Priorities in Med School

[Dr. Scribe]

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Hey everyone,

It looks like my school decides AOA nominations based on clinical grades, STEP1, and ECs (in that order).

So, I'm gonna prioritize board prep and research output over gunning for honors in my courses. I think I can still pull Pass with Commendation since I'm gonna study hard, but not kill myself trying to memorize every detail from lectures.

Does this plan sound okay, or do program directors really value class rank and pre-clinical grades that much?

Thanks

 

[Med Ed]

So, I'm gonna prioritize board prep and research output over gunning for honors in my courses.

Or, do both.

 

[Dr. Scribe]

Or, do both.

I'll like your comment since you're obviously like baiting.

But seriously, if I really want honors, I'll have to devote more time to studying instead of research. At what point is there diminishing returns in research and honors becomes more important?

 

[ciestar]

From the PD’s I’ve talked to, pre-clinical grades really don’t matter. They don’t place priority on getting honors for pre-clinical courses.. and so many schools have moved to P/F so maybe that is reflective of this? But, pre-clinical performance is probably the best indicator of how you’ll do on step 1.

 

[Med Ed]

I'll like your comment since you're obviously like baiting.

But seriously, if I really want honors, I'll have to devote more time to studying instead of research. At what point is there diminishing returns in research and honors becomes more important?

You listed three things: board prep, research, and courses. Doing well in coursework is prepping for boards. Nobody has significant time for research when preclinical courses are underway. So in the end there isn't much to prioritize.

 

[Dr. Scribe]

You listed three things: board prep, research, and courses. Doing well in coursework is prepping for boards. Nobody has significant time for research when preclinical courses are underway. So in the end there isn't much to prioritize.

From the PD’s I’ve talked to, pre-clinical grades really don’t matter. They don’t place priority on getting honors for pre-clinical courses.. and so many schools have moved to P/F so maybe that is reflective of this? But, pre-clinical performance is probably the best indicator of how you’ll do on step 1.

I agree with what you two are saying to an extent. Prepping for classes will prepare one for boards, assuming that the classes are always focused on board relevant material.

Only problem is: they aren't! We have a lot of lecturers (PhDs) who lecture us on minutiae that isn't board relevant (not in FA, Zanki, or B&B).

I'm asking whether I should just focus on learning board relevant material extremely well and not worrying so much about irrelevant details, as this way I will have more time for research output. (and apparently PDs don't care about class grades so why should I?)

 

[Med Ed]

I agree with what you two are saying to an extent. Prepping for classes will prepare one for boards, assuming that the classes are always focused on board relevant material.

Only problem is: they aren't! We have a lot of lecturers (PhDs) who lecture us on minutiae that isn't board relevant (not in FA, Zanki, or B&B).

Board prep materials focus on material that is considered "high yield", although how they determine yield is never fully explained.

Experts are writing new board questions all the time, so what is "board relevant" is never truly knowable. A faculty group that writes many of the biochemistry questions is convening soon to start revamping their general approach to question writing, migrating away from factual recall and toward application. Other disciplines may follow suit, although this trend has already been in progress for awhile.

If you are a real go-getter you could approach your school's administration and ask for data on the correlation between pre-clinical course performance and step 1 score. If there is reasonable correlation then focus on courses. If there is no correlation then aim for P's and do FA/Zanki/B&B/whatever.

 

[Goro]

Board prep materials focus on material that is considered "high yield", although how they determine yield is never fully explained.

Experts are writing new board questions all the time, so what is "board relevant" is never truly knowable. A faculty group that writes many of the biochemistry questions is convening soon to start revamping their general approach to question writing, migrating away from factual recall and toward application. Other disciplines may follow suit, although this trend has already been in progress for awhile.

If you are a real go-getter you could approach your school's administration and ask for data on the correlation between pre-clinical course performance and step 1 score. If there is reasonable correlation then focus on courses. If there is no correlation then aim for P's and do FA/Zanki/B&B/whatever.

There is a solid data at least from other schools, including mine that preclinical GPA is the best predictor for Board scores.
A very dangerous delusion that medical students have is the notion that all they need to know is in Board prep materials. It's not.

And a note for any DO students reading this. There is a major push by NBOME to get COMLEX to the level of USMLE, at least in style of board questions. Longer stems, more involved case presentations, and data tables to read.

 

[FindMeOnTheLinks]

I go to the same school as you, and I can tell you that the curriculum prepares very well for step 1. The first few weeks don't seem that way with the way they set up the course but I promise you that what you're learning will be useful. Basically almost everybody who honored all the preclerkship courses in my class did well on step 1 (>240 at least), where it was much more hit or miss for people who didn't honor all the pre clerkship courses. So that should give you some indication that it is important to do well in your courses. Just stick with it and try to learn everything you can, it's wayyyy too early to be worried about step 1 or research or any of that. Just focus on learning how to study and getting into a routine so that you have a good foundation.

 

[AnatomyGrey12]

And a note for any DO students reading this. There is a major push by NBOME to get COMLEX to the level of USMLE, at least in style of board questions. Longer stems, more involved case presentations, and data tables to read.

I hope that means the questions will be clearer. Even in COMBANK the difference between the COMLEX and USMLE questions is striking, with the USMLE questions more robust and clear. The COMLEX style ones are a crapshoot.

 

[Goro]

I hope that means the questions will be clearer. Even in COMBANK the difference between the COMLEX and USMLE questions is striking, with the USMLE questions more robust and clear. The COMLEX style ones are a crapshoot.

One thing at a time!!!!!

 

[Med Ed]

I go to the same school as you, and I can tell you that the curriculum prepares very well for step 1. The first few weeks don't seem that way with the way they set up the course but I promise you that what you're learning will be useful. Basically almost everybody who honored all the preclerkship courses in my class did well on step 1 (>240 at least), where it was much more hit or miss for people who didn't honor all the pre clerkship courses. So that should give you some indication that it is important to do well in your courses. Just stick with it and try to learn everything you can, it's wayyyy too early to be worried about step 1 or research or any of that. Just focus on learning how to study and getting into a routine so that you have a good foundation.

Excellent advice.

 

[Black Coffee 24/7]

There is a solid data at least from other schools, including mine that preclinical GPA is the best predictor for Board scores.
A very dangerous delusion that medical students have is the notion that all they need to know is in Board prep materials. It's not.

And a note for any DO students reading this. There is a major push by NBOME to get COMLEX to the level of USMLE, at least in style of board questions. Longer stems, more involved case presentations, and data tables to read.

ROFL. That means more trash questions. The biggest myth about the Comlex is that it’s a bunch of first order questions. It’s that way for the Comsae. However, on the Comlex, the stems are 1.5 longer than USMLE quests testing 1st or 2nd order quests with bs quests from Level 2. Let’s not forget the 70 secs per quest on the Comlex where you get actually 90 secs for each USMLE quest with shorter stem.

 

[Goro]

ROFL. That means more trash questions. The biggest myth about the Comlex is that it’s a bunch of first order questions. It’s that way for the Comsae. However, on the Comlex, the stems are 1.5 longer than USMLE quests testing 1st or 2nd order quests with bs quests from Level 2. Let’s not forget the 70 secs per quest on the Comlex where you get actually 90 secs for each USMLE quest with shorter stem.

Not making the news, just reporting it.
I don't know where anyone with half a brain would think that COMPLEX is first order questions. We're specifically forbidden by NBOME to use them when we write for COMPLEX.

70 sec /item? This is news to me. We 'be always worked at a clip of 90 sec. It was the case for all the times I've sat for COMPLEX as well.

Yes, we Faculty can take COMLEX. We need to know what it's like out in the field

 

[deleted645092]

Everything you get taught in classes is relevant for boards and can show up on boards. The best indicator of board performance is preclinical performance, and has been proven over and over.

The thing about board prep materials is that they're considered the absolute minimum you need to know and can get you a 220 or so, but you aren't going to blow the boards out of the water using them exclusively.

Also I'd like to know who told you that your class material isn't in any of all 3 of those resources. If you haven't personally gone through them all, especially BnB, do you really trust that info?

 

[Aerus]

Everything you get taught in classes is relevant for boards and can show up on boards. The best indicator of board performance is preclinical performance, and has been proven over and over.

The thing about board prep materials is that they're considered the absolute minimum you need to know and can get you a 220 or so, but you aren't going to blow the boards out of the water using them exclusively.

Also I'd like to know who told you that your class material isn't in any of all 3 of those resources. If you haven't personally gone through them all, especially BnB, do you really trust that info?

Speaking on behalf of my school, we get taught a lot of clinically relevant information that is useful for wards and perhaps Step 2, but is not tested on Step 1. Therefore, there is a lot of outside studying that needs to be done, since our curriculum does not come close to covering everything needed to know for Step 1. Because of this, there are people each year who almost completely ignore our curriculum and crush Step 1, even if they barely pass our class exams.

 

[deleted645092]

Speaking on behalf of my school, we get taught a lot of clinically relevant information that is useful for wards and perhaps Step 2, but is not tested on Step 1. Therefore, there is a lot of outside studying that needs to be done, since our curriculum does not come close to covering everything needed to know for Step 1. Because of this, there are people each year who almost completely ignore our curriculum and crush Step 1, even if they barely pass our class exams.

I'm glad my school has their priorities straight when it comes to our preclinical coursework then. Outside of a few extra minutiae that our professors might emphasize because it's relevant to their research in 1 or 2 lectures per block, and the clinical courses they throw at us 2nd year (internal medicine and surgery), there wasn't really anything taught in class that wasn't relevant to boards and that I would consider a waste of time. If anything I had to supplement the coursework with material in the other resources.

Sorry if your schools are completely different and your professors teach random minutiae, making my advice irrelevant.

 

[Aerus]

I'm glad my school has their priorities straight when it comes to our preclinical coursework then. Outside of a few extra minutiae that our professors might emphasize because it's relevant to their research in 1 or 2 lectures per block, and the clinical courses they throw at us 2nd year (internal medicine and surgery), there wasn't really anything taught in class that wasn't relevant to boards and that I would consider a waste of time. If anything I had to supplement the coursework with material in the other resources.

Sorry if your schools are completely different and your professors teach random minutiae, making my advice irrelevant.

As far as I know, your curriculum is not the norm being very focused on Step 1. I'm sure many, if not all students would prefer a curriculum like that.

Most schools try to supplement their curriculum with a lot of outside information that they find useful to clinicians outside just basic science, like social sciences, clinical practice, and other stuff. The logic is that schools should not let NBME dictate medical education and that there's more to being a clinician than First Aid. Because of this, though, our school's students typically excel during the third year clerkships and fourth year away rotations, at the cost of having a more stressful preclinical experience with Step 1.

 

[sunshinefl]

As far as I know, your curriculum is not the norm being very focused on Step 1. I'm sure many, if not all students would prefer a curriculum like that.

Most schools try to supplement their curriculum with a lot of outside information that they find useful to clinicians outside just basic science, like social sciences, clinical practice, and other stuff. The logic is that schools should not let NBME dictate medical education and that there's more to being a clinician than First Aid. Because of this, though, our school's students typically excel during the third year clerkships and fourth year away rotations, at the cost of having a more stressful preclinical experience with Step 1.

See, I’m not sure where the line should be drawn. How much clinical/Step 2 stuff should we already have an introduction to or competence in before starting 3rd year core rotations. This is something I have pondered myself and I honestly don’t know the answer. At some point you have to learn the clinical medicine, should that really all be learned on the fly during clerkships post-Step 1?

 

[Aerus]

See, I’m not sure where the line should be drawn. How much clinical/Step 2 stuff should we already have an introduction to or competence in before starting 3rd year core rotations. This is something I have pondered myself and I honestly don’t know the answer. At some point you have to learn the clinical medicine, should that really all be learned on the fly during clerkships post-Step 1?

That reasoning is always what admin at many schools use to justify not completely focusing on just First Aid material. It's a tough question with no answers.

 

[Angus Avagadro]

Speaking on behalf of my school, we get taught a lot of clinically relevant information that is useful for wards and perhaps Step 2, but is not tested on Step 1. Therefore, there is a lot of outside studying that needs to be done, since our curriculum does not come close to covering everything needed to know for Step 1. Because of this, there are people each year who almost completely ignore our curriculum and crush Step 1, even if they barely pass our class exams.

I would believe these students are in the minority. As GORO likes to say, these people think they are going to rush in at the last second, sink a 3 pointer and win the game. Low preclinical grades with a high board score,(RARE), would signify to PD a bright but lazy student. A bad combination in medicine.It would be a red flag for me and probably a NO vote.

 

[Dr. Scribe]

I would believe these students are in the minority. As GORO likes to say, these people think they are going to rush in at the last second, sink a 3 pointer and win the game. Low preclinical grades with a high board score,(RARE), would signify to PD a bright but lazy student. A bad combination in medicine.It would be a red flag for me and probably a NO vote.

Define "low preclinical grades"

Sure, having to remediate courses might be a red flag. But, if a student passes all his/her courses on the 1st try, has great research output, and kills boards, why would a PD care if the student passed or honored his/her courses?

 

[Angus Avagadro]

I would believe these students are in the minority. As GORO likes to say, these people think they are going to rush in at the last second, sink a 3 pointer and win the game. Low preclinical grades with a high board score,(RARE), would signify to PD a bright but lazy student. A bad combination in medicine.It would be a red flag for me and probably a NO vote.

Define "low preclinical grades"

Sure, having to remediate courses might be a red flag. But, if a student passes all his/her courses on the 1st try, has great research output, and kills boards, why would a PD care if the student passed or honored his/her courses?

Bottom third of the class= Poor preclinical grades

PD would care because there are lots of candidates who graduates in top third, killed boards, and has great research output . Especially for competetive spots

 

[Goro]

This is incorrect.

Gitta ask, Huggy, what year are you?

 

[Aerus]

I would believe these students are in the minority. As GORO likes to say, these people think they are going to rush in at the last second, sink a 3 pointer and win the game. Low preclinical grades with a high board score,(RARE), would signify to PD a bright but lazy student. A bad combination in medicine.It would be a red flag for me and probably a NO vote.

Note that I said they ignore class material which means they are using that time to study board material, not that they are "rushing in at the last second". There are people in our class who go so far as skipping TBL's (which cost you points in our grade but no professionalism issues since you just lose points) just to study for Step 1.

My school does true P/NP first two years. Grades are only reported as Pass or Fail on all our courses. Our school rankings are determined solely on Step 1 score and Clinical grades, so there is actually a significant portion of the class who ignores class material as there is an incentive to.

 

[Angus Avagadro]

Note that I said they ignore class material which means they are using that time to study board material, not that they are "rushing in at the last second". There are people in our class who go so far as skipping TBL's (which cost you points in our grade but no professionalism issues since you just lose points) just to study for Step 1.

My school does true P/NP first two years. Grades are only reported as Pass or Fail on all our courses. Our school rankings are determined solely on Step 1 score and Clinical grades, so there is actually a significant portion of the class who ignores class material as there is an incentive to.

Interesting way to assess class rank. I was never in favor of pass fail scoring, especially with people who mastered the material awarded the same evaluation as those who barely squeaked past. PDs have less information to evaluate candidates. As I have said in earlier posts, low pre clinical grades and high board scores would indicate a bright and lazy student. Now, good clinical grades are certainly a plus, hard to get if you are lazy. So I think I'm ok with how your school assess class rank. Thank you for your post