Third year grades: it seems nearly impossible to get honors and very hard to get high pass? Is this normal?

[Konigstiger]

As the title implies, third year has been going terribly for me and I've managed nothing but passes so far. I looked into my school's grading system for third year and did some rough calculations, and I'm wondering if this is normal:

Assuming a student gets around a 4/5 average on their clinical eval, which I'm assuming is above average, they still have to score in the 91st percentile on the end of rotation exam to get high pass on average, and 99th percentile on average to get honors. And assuming a student gets a perfect eval, which I don't think are given out very often, they still have to score in the 92nd percentile on average to get honors (disclaimer: none of these calculations are exact but should be pretty close to accurate).

It seems like my school almost places too much weight on the shelf/COMAT aspect. I certainly can't score in the 91st percentile consistently if at all, so I think I'm going to end up with all passes this year, which would basically kill my chances of applying to anything competitive. Is this pretty standard for most schools and I'm just way worse of a student than I thought? Or is this abnormal?

I am curious as to how other people's schools determine final third year grades for each rotation.

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[M&L]

oh my god.... this policy is truly horrific. This is NOT normal.
in my school these are criteria for honors (sorry for big letters, i copy pasted it):

Medical Knowledge​ ​	≥ 78%​	NBME Exam​ Equated Percent Correct Score​
Clinical Evaluation​	≥ 85.5%​	E*Value Preceptor Evaluation Average​
Applied Learning​ ​	≥ 85.5%​ ​	(different standardized pt stuff)​
Professionalism​	≥ 2 of 3 points​	See Professionalism Policy​

 

[M&L]

and this is high pass:

Medical Knowledge​ ​	≥ 70%​	NBME Exam​ Equated Percent Correct Score​
Clinical Evaluation​	≥ 79.5%​	E*Value Preceptor Evaluation Average​
Applied Learning​ ​	≥ 79.5%​ ​	Standardized Patient​
Professionalism​	≥ 2 of 3 points​	See Professionalism Policy​

 

[Taddy Mason]

Glad to know my school wasn’t/isn’t the only one with an asinine 3rd year grading policy. We only had H, P, F but similar cutoffs for preceptor evals and shelf exams. Shelf exam cutoffs ranged from 88-93% depending on the rotation which corresponded with >90th percentile for all shelf exams. To get honors you HAD to meet both the shelf cutoff and 4/5 (or 90%) on ALL preceptor evals for that rotation (e.g., one 3/5 eval but the rest being 5/5 and 99th percentile shelf would still result in a “pass”). Family medicine was the only exception to this grading scheme which gave honors to the top X% of the class based on shelf and clinical evals and used grades on a presentation given during the rotation for any potential tie breakers where the cutoff point fell. The kicker was that on the MSPE none of this was spelled out in any detail and it simply said honors went to the top ~X% based on overall grades for each clerkship, despite this being blatantly false (with the exception of family med). But if anyone bothered to look at the actual breakdown for each clerkship they’d see there were clerkships where no one got honors or less than 10% or even 5% of the class got honors. I guess the one possible positive in this is that it’s antithetical to the rampant grade inflation I’ve come across reviewing residency applications the past several years.

So yeah, definitely not the norm but not unheard of, and even though the n is small, you’re not alone in having a sh**ty clerkship grading system.

 

[IR3A4]

My school it's essentially get around 55th percentile on the shelf (so like 75-85% depending on the shelf) and you honor unless your evaluators hated you.

 

[mrbreakfast]

Assuming a student gets around a 4/5 average on their clinical eval, which I'm assuming is above average, they still have to score in the 91st percentile on the end of rotation exam to get high pass on average, and 99th percentile on average to get honors. And assuming a student gets a perfect eval, which I don't think are given out very often, they still have to score in the 92nd percentile on average to get honors (disclaimer: none of these calculations are exact but should be pretty close to accurate).

No offense, but I'm wondering if you're somehow making a math error. Your numbers imply your grade is overwhelmingly dependent on your exam, with it having several times the grading weight of your clinical evals (e.g. going from 4/5 to 5/5 on evals, a huge difference, is only equivalent to a 7 percentile difference on the exam). Is that correct?


My school had different cutoffs for HP/H depending on the clerkship, and there were other (easy) aspects to the grade, but a student who averaged a 4/5 evaluation but 90th percentile on the shelf would get almost entirely high passes, while a student who averaged a 4.5/5 evaluation but 50th percentile on the shelf would get mostly honors.

 

[Konigstiger]

No offense, but I'm wondering if you're somehow making a math error. Your numbers imply your grade is overwhelmingly dependent on your exam, with it having several times the grading weight of your clinical evals (e.g. going from 4/5 to 5/5 on evals, a huge difference, is only equivalent to a 7 percentile difference on the exam). Is that correct?

No offense taken; it certainly wouldn't be the first time it's happened. But basically the system is you get a raw score on your eval which is then just added to the raw score you get on the shelf exam to equal a final total score which determines your grade. The problem is that the max eval score is miniscule when compared to the max shelf score, so the final grade ends up being almost completely dependent on the shelf exam. There is no weight multiplier for the clerkship eval to make it more 'equal' as far as I'm aware.

 

[operaman]

I would ask your admin what percentage of students historically have honored each rotation. If you’re using national exams and 99th percentile is required to honor, then I suspect not many. Unless there’s some kind of adjustment given somewhere. Schools have that data and should be willing to share it since they usually share it on the MSPE anyhow.

 

[LeaveNoTrace]

That sounds pretty unusual: only a miniscule percent of students (like 5ish percent) would get Honors and maybe 20ish would get High Pass...and that might be a generous estimate!

 

[NeedSomeAdviceGuy]

This sounds like my friend's grading scale at PCOM.

Not sure if this is common practice at DO schools, but I assume it exists to further stratify the class to make the top of the class more competitive and increase their match rate into competitive specialties (which PCOM does quite well relative to other DO schools).

 

[Premed2295]

It varies wildly by school.
For us, you need stellar clinical evals, 50th percentile or above on shelves and strong performance (generally 90% and above but varies) on other assignments we get (case reports, mini quizzes, presentations etc).

 

[GoSpursGo]

I would ask your admin what percentage of students historically have honored each rotation.

I'd emphasize this. Grading systems are highly variable across schools without even accounting for the fact that some schools are P/F even in clinicals. Ultimately the grades are put into context on your MSPE where they say "X percent get honors, Y percent get HP, and Z percent got P." If something like 75% of your class gets P, well then that does you no favors but that just sort of is how your school grades.

Another thing you could consider is (delicately) explaining the grading system to your preceptors before sending them your evaluation. Not that you should pander for straight 5's... but if your preceptor learns that you basically need straight 5's to have any chance of honors, they may think twice about the evaluation.

 

[mistafab]

Your entire experience in med school in the end boils down to the dean's letter. There will be percentile charts showing how many folks get honors in each rotation. If across your school the rate is truly atrocious, it really doesn't negatively impact your residency application so I wouldn't stress it. Just do well and get great evaluations/comments from your work ethic and professionalism.

 

[Yhwach]

Only 10% get H at my school. No HP either. I heard our MPSE reflect that and programs know how hard it is for us to honor.

 

[Captain_Falcon]

My school it varies slightly by rotation, but in general around 40% get honors, 45% get high pass, and 15% get pass. Thus honors in a single rotation or few isn’t impressive, though only ~30% of students get 5+ honors out of the 7 rotations (this is explained on our MSPE in so many words)

 

[Niwrad]

Everyone gets 'P' instead of A/B/C/fail