Pass/fail or graded clinical years?

[alt12345]

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Hey SDN,

I'm currently an MS1 at UCLA, where 3rd and 4th year grades have been pass/fail for a long time. They are currently switching the grading scheme such that all classes after mine will be graded (Honors, high pass, pass, fail I believe). My class is the first with this new grading scheme, and because many of us were uninformed of this change as applicants, they are giving us the option to have the old system (pass/fail) or the new (graded).

Old system: pass/fail clinical years. Letters of distinction are given for students who are exceptional in their rotations. Letters of distinction do not appear on the transcript apparently, but I assume they must be on the residency application somewhere.

New system: graded clinical years, with honors/high pass/pass/fail. Grading is "criterion-based," meaning the criteria for getting honors is standardized, rather than "norm-based," which is when the highest X% of the rotation gets honors. Theoretically all students could get honors.

The administration has told us that the new system was suggested by previous generations of medical students. It is supposed to allow us to differentiate ourselves from our peers, within our class and against students in other medical schools. It is also supposed to place slightly less emphasis on our step 1 scores, as now PD's will be able to differentiate us in a more data-driven way, rather than just seeing a bunch of Passes and relying on our step 1 score.

I was hoping to get your thoughts on what we should choose! All students make the choice individually, there is not a class vote or anything.

@Juan Solo @catzzz88 @lostintranscrip It would be nice to hear your thoughts/let me know if you see anything wrong here!

 

[Serous Demilune]

Good question. I think I would choose Pass/Fail and take the pressure off me in 3rd year to really enjoy the experience. Just bust your ass for Step 1, and come interview time you can skate by on that and your school's reputation (which is really excellent). But I see the validity of the other argument as well.

 

[charmiedermie]

So I was googling and saw this:
http://mscdgsom.weebly.com/dgsom-3rd-year-grade-changes---history-and-proposed-changes.html, so people can give u better informed opinions. It looks like the Letter of Distinction you can get is not a grade like Honors but just like an extra award, but it is noted in your MSPE.

Its very difficult to "standardize" rotation grades. I read what u wrote about the new system, but that's really just hot air. Whether criterion or norm referenced, it really doesn't mean much for your evaluator checking off boxes. Just like the LOD distribution varies a lot at UCLA by site and clerkship, the same thing will happen in the new system with Honors.

TL; DR I think @Serous Demilune is on the money. Use your school's reputation to your advantage and stay with pass/fail.

Maybe I'm reading this wrong on the powerpoint but do 57% of UCLA students who rotate at Kaiser/Olive View for IM really get a letter of distinction?

 

[operaman]

P/F only really helps students at the bottom, and you can make an argument that it somewhat hurts those at the top by not allowing them to easily distinguish themselves from their peers. If you don't have to decide until 3rd year, I would wait and see how well you do in preclinicals. If you're consistently in the top 10% of the class, then by all means take the graded option and run the table with honors. If you're hovering average/below, then definitely take the P/F. If you have to decide now before seeing how you stack up with your class, that's a tougher call. I think I would lean toward P/F, but would definitely want to ask the dean how this would show up on your transcript/MSPE. If half your class takes grades, then PDs may see your transcript as simply all Passes versus others in your class who have a mix a of HP/H. My guess is most of your class will take the P/F, but I'd ask anyhow before making a decision.

 

[alt12345]

P/F only really helps students at the bottom, and you can make an argument that it somewhat hurts those at the top by not allowing them to easily distinguish themselves from their peers. If you don't have to decide until 3rd year, I would wait and see how well you do in preclinicals. If you're consistently in the top 10% of the class, then by all means take the graded option and run the table with honors. If you're hovering average/below, then definitely take the P/F. If you have to decide now before seeing how you stack up with your class, that's a tougher call. I think I would lean toward P/F, but would definitely want to ask the dean how this would show up on your transcript/MSPE. If half your class takes grades, then PDs may see your transcript as simply all Passes versus others in your class who have a mix a of HP/H. My guess is most of your class will take the P/F, but I'd ask anyhow before making a decision.

Thanks for everyone's responses!

It seems like the vast majority of the class will take the graded option, just from speaking with fellow classmates. There is a good amount of pressure from the administration to do so -- when they describe it to us, they essentially point out all of the positives and defend why it's changing, there's not much discussion about the negatives.

Also, I wonder if PD's would see that the applicant chose LOD/P/F rather than H/HP/P/F and think less of the applicant somehow?

 

[Dave89]

Top students don't just happen to get Honors. They work hard for those scores. And I don't believe anybody really enjoys having to study for shelf exams into the wee hours of the morning.

So, I don't see how switching to the H/HP/P/F scheme will help anyone. While Step 1 is a crappy test (and mileage varies a great deal regardless of preclinical performance), there will still be a general tendency for the better students to have higher scores than those of the average students. So they can use that as an opportunity to distinguish themselves academically.

Ultimately, having a P/F scheme in 3rd year will allow everyone in your class to have better lives, be more involved in extracurriculars, etc.

 

[alt12345]

So I was googling and saw this:
http://mscdgsom.weebly.com/dgsom-3rd-year-grade-changes---history-and-proposed-changes.html, so people can give u better informed opinions. It looks like the Letter of Distinction you can get is not a grade like Honors but just like an extra award, but it is noted in your MSPE.

Its very difficult to "standardize" rotation grades. I read what u wrote about the new system, but that's really just hot air. Whether criterion or norm referenced, it really doesn't mean much for your evaluator checking off boxes. Just like the LOD distribution varies a lot at UCLA by site and clerkship, the same thing will happen in the new system with Honors.

TL; DR I think @Serous Demilune is on the money. Use your school's reputation to your advantage and stay with pass/fail.

Maybe I'm reading this wrong on the powerpoint but do 57% of UCLA students who rotate at Kaiser/Olive View for IM really get a letter of distinction?

I believe you're right about the powerpoint. It's a little disheartening that it varies so much between sites.

 

[charmiedermie]

P/F only really helps students at the bottom, and you can make an argument that it somewhat hurts those at the top by not allowing them to easily distinguish themselves from their peers. If you don't have to decide until 3rd year, I would wait and see how well you do in preclinicals. If you're consistently in the top 10% of the class, then by all means take the graded option and run the table with honors. If you're hovering average/below, then definitely take the P/F. If you have to decide now before seeing how you stack up with your class, that's a tougher call. I think I would lean toward P/F, but would definitely want to ask the dean how this would show up on your transcript/MSPE. If half your class takes grades, then PDs may see your transcript as simply all Passes versus others in your class who have a mix a of HP/H. My guess is most of your class will take the P/F, but I'd ask anyhow before making a decision.

But will a competitive residency really not interview an applicant bc of their grading system? I think its doubtful bc policies change all the time and students aren't in control of that. The only reason this change is being implemented is bc of students at the top of the class who have a perception, but no actual proof, that it may have hurt them. How would they know? Also he may be in top 10% in exams for preclinicals, but may be closer to average/above average in clinicals. I think his school is only pushing the new system bc it makes it tougher on them from a calculation perspective.

For @alt12345, I would find out how exactly your rank is calculated on the MSPE and for AOA with this hybrid system in your class. I don't think your evaluators are going keep track in their heads of the nuances of LODs vs. Honors. I guess they have 2 different eval forms?

Step 1 is an objective test. It can be studied for and aced with familiarity, brute force, and Qbank questions. Clerkships are different and bc each UCLA clerkship has too many sites there is just no way UCLA will be able to make up the variability, unless they actively change student grades, which they won't. Unless they have an active plan in place for better distributing the Honors grade, its really not a real change from now.

 

[operaman]

But will a competitive residency really not interview an applicant bc of their grading system? I think its doubtful bc policies change all the time and students aren't in control of that. The only reason this change is being implemented is bc of students at the top of the class who have a perception, but no actual proof, that it may have hurt them. How would they know? Also he may be in top 10% in exams for preclinicals, but may be closer to average/above average in clinicals. I think his school is only pushing the new system bc it makes it tougher on them from a calculation perspective.

For @alt12345, I would find out how exactly your rank is calculated on the MSPE and for AOA with this hybrid system in your class. I don't think your evaluators are going keep track in their heads of the nuances of LODs vs. Honors. I guess they have 2 different eval forms?

Step 1 is an objective test. It can be studied for and aced with familiarity, brute force, and Qbank questions. Clerkships are different and bc each UCLA clerkship has too many sites there is just no way UCLA will be able to make up the variability, unless they actively change student grades, which they won't. Unless they have an active plan in place for better distributing the Honors grade, its really not a real change from now.

The more I think about it, I doubt it will make all that much of a difference because everyone knows who the stars are and LORs and step scores will bear that out. My only concern would be what others are doing as I could imagine being one of 10 people in your class applying for X field and being the only one with all P's. Sure, evaluators may take the time to delve more deeply and see that your grading system was P/F while your classmates were graded, but they may not. That's why I would want to know how it would be reported. If it's front and center (ie. "Internal Medicine -- Pass [graded Pass/Fail]). If it's just a transcript and the explanation is buried somewhere in an appendix at the end of your MSPE, then that might be an issue.

Good call on also asking about how AOA will be calculated as well.

My experience is that almost without exception, the top students preclinically are the same ones who honor all/most everything clinically.

 

[alt12345]

The more I think about it, I doubt it will make all that much of a difference because everyone knows who the stars are and LORs and step scores will bear that out. My only concern would be what others are doing as I could imagine being one of 10 people in your class applying for X field and being the only one with all P's. Sure, evaluators may take the time to delve more deeply and see that your grading system was P/F while your classmates were graded, but they may not. That's why I would want to know how it would be reported. If it's front and center (ie. "Internal Medicine -- Pass [graded Pass/Fail]). If it's just a transcript and the explanation is buried somewhere in an appendix at the end of your MSPE, then that might be an issue.

Good call on also asking about how AOA will be calculated as well.

My experience is that almost without exception, the top students preclinically are the same ones who honor all/most everything clinically.

It's almost like game theory...if everyone chose pass/fail it would be ideal, but purely from an individual perspective if you are an above average student it would make sense to choose h/hp/p/f.

Regarding AOA, as it stands right now (old grading system) the selection is based on:

"All seniors who are enrolled, plan to graduate the following spring, and wish to apply, are eligible for consideration. Application details will be provided by the Student Affairs Office each summer prior to the election...The David Geffen School of Medicine at UCLA is a true Pass/Fail institution. Therefore, selection criteria is determined annually by the Chapter, who may consider (in alphabetical order):

• Academic/clinical performance
• Extracurricular involvement including research, community service, teaching, and leadership
• Honors and awards received
• Letters of Distinction
• Professionalism
• USMLE Step 1 score"

http://alphaomegaalpha.org/ucla_chapter_info.html

As far as I know, there is no junior AOA but the website does refer to "newly elected Junior AΩA co-presidents."

 

[operaman]

Yeah I would ask your chapter's AOA faculty councilor for more info, especially how academically your straight Passes would fare against someone else's straight Honors (since that is the issue we're thinking about here). I would want to know if the all honors person has an advantage over a similar student who elected for P/F.

Obviously this assumes you've got a good shot at AOA. If you think this is highly unlikely, it may be a moot point.

 

[byaaaaaaah23]

Tough call. I personally would go for the graded system mostly because it does give you a chance to distinguish yourself. Especially since a lot of other people in your class will pick graded, it might look bad for you to stick with pass/fail. I would defer to MS3s and MS4s though.

 

[ucladoc2b]

Yeah, I'd be cautious with being the "guinea pig" for the new grading system. Chances are the faculty will have to adjust to the new system of med student evaluation, as well. I could see this causing a whole bunch of confusion when it first rolls out (and probably for a couple of classes). I could see a whole bunch of opportunity for evaluative error. Personally, I'd save myself the headache and stress and opt for the P/F.

 

[Psai]

Imo I'm just relaying one programs anecdotes here...but when we evaluate UCLA students apps now we basically just look at their LORs. They have a few very frequent LOR writers (clerkship director, PD) who we pretty much rely on to "tell us like it is" and their letters consistently help us read between the lines as to the top/not top students.

So even without the grades the school is still informally internally ranking you and telling programs where you stand. It's just more obfuscative and not transparent to the students.

oh god i can't even imagine how difficult your job is. people ask people for letters that will say nice things so most lors are full of crap