Residency directors ranked class rankings at number 7, after required clerkship grades, step 1 scores, senior electives in the specialty, number of honors grades (unclear if this means clinical or not), step 2 score, and step 2 CS pass. Preclinical grades per se were ranked number 12.
Green M, Jones P, Thomas JX Jr. Selection criteria for residency: results of a national program directors survey. Acad Med 2009; 84(3): 362-367.
What you present is true according to the study. However, the full picture is that number of honor grades (#4) and class rank (#7) both interrelated are top 7 out of
at least 14 different components of the criteria list. There are also extracurricular activities, interviews, personal statement, letters of recommendation, and other miscellaneous components that
are not incorporated into that 14 component chart.
Therefore, class rank, which is 50% determined by your preclinical grades at RFUMS, and number of honor grades, which may include preclinical grades, are ranked top 7 out of possibly 14-?? things that residency programs actually look at. When you interpret the data from this angle, you can see that preclinical grade has quite some impact on residency decisions. Top 7 out of at least more than 14 factors is quite alot of weight.
Also, look at it from this angle, if the published paper only listed 3 components as the factors in residency selection: #1 3rd year clerkship grade, #2 step 1, #3 grades in senior elective grade in specialty, it can easily be misinterpreted that #3 grades in senior elective grade is "who cares, they are least important."
Also the top 6 criteria can actually be condensed to 4 things: 1)3rd year clerkship grades, 2)step 1, 3)4th year elective grade, 4)step 2 (# of grades are redundant and overlap with each other) therefore, moving class rank closer to actually top 5 things out of at least 14 things. Again, residency programs also look at your interview, personal statement, extracurricular activities, and evaluations from Dean, attendings, researcher you worked with....list goes on so theres actually more than just 14 things because this study left out alot of selection factors. (perhaps extending the criteria list to 25+ things)
Also, it is certainly true that preclinical grades are used to determine class rank at many schools including ours. For the purposes of the study, however, program directors were considering preclinical grades alone (independent of their effects on class rank). Therefore their ranking preclinical grade at number 12 does not really apply to CMS's case.