Pros vs. cons of pass/fail clinical years

[and 99 others]

I am at a mid-tier MD school that is true pass/fail preclin. I just found out that M3 and M4 will also likely be just pass/fail. No honors or high pass or anything. I'm wondering what the advantages and disadvantages are to this. It's nice not to have to worry about reaching a high pass or anything but at the same time, is it obvious to residencies that pass is the highest grade at my school? or will they assume that high pass or honors were available and that I just didn't acheive them? Are there any other factors I may be overlooking? Thanks!

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[NotAProgDirector]

It's totally obvious to programs, so you don't need worry about that.

The problem programs face is that with all P/F courses and P/F S1, what is there left to assess your performance? Everyone's LOR's say that you're in the top 1-5% of everyone they have ever worked with. MSPE's often not very helpful when all P/F.

The Lerner school at Case (it's a subgroup of their students) has been P/F for a long time, all courses, everything. Whom we pick for interviews often ends up based solely on S2, and random things we find in their applications. One year I was frustrated enough I called the dept letter writer and asked for help. They told me to interview them all. I invited none of them.

 

[GoSpursGo]

is it obvious to residencies that pass is the highest grade at my school?

Yes. This will be spelled out in your MSPE.

It all depends on your perspective. On the one hand, you don't have to feel the need to "gun" for honors. At the same time, you have no way of distinguishing yourself clinically and this thus increases the importance of your step 2 score and research output.

As pointed out by @NotAProgDirector who beat me to it, this is maddening on the residency side who have nothing to go on when evaluating students. For better or worse, schools seem to have prioritized not having to criticize below-average students over being able to highlight the truly outstanding students, and whether that is a good or bad thing depends on whether you are above or below average.

 

[Lawpy]

It's totally obvious to programs, so you don't need worry about that.

The problem programs face is that with all P/F courses and P/F S1, what is there left to assess your performance? Everyone's LOR's say that you're in the top 1-5% of everyone they have ever worked with. MSPE's often not very helpful when all P/F.

The Lerner school at Case (it's a subgroup of their students) has been P/F for a long time, all courses, everything. Whom we pick for interviews often ends up based solely on S2, and random things we find in their applications. One year I was frustrated enough I called the dept letter writer and asked for help. They told me to interview them all. I invited none of them.

You interviewed none from Lerner? I thought you could just rely on the school prestige

 

[Lawpy]

I am at a mid-tier MD school that is true pass/fail preclin. I just found out that M3 and M4 will also likely be just pass/fail. No honors or high pass or anything. I'm wondering what the advantages and disadvantages are to this. It's nice not to have to worry about reaching a high pass or anything but at the same time, is it obvious to residencies that pass is the highest grade at my school? or will they assume that high pass or honors were available and that I just didn't acheive them? Are there any other factors I may be overlooking? Thanks!

I don’t know why your school decided to do that. The top schools can get away with P/F in everything because they have the prestige and massive resources/networking to do so. A mid tier doing that is self defeating and unnecessarily severely handicaps the students. Bad move from the admins

Also this is yet another reason why making Step 1 P/F was a completely idiotic idea

 

[srirachamayonnaise]

I am at a mid-tier MD school that is true pass/fail preclin. I just found out that M3 and M4 will also likely be just pass/fail. No honors or high pass or anything. I'm wondering what the advantages and disadvantages are to this. It's nice not to have to worry about reaching a high pass or anything but at the same time, is it obvious to residencies that pass is the highest grade at my school? or will they assume that high pass or honors were available and that I just didn't acheive them? Are there any other factors I may be overlooking? Thanks!

At a t5 P/F only school, pretty chill on rotations. But you are expected to have an H in your chosen field in fourth year before ERAS. As previous posters have said, we can get away with this non-distinction, because most PD’s would be happy to get everyone from my school. Mid-tier with no grades sounds rough for your ERAS.

 

[collegestud2013]

I am at a mid-tier MD school that is true pass/fail preclin. I just found out that M3 and M4 will also likely be just pass/fail. No honors or high pass or anything. I'm wondering what the advantages and disadvantages are to this. It's nice not to have to worry about reaching a high pass or anything but at the same time, is it obvious to residencies that pass is the highest grade at my school? or will they assume that high pass or honors were available and that I just didn't acheive them? Are there any other factors I may be overlooking? Thanks!

Schools are supposed to be provide some information to residency programs in the MSPE about how students are graded and ranked. A lot of schools may vaguely code it into superlatives like "Excellent" or "Very good" or "Highest recommendation," and it's totally school-dependent what each means. But schools do disclose this, so unless you're coming from a brand new med school, most residency programs will be somewhat familiar with your school's grading system.

A true P/F system would probably be beneficial for most students in the school. While the main argument against it is that it does not allow top students to be identified and can hinder them from getting into a competitive specialty (especially if coming from a lower tier school without much "brand name" or reputation), it probably allows for a better work-life balance in M1-M3 years of med school for the entire class without hindering most of them in the residency app process. It will also help those at the bottom a bit (especially those with poor grades but average or above average Step scores).

For students who are interested in less competitive specialties like IM, FM, or peds would make med school a lot less stressful without some of the B.S. that everyone in the past had to go through. In a graded and ranked system, too much effort and time is spent working much harder trying to outdo the rest of the class just for a few extra points on each exam or course (eg there is usually a lot more studying required to boost your grade from a 90 to a 96 than from a 70 to 76). True P/F curriculums opens up more time for stuff like research that will be more important for competitive specialties. Of course Step 2 CK will just become even more high stakes now that Step 2 and all of med school is P/F.

 

[NotAProgDirector]

Schools are supposed to be provide some information to residency programs in the MSPE about how students are graded and ranked. A lot of schools may vaguely code it into superlatives like "Excellent" or "Very good" or "Highest recommendation," and it's totally school-dependent what each means. But schools do disclose this, so unless you're coming from a brand new med school, most residency programs will be somewhat familiar with your school's grading system.

Schools that are P/F always state that because of their P/F curriculum, they cannot rank or quartile their students and instead I'm supposed to do a holistic review, whatever that is.

 

[aldol16]

Your MSPE should mention that pass is the highest grade from your school. They care more about your board scores anyway - well, nowadays only Step 2 since Step 1 is also pass fail. This is the exact reason, by the way, why making Step 1 pass fail was such a bad idea. You need to perform well on Step 2 now because there is no other way for residencies to distinguish you from your peers or from applicants across the country.

 

[ItAintEasyBeingCheesy]

It's totally obvious to programs, so you don't need worry about that.

The problem programs face is that with all P/F courses and P/F S1, what is there left to assess your performance? Everyone's LOR's say that you're in the top 1-5% of everyone they have ever worked with. MSPE's often not very helpful when all P/F.

The Lerner school at Case (it's a subgroup of their students) has been P/F for a long time, all courses, everything. Whom we pick for interviews often ends up based solely on S2, and random things we find in their applications. One year I was frustrated enough I called the dept letter writer and asked for help. They told me to interview them all. I invited none of them.

When applying to competitive specialties like derm/ortho, would a P/F 3rd year applicant be assumed to be equivalent to say a half honors/HP applicant?

 

[GoSpursGo]

When applying to competitive specialties like derm/ortho, would a P/F 3rd year applicant be assumed to be equivalent to say a half honors/HP applicant?

Nobody knows. This is why it’s infuriating

 

[ItAintEasyBeingCheesy]

Do below average clerkship grades still hurt you if coming from a T10 or do they matter less now given that so many of their peer institutions are P/F clerkships?

 

[Lawpy]

Do below average clerkship grades still hurt you if coming from a T10 or do they matter less now given that so many of their peer institutions are P/F clerkships?

Nobody knows. This is why it’s infuriating

^

 

[GoSpursGo]

Do below average clerkship grades still hurt you if coming from a T10 or do they matter less now given that so many of their peer institutions are P/F clerkships?

Yes, they hurt you. Obviously you still gain the benefit of your institution’s name, but you will not be on bar with your classmates who did better.

Again, whether P/F helps or hurts you depends on whether you would naturally be in the top half or bottom half of your class

 

[Mr.Smile12]

Schools that are P/F always state that because of their P/F curriculum, they cannot rank or quartile their students and instead I'm supposed to do a holistic review, whatever that is.

Lake Wobegon University School of Medicine probably needs to be told how useless their MSPEs are. I'm guessing other PDs are fine with the rubber stamp that the student isn't a liability.

 

[Lawpy]

Can we just talk about the central issue here?

Instead of dealing directly with the problem of overapplication, we’re placing an absurdly high weight on extremely subjective and easily corrupted metrics in MS3 clinical grades and shifting all the problems of Step 1 mania into Step 2.

 

[operaman]

Can we just talk about the central issue here?

Instead of dealing directly with the problem of overapplication, we’re placing an absurdly high weight on extremely subjective and easily corrupted metrics in MS3 clinical grades and shifting all the problems of Step 1 mania into Step 2.

And also obfuscated another central truth: not all medical students are equal. Some are better than others.

Making it harder to tell them apart only makes it harder for programs, and ultimately does some disservice to all their top students who now look suspiciously like the bottom ones.

 

[ItAintEasyBeingCheesy]

Yes, they hurt you. Obviously you still gain the benefit of your institution’s name, but you will not be on bar with your classmates who did better.

Again, whether P/F helps or hurts you depends on whether you would naturally be in the top half or bottom half of your class

Yes, clearly they’d hurt compared to classmates at the same school who did better. But how would they compare to applicants from other peer institutions with P/F clerkships, would they be viewed about the same?

 

[collegestud2013]

Yes, clearly they’d hurt compared to classmates at the same school who did better. But how would they compare to applicants from other peer institutions with P/F clerkships, would they be viewed about the same?

Yes, would probably hurt a bit relatively speaking assuming everything else about their app was identical. In a P/F system, everyone who has all passes will assumed to be near the middle/average, except for those who failed a course and had to remediate it (assuming this is reported on the MSPE). However, being towards the bottom of graded Top tier med school obviously hurt as much as being at the the bottom of the bottom. Programs however will likely use Step 2 as the main point of separating applicants now.

The switch from P/F Step 1 and move toward more med schools being P/F across all 4 years has been hypothesized to help those at top brand-name or reputable med schools. Connections, research and med school reputation are now becoming bigger factors in the residency selection process when grades and Step 1 scores can't differentiate applicants. So strong applicants new and "no name" MD schools, DOs, and IMGs will be probably be hurt the most. by the change, will weaker applicants at top tier med schools probably benefit the most.

 

[Darrow O'Lykos]

It's totally obvious to programs, so you don't need worry about that.

The problem programs face is that with all P/F courses and P/F S1, what is there left to assess your performance? Everyone's LOR's say that you're in the top 1-5% of everyone they have ever worked with. MSPE's often not very helpful when all P/F.

The Lerner school at Case (it's a subgroup of their students) has been P/F for a long time, all courses, everything. Whom we pick for interviews often ends up based solely on S2, and random things we find in their applications. One year I was frustrated enough I called the dept letter writer and asked for help. They told me to interview them all. I invited none of them.

I am shocked that a department head would be that pompous and/or naive as to suggest that. Yikes.

 

[deleted1095841]

How much detail to schools typically provide regarding clinical grades on the MSPE? Is it just the grade for each clerkship and the distribution of grades (e.g. Internal Medicine: Grade: HP, with distribution 40% H, 40% HP, 20% P)?

 

[collegestud2013]

How much detail to schools typically provide regarding clinical grades on the MSPE? Is it just the grade for each clerkship and the distribution of grades (e.g. Internal Medicine: Grade: HP, with distribution 40% H, 40% HP, 20% P)?

Grade with grade distribution in your class. So if your school is grade inflated and gives nearly everyone honors, residency programs will probably know if their faculty look thoroughly enough at the MSPE and that would obviously dilute the value of Honors. Also, there's a narrative summary paragraph for each clerkship too (and this can get people into more trouble when applying for residencies more so than a lower grade if there's negative or even lukewarm comments in any paragraph).

 

[NotAProgDirector]

How much detail to schools typically provide regarding clinical grades on the MSPE? Is it just the grade for each clerkship and the distribution of grades (e.g. Internal Medicine: Grade: HP, with distribution 40% H, 40% HP, 20% P)?

School dependent. There is almost always a breakdown of the distribution of grades. There's also usually lots of text comments from your evaluators. Some schools edit those, and some (theoretically) report them verbatim. Some schools break down your performance at a more detailed level, reporting clinical grade, NBME score, OSCE's, and whatever else may go into the grading rubric.

Does anyone know how common it is for someone to honor all their rotations? is this a common occurance at grade inflated clinical programs? is there statistical data on percentage of students achieving honors on all rotations? I heard that it is very difficult to acieve all honors and only a very small percentage achieve all honors. I guess I can just ask my school dean.

Very school dependent.

 

[Med Ed]

And also obfuscated another central truth: not all medical students are equal. Some are better than others.

The problem is with the students in the middle. In every class there are some exceptional students, basically acting like PGY-2s at the end of third year. Invariable there are also some students at the other end of the spectrum. Those two groups are relatively easy to define.

But in the middle, students show up, do their work, learn and express their knowledge, and get along with others. And unless the school runs some sort of longitudinal clerkship model, those doing the evaluating have only a snapshot on which to base their evaluations.

For that big lump in the center of the distribution I've never been convinced it is even possible to differentiate them in a truly meaningful way. That's part of the reason why we rely so heavily on shelf exams to assign clerkship grades.

 

[Captain_Falcon]

my school has P/F preclinical, but If you end up with >/= 89.5 average then you get a distinction on your MSPE. The MSPE otherwise shows overall clerkship grade (H/HP/P/F) with a bar graph showing the distribution of grades per each clerkship. At the end there is a summary description with another bar graph showing your overall 3rd year academic performance as well as the distribution of the class (ie Excellent, Outstanding, Very Good, and Good).

No description of shelf scores, though it is states our overall clerkship grade is derived from 2/3 evals and 1/3 shelf score

 

[ChordaEpiphany]

Maybe this is too cynical, but it feels like going P/F is just another way to push students into extra education and free labor.

Sure it's marketed as a way to decrease stress, but if anything it concentrates all that stress into smaller and smaller time periods. When preclinical went largely P/F, it concentrated all of that stress and work onto a single exam day with a very flawed exam. Then step 1 went P/F and now only 1 year of med school even matters. Now some IM residencies are claiming they won't even look at step 2, and more and more schools are going clinical P/F.

So what's left to distinguish yourself?

1) School name. So absolutely forget being close to family or picking a school based on culture or cost, everything relies on the brand name value.

2) Extra accomplishments and years of education. Now students will be taking research years left and right and stacking degrees in an effort to stand out. More labor for the academic labs. More tuition for the school.

It's also very obviously a way to allow top PDs to just pick what their residency class looks like without any justification (e.g., T10 grads, URM quotas, favors to colleagues, etc...), and it takes the burden off of medical schools to educate and produce top grads.

I can't see how this can be at all good for students or encourage any sort of equity. Top med schools will continue to admit students who were privileged enough to begin their admissions journey shortly after birth (or at least upon entering college). Doctors will continue to burn out as they push their education into their 30s and even 40s. Medicine desperately needs a more aggressive "up or out" culture, and instead we're moving in the other direction.

 

[Lawpy]

Maybe this is too cynical, but it feels like going P/F is just another way to push students into extra education and free labor.

Sure it's marketed as a way to decrease stress, but if anything it concentrates all that stress into smaller and smaller time periods. When preclinical went largely P/F, it concentrated all of that stress and work onto a single exam day with a very flawed exam. Then step 1 went P/F and now only 1 year of med school even matters. Now some IM residencies are claiming they won't even look at step 2, and more and more schools are going clinical P/F.

So what's left to distinguish yourself?

1) School name. So absolutely forget being close to family or picking a school based on culture or cost, everything relies on the brand name value.

2) Extra accomplishments and years of education. Now students will be taking research years left and right and stacking degrees in an effort to stand out. More labor for the academic labs. More tuition for the school.

It's also very obviously a way to allow top PDs to just pick what their residency class looks like without any justification (e.g., T10 grads, URM quotas, favors to colleagues, etc...), and it takes the burden off of medical schools to educate and produce top grads.

I can't see how this can be at all good for students or encourage any sort of equity. Top med schools will continue to admit students who were privileged enough to begin their admissions journey shortly after birth (or at least upon entering college). Doctors will continue to burn out as they push their education into their 30s and even 40s. Medicine desperately needs a more aggressive "up or out" culture, and instead we're moving in the other direction.

The answer involves directly addressing overapplication. Also we need a leadership change in medical education because the current leaders are causing more problems (see Step 1 P/F change, the recent shift to P/F clinical years etc) rather than solving them

 

[srirachamayonnaise]

Maybe this is too cynical, but it feels like going P/F is just another way to push students into extra education and free labor.

Sure it's marketed as a way to decrease stress, but if anything it concentrates all that stress into smaller and smaller time periods. When preclinical went largely P/F, it concentrated all of that stress and work onto a single exam day with a very flawed exam. Then step 1 went P/F and now only 1 year of med school even matters. Now some IM residencies are claiming they won't even look at step 2, and more and more schools are going clinical P/F.

So what's left to distinguish yourself?

1) School name. So absolutely forget being close to family or picking a school based on culture or cost, everything relies on the brand name value.

2) Extra accomplishments and years of education. Now students will be taking research years left and right and stacking degrees in an effort to stand out. More labor for the academic labs. More tuition for the school.

It's also very obviously a way to allow top PDs to just pick what their residency class looks like without any justification (e.g., T10 grads, URM quotas, favors to colleagues, etc...), and it takes the burden off of medical schools to educate and produce top grads.

I can't see how this can be at all good for students or encourage any sort of equity. Top med schools will continue to admit students who were privileged enough to begin their admissions journey shortly after birth (or at least upon entering college). Doctors will continue to burn out as they push their education into their 30s and even 40s. Medicine desperately needs a more aggressive "up or out" culture, and instead we're moving in the other direction.

Curious about which IM programs have said that about Step 2?

 

[Med Ed]

Also we need a leadership change in medical education because the current leaders are causing more problems (see Step 1 P/F change, the recent shift to P/F clinical years etc) rather than solving them

How long until you can join the fun?

 

[throwaway123342]

Yes, they hurt you. Obviously you still gain the benefit of your institution’s name, but you will not be on bar with your classmates who did better.

Again, whether P/F helps or hurts you depends on whether you would naturally be in the top half or bottom half of your class

Very doubtful of this opinion. Harvard across the board puts students in top programs. Surely some of them were at the bottom.

 

[GoSpursGo]

Very doubtful of this opinion. Harvard across the board puts students in top programs. Surely some of them were at the bottom.

I believe I said you still get the benefit of your institution’s name. If hypothetically someone got all P from Harvard, they would be at a disadvantage relative to the student from Harvard who got all H. You could still match well, because as you note, Harvard. It’s all relative.

Unsurprisingly, it is a moot point since it appears Harvard is pass/fail: Harvard Life.

 

[ChordaEpiphany]

Curious about which IM programs have said that about Step 2?

Some top tier PSTPs and maybe categorical, according to people from my program applying now. It's not an official policy, just something they're telling people as they apply/interview.

 

[srirachamayonnaise]

Some top tier PSTPs and maybe categorical, according to people from my program applying now. It's not an official policy, just something they're telling people as they apply/interview.

Interesting, since I started to hear that too from others applying now.

 

[catnip12]

But in the middle, students show up, do their work, learn and express their knowledge, and get along with others. And unless the school runs some sort of longitudinal clerkship model, those doing the evaluating have only a snapshot on which to base their evaluations.

For that big lump in the center of the distribution I've never been convinced it is even possible to differentiate them in a truly meaningful way. That's part of the reason why we rely so heavily on shelf exams to assign clerkship grades.

This reminds me of an episode of Malcom Gladwell's Revisionist history where he talks about the "Hare" vs the "Tortoise". How selecting for test taking aptitude in the end really doesn't correlate to the quality of lawyer one will become and his general inquiry into the question. I will just share it here cause I think it's interesting.

Source: Revisionist history episode

 

[i-doctor]

In the pursuit of fairness, we are actually going backwards. Eventually to achieve your goals you’ll need to prostitute yourself and sleep your way to the top (like in the Netflix series “Hollywood”). Welcome to the good old days…

We are halfway there. One can argue that forcing students to do research without pay for competitive specialties is already a form of exploitation/prostitution.