Variability in clinical year honors

[fizzle]

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I was talking to a friend of mine at another med school, and he mentioned that the percentage of his class who gets honors in any rotation can be as high as 45%. In the meantime, my school does not give out honors to more than 10% of the students in any rotation.

Given the context in which everyone considers clinical year honors to be one of the most important parts of a good application, how is this even fair? I've heard some people briefly mention that a grading rubric/breakdown is sent along with the grades to program director, but this is mentioned rarely and as an afterthought, with everyone simply saying "Get honors" without even stopping to consider that honors can be relatively easy to get at one school and near impossible in the next. It's almost a mantra to say, "get honors in surgery and internal medicine" to be competitive for a tough specialty, but given that one school gives 45% of its students honors, while another gives <10% honors, why is it that almost no one brings this up on the forums and almost blindly seems to assume that clinical honors are of similar difficulty to achieve at every school? This isn't even mentioning that "high pass" is the average score at some schools, while at others "high pass" is limited to the top 25% after honors.

 

[FSU2013]

People bring it up often......search some past threads. Some schools are notorious for grade inflation. Theoretically, it shouldn't be an issue as many (if not all) dean's letters have an explanation of grades included - that is assuming the PDs read the rubric. This is at least part of the reason standardized tests are given so much weight.

It is what it is.....all you can do it work your butt of and hope you pull the all-important 'H' considering 3rd year isnt really a great time to consider switching med schools.

Cheers.

 

[ArcGurren]

This is why Step 1 is used ultimately as the main comparison metric

 

[fizzle]

This is why Step 1 is used ultimately as the main comparison metric

Unfortunately, going by the NRMP program director's surveys, program directors and advisors I've spoken to, and others, clinical grades are often given as much weight as Step 1, if not more.

 

[drizzt3117]

People bring it up often......search some past threads. Some schools are notorious for grade inflation. Theoretically, it shouldn't be an issue as many (if not all) dean's letters have an explanation of grades included - that is assuming the PDs read the rubric. This is at least part of the reason standardized tests are given so much weight.

It is what it is.....all you can do it work your butt of and hope you pull the all-important 'H' considering 3rd year isnt really a great time to consider switching med schools.

Cheers.

Many programs send out interviews before the MSPE is released, although this may change this year because it's coming out a month earlier.

 

[ArcGurren]

Unfortunately, going by the NRMP program director's surveys, program directors and advisors I've spoken to, and others, clinical grades are often given as much weight as Step 1, if not more.

In what fields? I've seen almost universally that Step 1 is one of the most important considerations just for granting interviews.

 

[username456789]

In what fields? I've seen almost universally that Step 1 is one of the most important considerations just for granting interviews.

In most fields. The PD surveys often show minimal variation between importance between Step 1 and clinical honors (usually this goes for 3rd year clerkships and any 4th year specialty rotations).

That said, my school is super-stingy with clinical honors (usually 5% max will get it on a given rotation, if that). And some particular rotations pride themselves on never having given out "honors" in the past X years. It's absurd, but it's out of our control. I was worried, as I only had one clinical honors in 3rd year (Neurology) and was applying for Derm. I did honor my home derm rotation and my medicine sub-I during 4th year, but I still felt like the otherwise lack of 3rd year honors would hurt my application in such a ridiculously competitive field.

Fortunately, I got 16 interviews, and no one ever made any mention about any honors. And now I found out last week that I matched into my #1 Derm program and #1 TY. So, all in all it didn't hurt me one bit!

n=1, I know.

 

[RySerr21]

They do look at how many other people honored a rotation. In a meeting I had lats week with a programs director for peds he said that is the first thing he looks for is how many other people honored the rotation as well....if its a large % then its not really that impressive. They aren't dumb, they know the system is flawed and a lot of what goes in to a good grade in any one rotation is dependent on luck regarding who is evaluating you (being a rockstar and getting a hardass who only gives 'average' or being a slacker and getting someoen who just gives everyone 'top 5%').

In terms of importance of step 1 and all that jazz, people on SDN will forever refuse to believe that step 1 is not the single most important thing on your application to residency (or in your life), probablly because most have spent every last waking moment of the last two years obsessing over their score and future application to dermatology...... Its a ridiculous argument to get in to that you will lose every time. Not worth it!

 

[drizzt3117]

Step 1 is the most important, but in a different way than you're implying. It's the most important because it's used to screen applications and because it's so easy to use. PDs get so many apps that using ERAS to "show all apps with step 1 > 230" is such an easy way to cut down their applicant pool. It's less important post-interview, but really makes a difference in getting you in the door.

They do look at how many other people honored a rotation. In a meeting I had lats week with a programs director for peds he said that is the first thing he looks for is how many other people honored the rotation as well....if its a large % then its not really that impressive. They aren't dumb, they know the system is flawed and a lot of what goes in to a good grade in any one rotation is dependent on luck regarding who is evaluating you (being a rockstar and getting a hardass who only gives 'average' or being a slacker and getting someoen who just gives everyone 'top 5%').

In terms of importance of step 1 and all that jazz, people on SDN will forever refuse to believe that step 1 is not the single most important thing on your application to residency (or in your life), probablly because most have spent every last waking moment of the last two years obsessing over their score and future application to dermatology...... Its a ridiculous argument to get in to that you will lose every time. Not worth it!

 

[HalladayWeekend]

Makes me wonder why all schools don't go Pass/Fail (with comments) in clinical years and all require the same shelf exams. If they absolutely must, use subjective clinical grades for internal ranking but don't list on the transcript. List shelf exam grades on transcripts = equal playing field. Makes too much sense to me.

 

[Gannador]

Makes me wonder why all schools don't go Pass/Fail (with comments) in clinical years and all require the same shelf exams. If they absolutely must, use subjective clinical grades for internal ranking but don't list on the transcript. List shelf exam grades on transcripts = equal playing field. Makes too much sense to me.

The problem is that basically if shelf grades are the only thing of importance then it rewards the person who is able to be the least present and engaged on the wards (or just schools that have more time to study vs being on the wards). By making clinical grades in part subjective based on your performance (and I'm not saying this is perfect or even pleasurable), they keep students more engaged and try to balance the clinical and text book aspects of medical practice. Medicine is more than just multiple choice exams. Comments are great, but difficult to interpret sometimes. Also, program directors would either have to read through pages of comments (not going to happen) or school advisers are going to have to stop hand picking the best comments from your rotations to put in your letter (also not going to happen).

 

[MossPoh]

Yes, but for the people who did well on Step 1, much of the data points towards the number of patients seen on that particular rotation as a stronger predictor of shelf performance. The people with a weak foundation often benefit from more time to study. If someone has a poor foundation, they are less likely to be up to par clinically. Naturally, this is all just correlation and everyone is different.

It also assumes that someone studying a lot will do better. One could just raise the expectations of the P/F aspect to force more effort.

My school has a 17 question evaluation form where a student must get 10 excellents. Excellents are supposed to be "top 10% of students". The problem is that each preceptor reads that differently. It would probably be better to say what percentage of students that individual preceptor gave honors to. We also have to get 75 percentile or greater on the shelf. What is frustrating is that if you get 17 excellent ratings on the eval, they may give some slack on the shelf BUT if you absolutely destroy the shelf, they won't budge on the evals to give you honors. That stands true when a preceptor is notorious for never giving honors. It is frustrating, but just part of the game at this point.

The only advantage to still trying hard on the shelf is that they put your scores in the MPSE if you did well, which could potentially defuse non-honors evals a little.

 

[HalladayWeekend]

In my experience so far, a good portion of my evals had the same score for every category checked off (for better and worse). As such, it is clear that they are not using the rubric to accurately judge. I understand that it is time consuming, but it is disappointing that something that is apparently a big part of the application is not taken as seriously as it should. I do agree that the stats on the MSPE should break down grades by clinical site and/or preceptor. If a student happens to get lucky and work at easier rotation sites who hand out a bunch of honors, that is not currently accounted for.

 

[dude1344]

In my experience so far, a good portion of my evals had the same score for every category checked off (for better and worse). As such, it is clear that they are not using the rubric to accurately judge. I understand that it is time consuming, but it is disappointing that something that is apparently a big part of the application is not taken as seriously as it should. I do agree that the stats on the MSPE should break down grades by clinical site and/or preceptor. If a student happens to get lucky and work at easier rotation sites who hand out a bunch of honors, that is not currently accounted for.

Third year is such bullsh*t. It's clear certain residents/attendings don't take evals seriously and consider how important they are to us med students. 👎

 

[mmmcdowe]

n

 

[FSU2013]

What is there to be gained by putting attending specific stats on? It would hurt the students that got lucky, I don't think it would help te students that had hard attendings and the people who got honors in spite of rough attendings probably don't need the help. If you get stuck with a doc that never gives honors, be the one that breaks the mold. All it gives you is an excuse for residency interviews and my assumption is that you'd rather focus your positives instead of saying "well, I had a really hard attending. "

 

[MossPoh]

There are attendings that don't have a mold to break and will never give honors. If your attending gives everyone honors then the test is where you would show you earned it. I think that if you were one of the people that were told they excelled beyond every medical student and then didn't get honors, your stance may be different. You assume that programs only look at the negatives but totally ignore the positives. When one is on the positive side, it is easy to be defensive of your grades.

"Working hard", "breaking the mold" or whatever other phrasing you want create many opportunities, but there are still multiple external factors that contribute to one's success. All it takes is a little crap out of your control at one moment to tip the scale.

All it does is create an accurate representation of your performance. They already provide a breakdown of what percentage of people get honors on each rotation as a whole. If you work hard and break the mold, wouldn't you want people to know?