basically regression to the mean and it becomes hard to distinguish people when they're all at the mean. PDs still want to know if you'll be a good clinician.

 

[differentiating]

Yah, I'd say capped grading is a bigger issue than the grades themselves.

As for the shelf vs step thing, I went to a school that allowed you to choose before, middle, or after, and I ended up doing it after 1 rotation - IM. It was the best decision I could have made. For one, it really motivated me on shelf studying. For another, I got to take IM right after finishing preclinicals, so it didn't affect me there as much as people think. You need a dedicated period for all of the random minutiae that only show up on Step 1, but honestly for the wards you mostly need OME, which is true both before and after Step anyways.

However, for Step itself? My UW scores went up like 20% before and after my IM rotation, but didn't budge one damn iota during my 2mo of dedicated itself. Now, I was also kind of a crummy student during that time, but no more than most people end up, if they're being honest. I also think I burnt out less both in clinicals and on Step by staggering my clinical time and also my study time (aka not starting dedicated right after finals period in M2, and breaking up my rotations a bit).

Everyone I knew who chose to do a rotation before Step ended up hitting honors threshold on their Shelf except one. It seemed to have no effect on clinical evals. Not sure about those who waited until the end (or at least more than halfway through) yet, since most are still finding out.

I have no idea what OME is - that’s an acronym I haven’t seen before.

But regardless, I think Step after 1 rotation is very different than step after core clerkships, both in terms of its impact on your performance on the clerkship and your knowledge base. I know the first class of step-after-clerkships at my school had >50% failure on the surgery shelf because they didn’t know how to study for NBME-style tests yet. As a sub-I, I was also surprised by the knowledge gaps present between the new rotators and where our class had been. Now, some of these kinks have been worked out at my school, but I still suspect that they’re starting at a lower knowledge base all the same. Again - pluses and minuses of the system that OP should be aware of.

In your case, you were studying for step alongside IM, which probably helped.

True P/F clerkships could go either way. On the one hand, they're great as a student because you don't feel that constant stress to honor or high-pass a clerkship. On the other hand, it's much harder for PDs to distinguish students from your school and to compare you to students across the country. This is less of an issue if it's an elite school and your Step score is phenomenal but may become more of an issue if your Step score is less than stellar. P/F is basically regression to the mean and it becomes hard to distinguish people when they're all at the mean. PDs still want to know if you'll be a good clinician.

Of course, if OP were to get straight passes, it would look better at a P/F school than one that has honors. The benefit of grades only exists if you’re in the honors cohort.

 

[MaxPlancker]

HMS hands down, having no grades clerkship year is a godsend and your life is so much more chill and recent match results show absolutely no disadvantage of the p/f system. Also PBL 1-year basic science curriculum is really good, barely any lectures to sit through.

 

[longhaul3]

I have no idea what OME is - that’s an acronym I haven’t seen before.

But regardless, I think Step after 1 rotation is very different than step after core clerkships, both in terms of its impact on your performance on the clerkship and your knowledge base. I know the first class of step-after-clerkships at my school had >50% failure on the surgery shelf because they didn’t know how to study for NBME-style tests yet. As a sub-I, I was also surprised by the knowledge gaps present between the new rotators and where our class had been. Now, some of these kinks have been worked out at my school, but I still suspect that they’re starting at a lower knowledge base all the same. Again - pluses and minuses of the system that OP should be aware of.

In your case, you were studying for step alongside IM, which probably helped.

Step 1 is much more important than any one clinical grade or shelf exam, so I think it was advantageous for me to learn the NBME style and be put under that exam-taking stress on the shelf exams over the course of a year and then have that experience in my back pocket when it came time for Step 1. I also think that a year's worth of rotations gives you more prep for Step 1 than a few weeks' worth of Step 1 studying gives you for rotations.

But of course I acknowledge that it has been done that way at many schools for many years and don't claim my school's way was the only way. All just my opinion colored by my positive experience.

 

[differentiating]

Step 1 is much more important than any one clinical grade or shelf exam, so I think it was advantageous for me to learn the NBME style and be put under that exam-taking stress on the shelf exams over the course of a year and then have that experience in my back pocket when it came time for Step 1. I also think that a year's worth of rotations gives you more prep for Step 1 than a few weeks' worth of Step 1 studying gives you for rotations.

But of course I acknowledge that it has been done that way at many schools for many years and don't claim my school's way was the only way. All just my opinion colored by my positive experience.

Like I said before- I don’t really have an opinion either way, since there are pros and cons for both ways. I did well on step 1 pre-clerkships, but that doesn’t mean that I wouldn’t have done well post-clerkships. I just think it’s important to weigh all the pros and cons.

 

[mehc012]

I have no idea what OME is - that’s an acronym I haven’t seen before.

But regardless, I think Step after 1 rotation is very different than step after core clerkships, both in terms of its impact on your performance on the clerkship and your knowledge base. I know the first class of step-after-clerkships at my school had >50% failure on the surgery shelf because they didn’t know how to study for NBME-style tests yet. As a sub-I, I was also surprised by the knowledge gaps present between the new rotators and where our class had been. Now, some of these kinks have been worked out at my school, but I still suspect that they’re starting at a lower knowledge base all the same. Again - pluses and minuses of the system that OP should be aware of.

In your case, you were studying for step alongside IM, which probably helped.



Of course, if OP were to get straight passes, it would look better at a P/F school than one that has honors. The benefit of grades only exists if you’re in the honors cohort.

Sorry, Online MedEd. Aka the primary resource most people I know use for shelf and ward studying.

 

[differentiating]

Sorry, Online MedEd. Aka the primary resource most people I know use for shelf and ward studying.

I had a friend who used that, but I just stuck to UWorld Step 2 for studying. Plenty of different resources available- everyone uses something that works for them.

 

[mehc012]

I had a friend who used that, but I just stuck to UWorld Step 2 for studying. Plenty of different resources available- everyone uses something that works for them.

Sure - all I was saying is that Step 1 prep is overkill for the wards. For the most part, I don't think it's necessary/helpful. Step 2 prep materials (whatever those may be for you) are a lot more pertinent in the hospital. In fact, I'd say that a lot of my friends who joined me on the wards just after their Step exams started falling into the "med student who constantly suggests zebras" stereotype, more than anything helpful. Obviously this will depend on how well you prep for shelves and wards and Step 2 material, as well as how much you gleaned during preclinicals, but personally I don't see "hasn't studied for Step 1" as a particularly notable detriment for clinical evals among my classmates who took Step after one or more rotations. It did mean they had to study more specifically for the shelf exams, but then, I suspect that's one factor that helped them with Step down the line anyway.

 

[differentiating]

Sure - all I was saying is that Step 1 prep is overkill for the wards. For the most part, I don't think it's necessary/helpful. Step 2 prep materials (whatever those may be for you) are a lot more pertinent in the hospital. In fact, I'd say that a lot of my friends who joined me on the wards just after their Step exams started falling into the "med student who constantly suggests zebras" stereotype, more than anything helpful. Obviously this will depend on how well you prep for shelves and wards and Step 2 material, as well as how much you gleaned during preclinicals, but personally I don't see "hasn't studied for Step 1" as a particularly notable detriment for clinical evals among my classmates who took Step after one or more rotations. It did mean they had to study more specifically for the shelf exams, but then, I suspect that's one factor that helped them with Step down the line anyway.

I’m basing my commentary on what I and a number of residents noticed from the new class - they simply had a lower knowledge base going in than classes before had had. It’s something they might be able to make up with studying hard, but it is notable. Step 1 isn’t as irrelevant to the wards as you’re suggesting, imo.

 

[aldol16]

Of course, if OP were to get straight passes, it would look better at a P/F school than one that has honors. The benefit of grades only exists if you’re in the honors cohort.

Yes, regression to the mean works in both directions. If you're a below-average student, you tend to benefit from it. If you're an above-average student, you tend to be hurt by it. If you're average, well, you don't care either way. But that still doesn't make it easier for PDs to distinguish students from your school, which makes them have to rely on Step 1 more. If you're great at Step 1 and suck at clerkships, the true P/F may work out to your benefit. If you're the reverse, it won't. But it's silly to choose schools based on how good of a clinician you think you can be during clerkships anyway.