Pass/Fail schools aren't all they are cracked up to be

[golfman]

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Just a word of advise. It seems like many people really favor pass/fail only schools. I will tell you why I do not favor them.

If you go to a true pass/fail only school, the only things that will really help you get a good residency are Board Scores, Clinical Evaluations (what the Dr's you rotate with say about you), LOR, and Research.

From my experience, the only thing you have total control over is Board scores. You have control over the other things, but not total control. Trust me, during 3rd year you may be the best student on a certain rotation, but if you get an attending that is a notoriously tough evaluator, is in a pissy mood the day an evaluation is done, you are just out of luck. And your buddy that may have been slacking may just get an attending that gives everybody a great evaluation. This happens more than you would think. Not all attendings grade equally. Also, some people just luck into good research jobs and good LOR situations. There is a lot of luck involved in getting into an awesome research position, and a lot of luck into getting good LOR. Obviously skill is involved, but there is some luck.

If you are a good student, doing well in class is just another way to distinguish yourself, and studying will help you do well on Step 1. This is something you have total control over (even though grades aren't too important).

If you go to a pass/fail school, you really only have total control over your Board scores. Mess that up, and with a little bit of bad luck in research on on clinicals, you could get hosed pretty fast.

I was cursing that my school wasn't pass fail when I was an MS1 and MS2, but now that I did well, and see how lame 3rd year evaluations can be, I'm very glad.

 

[Tippyboat]

That's an interesting perspective, and one that I heard from a student interviewer just today at a school that graded A/B/C/D/F.

I have a few questions though

- Pass/Fail schools, or at least the few that I have gone to, really stress that residency directors don't care at all about preclinical grades. Is this not true? And if it is true, then how much can you really distinguish yourself with them?

- What if you don't do well? When you say total control, doesn't it still depend on how harshly a professor grades/curve of the class/etc.? So can't you end up with bad grades and therefore sabotage yourself?

- P/F schools stress how much of a difference it makes to the atmosphere of the class to not have competition, and grading/ranked schools stress that the grades do not ruin the atmosphere. So...does the grading system really not affect how cooperative/friendly the class is?

Thanks

 

[lord_jeebus]

The biggest myth is that a P/F system prevents your school from indicating how you stand relative to your peers. Essentially every medical school determines (either by numbers or some gestalt method) where you rank, and includes it in your MSPE ("Dean's Letter") as the "magic adjective" in your overall evaluation.

I also don't believe that grading systems make people more or less "cooperative," coming from an H/P/F school. Competitive people will find ways to look good at others' expense, regardless of the grading system, and most normal people will continue to be normal.

 

[ronaldo23]

Just a word of advise. It seems like many people really favor pass/fail only schools. I will tell you why I do not favor them.

If you go to a true pass/fail only school, the only things that will really help you get a good residency are Board Scores, Clinical Evaluations (what the Dr's you rotate with say about you), LOR, and Research.

From my experience, the only thing you have total control over is Board scores. You have control over the other things, but not total control. Trust me, during 3rd year you may be the best student on a certain rotation, but if you get an attending that is a notoriously tough evaluator, is in a pissy mood the day an evaluation is done, you are just out of luck. And your buddy that may have been slacking may just get an attending that gives everybody a great evaluation. This happens more than you would think. Not all attendings grade equally. Also, some people just luck into good research jobs and good LOR situations. There is a lot of luck involved in getting into an awesome research position, and a lot of luck into getting good LOR. Obviously skill is involved, but there is some luck.

If you are a good student, doing well in class is just another way to distinguish yourself, and studying will help you do well on Step 1. This is something you have total control over (even though grades aren't too important).

If you go to a pass/fail school, you really only have total control over your Board scores. Mess that up, and with a little bit of bad luck in research on on clinicals, you could get hosed pretty fast.

I was cursing that my school wasn't pass fail when I was an MS1 and MS2, but now that I did well, and see how lame 3rd year evaluations can be, I'm very glad.

even on the traditional grading system, most people on here say that preclinical grades don't matter very much at all to residency directors

 

[golfman]

That's an interesting perspective, and one that I heard from a student interviewer just today at a school that graded A/B/C/D/F.

I have a few questions though

- Pass/Fail schools, or at least the few that I have gone to, really stress that residency directors don't care at all about preclinical grades. Is this not true? And if it is true, then how much can you really distinguish yourself with them?

That is true they don't distinguish you that much. But, let's say you just have a bad day on Step 1. You're sick, nervous, or just have a bunch of questions that you don't know. Believe it or not, the bank of questions you get will affect your score. If you do bad on Step 1, then residencies are going to question your ability to study. If you've done well in classes, and got some honors, that will take away some of their concern. You can say "I just had a bad Step 1 day, but as you can see from my classes I am capable of doing well. I just had a bad day." Versus if you are in a pass/fail school you just have to say "Well you have no other proof that I can handle material well, but just take my word for it."
So, you are right, preclinical grades don't really matter too much. But, they can help you at least explain a bad step 1 score. That being said, if you can guarantee a 240 or 250+ on Step 1, maybe I could see going to a pass/fail school, because then they will just assume you are money. It's just scary putting the rest of your career in the hands of 1 test, with no other way for them to assess how you do bookwise. That is a lot of pressure.

- What if you don't do well? When you say total control, doesn't it still depend on how harshly a professor grades/curve of the class/etc.? So can't you end up with bad grades and therefore sabotage yourself?

You could. But most schools give a certain amount of students honors. Like 25% or so. So, it doesn't matter how the teacher grades, a certain percentage will get honors (at least that's how it was at my school). Maybe other schools were different. I knew that if I put in the time, I personally would have about a 75% chance of honoring a class (this will be different for different people. If you struggle in classes, maybe a pass/fail school would be better.) It's tough to honor all classes, though. Especially when the difference between honors or not sometimes is like the difference between a 93 and a 94, and the class high was a 96 on that test. Just one or two unlucky mistake can knock you out of honors range.

- P/F schools stress how much of a difference it makes to the atmosphere of the class to not have competition, and grading/ranked schools stress that the grades do not ruin the atmosphere. So...does the grading system really not affect how cooperative/friendly the class is?

Our class was great, very cooperative and friendly during the 1st two years. We all shared notes and stuff (well, the ultra gunners did not, but I never really got a lot of out whatever people sent out). 3rd year is where the competition really starts, when you are in teams of like 4 or 5, and everybody is trying to impressive the physician/resident. That doesn't change in a pass/fail school.

I may be wrong. Clearly pass/fail works better for some, and grades work better for others. Depends on you. But the lovefest for pass/fail schools I think is a little blown out of proportion. I recently talked to a residency director frustrated with Harvard, I think, because he says there is no way to evaluate them expect Step 1. They are pass fail, all the evals look the same, they all have research, etc...

 

[golfman]

even on the traditional grading system, most people on here say that preclinical grades don't matter very much at all to residency directors

They don't. But they can help you in case you get a bad Step 1 score, granted you get interviews at those schools (many schools have Step 1 score cut offs). It's a lot easier when they ask you on interviews, "what happened on Step 1", for you just to say "I got good grades the 1st two years, I just had the flu on Step 1 day, or I just had a bad day, or my kitten died the day before, or some other excuse. Your grades can back you up."

 

[drizzt3117]

Preclinical grades also contribute to AOA.

 

[ssahjm]

I'm really happy this thread was started. The whole idea of P/F vs. grading system didn't come up much when I was choosing schools to which I would apply, but now that interview season is getting into gear, I feel like it's really coming to the forefront of many discussions. I appreciate the questions and the feedback... keep them coming! 👍

 

[CCLCMer]

I'm in my final year at a true P/F school, so in the interest of presenting both sides, I'll tell you why I DO favor it. First, I want to clarify that CCLCM is P/F all five years, including third year. We have no rankings, secret or otherwise, and no AOA. (For those who don't know, AOA is the medical honor society. Most medical schools do have a chapter, and class rank is one of the factors used to decide who can be elected.)

Concerning factors used to decide where you get a residency, there is one other that wasn't mentioned, which is the Dean's Letter. This is an extra LOR written by your dean (big surprise!), and it summarizes your overall performance throughout medical school. At my school, the dean takes direct quotes out of our third year evals. Most schools also use the Dean's Letter to give residency program directors (PDs) a sense of how your performance compares with your classmates. I can't say for sure how PDs use Dean's Letters, but it appears that many programs don't invite anyone to interview until they receive it.

Next, our system is geared toward this P/F type of evaluation, and it is not completely subjective. There are specific competencies that we are expected to demonstrate, such as professionalism, medical knowledge, etc. Under each competency are several standards. For example, not showing up on time or failing to complete your work will get you dinged on professionalism. There is still some room for subjectivism there, but it's not as much as you might expect. In addition, there is not only one person evaluating you, and so you will not do well or do badly based solely upon one person's judgment.

I have to also point out that at most schools, there is more to third year evals than just what attendings say about you. Most schools use shelf exams or some other kind of final exam to help determine grades for third year rotations. (CCLCM does not.) These exams count for different amounts at different schools, and again, you do not have control over what appears on the exam or how the curve is adjusted. So at some schools, your third year grades may depend heavily on a test score, and your evals will not matter so much, while at others, your test score will barely matter and your grade depends almost entirely on your evals. At a school where the shelf exams barely matter, you basically have a situation like ours anyway, only now you're getting an honors versus high pass versus pass based on the subjective evals of attendings. I actually think that would probably be more stressful, not less.

Third, I would argue that your Step 1 score is NOT totally under your control, not any more than any other test score is totally under your control. Do any of you who have taken the MCAT feel like the passages that appeared on your test were under your control? How much control did you have over the guy next to you who was coughing the whole time? Unlike the MCAT, you basically get one shot at Step 1, unless you fail it. Whether you have third year grades or not, PDs care a great deal about your Step 1 score, especially for the most competitive specialties. Even if you have straight honors for third year, a barely pass on Step 1 is not going to get you into a derm residency.

That being said, I agree with golfman that Step 1 scores will probably matter more for students like us who graduate from schools with P/F grades. I also think that Step 2 scores will matter more, and that consistent performance on both tests will do a lot to reassure PDs. However, I don't think this is as much of a disadvantage as was suggested. I am only in the third class that will graduate from CCLCM, so we don't have a lot of years of data yet on how people do in the match. But the first two classes have both done very well, in spite of having no third year grades. (Feel free to check the CCLCM website or do a search for our match results if you're interested.)

Concerning competitiveness, I really can't tell you if this school is more or less competitive than other schools, since I've never gone to another med school. It seems like students at most schools will tell you that their classmates are not cutthroat competitive, and I would agree with that as well. Plus, since our class is so small (only 32 students), we get to know each other fairly well, and we have already spent a lot of time working together by the time we hit the wards. There is a camaraderie that forms from going through hardships together.

Finally, we have an extra fifth year for research. Since many of the most competitive specialties, and many of the competitive programs in less competitive specialties, want to see research, having a full year of research (or more in many cases) is a significant difference compared to students who have one summer of research between first and second years. How much that matters to a specific program or in a specific specialty probably varies a lot, but it does give us something different to bring to the table.

I want to end this total book (sorry about that, and thanks to those of you who have read this far!) by saying that I'm not suggesting that all of you should go to a P/F school. I definitely don't think my school is right for everyone, probably not right for most people even. But going to medical school here is as fun and low stress as medical school can possibly be. I don't regret choosing CCLCM, and if I had to do it all over again, I would make the same choice to come here.

 

[CarlATHF]

I'm in my first month of a P/F system and I have to say that I absolutely love it here. Nobody cares what anybody else's grades are, and we all help each other to succeed. We learn for the sake of learning (which can certainly be said of students in traditional grading systems, but I haven't noticed a bit of competition in our class).

In addition, Marianne Green et al. published a study which surveyed residency directors and their preferences about selection criteria for residents. Pre-clinical scores came out at #12 of 14. It can be found here: http://journals.lww.com/academicmed..._Criteria_for_Residency__Results_of_a.24.aspx

There are plenty of other places in med school to distinguish yourself; screwing your classmates over for that "A" in biochemistry isn't going to help you.

 

[ssahjm]

In addition, Marianne Green et al. published a study which surveyed residency directors and their preferences about selection criteria for residents. Pre-clinical scores came out at #12 of 14. It can be found here: http://journals.lww.com/academicmed..._Criteria_for_Residency__Results_of_a.24.aspx

Great source — clear and concise, and it broke down the data into specialty-specific lists. I was also interested to see that most residency programs put "medical school reputation" at the bottom (or near bottom) of the list. The relative importance of a school's prestige seems to be an ongoing debate on SDN, so hopefully this will shed some light on the issue.

 

[MilkmanAl]

The biggest myth is that a P/F system prevents your school from indicating how you stand relative to your peers. Essentially every medical school determines (either by numbers or some gestalt method) where you rank, and includes it in your MSPE ("Dean's Letter") as the "magic adjective" in your overall evaluation.

I also don't believe that grading systems make people more or less "cooperative," coming from an H/P/F school. Competitive people will find ways to look good at others' expense, regardless of the grading system, and most normal people will continue to be normal.

My thoughts precisely. For what it's worth, UAMS is ABCDF, and everyone in my class is pretty cooperative, or at least as cooperative as I could expect a bunch of exceptionally driven, neurotic people to be.

I'm in my first month of a P/F system and I have to say that I absolutely love it here. Nobody cares what anybody else's grades are, and we all help each other to succeed. We learn for the sake of learning (which can certainly be said of students in traditional grading systems, but I haven't noticed a bit of competition in our class).

Emphasis mine. Here's a news flash: you're in medical school. The demons will come out soon enough, I promise you.

 

[CarlATHF]

My thoughts precisely. For what it's worth, UAMS is ABCDF, and everyone in my class is pretty cooperative, or at least as cooperative as I could expect a bunch of exceptionally driven, neurotic people to be.

Emphasis mine. Here's a news flash: you're in medical school. The demons will come out soon enough, I promise you.

Right, they'll probably come out when we start getting graded. That's beside the point I was making: pre-clinical grades don't matter.

 

[sylvanthus]

I'm in my first month of a P/F system and I have to say that I absolutely love it here. Nobody cares what anybody else's grades are, and we all help each other to succeed. We learn for the sake of learning (which can certainly be said of students in traditional grading systems, but I haven't noticed a bit of competition in our class).

In addition, Marianne Green et al. published a study which surveyed residency directors and their preferences about selection criteria for residents. Pre-clinical scores came out at #12 of 14. It can be found here: http://journals.lww.com/academicmed..._Criteria_for_Residency__Results_of_a.24.aspx

There are plenty of other places in med school to distinguish yourself; screwing your classmates over for that "A" in biochemistry isn't going to help you.

Everyone is still on their best behavior, wait a little bit it has only been a month.

 

[slowbutsteady]

They don't. But they can help you in case you get a bad Step 1 score, granted you get interviews at those schools (many schools have Step 1 score cut offs). It's a lot easier when they ask you on interviews, "what happened on Step 1", for you just to say "I got good grades the 1st two years, I just had the flu on Step 1 day, or I just had a bad day, or my kitten died the day before, or some other excuse. Your grades can back you up."

Good luck with that.

 

[CougarMD]

Good luck with that.

Hahaha.....as a non-med student, that sounded a little BS-y to me too, but I had no place to say it.

Glad someone who is more in the know agrees.

 

[MilkmanAl]

Of course it's BS. What do you think interviews are?

 

[slowbutsteady]

Preclinical grades also contribute to AOA.

Not if you don't have any.

My school is P/F the first to years and I cannot imagine life any other way. We all studied hard because you have to learn this stuff and you get a "grade" for your own purposes as a guide to how you are doing. I experienced no peer unpleasantness at all, we all supported each other as far as I could tell.

And second year for Step I studying I was able to focus on what I needed to learn for the boards and not what I needed to know for course exams. Obviously, there is a lot of overlap, but they are definitely not the same.

I am now third year and the pressure is on!! Life with grades is completely different and it is rough. You have the pressure of shelf exams, but most of the pressure is your clinical performance every minute of every day.

I do not know how I would have survived 4 years of that day to day pressure. Med school is tough enough without grades!!