Pre-Clinical Grades/Class Rank and Residency?

[MD2b06]

Ok, everyone I've talked to says pre-clinical grades are amongst the least important factors when it comes time to land a residency. However, class rank is significantly more important. Say if Pre-clinical grades are #10 out of 10, class rank would be around #5. I always found this strange since pre-clinical grades compose half of your class rank, yet are deemed rather insignificant.

Scenario:

Student #1: Does well during pre-clinical years, but below average during clinical rotations. Class rank is middle of the pack due to third year performance

Student #2. Does below average during the pre-clinical years, but kicks ass during rotations. Class rank is still middle of the pack though due to lackluster first 2 years.

When it comes time to apply to a competitive specialty (Rads), are both applicants screwed b/c of an average rank? I guess what I'm trying to figure out is how is class rank viewed precisely? Just as a number w/o any context or do they break it down and see what contributed to it, so an avg rank w/ above avg grades on rotations is favored over an avg rank w/ below avg grades on rotations?

Did I manage to lose you yet? If anyone can decipher what I'm getting at, and has some insight, I'd appreciate it. Thanks.

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[Big Lebowski]

I heard that crap too as a first year student...

My advice...try your best and do well in preclinical years. Though, from your scenario, student #2 will look better because not only did he/she show improvement, but clinical coursework is more indicative of residency perfomance than preclinical coursework.

However, preclinical courses are still important...don't let anyone convince you to blow them off. You'll kick yourself in the a$$ senior year....and you'll have to explain why you did so poorly on all your interviews...

 

[Jalby]

Normally the clinical years are more weighted than the pre-clinical years. A lot of places don't even count the pre-clinical years anymore.

 

[birdie]

Student #2 will also probably have better recommendations, which will carry significant weight. Question: Do you think pre-clinical grades would matter more for students that don't get ranked? The school I'm interested in doesn't even rank their med students and grades are all pass/fail. So rankings come into play for some med students but not others....

 

[Brewster]

Different schools determine class rank differently. I am not quite sure how it is done at my school (preclinical grades may count, and if they do, I bet the clinical grades are more heavily weighted). I do know that for AOA at my school, they totally ignore preclinical grades and look only at step I score and third year grades (leading me to believe that class rank is determined in a similar fashion).

Certainly, clinical grades are more important than preclinical grades (particularly in the field you are interested in). Letters, I believe, are more important than any grades.

 

[secretwave101]

Pre-clinical grades and rank don't matter as much as other things, but the USMLE I score often plays a role. My school runs a 1st year class called BGMC, which is Biochem, Genetics, Mol. Bio. and Cell Bio all rolled into 1 year-long class. It's a wierd class that works for my school, but isn't very useful in comparing other residency applicants.

Since every school has little twists in their curricula, residency dir's often just focus on the nice, standardized, USMLE I. So, if you blow off the 1st two years - you'll pay for it.

But in terms of getting a residency, I'm told the rubber meets the road in 3rd year - both grades and evaluations are huge.

Bottom line: if you tanked the 1st two years, don't give up, you aren't out of the game yet. And, if you aced the 1st two years, don't give up either, because you aren't IN the game yet.

 

[Andrew_Doan]

Originally posted by Jalby
Normally the clinical years are more weighted than the pre-clinical years. A lot of places don't even count the pre-clinical years anymore.

This is a very good point. Pre-clinical years do not have that much weight in calculating your medical school GPA. For instance, this is the weight system at Hopkins for some pre-clinical course work:

Human Anatomy: 155 hours
organ Phys: 169 hours
Dev Bio: 77 hours
Human Pathophys (one year long): 328 hours
Pathology (one year long): 237 hours
Pharmacology (one year long): 85 hours

The course carrying the most weight is Human Pathophys with 328 hours for one year of class work.

Guess how many hours Surgery, Medicine, and Peds are worth...? These are 2 month rotations each.

Each is worth 351 hours. A one month ER rotation is worth 175 hours.

If you take all the courses taken the second year, they are worth a total 867 hours.

The third year of clinical courses is worth a total of: 1813 hours.

While you need to study and do well during the first two years, it's really the clinical years that will have the greatest impact on your GPA and class ranking. As you can see, it's not really 50-50 preclinical/clinical grade emphasis. You must also consider that the fourth year could add another 1500 hours of clinical courses if you complete sub-Is and electives.

 

[tonem]

There are other incentives for doing well in the preclinical years. Some schools award AOA for performance in both the preclinical and clinical years of medical school. Presumably, a strong showing in the first two years will make study/review for Step I (which is really important) a lot less stressful which might translate to a higher score. Finally, out of the 125 or so allopathic schools in this country I'm sure there are quite a few that do factor the preclinical years into the class rank.

 

[ArrogantSurgeon]

Ahhh yes, memories of pre-clinical classes...countless hours and hours spent studying fact after fact...90% of which was forgotten after USMLE I and never used again.

 

[Jalby]

There was one guy in my class who was average pre-clinical, but the best ass kisser of all time. He ended up getting AOA and did quite well until he got caught ditching rotations in residency.

 

[22031 Alum]

I really think the best approach is to try to kick ass throughout med school, and not worry too much about what is important when. If you aren't doing great in the preclinical years, better to up your efforts than to comfort yourself with "It's okay, I'll just do better when it matters more." Act like whatever stage you are at is the most important.

 

[username456789]

I really think the best approach is to try to kick ass throughout med school, and not worry too much about what is important when.

That's what I did. If you excel in everything, you don't have to look back and wonder what was more or less important.

 

[michiganpsych08]

I think it also varies like someone said between schools. I would take a look at your school MSPE to see what is included and more importantly the wording. My school doesn't rank you when it comes to pre-clinical grades and we are basically pass/fail. If you honor a course, they make a note on your MSPE letter and thats it. What we are ranked on is how well we did on step in comparison with our classmates utilizing those trigger adjectives - good, very good, excellent etc....So a person who passes a class with a 60 and a person who passes it with an 80, the grade will look exactly the same P. Im focusing on learning the material and getting my foundation down so there is less that I have to do when it comes time to study for step. If that means I honor a class along the way then so be it, but Im personally not stressing myself out trying to honor everything when the professors spend more time talking about their own research rather than material that will be tested on the step. just my $ 0.02

 

[22031 Alum]

I think it also varies like someone said between schools. I would take a look at your school MSPE to see what is included and more importantly the wording. My school doesn't rank you when it comes to pre-clinical grades and we are basically pass/fail. If you honor a course, they make a note on your MSPE letter and thats it. What we are ranked on is how well we did on step in comparison with our classmates utilizing those trigger adjectives - good, very good, excellent etc....So a person who passes a class with a 60 and a person who passes it with an 80, the grade will look exactly the same P. Im focusing on learning the material and getting my foundation down so there is less that I have to do when it comes time to study for step. If that means I honor a class along the way then so be it, but Im personally not stressing myself out trying to honor everything when the professors spend more time talking about their own research rather than material that will be tested on the step. just my $ 0.02

Is looking at the school's MSPE really a thing pre-clinical students do?? I am feeling really out of touch. I didn't even know what that was until third year, and didn't realize the importance of the adjective until I was in residency looking at applications. Also, stressing out trying to honor everything, and putting in a strong effort rather than planning to just do better later are two different things.

 

[Dave89]

There was one guy in my class who was average pre-clinical, but the best ass kisser of all time. He ended up getting AOA and did quite well until he got caught ditching rotations in residency.

What happened to him?

 

[tiedyeddog]

There was one guy in my class who was average pre-clinical, but the best ass kisser of all time. He ended up getting AOA and did quite well until he got caught ditching rotations in residency.

Jalby lives!!!!!!

This thread is mad old. OP called rads competitive, that is how you know how long it has been, lol.

 

[Winged Scapula]

There was one guy in my class who was average pre-clinical, but the best ass kisser of all time. He ended up getting AOA and did quite well until he got caught ditching rotations in residency.

1) how does one even go about "ditching rotations" during residency?

2) not only does Jalby live but he's bumping 12 year old threads!

 

[Guero]

1) how does one even go about "ditching rotations" during residency?

2) not only does Jalby live but he's bumping 12 year old threads!

I'm glad Jalby did, though. This is a great topic to put into a modern perspective for entering students and students nearing the ERAS phase. From what I've gathered, it seems like so long as you don't have any remediations or failures to explain on ERAS and during interviews, the preclinical grades are rather insignificant when compared to the importance of the Step score, core rotation grades, letters, and if aiming competitive, research track record.

Any admin wanna comment on that first approximation? I'm curious to hear from a PD (if they exist on SDN) or a resident. I'm also curious to know how leadership is viewed on the interview trail, if that might be something that can set one competitive and highly research oriented applicant apart from another...

EDIT: And we ARE always telling the newbies to use the search function...

 

[Law2Doc]

The preclinical years really don't count for much if you pass. Class rank doesn't really count for much, although AOA looks good to residencies, so it's a nice cherry on the sundae if you have it, no sweat if you don't. The Step 1 and clinical year evaluations tend to matter most. For some fields research matters too. So yeah, I'd say always do your best but honestly you can actually do pretty mediocre in the first two years of med school and still end up with a pretty choice residency.

 

[Tired]

1) how does one even go about "ditching rotations" during residency?

Quietly.

Very quietly.

 

[Guero]

The preclinical years really don't count for much if you pass. Class rank doesn't really count for much, although AOA looks good to residencies, so it's a nice cherry on the sundae if you have it, no sweat if you don't. The Step 1 and clinical year evaluations tend to matter most. For some fields research matters too. So yeah, I'd say always do your best but honestly you can actually do pretty mediocre in the first two years of med school and still end up with a pretty choice residency.

Thanks, much appreciated. Great to see you're still around providing advice and answers.

 

[qw098]

The preclinical years really don't count for much if you pass. Class rank doesn't really count for much, although AOA looks good to residencies, so it's a nice cherry on the sundae if you have it, no sweat if you don't. The Step 1 and clinical year evaluations tend to matter most. For some fields research matters too. So yeah, I'd say always do your best but honestly you can actually do pretty mediocre in the first two years of med school and still end up with a pretty choice residency.

Even for schools that give out a GPA?

 

[Guero]

Even for schools that give out a GPA?

During pre-clin? Although rare, even those schools' pre-clin grades have less impact on GPA than rotation GPA hours (i.e., 22hrs each M1/M2 semester & 32hrs each M3 semester; M4 is only eval).

EDIT: And I imagine it still aligns w/what @Law2Doc said. But I won't put words in anyone's mouth and await Law2Doc's input...

 

[TwinsFan]

Word over here is that class rank matters quite a bit for a number of specialties. Any surgical sub specialty, derm, or competitive locations for most other specialties. We've been told being in the bottom half is practically a deal breaker for anything competitive. Is this just institutional bias? Charting outcome doesn't publish class rank, but our internal data seems to align with what they tell us.

Would love to hear other people's info from their PDs, admin etc about varying specialties.

 

[Law2Doc]

....We've been told being in the bottom half is practically a deal breaker for anything competitive. Is this just institutional bias? Charting outcome doesn't publish class rank, but our internal data seems to align with what they tell us.

Would love to hear other people's info from their PDs, admin etc about varying specialties.

Don't buy everything they're selling. That's what my mentor once described as the "dirty little secret " of med school.

 

[tiedyeddog]

Word over here is that class rank matters quite a bit for a number of specialties. Any surgical sub specialty, derm, or competitive locations for most other specialties. We've been told being in the bottom half is practically a deal breaker for anything competitive. Is this just institutional bias? Charting outcome doesn't publish class rank, but our internal data seems to align with what they tell us.

Would love to hear other people's info from their PDs, admin etc about varying specialties.

Who told you that? Straight false....

 

[clairephillips]

This thread is a big stress relief for me. I'm going to be attending one of the few schools that still uses letter grades for preclinicals (UTHSCSA) and I've been pretty nervous about how that will affect residency options. I'm certainly not PLANNING to do poorly, but it looks like people think it won't matter extraordinarily? Am I reading this right?

 

[Guero]

This thread is a big stress relief for me. I'm going to be attending one of the few schools that still uses letter grades for preclinicals (UTHSCSA) and I've been pretty nervous about how that will affect residency options. I'm certainly not PLANNING to do poorly, but it looks like people think it won't matter extraordinarily? Am I reading this right?

Yes, always try your best and try not to succumb to the "eh, it won't really matter" senoritis-type philosophy. But in the end, pre-clin grades are largely phasing out. To my knowledge, there are only around 10 or so schools left that use pre-clin grades. Granted, many of the pass/fail schools still use the Honors/High Pass/Pass or an analogous system (e.g., Honor/Pass), which are tantamount to grades. But many schools are gravitating toward entirely doing away with pre-clin stratification and putting more emphasis on the clinical years.

 

[username456789]

This thread is a big stress relief for me. I'm going to be attending one of the few schools that still uses letter grades for preclinicals (UTHSCSA) and I've been pretty nervous about how that will affect residency options. I'm certainly not PLANNING to do poorly, but it looks like people think it won't matter extraordinarily? Am I reading this right?

Most of the schools that are "pass/fail" are basically handing out letter grades anyway (H/HP/P/F), and nearly all still rank you just like an A/B/C/D/F school does. There's not as much difference as you think.

 

[TwinsFan]

Who told you that? Straight false....

Our admin and some people who review apps for a residency in a surgical us specialty.

We also have access to deidentified match data from previous five years based on steps and quartile that seem to corroborate what they say for the most part. But it's possible this is skewed by self selection for the more competitive specialties.

Who told you it didn't matter, and what did they say? I'm genuinely interested, as memorizing endless details and picture captions to score well above average is painful and dehumanizing

 

[tiedyeddog]

Our admin and some people who review apps for a residency in a surgical us specialty.

We also have access to deidentified match data from previous five years based on steps and quartile that seem to corroborate what they say for the most part. But it's possible this is skewed by self selection for the more competitive specialties.

Who told you it didn't matter, and what did they say? I'm genuinely interested, as memorizing endless details and picture captions to score well above average is painful and dehumanizing

I matched a "competitive" surgical subspecialty and if I was in the top 50% then I was right at the border....

No one even asked me about what quartile I was in, never came up in interviews.

And I say NOT so you can slack off. I say this because where you fall on a class rank list depends on what school you go to and other factors. You should be trying your best so you can do well on step and in clinicals.

 

[username456789]

No one even asked me about what quartile I was in, never came up in interviews.

That's because it's easily and fairly clearly identified by your MSPE . . . both in word form and in graph form.

I'm not saying people are going to grill you about where they see you ended up during an interview, nor am I suggesting it's super important; however, it is still part of the larger overall assessment of your academic achievement, and is readily available to anyone evaluating your application.

 

[tiedyeddog]

That's because it's easily and fairly clearly identified by your MSPE . . . both in word form and in graph form.

I'm not saying people are going to grill you about where they see you ended up during an interview, nor am I suggesting it's super important; however, it is still part of the larger overall assessment of your academic achievement, and is readily available to anyone evaluating your application.

I know it is in there, my point is that I was never asked about where I fell and it didn't stop me from matching.

 

[anaesthetic]

.

 

[TwinsFan]

I was asked by a program chair why my class ranking didn't match up with my Step scores. One of the more difficult questions on the interview trail, but it was relevant.

If it's not too much, what kind of step range vs quartile are we talking? And was it for a competitive specialty/program?

 

[charmiedermie]

That's what I did. If you excel in everything, you don't have to look back and wonder what was more or less important.

I'm pretty sure if one could get the highest grade in every course in med school he/she would. That's not possible for everyone or even a majority of people, so you have to pick and choose where to focus your energies.

 

[charmiedermie]

I know it is in there, my point is that I was never asked about where I fell and it didn't stop me from matching.

The reason you weren't asked about your class rank at the interview is because the class rank filter was already placed on whether or not to even give you the interview in the first place. There is no need to mention it again.

 

[anaesthetic]

.

 

[Guero]

It wasn't a bad contrast. I was outside of the top quartile, but my Step I was ~250 for anesthesia, which is only mildly competitive now. I didn't do very well academically during third year (compared to the first two years) due to some personal issues which I explained pretty well, and that took me out of the running for AOA. I still honored and high-passed a few rotations due to great evaluations but felt like I could have done better overall had I been healthier.

Just so other students don't freak at this reply, I'd like to emphasize that the median Step score for those successfully matching anesthesia in the 2014 match was 230, with a mid IQR of 220-240. I disagree that a student would currently be considered "mildly competitive" with a 250, unless s/he was applying to *top* anesthesia programs. I'd say that with a well rounded app of good grades and research, a 240 is a typical entry level mark for many competitive specialties (i.e., minus the insanity of plastics and derm, which both reported median scores of 250).

 

[anaesthetic]

.

 

[Guero]

My mistake for the ambiguity. I meant anesthesiology as a specialty that's mildly competitive, not myself as an applicant.

Phwew!

 

[Guero]

Ugh, regarding the earlier debates about rank, I just saw this answer while procrastinating: when asked what a certain competitive residency program is looking for in its interviewees, they responded ". . . If you are not in the top 1/3 of your class, it is unlikely that you will be invited to interview." I've always found statements like these frustrating, from when I was a pre-med applicant to now, and forever will. But in the end, if you're receiving thousands of apps, setting a bar like that is one heck of an easy way to narrow down a crap ton of applications.

 

[TwinsFan]

Hilarious think about class rank is that ranking in the upper part of a top school is a whole other thing than doing it from a bottom one. A bit like the uGPA bs all over again.

Those of you who were saying it doesn't matter much, what specialties have you seen this in?

 

[Jalby]

The most important thing for getting a residency spot, in ranked order:
1. USMLE Scores
2. Away rotations (Or home if you want to go to your own place)
3. Personal recommendations from attendings who know attendings from other places. Of note, you can also be eliminated for this reason. And by personal recommendations I mean phone calls.
4. People from your program who have gone to that residency and done well
5. Everything else.

 

[Stedari]

Away rotations are not the #2 most important factor in obtaining a residency.

 

[volcomx]

A few PDs of competitive surgical subspecialties at my school told us that being in the top half of the class would put us in good shape. Being in the 75-50th percentile is ok but not ideal, and being in the bottom quarter puts us at risk of going unmatched. They said that being at a top school in the region cuts us some slack when it comes to class ranking, implying that residency programs do take into account school rank.

 

[Wordead]

Away rotations are not the #2 most important factor in obtaining a residency.

#1-3 on his list are all interchangeable depending on who you talk to.

 

[Jalby]

Away rotations are not the #2 most important factor in obtaining a residency.

And as a medical student, how many residencies have you applied to and been accepted at??

1. The USMLE needs to be at a minimum or you won't be considered for most spots.

2. Actually seeing a person work and seeing if they fit with your staff is quite important. That is why actually doing away rotations where you want to be is one of the most important things you can do.

3. Getting someone to vouch for you who is known at an different institution is a poor imitation for number 2 above.

 

[Jabbed]

I know it is in there, my point is that I was never asked about where I fell and it didn't stop me from matching.

Your logic doesn't follow. I bet that nobody asked you what your step score was, does that mean that it wasn't important?

 

[Jabbed]

Yes, always try your best and try not to succumb to the "eh, it won't really matter" senoritis-type philosophy. But in the end, pre-clin grades are largely phasing out. To my knowledge, there are only around 10 or so schools left that use pre-clin grades. Granted, many of the pass/fail schools still use the Honors/High Pass/Pass or an analogous system (e.g., Honor/Pass), which are tantamount to grades. But many schools are gravitating toward entirely doing away with pre-clin stratification and putting more emphasis on the clinical years.

The majority of med schools still have pre-clinical ranking that is reported on the MSPE. Whether your institution is P/F or A/F or xx% does not matter as much as the fact that you are being ranked and that ranking is being reported on the Dean's letter.

I agree with what you said about avoiding senioritis.