Would these be considered "good" or "okay" clinical grades?

[datpremedgirl]

Hi all,

Here are my clinical grades:

Surgery - HP
Ob/Gyn - H
Family Medicine - HP
Outpatient Internal Medicine - P
Psychiatry - HP
Neurology - H
Internal Medicine - H
Pediatrics - H

As the name of this thread says, would these be considered "good" or "okay" clinical grades? i.e. when residency directors see them, what kind of impression will they have? I kind of had a rocky start to rotations and despite doing well on the exams, my evals were quite mediocre, thus dropping me down from honors to HP and even P for my outpatient IM rotation. I started to really get the hang of the wards towards the end of my clinical year and was able to rock my evals in Neuro, IM, and Peds.

Any feedback would be appreciated! Thanks!

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[Dwan]

Hi all,

Here are my clinical grades:

Surgery - HP
Ob/Gyn - H
Family Medicine - HP
Outpatient Internal Medicine - P
Psychiatry - HP
Neurology - H
Internal Medicine - H
Pediatrics - H

As the name of this thread says, would these be considered "good" or "okay" clinical grades? i.e. when residency directors see them, what kind of impression will they have? I kind of had a rocky start to rotations and despite doing well on the exams, my evals were quite mediocre, thus dropping me down from honors to HP and even P for my outpatient IM rotation. I started to really get the hang of the wards towards the end of my clinical year and was able to rock my evals in Neuro, IM, and Peds.

Any feedback would be appreciated! Thanks!

Looks a lot better than mine.

 

[Psai]

good

 

[Waterlover]

Lolol, I could only wish for clinical grades nearly as good, but to each their own!

 

[21Rush12]

I understand where you’re coming from OP. Everyone says do well on clinical rotations but it’s hard to tell what that actually means. Hopefully some PD’s or other experienced posters can give some idea of what constitutes excellent, good, average, poor

 

[Dro133]

Looks really good. I was happy to just have a single honors.

 

[MerYangBey]

I understand where you’re coming from OP. Everyone says do well on clinical rotations but it’s hard to tell what that actually means. Hopefully some PD’s or other experienced posters can give some idea of what constitutes excellent, good, average, poor

Yeah it’s interesting at my school we don’t have HP it’s either Pass or Honors. So HP is meaningless to me.
So it makes me wonder if anything other than outstanding vs average/poor performance actually matters. For example a student that got straight honors vs a student that got straight Ps. I’m not sure if that actually made sense...

 

[afib123]

Those look really good and should not harm your app, if anything will help it. My program PD said he just looks to see that are at least a few honors throughout the year and honors in the specific clerkship to see that students can excel on wards.
He also did not tell me that honors is mandatory in the speciality you're applying to. He said it's nice and an added bonus but they took in plenty of residents that didn't honor.

 

[Lawpy]

Yeah it’s interesting at my school we don’t have HP it’s either Pass or Honors. So HP is meaningless to me.
So it makes me wonder if anything other than outstanding vs average/poor performance actually matters. For example a student that got straight honors vs a student that got straight Ps. I’m not sure if that actually made sense...

I could see how a line is drawn between an H and a P (i.e. excellent vs average) but HP just seems subjective and I don't really know what's the difference between HP and H, and the attendings on here didn't provide clear answers.

 

[WedgeDawg]

I could see how a line is drawn between an H and a P (i.e. excellent vs average) but HP just seems subjective and I don't really know what's the difference between HP and H, and the attendings on here didn't provide clear answers.

That’s because the distribution of grades and how each is awarded varies drastically by school. This information is a part of your MSPE so that PDs have at least some ability to interpret your grades.

 

[831929]

Michigan has a page on what residencies consider good medical school performance. Check it out. It's a lot more realistic than what you see on sdn. Having straight HP all 3rd year shows a very good clinical performance. Having a few honors is amazing. A few Ps will be fine.

Those grades are really good in my opinion.

 

[mrbreakfast]

Solid, even if you have a generous distribution at your program.

Based on conversations with residency directors and from my interviews, I think in general residency directors ignore HPs and look only at Hs and Ps.

 

[libertyyne]

Doesnt look bad as it is, but cant really tell where you stand without looking at distributions on the MSPE. It is possible although unlikely that 80% of your class has HP or H in the rotations you did.

 

[bananafish94]

In what universe would these be anything but excellent? It looks like you got almost all honors!

 

[ciestar]

I could see how a line is drawn between an H and a P (i.e. excellent vs average) but HP just seems subjective and I don't really know what's the difference between HP and H, and the attendings on here didn't provide clear answers.

At my school shelf cutoffs help with the dividing line for HP

 

[datpremedgirl]

Doesnt look bad as it is, but cant really tell where you stand without looking at distributions on the MSPE. It is possible although unlikely that 80% of your class has HP or H in the rotations you did.

My school has it set so that 20% of the class honors and 20% of the class has high pass, so 60% of the class ends up passing. I don't know how this distribution compares to other schools though...

 

[libertyyne]

My school has it set so that 20% of the class honors and 20% of the class has high pass, so 60% of the class ends up passing. I don't know how this distribution compares to other schools though...

If that is the case you are doing awesome!

 

[mrbreakfast]

I could see how a line is drawn between an H and a P (i.e. excellent vs average) but HP just seems subjective and I don't really know what's the difference between HP and H, and the attendings on here didn't provide clear answers.

At my program P = below average (~40-45%), HP = above average (~40%), H = exceptional (~15-20%).

The simplistic distinction between HP and H is to HP you must do well on either evaluations or on the shelf/simulated exam/etc, while to H you must do very well on both.

 

[operaman]

Hard to fully interpret without knowing your intended field, specific comments in your mspe, and order of rotations. Would also need to see your performance during your sub-I. All of that is viewed together.

That said, this looks pretty good overall. More than anything, clinical grades reflect how much people like you. They say very little about your clinical ability and even less about your potential as a physician. They do reliably show some measures of how well you get along with people and yours show that you managed to be very well liked by a wide array of individuals.

Assuming no red flags in your comments and solid performances as a sub I, your clinical grades should not close any doors.

 

[idkididk]

In what universe would these be anything but excellent? It looks like you got almost all honors!

SDN

 

[mehc012]

In what universe would these be anything but excellent? It looks like you got almost all honors!

In what universe does "half" = "almost all"?

 

[bananafish94]

In what universe does "half" = "almost all"?

I thought it was 5 Hs and not 4. I guess that’s not almost all. But still, getting in the top 20% of the class in half of the rotations is extremely good and hardly warrants a post on SDN.

 

[Lawpy]

I thought it was 5 Hs and not 4. I guess that’s not almost all. But still, getting in the top 20% of the class in half of the rotations is extremely good and hardly warrants a post on SDN.

There are also people who straight honor everything and they're barely on SDN unless they're posting on WAMC threads in the specialty forums. Still pretty remarkable that they accomplished that.

 

[bananafish94]

There are also people who straight honor everything and they're barely on SDN unless they're posting on WAMC threads in the specialty forums. Still pretty remarkable that they accomplished that.

If they're at a school where honors is genuinely the top quartile/quintile or so of students and comprised of a balance of the shelf score and evaluations, then that is an unfathomably impressive achievement. For schools where the grade is mostly or entirely comprised of the shelf, then a certain cohort of people who generally do really well on standardized tests are probably going to get all or mostly honors. Still very impressive to be sure, but not quite as astronomical. And then there are schools where a relatively large portion of the class get honors or some version of honors. Overall because of the huge variability in grading schema it's hard to say much without knowing distributions and how the grades are calculated - I know that my school provides this information on the dean's letter so that PDs can make a more informed judgment on the clinical grades.

 

[atomi]

Would you rather trade for honors in everything with a step 1 score 15 points lower? 10 points lower?

That’s what I thought. Move along and enjoy your competitive sub specialty.

 

[21Rush12]

Would you rather trade for honors in everything with a step 1 score 15 points lower? 10 points lower?

That’s what I thought. Move along and enjoy your competitive sub specialty.

??

 

[mehc012]

If they're at a school where honors is genuinely the top quartile/quintile or so of students and comprised of a balance of the shelf score and evaluations, then that is an unfathomably impressive achievement. For schools where the grade is mostly or entirely comprised of the shelf, then a certain cohort of people who generally do really well on standardized tests are probably going to get all or mostly honors. Still very impressive to be sure, but not quite as astronomical. And then there are schools where a relatively large portion of the class get honors or some version of honors. Overall because of the huge variability in grading schema it's hard to say much without knowing distributions and how the grades are calculated - I know that my school provides this information on the dean's letter so that PDs can make a more informed judgment on the clinical grades.

Unfortunately, my school doesn't publish this in the MSPE or otherwise. We only got a breakdown for our surgery rotation, when it was 20% H, most HP, some P. Ours are determined for each student independently from clinical evals, though honors isn't possible unless you get outstanding evals and also hit a certain threshold on the shelf score (which they tell us ahead of time and which is set by the national first quarter percentiles.) Theoretically, every student on a given rotation could get honors...or none of them could. I heard that few, if any, honors clinical evals were given out for the group before mine last rotation, but my cohort seemed to do well. But then, people don't talk about grades much, mostly they speculate before they come in, so who knows the real numbers. Basically, I have no idea whether even straight honors at my school means anything or nothing...and if PDs don't, either, that's probably not going to help me much.

 

[operaman]

Unfortunately, my school doesn't publish this in the MSPE or otherwise. We only got a breakdown for our surgery rotation, when it was 20% H, most HP, some P. Ours are determined for each student independently from clinical evals, though honors isn't possible unless you get outstanding evals and also hit a certain threshold on the shelf score (which they tell us ahead of time and which is set by the national first quarter percentiles.) Theoretically, every student on a given rotation could get honors...or none of them could. I heard that few, if any, honors clinical evals were given out for the group before mine last rotation, but my cohort seemed to do well. But then, people don't talk about grades much, mostly they speculate before they come in, so who knows the real numbers. Basically, I have no idea whether even straight honors at my school means anything or nothing...and if PDs don't, either, that's probably not going to help me much.

I've yet to see an MSPE that does not try and give some context for clinical grades and even specifically spell out how the clinical grades are calculated and give the general class distribution. This is pretty standard across schools at least among the applications I've seen come to us. Otherwise you just have no idea what you're looking at as this varies so much between schools.

 

[mehc012]

I've yet to see an MSPE that does not try and give some context for clinical grades and even specifically spell out how the clinical grades are calculated and give the general class distribution. This is pretty standard across schools at least among the applications I've seen come to us. Otherwise you just have no idea what you're looking at as this varies so much between schools.

I specifically asked our 4th years, who can all see the text of their MSPEs, and they say there's no distribution information in them. Calculation, sure...but not distribution.

 

[operaman]

I specifically asked our 4th years, who can all see the text of their MSPEs, and they say there's no distribution information in them. Calculation, sure...but not distribution.

That's strange. Every MSPE I've read gives the distribution, but I haven't scrutinized them all that much so maybe I've just missed it. Some also send a supplemental appendix that shows distribution and whatnot, so your 4th years may not have seen that part.

Looking at the literature I see a 2016 paper from Academic Medicine (PMID 26703411) where they looked at this. 99% described their grading schema and 82% provided the comparative data. So perhaps I've just not happened to go looking for it on one of the 18% that don't include it.

 

[mrbreakfast]

If they're at a school where honors is genuinely the top quartile/quintile or so of students and comprised of a balance of the shelf score and evaluations, then that is an unfathomably impressive achievement.

A few people in my class did this, including a good friend. In my program - in addition to smoking every shelf - this can be achieved with some schedule manipulation, as some preceptors are known for giving high evaluations while others fill them out the day they're due and give every student average grades.

The unfortunate fact is that - at least at my program, and based on what I've heard, at a number of programs - for about half of preceptors I could tell you what your evaluations would look like before you even started your rotation. For example, our psych clerkship involves two sub-rotations selected from 3 possible clinical sites, randomly selected prior to the start: A, B, and C. That almost entirely determines your grade; unless you bomb the shelf, A+B = H, A+C = HP, and B+C = P for 95%+ of students. Doesn't matter how good or bad you are, as the preceptors at A give almost every student perfect evals and those at C give average evals to even the best students.

 

[mehc012]

That's strange. Every MSPE I've read gives the distribution, but I haven't scrutinized them all that much so maybe I've just missed it. Some also send a supplemental appendix that shows distribution and whatnot, so your 4th years may not have seen that part.

Looking at the literature I see a 2016 paper from Academic Medicine (PMID 26703411) where they looked at this. 99% described their grading schema and 82% provided the comparative data. So perhaps I've just not happened to go looking for it on one of the 18% that don't include it.

I'll ask my deans the next time I meet with one, I guess. I'd really like to know the answer myself, but I guess it doesn't change anything for me...just keep aiming for that H and try to rack up as many as I can.

 

[bananafish94]

In my program - in addition to smoking every shelf - this can be achieved with some schedule manipulation, as some preceptors are known for giving high evaluations while others fill them out the day they're due and give every student average grades.

I tip my hat to anyone who can pull that off. It's absolutely the same case at my school, but we get no say at all in preceptors except for electives.

for about half of preceptors I could tell you what your evaluations would look like before you even started your rotation.

Oh yeah. It mostly has to do with the individual preceptor's grading system. If you're extraordinary you might be able to shift your numbers slightly up, but you're never going to get a 3/5 person to give you 5/5, no matter how good you are. I had one attending who notoriously gives every single person the exact same (low) grade without fail. One another clerkship a friend of mine got a ridiculous score on the shelf and ended up with a P because of one notorious preceptor. Which isn't to say it doesn't go both ways; I've had people who give me unwarranted straight perfect scores (which are "supposed" to be reserved for students who are basically performing at resident level). It's just that I've found it mostly depends on the grader.

 

[WedgeDawg]

I specifically asked our 4th years, who can all see the text of their MSPEs, and they say there's no distribution information in them. Calculation, sure...but not distribution.

The grade distribution may not be in the portion of your MSPE that you’re given the opportunity to see as a 4th year. At my school, we are given the text of our MSPE but there is another section with grade distributions for our year etc that is sent to PDs but not shown to us. Your school may operate similarly.

 

[mehc012]

The grade distribution may not be in the portion of your MSPE that you’re given the opportunity to see as a 4th year. At my school, we are given the text of our MSPE but there is another section with grade distributions for our year etc that is sent to PDs but not shown to us. Your school may operate similarly.

At this point, I'm just curious for my own interest. I'm not super worried about what PDs will think other than that if honors is given out super frequently here, it will count for less to have them. I suspect we may be one of those schools, since both I and another classmate I know have straight honors so far with only one rotation left in 3rd year (though they technically didn't hit the shelf cutoff on one of them, but got it anyways...we're not asking questions about a good thing, though!)

 

[afib123]

At this point, I'm just curious for my own interest. I'm not super worried about what PDs will think other than that if honors is given out super frequently here, it will count for less to have them. I suspect we may be one of those schools, since both I and another classmate I know have straight honors so far with only one rotation left in 3rd year (though they technically didn't hit the shelf cutoff on one of them, but got it anyways...we're not asking questions about a good thing, though!)

From conversations on sdn and with friends from other schools , honors are the exception and not given out easily. So if you do have that many honors, most people will probably give you the benefit of doubt and think you're exceptional than think that your school gives out easy honors. So it should benefit you to not have it listed on your mspe

 

[NickNaylor]

I'd be curious about what happened on your FM rotation, but otherwise they look perfectly fine.

Note that while grades are certainly important, it's really the comments from your evaluations that are included in your dean's letter that will likely carry more weight.

 

[Lawpy]

I'd be curious about what happened on your FM rotation, but otherwise they look perfectly fine.

Note that while grades are certainly important, it's really the comments from your evaluations that are included in your dean's letter that will likely carry more weight.

But I read that schools can modify those comments to make their students look good (minimizing negative comments and emphasizing the positives). Or is that off?

 

[NickNaylor]

But I read that schools can modify those comments to make their students look good (minimizing negative comments and emphasizing the positives). Or is that off?

In all of the dean’s letters that I’ve seen, the comments are presented as direct quotes. I doubt a school would “modify” comments, but certainly they decide what will and won’t be included. That being said, negative comments do still occasionally get included.