I attend a school that has Pass/Fail system, though they do internally rank our class. I was curious if anybody knew how much internal rankings during our preclinical years play into our ability to get into residency programs down the road. I am not adjusting as well to remote learning as I would have liked to, so I'm not as happy with my grades as I would like to be. I'm also especially nervous since Step 1 will be Pass/Fail for my year as well. Anyone have any insight?
It will depend on 3 things:
1. Your medical school: Internal ranking probably means at less prestigious schools (i.e. state schools) because the whole purpose of internal ranking is to reward those who worked very hard and rose to the cream of the crop in a competitive environment to give its best students a chance at top places. That said, if you're consistently average/below average at this point, I would not kill yourself mentally if you have reached a peak. The preclinical material is always good to know, but not as important as what comes next.
2. How the internal rankings figures into other things you may care about (MSPE, AOA designation). The internal ranking often comes into play when the school writes your MSPE (Medical School Performance Evaluation). They often have coded words (Outstanding, Excellent, Very Good, Good) which represent the quartiles/quintiles at schools. The MSPE plays a significant part of how schools interpret how competitive you are for residency as they are an attempt to give you a class rank and most residency programs won't look at your application until they see the MSPE. You need to figure out how the pre-clinical work will factor into your MSPE. Also, AOA is a competitive distinction earned by top students. Having AOA on your CV is a major boost to your application. For mortals like myself, that shipped sailed early on in medical school, but look into it if it matters for you.
3. Last and most obvious is the competitiveness of your field. Many fields or programs within fields have 25-50% of its students having AOA or being in the top part of their class. The sad truth of it is that in medical school everything matters. There are just some things that matter more.
4. I understand the notion that Step 1 being P/F is creating an internal pressure to excel elsewhere. I will say that I do not think adcoms will default to your pre-clinical grades (if they are able to separate them from your overall rank) next. There are just too many other factors (clinical grades, Step 2, narrative evaluations, letters, research/perceived interest in the field) that translate better to residency success than whether or not you know what a zinc linked DNA zipper is
Best of luck. If you're not excelling early on in med school, they key is to just do your best and not let it affect the next place you have to excel (second year grades, clinical work, so on).
