preclinical grades

[saltbreeze55]

Current MS1 here at top 40 US MD school. It seems no matter how hard I study or whatever I try, I pretty much always score the class average or 2 or 3 percentage points lower on our block exams. I'm really aiming to be top 1/3 of my class (preclinical is only 1/3 weighted and clinical is weighted 2/3) and wondering if it is worth the pressure I've been putting on myself to do better on these exams or not. i'm wondering from a perspective of 1) if it is significant enough strictly from a grade standpoint that i can't keep doing average or a few points below and still graduate top 1/3 and 2) is this a sign that i'm doomed for mediocracy in clinical years as well? would putting in the effort to score better in preclinical translate to being better during clerkships?

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[SurfingDoctor]

What’s wrong with being an average doctor amongst your peers? You realize that they all probably excelled in undergrad too.

And no, your appearance and aptitude in the clinical setting doesn’t necessarily reflect your test taking abilities. One of co-fellows was an excellent test taker (Harvard grad) and couldn’t diagnose his way out of a paper bag.

 

[Matthew9Thirtyfive]

You’re at a top 40 med school. You’re already not mediocre. Being average at that school means you’re already doing great. Look, someone will have to be average at your school, and just purely based on odds you are more likely to be in that group than in the top of your class group.

But just to set your mind at ease, no one cares about preclinical grades. And your preclinical grades are not necessarily predictive of your clinical performance. The people at the top of the class may have a slight leg up on answering pimp questions—and I say “may” because in my experience so far, the stuff I’ve been pimped on has very rarely been the little preclinical details.

Shining in clinical rotations is about being prepared, being helpful, and being able to anticipate what the team needs. You get prepared by reading about the conditions your patients have and the cases you’re going to see (when you’re on surgery or OB), and you get good at the latter two just through practice. Checking for the repeat labs on your patient and letting the team know that they’re back. Seeing the patient at noon and letting the team know she’s now meeting discharge criteria. Grabbing some gauze for rounds cause you know they’ll want to put a fresh dressing on. Offering to call IR to get your patient’s PICC pulled before they go home. Having a skeleton note in before rounds so you can have your notes done really quickly after rounds so the interns can sign them before morning report (or however it works for your specific rotation).

There are a million little things that have to happen, and you can help with a lot of them. It might seem like you’re just in the way, but I’ve gotten excellent evals just by trying to anticipate some of those little things that have to be done that I can help with.

 

[YCAGA]

I am just speculating but I think OP might be worried about being “average” (or middle third at their school) because there has been talk that class rank will be more important now that Step 1 is P/F. I personally think Step 2, clerkship grades, letters, and research all will be more important than class rank, but honestly every prediction is pretty tenuous since Step 1 was such a big part of getting interviews in the past. No one knows how things will shift for the class of 2024 and beyond.

 

[Matthew9Thirtyfive]

I am just speculating but I think OP might be worried about being “average” (or middle third at their school) because there has been talk that class rank will be more important now that Step 1 is P/F. I personally think Step 2, clerkship grades, letters, and research all will be more important than class rank, but honestly every prediction is pretty tenuous since Step 1 was such a big part of getting interviews in the past. No one knows how things will shift for the class of 2024 and beyond.

Iirc, there was a thread somewhere here that included some statements from PDs who said they will just look at step 2 now. I doubt the low emphasis on preclinical grades is going to change.

 

[YCAGA]

Iirc, there was a thread somewhere here that included some statements from PDs who said they will just look at step 2 now. I doubt the low emphasis on preclinical grades is going to change.

There is a difference between preclinical grades in isolation, which I agree will never be that important, and class rank, which is determined in part by preclinical grades. I never mentioned preclinical grades in isolation, just class rank maybe becoming more important. At OP’s school, being average preclinically could very well keep him out of the top 1/3 when his MSPE is submitted.

 

[Banco]

It's fine to be average in a cohort of people who are very above average. Also, pre-clinical grades are so low on the totem pole for what's important for residency that they might as well not be there. Even if you end up being "middle 1/3" on your MSPE, it's not something to be ashamed about.

Get those P's in pre-clinical and crush it on your clerkships. And to your question, a few points in pre-clinical will make 0 difference on clerkship performance, I promise.

 

[Matthew9Thirtyfive]

There is a difference between preclinical grades in isolation, which I agree will never be that important, and class rank, which is determined in part by preclinical grades. I never mentioned preclinical grades in isolation, just class rank maybe becoming more important. At OP’s school, being average preclinically could very well keep him out of the top 1/3 when his MSPE is submitted.

Yeah, and I’m saying it doesn’t seem like it will be based on what some of the PDs are saying. We also had a meeting at my school with PDs from various specialties, and the general consensus was that step 2, your clinical performance in relevant rotations, and research. So basically all the same stuff, just step 2 instead of step 1. Obviously, this is still speculative and based on a small number of PDs, but the theme seems pretty common.

 

[YCAGA]

You’re at a top 40 med school. You’re already not mediocre. Being average at that school means you’re already doing great. Look, someone will have to be average at your school, and just purely based on odds you are more likely to be in that group than in the top of your class group.

But just to set your mind at ease, no one cares about preclinical grades. And your preclinical grades are not necessarily predictive of your clinical performance. The people at the top of the class may have a slight leg up on answering pimp questions—and I say “may” because in my experience so far, the stuff I’ve been pimped on has very rarely been the little preclinical details.

Shining in clinical rotations is about being prepared, being helpful, and being able to anticipate what the team needs. You get prepared by reading about the conditions your patients have and the cases you’re going to see (when you’re on surgery or OB), and you get good at the latter two just through practice. Checking for the repeat labs on your patient and letting the team know that they’re back. Seeing the patient at noon and letting the team know she’s now meeting discharge criteria. Grabbing some gauze for rounds cause you know they’ll want to put a fresh dressing on. Offering to call IR to get your patient’s PICC pulled before they go home. Having a skeleton note in before rounds so you can have your notes done really quickly after rounds so the interns can sign them before morning report (or however it works for your specific rotation).

There are a million little things that have to happen, and you can help with a lot of them. It might seem like you’re just in the way, but I’ve gotten excellent evals just by trying to anticipate some of those little things that have to be done that I can help with.

This is great advice by the way. The only caveat is that OP should look into how clerkship grades are determined at their school. I know at my school you have to get >75th percentile on the shelf to get honors on the clerkship. So even if you get 5/5 from every single person you worked with and they say you function at the level of a PGY-2, but get 74th percentile on the shelf, you get a B/high pass. So if that is how OP's school works, they might want to keep up on the Step 1 Anki cards that cross over to Step 2 decks. Especially if they are an "average" test taker and their school uses NBME style questions. Keeping up with the Anki overlap alone will give them an advantage on content heavy shelfs like IM because they will just need to keep reviewing cards they have matured for months, instead of relearn it. Then just learn the new Step 2/shelf relevant stuff. And that also means more time and energy to focus on time spent in the hospital, compared to your peers that will be cramming 1800 UWorld questions and 7,000 Anki cards in 7 weeks for all the stuff they forgot for Step 1.

If OP's preclinical exams are 100% in-house and not similar to NBME's and/or his school doesn't require a certain shelf score to honor rotations, then most of what I said is less relevant, but it would still help for Step 2, which is now a make or break exam with no second chance.

 

[YCAGA]

Yeah, and I’m saying it doesn’t seem like it will be based on what some of the PDs are saying. We also had a meeting at my school with PDs from various specialties, and the general consensus was that step 2, your clinical performance in relevant rotations, and research. So basically all the same stuff, just step 2 instead of step 1. Obviously, this is still speculative and based on a small number of PDs, but the theme seems pretty common.

Yeah that is fair. This next part is the ultimate question of correlation or causation, but a large number of people who match into ultra-competitive specialties like ortho and derm are AOA. AOA people probably have better Step scores and resumes in addition to their high class rank, but it isn't like high class rank doesn't at least somewhat correlate with matching something competitive. All of that is to say I don't think OP is completely neurotic for caring about this, depending on their specialty goals.

Anyways, if I were them, I would focus on remaining "just average" preclinically, shadowing specialties I am interested in to make connections early, getting involved in research, and keeping clinically relevant stuff fresh with Anki so they can hit the ground running third year.

 

[Matthew9Thirtyfive]

The only caveat is that OP should look into how clerkship grades are determined at their school.

This is a good point. Definitely helps when prioritizing your shelf studying.

 

[saltbreeze55]

Thank you everyone for taking the time to write these responses. I really appreciate it.

I have heard that a lot of step 2 material is actually from step 1, so the best prep for step 2 is to still try to really be prepared for step 1. Do you agree with this? I'm just worried because it does seem like each "phase" matters. For example, in order 2 do well on step 2, do well on step 1 (it will be p/f, but i'm guessing you'd have an idea of where you are based on practice exam scores). In order to do well on step 1, do the best you can in preclinical. I'm worried that me already being "average" feels like I'm already behind so many of my peers, and it's just going to get harder to catch up because there is just so much to know. I use Anking and unsuspend based on in house exam material and then add extra cards in a separate deck just for class. I try to unsuspend some based on 3rd party resources of material that in house exams doesn't cover, but I only get to this sometimes, but maybe I could try to cover this more as I go along? I know this probably sounds neurotic and I appreciate your comments that "just average" isn't something to be ashamed of. I think it's more coming from a place of fear/ imposter syndrome that I'm already behind so many of my peers because it seems like it comes so much easier for other people, and even if I try extra hard I still am stuck in the same place. Maybe other people just want to give off the perception that they're not trying as hard when they really are, I'm not sure though.

edit: TLDR; I want to be a great/ top med student so i can be a great doctor and also not close any doors for specialities or top residency programs, and I feel overwhelmed by how much there is and that I'm already behind, and worrying I will never be able to catch up and be a top student.

 

[YCAGA]

Thank you everyone for taking the time to write these responses. I really appreciate it.

I have heard that a lot of step 2 material is actually from step 1, so the best prep for step 2 is to still try to really be prepared for step 1. Do you agree with this? I'm just worried because it does seem like each "phase" matters. For example, in order 2 do well on step 2, do well on step 1 (it will be p/f, but i'm guessing you'd have an idea of where you are based on practice exam scores). In order to do well on step 1, do the best you can in preclinical. I'm worried that me already being "average" feels like I'm already behind so many of my peers, and it's just going to get harder to catch up because there is just so much to know. I use Anking and unsuspend based on in house exam material and then add extra cards in a separate deck just for class. I try to unsuspend some based on 3rd party resources of material that in house exams doesn't cover, but I only get to this sometimes, but maybe I could try to cover this more as I go along? I know this probably sounds neurotic and I appreciate your comments that "just average" isn't something to be ashamed of. I think it's more coming from a place of fear/ imposter syndrome that I'm already behind so many of my peers because it seems like it comes so much easier for other people, and even if I try extra hard I still am stuck in the same place. Maybe other people just want to give off the perception that they're not trying as hard when they really are, I'm not sure though.

You aren't average in the cohort of students that take step 1 though...you got to a top 40 school. You are average in your more elite cohort. Look up your school's average step 1 and I would not be surprised if it is 60-70th percentile. Keep that in mind. Also, people gunning for AOA preclinically very rarely keep up with Anking. They are cramming in house lectures each block and then purging it after the exam. If you keep up Anking all of preclinical, you are going to have a much stronger foundation of knowledge than someone who learns a bunch of PhD details for 4-6 weeks and then never thinks about that organ system again until Step 1 dedicated. That is just how human memory works.

It also is very unlikely you will get pimped on anything that was covered preclinically AND is not in Anking, if that makes sense. The chances of some big brain IM attending pimping you on an obscure Step 1 subject like biochemistry or embryology is pretty small, but if they do, it is most likely going to be something relatively high yield from Step 1. Just my opinion though. The main thing is that keeping up with Anking is that it will give you a solid foundation in physiology, pathology, pharm, and micro, which is all clinically relevant, for exams and getting pimped.

 

[Matthew9Thirtyfive]

It also is very unlikely you will get pimped on anything that was covered preclinically AND is not in Anking, if that makes sense. The chances of some big brain IM attending pimping you on an obscure Step 1 subject like biochemistry or embryology is pretty small, but if they do, it is most likely going to be something relatively high yield from Step 1. Just my opinion though. The main thing is that keeping up with Anking is that it will give you a solid foundation in physiology, pathology, pharm, and micro, which is all clinically relevant, for exams and getting pimped.

Agree with this mostly. The vast majority of the pimping I’ve gotten has been very step 2 stuff. I did get pimped pretty extensively on poiseuille’s law the other day though lol.

 

[YCAGA]

Agree with this mostly. The vast majority of the pimping I’ve gotten has been very step 2 stuff. I did get pimped pretty extensively on poiseuille’s law the other day though lol.

What speciality did that lol

 

[Matthew9Thirtyfive]

What speciality did that lol

Urology lol

 

[Redpancreas]

Current MS1 here at top 40 US MD school. It seems no matter how hard I study or whatever I try, I pretty much always score the class average or 2 or 3 percentage points lower on our block exams. I'm really aiming to be top 1/3 of my class (preclinical is only 1/3 weighted and clinical is weighted 2/3) and wondering if it is worth the pressure I've been putting on myself to do better on these exams or not. i'm wondering from a perspective of 1) if it is significant enough strictly from a grade standpoint that i can't keep doing average or a few points below and still graduate top 1/3 and 2) is this a sign that i'm doomed for mediocracy in clinical years as well? would putting in the effort to score better in preclinical translate to being better during clerkships?

Couple assumptions to consider below.

1. Assuming normal distribution and similar M2 performance you'll have to be in the top 25% to hit top third overall.

2. Assuming your school is somewhere around 40th research ranking on US News and you fall below top third, but do above average clinically, overall, have an overall good Step 2 CK (250+), research, and honors/high pass in critical rotations, you should still be able to match a competitive field.

I don't think pushing yourself to the point of insanity now is worth it, but it will be critical to maintain the performance you have now and may also be helpful to invest time in finding/completing a research project now. In terms of preclinical to clinical correlation it's tough to say for certain given variables like how M3 is graded at your school. In general, those who do well on MCQs on M1/2 exams replicate that on M3/M4 on shelf exams, but there are obviously clinical evaluations that are a different ball game (albeit an unpredictable one). I would, at this point, focus on learning the material as well as you can and try to find a research project in your field of your interest. If the rest of your profile is above average, you shouldn't have any issues come ERAS time.

 

[Osteosaur]

No idea how things will be now that USMLE is gone.

But its very easy during M1 and M2 to fall down the rabbit hole of tying your whole self worth to how many ion channels you can remember on a Nephro exam. Its awful and the feeling goes away.

 

[saltbreeze55]

Thank you all so much. This is all really solid advice and I appreciate everyone being so supportive and helpful.

 

[Jeff0302]

I am in the same boat - top 40 and making Cs. I've been told by many NOT to ready books - just to repeat lectures. Memorize it all and repeat with Anki and then some practice testing. Is it true that no one reads books anymore? I'm just tyring to find a blend that works for me, and its been 60% lecture 30% memorization (Anki, Sketchy) and 10% practice questions (USMLE RX, BNB, Kaplan Test, AMBOSS). How do you all split your time percentage wise? I'm an MS1 in an organ based systems program.

A) Lectures and review of lectures
B) Memorization with Anki or Sketchy
C) Reading actual Books like Robbins Pathology or Gutton Hall Physiology
D) Practice questions using test banks like USMLE RX, BNB, Kaplan, AMBOSS

 

[Matthew9Thirtyfive]

I am in the same boat - top 40 and making Cs. I've been told by many NOT to ready books - just to repeat lectures. Memorize it all and repeat with Anki and then some practice testing. Is it true that no one reads books anymore? I'm just tyring to find a blend that works for me, and its been 60% lecture 30% memorization (Anki, Sketchy) and 10% practice questions (USMLE RX, BNB, Kaplan Test, AMBOSS). How do you all split your time percentage wise? I'm an MS1 in an organ based systems program.

A) Lectures and review of lectures
B) Memorization with Anki or Sketchy
C) Reading actual Books like Robbins Pathology or Gutton Hall Physiology
D) Practice questions using test banks like USMLE RX, BNB, Kaplan, AMBOSS

Some people read. It’s one of the least efficient methods of learning, so most people don’t. Questions is your most active learning method, followed by anki.

 

[mmchick]

Some people read. It’s one of the least efficient methods of learning, so most people don’t. Questions is your most active learning method, followed by anki.

I am in the same boat - top 40 and making Cs. I've been told by many NOT to ready books - just to repeat lectures. Memorize it all and repeat with Anki and then some practice testing. Is it true that no one reads books anymore? I'm just tyring to find a blend that works for me, and its been 60% lecture 30% memorization (Anki, Sketchy) and 10% practice questions (USMLE RX, BNB, Kaplan Test, AMBOSS). How do you all split your time percentage wise? I'm an MS1 in an organ based systems program.

A) Lectures and review of lectures
B) Memorization with Anki or Sketchy
C) Reading actual Books like Robbins Pathology or Gutton Hall Physiology
D) Practice questions using test banks like USMLE RX, BNB, Kaplan, AMBOSS

Additionally the most effective tool for long-term retention is spaced recall. It fascinates me that people believe they will be able to memorize something after only having been exposed to it 1-2 times... then expect to know it a year from now on Step or years from now during rotations. The review you do in prep for Step months later after you've seen the material and years later during rotations is what makes it automatic to recall while practicing several years down the line. I never let not remembering something that is relatively new stress me out - recalling it actively is a step forward in coding it for a lifetime. People tend to forget that this short-term memory loss + recall is very much an important step in learning.

 

[Matthew9Thirtyfive]

Additionally the most effective tool for long-term retention is spaced recall.

Yeah, this is literally the entire function of anki.