So I wanted to get some community thoughts on this. I'm still trying to understand the inner workings of all the grade implications for M1 and M2 years. I'm an M1 at a US MD school that does A,B,C,F grading (not pass-fail). I don't think that there is a competitive environment at my school to make top grades, it's more of a camaraderie-type atmosphere, which is great. I have read all the residency reports as to how much grades matter from the first 2 years.. aka not that much.. and that there are way more valuable things to do well on (step 1, clerkships, etc.). HOWEVER, here is where my questions come in. Class rank has to matter somewhat, being in the top 25% in your class if you're shooting for AOA is a must as well. So why do people that go to pass-fail schools seem to not care at all about grades and go out 3-4 times a week, etc. You still get put into a class rank at a pass-fail school, do you not? Being in the bottom 25% of your class on your CV also seems to have bad implications. When it comes to residency, is every school required to put your GPA/rank even if they were pass-fail? (I heard rumors that Stanford med does not release the class-rank of any students as long as they're passing, true?). I know the ultimate goal is to do well on boards and come out as a well-trained doctor.. and I understand that people have different goals for themselves. But I don't understand how some people just seem not to care. I've heard that being in AOA is a giant leg-up for applying to competitive residencies in rads, onc, derm, surg.. so why do people not seem concerned with being in the top 25% of their class? Thoughts?