MD Stressed with class/grades

[pillowsnice]

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So I was always told that pre clinical grades don't really matter much, but my school takes them into account for class rank apparently so I guess they do :/ I'm finishing MS2 and have felt overwhelmed with doing well in my courses as my class does very well on exams. It's kinda annoying because the average will be high 80s and getting two more questions correct can bump your percentile up by a lot. So, to be in the top quartile, you need to get mid 90s on exams and thus have to know the nit picky details well to be top. This has been stressing me out because I feel like I have to be nearly perfect on exams to do well. I was never like this in college, so I don't know why I'm feeling this way.

On a side note, I feel like clinical grades are more important imo, but with my class I don't know how easy it will be to get honors if this trend continues.

 

[.hematoma.]

The most important aspect of your application will be your Step 1 score, which is not necessarily correlated with class performance. If you can get a good class rank, great (and somewhat important for top specialties since it often plays a role in AOA determination). If not, it's not the end of the world. A low step 1 score is, for competitive specialties, a bad situation.

 

[Goro]

The most important aspect of your application will be your Step 1 score, which is not necessarily correlated with class performance. If you can get a good class rank, great (and somewhat important for top specialties since it often plays a role in AOA determination). If not, it's not the end of the world. A low step 1 score is, for competitive specialties, a bad situation.

Actually, one of the best predictors of Boards performance is pre-clinical GPA.

 

[deleted645092]

To be honest the difference between knowing the big-picture well and really getting into the nit-picky details is what’s going to make the difference between 50th and 75th percentiles from here on out. In classes, boards, and rotations.

Just as a single example, and without going into specifics, I got a question on Step 1 that literally asked what percent of patients with x disease got y complication. And it wasn’t a softball question that wanted 0, 25, 50, 75, 100%. It was 10, 20, 30, 40, or 50%. Did that single question boost/ lower my overall score? I dunno, but maybe if I’d gotten it correct I would have gotten a 250 instead of a 249.

It sucks but those details are the difference between being average and above average, because the bare minimum expectation is that you know enough to be average, or what would be considered big-picture stuff.

Edit: Also +1 to @Goro’s comment that preclinical GPA is the best indicator of board scores. It’s a weird situation where they’re lower on the list of “what’s important” from residency director surveys, but are still predictive of your board scores.

 

[Aerus]

Actually, one of the best predictors of Boards performance is pre-clinical GPA.

This might be more of the case with traditionally graded schools, since pre-clinical grades will determine things like AOA. For pure P/NP schools where AOA is determined just by Step 1 score, they would not exhibit this trend, as a lot of the low scorers on school exams will also consist of people who are intelligent, work hard, and have the capacity to score top on school exams, but willingly choose to focus more on board-focused material.

 

[Goro]

This might be more of the case with traditionally graded schools, since pre-clinical grades will determine things like AOA. For pure P/NP schools where AOA is determined just by Step 1 score, they would not exhibit this trend, as a lot of the low scorers on school exams will also consist of people who are intelligent, work hard, and have the capacity to score top on school exams, but willingly choose to focus more on board-focused material.

100% correct! It looks like I have qualify these types of comments from now on, or at least until we see what's discussed at the next few medical education conferences.

 

[PhillyMed777]

So, to be in the top quartile, you need to get mid 90s on exams and thus have to know the nit picky details well to be top. This has been stressing me out because I feel like I have to be nearly perfect on exams to do well. I was never like this in college, so I don't know why I'm feeling this way.

yep that's how it feels when you are aiming for >95% on every exam. Feels like life or death every time with zero room for error. I lived that life for 2 yrs straight. Was miserable. But yes, those of us that consistent "top" things are not magically doing it. we struggle, and fight to be there. It wont get easier unfortunately. You will beaten to a pulp for all of pre-clinical if you intend to continue to do well.

At my school correlation of preclinical grades was .7 (i.e very high)

 

[fantasticman221]

Actually, one of the best predictors of Boards performance is pre-clinical GPA.

Actually, one of the best predictors of Boards performance is pre-clinical GPA.

Wouldn't this be variable depending on the program? At my school, all of our exam averages are in the high 80s mid 90s, yet we have a average step score below 225.

 

[Birdstrike]

So I was always told that pre clinical grades don't really matter much, but my school takes them into account for class rank apparently so I guess they do :/ I'm finishing MS2 and have felt overwhelmed with doing well in my courses as my class does very well on exams. It's kinda annoying because the average will be high 80s and getting two more questions correct can bump your percentile up by a lot. So, to be in the top quartile, you need to get mid 90s on exams and thus have to know the nit picky details well to be top. This has been stressing me out because I feel like I have to be nearly perfect on exams to do well. I was never like this in college, so I don't know why I'm feeling this way.

On a side note, I feel like clinical grades are more important imo, but with my class I don't know how easy it will be to get honors if this trend continues.

Don't worry too much about this. Slow and steady wins the race. Just be consistent. Learn the material well as you can and let the chips fall where they may. The majority of doctors in this world, that you'd look up to, didn't get honors in medical school, and you have no idea which are which, do you? That being said, if you can get it, awesome. If not, you're in the majority with lots of good company and you'll do just fine, make good money and get a good job, because that's what doctors do.

 

[libertyyne]

This might be more of the case with traditionally graded schools, since pre-clinical grades will determine things like AOA. For pure P/NP schools where AOA is determined just by Step 1 score, they would not exhibit this trend, as a lot of the low scorers on school exams will also consist of people who are intelligent, work hard, and have the capacity to score top on school exams, but willingly choose to focus more on board-focused material.

every person who is the bottom half of graded scores also considers themselves as hardworking intelligent and having the capacity to score top percentile on school exams. The correlation still probably stands.

 

[Goro]

Wouldn't this be variable depending on the program? At my school, all of our exam averages are in the high 80s mid 90s, yet we have a average step score below 225.

Multiple med schools report the same thing. ...but you have a point. GPA might be a predictor, but it is not a guarantee of the highest board scores compared to the Nationwide medical student pool.

 

[Frogger27]

Wouldn't this be variable depending on the program? At my school, all of our exam averages are in the high 80s mid 90s, yet we have a average step score below 225.

My school has an average test score around 85 but our step score the last two years has been ~240. I’m average/ slightly below average but I trust our schools curriculum to prep me for boards and hopefully when it comes dedicated time I can put in that extra effort to get over the 240 hump

 

[deleted645092]

The correlation between board scores and preclinical GPA is based on your own schools grading scale comparing their own stusents, not compared against national averages. My school compiles our own data annually and since it's been established the correlation is 0.7 right on the dot as of last year.

Obviously there are outliers in both directions but on a population level as shown by any school that follows the data, it really isn't an argument anymore.

 

[Aerus]

every person who is the bottom half of graded scores also considers themselves as hardworking intelligent and having the capacity to score top percentile on school exams. The correlation still probably stands.

Not necessarily. Not everyone who gets into medical school is academically gifted. Medical school screens for those who are academically competent, but some just aren't talented test-takers or perhaps have not discovered how they learn well compared to others. That's fine, since mediocre test takers don't mean mediocre doctors.

But regardless of how they "consider" themselves, when everyone puts their best foot forward, there will still be a distribution. Now, apply that to a school where pre-clinical grades mean nothing and many of those top scorers will be found more often in the lower half of scorers because the AOA requirements shifted from class exam scores to Step 1.

 

[libertyyne]

Not necessarily. Not everyone who gets into medical school is academically gifted. Medical school screens for those who are academically competent, but some just aren't talented test-takers or perhaps have not discovered how they learn well compared to others. That's fine, since mediocre test takers don't mean mediocre doctors.

But regardless of how they "consider" themselves, when everyone puts their best foot forward, there will still be a distribution. Now, apply that to a school where pre-clinical grades mean nothing and many of those top scorers will be found more often in the lower half of scorers because the AOA requirements shifted from class exam scores to Step 1.

This is incorrect. Even in graded systems people don't care about grades because frankly pds don't care about grades. So yes there is a significant portion of the class who thinks they are going to do amazing on step. The correlation still stands.

 

[mistafab]

The farther I go in school the more and more I question this.

since mediocre test takers don't mean mediocre doctors.

 

[Eyeronic]

I think schools have a funny way of internally tracking consistency with performance, especially in the pre-clinical MS1-MS2 black hole. I can only recall two instances (on exams or overall course grade) in those first 2 years where I truly killed it and broke the curve. Otherwise, I was almost always borderline top-1/3rd in the class. On all bar graphs, histograms, etc. Every time.

Turns out a lot of my classmates were much less consistent. All in all, I ended up way higher in the rankings for pre-clinicals than I would have ever imagined. Plus, not acing everything in pre-clinical classes only made me hungrier to succeed during MS3. Which is the year that matters most for AOA anyways.

 

[Aerus]

This is incorrect. Even in graded systems people don't care about grades because frankly pds don't care about grades. So yes there is a significant portion of the class who thinks they are going to do amazing on step. The correlation still stands.

I can speak to my school specifically that the correlation doesn't stand. Stop broadly applying that statement everywhere.

At least here, the trend is that the people who abandon the curriculum sooner are the ones who score well each year. Thus, the bottom half of class exam scorers consist of a mix of people who do this and people who struggle with tests in general.

 

[Aerus]

The farther I go in school the more and more I question this.

There are many fantastic doctors out there who are not very great test takers.

 

[Chibucks15]

I refuse to believe that someone who gets an 85 and is in the 3rd quartile will be a worse doctor than someone who gets a 92 and is in the second. I second the ability some students have to 'game' the test. Nothing against them at all, more power to them, but being able to figure out who is asking the question (since we have multiple professors) and what they would want the answer to be is not the same as knowing the material at all. At many schools, mine included, the line between the quartiles really isn't all that big to begin with either. An example...a 3.5 would put you in the 3rd quartile at my school currently, and the first quartile line is up close a 3.8 ish. That really isn't that much of a difference when you think of going from an A to a B in 1 class can bring you down pretty significantly, especially in the larger credit hours.

P/F should be the way to go. Rank if you have to, but stressing over an 89.3 cuz it destroys your GPA compared to a 89.6 is about as hypocritical as it gets when you preach about 'student well-being and happiness'.

 

[.hematoma.]

Actually, one of the best predictors of Boards performance is pre-clinical GPA.

Most schools don't have GPA anymore, get with the times. Also that's why I said "not necessarily correlated."

 

[AnatomyGrey12]

Obviously there are outliers in both directions but on a population level as shown by any school that follows the data, it really isn't an argument anymore.

This is my problem with that statistic, it's a population statistic and is almost completely irrelevant to any one individual student. I also wonder if the correlation only exists because the students who work the hardest to get good grades in class will generally be the ones who put forth the most effort for boards, so it isn't so much a matter of GPA as it is a matter of effort.

 

[Goro]

Most schools don't have GPA anymore, get with the times. Also that's why I said "not necessarily correlated."

The students might not see the GPA, but the people giving the exam sure do.

 

[.hematoma.]

The students might not see the GPA, but the people giving the exam sure do.

Maybe at your school, n =1. Also you are faculty at a DO school, aren't you? Different playing field, because from what I gather GPA still exists at a lot of places (correct me if I'm wrong).

 

[Goro]

Maybe at your school, n =1. Also you are faculty at a DO school, aren't you? Different playing field, because from what I gather GPA still exists at a lot of places (correct me if I'm wrong).

Even though I'm at a. School I see data from people at MD schools. We medical Educators do talk to each other, . Stop arguing for the sake of arguing. We already have agreed that having a pass-fail curriculum is confounder and trying to figure out what is the best predictor of board scores. I'm just telling you what's in the published data

 

[deleted645092]

The only time the correlation may not apply, whether at a DO or MD school, is how well your curriculum correlates with board material; do they teach their own research or do they make sure they cover at least 75% of First Aid in-depth? I would imagine that those who blindly study the curriculum at the former would have a lower correlation between board scores and preclinical GPA, whereas for the latter studying for classes is literally studying for boards. I know that my school is great about teaching for boards and not just faculty research, which is why the correlation is so strong.

I wouldn’t imagine that pass/fail vs. graded makes much of a difference because there are plenty of people that study their hardest no matter the grading scheme and still fail.

 

[libertyyne]

I can speak to my school specifically that the correlation doesn't stand. Stop broadly applying that statement everywhere.

At least here, the trend is that the people who abandon the curriculum sooner are the ones who score well each year. Thus, the bottom half of class exam scorers consist of a mix of people who do this and people who struggle with tests in general.

That's impressive that you can speak to all of your school, did someone run these numbers or did you just survey people ?

Everything that is published in the literature dictates that class performance or some subset of it and mcat score are good predictors of step 1 score. Yes it may not apply to every school, but 10+ md schools with different corricula says it does. So yes, i would generally speaking say it is true. but maybe there are outliers. I haven't seen them in the studies.

 

[Aerus]

That's impressive that you can speak to all of your school, did someone run these numbers or did you just survey people ?

Everything that is published in the literature dictates that class performance or some subset of it and mcat score are good predictors of step 1 score. Yes it may not apply to every school, but 10+ md schools with different corricula says it does. So yes, i would generally speaking say it is true. but maybe there are outliers. I haven't seen them in the studies.

Our school actually administers a survey to all the MS3's after they take Step 1 but they also have the numeric grades of every student and their Step 1 score too. They put together a huge analysis and give the new MS2's general trends they notice. They've been doing this for a few years now and they conclude that there is no correlation to any type of study method that leads to better scores. If there was even a small correlation between class grades and Step 1 or "curriculum time spent" (a parameter they survey) and Step 1 scores, you'd bet they'll definitely tell us because they're also the same staff in charge of scheduling classes and lecturers.

 

[deleted645092]

Our school actually administers a survey to all the MS3's after they take Step 1 but they also have the numeric grades of every student and their Step 1 score too. They put together a huge analysis and give the new MS2's general trends they notice. They've been doing this for a few years now and they conclude that there is no correlation to any type of study method that leads to better scores. If there was even a small correlation between class grades and Step 1 or "curriculum time spent" (a parameter they survey) and Step 1 scores, you'd bet they'll definitely tell us because they're also the same staff in charge of scheduling classes and lecturers.

Lol except when they administer that same survey at my school you can bet we all put 10+ hours spent in class every week. I used to work on these types of studies in undergrad as the data analysis guy and student surveys are the worst form of data collection out there.

 

[mistafab]

Fantastic meaning what? A mediocre doctor is a pretty decent doctor. The “average” doctor tends to get pretty good reviews, is kind, caring, well-liked by their patients, and is easy to get along with. Nothing wrong with that.

So saying test scores don’t correlate is not really true. I’d say that yes, many “fantastic” doctors (who are excellent by many standards) do not have to be the best test takers. Because being a mediocre doctor is good enough.

I would wager, however, that the current leaders in medicine in general tend to be great test takers - and the best in a field were probably also the best in school and the best on tests.

There are many fantastic doctors out there who are not very great test takers.

 

[Aerus]

Lol except when they administer that same survey at my school you can bet we all put 10+ hours spent in class every week. I used to work on these types of studies in undergrad as the data analysis guy and student surveys are the worst form of data collection out there.

I can't speak to why that happens at your school but there is no incentive to do this at our school, since the survey is purely for the class below. Administration doesn't use the data to enact any changes. Even if they do, what would be the incentive in putting MORE hours? To prove to admin that we benefit from more hours in the classroom and that they should give us more mandatory things?

 

[Aerus]

Fantastic meaning what? A mediocre doctor is a pretty decent doctor. The “average” doctor tends to get pretty good reviews, is kind, caring, well-liked by their patients, and is easy to get along with. Nothing wrong with that.

So saying test scores don’t correlate is not really true. I’d say that yes, many “fantastic” doctors (who are excellent by many standards) do not have to be the best test takers. Because being a mediocre doctor is good enough.

I would wager, however, that the current leaders in medicine in general tend to be great test takers - and the best in a field were probably also the best in school and the best on tests.

Except the current leaders in medicine aren't selected based on being "fantastic" doctors but by their academic accomplishments. You're comparing two completely different things.

 

[Lawpy]

There are many fantastic doctors out there who are not very great test takers.

Fantastic meaning what? A mediocre doctor is a pretty decent doctor. The “average” doctor tends to get pretty good reviews, is kind, caring, well-liked by their patients, and is easy to get along with. Nothing wrong with that.

So saying test scores don’t correlate is not really true. I’d say that yes, many “fantastic” doctors (who are excellent by many standards) do not have to be the best test takers. Because being a mediocre doctor is good enough.

I would wager, however, that the current leaders in medicine in general tend to be great test takers - and the best in a field were probably also the best in school and the best on tests.

Except the current leaders in medicine aren't selected based on being "fantastic" doctors but by their academic accomplishments. You're comparing two completely different things.

What do you mean by fantastic?

 

[.hematoma.]

Even though I'm at a. School I see data from people at MD schools. We medical Educators do talk to each other, . Stop arguing for the sake of arguing. We already have agreed that having a pass-fail curriculum is confounder and trying to figure out what is the best predictor of board scores. I'm just telling you what's in the published data

No one's arguing for the sake of arguing, I'm just trying to explain to you that the times of changed (published data probably doesn't apply as strongly anymore). Anyway, you're n=1-5 opinion won't change, so carry on.

 

[sonofababinski]

Actually, one of the best predictors of Boards performance is pre-clinical GPA.

that's true to a good extent but honestly.. i'm sure there's been quite a few times where people just didn't review everything because of poor time management, didn't do some lectures, or got sick/lazy/too occupied with EC's. I feel like there are quite a bit of people like that, so GPA's really don't give you very reliable predictions for STEP scores.

 

[Goro]

that's true to a good extent but honestly.. i'm sure there's been quite a few times where people just didn't review everything because of poor time management, didn't do some lectures, or got sick/lazy/too occupied with EC's. I feel like there are quite a bit of people like that, so GPA's really don't give you very reliable predictions for STEP scores.

All I can tell you is what the data says. Will there be outliars? Yes. But people should not engage in magic thinking and beleive that they'll come off the bench and hit a home run for the red Sox, or score 260, especially if they're the type of student who have poor time management, didn't do some lectures, or got sick/lazy/too occupied with EC's

 

[sonofababinski]

All I can tell you is what the data says. Will there be outliars? Yes. But people should not engage in magic thinking and beleive that they'll come off the bench and hit a home run for the red Sox, or score 260, especially if they're the type of student who have poor time management, didn't do some lectures, or got sick/lazy/too occupied with EC's

Oh yeah, I definitely agree with that. Obviously if you're doing well in class, you know your stuff not only for class, but beyond that --QBanks, STEP, etc.. My point was that a good amount of people I have talked to, have had a few speed bumps down the road where their GPA wasn't anything you'd look at and automatically say "this person definitely got a 250+"

 

[Goro]

Oh yeah, I definitely agree with that. Obviously if you're doing well in class, you know your stuff not only for class, but beyond that --QBanks, STEP, etc.. My point was that a good amount of people I have talked to, have had a few speed bumps down the road where their GPA wasn't anything you'd look at and automatically say "this person definitely got a 250+"

NBME shelf exams are also great Boards predictors

 

[sonofababinski]

NBME shelf exams are also great Boards predictors

yup! couldn't agree more with that. I went to the ACS conference last month and literally all the PD's said that.