How much does preclinical rank matter when the class average is fairly high?

[PreMedPerson1020]

I'm an M1 at a lower mid-tier school with pass/fail with internal rankings (which determine adjectives on Dean's letter to residency). I score pretty consistently in the low-mid 80%s on exams, which I would feel pretty good about given the pass/fail situation, except for the fact that the class average is usually 80-85%. A few times, I've scored a percent or two above the average, but usually I'm one or two percent below. I'm worried that this will put my class rank just barely into "below average"/bottom 50% on the Dean's letter to residency and am wondering how important this is?

I would understand "bottom 50% of the class" being a red flag if the class average were something like 75% or 70%, but given that I'd need to average a B+/A equivalent on our exams (which are all cumulative) just to make it out of this classification, I'm not sure what I can do. I don't think residency programs get to know the class's average percentage that determines our rank, but do they?

(In case this information helps: I think it's too early to tell what I'm interested in, but I'm leaning toward IM, though I also have one eye on a competitive specialty that I would like to not be shut out of due to this.)

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[Billiam95]

Here's the data from 2020:

https://www.nrmp.org/wp-content/uploads/2020/08/2020-PD-Survey.pdf

I don't really think class average matters all that much, rather your place in the pecking order does.

 

[Throwaway5129]

I would worry more about grades in M3 and M4. Just keep trying your best in M1/M2. Don't worry about rankings right now.

 

[collegestud2013]

I'm an M1 at a lower mid-tier school with pass/fail with internal rankings (which determine adjectives on Dean's letter to residency). I score pretty consistently in the low-mid 80%s on exams, which I would feel pretty good about given the pass/fail situation, except for the fact that the class average is usually 80-85%. A few times, I've scored a percent or two above the average, but usually I'm one or two percent below. I'm worried that this will put my class rank just barely into "below average"/bottom 50% on the Dean's letter to residency and am wondering how important this is?

I would understand "bottom 50% of the class" being a red flag if the class average were something like 75% or 70%, but given that I'd need to average a B+/A equivalent on our exams (which are all cumulative) just to make it out of this classification, I'm not sure what I can do. I don't think residency programs get to know the class's average percentage that determines our rank, but do they?

(In case this information helps: I think it's too early to tell what I'm interested in, but I'm leaning toward IM, though I also have one eye on a competitive specialty that I would like to not be shut out of due to this.)

If your class rank is disclosed on the Deans letter, the ranking are NOT internal at all, and for residency application purposes your med school is also NOT pass/fail. The absolute percentages aren't that useful, but your RANK in the class is what residency programs will look at. That's probably why the averages in your class are so high - people are gunning since the are effectively being ranked.

While being in the bottom half of the class is okay if you just want to get into any IM program and will be a USMD grad, it can definitely make the competitive specialties much more difficult to get into. For the most competitive specialties, you should at LEAST be in the top half of your class if you're from a lower mid-tier USMD school but many who are applying to competitive specialties from lower tier med schools will be in the top quartile.

 

[collegestud2013]

I would worry more about grades in M3 and M4. Just keep trying your best in M1/M2. Don't worry about rankings right now.

M4 grades are not useful since most schools don't even include them for class ranking (since you take most of your M4 rotations after applying to residency), unless it's rotation in the specialty you want to go into you're trying to get rec letters, or if it's an away rotation. If OP's school averages M1, M2, M3 together for a final class rank, then M1 and M2 are equally important as M3.

 

[PreMedPerson1020]

If your class rank is disclosed on the Deans letter, the ranking are NOT internal at all, and for residency application purposes your med school is also NOT pass/fail. The absolute percentages aren't that useful, but your RANK in the class is what residency programs will look at. That's probably why the averages in your class are so high - people are gunning since the are effectively being ranked.

While being in the bottom half of the class is okay if you just want to get into any IM program and will be a USMD grad, it can definitely make the competitive specialties much more difficult to get into. For the most competitive specialties, you should at LEAST be in the top half of your class if you're from a lower mid-tier USMD school but many who are applying to competitive specialties from lower tier med schools will be in the top quartile.

Yeah, unfortunately the school advertised pass/fail pretty heavily until we matriculated, then they changed a lot of how they rank/grade students for this year. Surprisingly, most people I talk to don't even know about the internal rankings, since it's not really advertised-- I think the average is just high due to a smart class and quality professors. It's too bad that "top quartile" can mean such a different actual percentage/letter grade depending on the school and cohort. I wonder if there's anything that is done by residency directors to consider/correct for that? Will a high Step 2 (since 1 is P/F now) evidence that?

 

[Billiam95]

Yeah, unfortunately the school advertised pass/fail pretty heavily until we matriculated, then they changed a lot of how they rank/grade students for this year. Surprisingly, most people I talk to don't even know about the internal rankings, since it's not really advertised-- I think the average is just high due to a smart class and quality professors. It's too bad that "top quartile" can mean such a different actual percentage/letter grade depending on the school and cohort. I wonder if there's anything that is done by residency directors to consider/correct for that? Will a high Step 2 (since 1 is P/F now) evidence that?

I don't think there's any utility to comparing class averages across schools - one school might have more participation points as part of a final grade, easier inhouse exams/quizzes, easier NBME questions, etc.

 

[PreMedPerson1020]

I don't think there's any utility to comparing class averages across schools - one school might have more participation points as part of a final grade, easier inhouse exams/quizzes, easier NBME questions, etc.

I think that's what the issue is with percentile rankings to begin with. Too many variables between one school's "top 15%' and another's.

 

[Thesimplelifeofamyloid]

Figure out what matters vs. what doesn't matter for AOA. The more you find out about the nitty gritty in regards to your school the better

 

[Redpancreas]

Nothing to do about it now. I would continue to chug along with what you’re doing and try your best to set yourself up for the best 3rd year performance. Usually M1/2 = 25% each and third year is 50%. Also your Step 2 CK and 3rd year grades both still mean more than whether you’re in the 2nd or 3rd quartile and in my opinion I’d rather have good Step 2CK and 3rd year grades than weaknesses in one of those two in lieu of a better class rank. That said, having a great class rank/AOA status does really boost your application in terms of top residencies in IM/Peds/etc or more competitive surgical sub specialty residencies.

 

[collegestud2013]

Yeah, unfortunately the school advertised pass/fail pretty heavily until we matriculated, then they changed a lot of how they rank/grade students for this year. Surprisingly, most people I talk to don't even know about the internal rankings, since it's not really advertised-- I think the average is just high due to a smart class and quality professors. It's too bad that "top quartile" can mean such a different actual percentage/letter grade depending on the school and cohort. I wonder if there's anything that is done by residency directors to consider/correct for that? Will a high Step 2 (since 1 is P/F now) evidence that?

At most USMD schools, nearly everyone is at least reasonably smart. And given that a lot of pre-clinical medicine involves rote memorizing, intelligence differences less of a factor, and work ethic and studying habits will be the major determinant of your class rank. It's very common in medical school to have high exam averages if the class ranked (giving people more incentive to study much harder) and if the exams are in-house exams that are nearly based verbatim on lecture slides. Most people will get most of the questions right and it's usually a small number of slightly more difficult questions or questions that test concepts that were not advertised by the professor as high yield that will separate the quartiles. Other schools may use NMBE exams or make harder in house exams which often are harder to score a very high absolute percentage correctly since you won't be told exactly every detail that is on the exam. So for that reason residency programs don't really take absolute percentages into account the same way that's done in high school or undergrad courses (and most PDs don't even have the time to comb through the details in each app). The most they'll take account is the overall reputation of your med school (for example they won't hold it against as much if you're coming from a ranked Top 10 med school but rank lower).

A strong Step 2 CK will obviously be helpful now that Step 1 is P/F. The only problem now is that since Step 2 CK is not typically taken until the end of M3 to the beginning of M4, most students won't know how competitive their application will be for a given specialty until its application time. In the past it was common at many schools for more than half the incoming class to want to do specialties that commonly get a lot of attention like ortho, derm, plastics, neurosurgery, but after M2 year and getting their Step 1 scores back many will select out and choose a less competitive specialty once they realize their preclinical grades and Step 1 score weren't quite competitive (remember that your actual Step scores on test day can fluctuate and be very different than your practice averages). But since the most competitive specialties also require extensive research (and often a dedicated research year), networking, and away rotations to be arranged well in advance, it's much more likely now that M4s may be stuck applying to a competitive specialty with a subpar Step 2 CK score that they found out "last minute" but already spent 3 years building an app for.

 

[Phloston]

I'm an M1 at a lower mid-tier school with pass/fail with internal rankings (which determine adjectives on Dean's letter to residency). I score pretty consistently in the low-mid 80%s on exams, which I would feel pretty good about given the pass/fail situation, except for the fact that the class average is usually 80-85%. A few times, I've scored a percent or two above the average, but usually I'm one or two percent below. I'm worried that this will put my class rank just barely into "below average"/bottom 50% on the Dean's letter to residency and am wondering how important this is?

I would understand "bottom 50% of the class" being a red flag if the class average were something like 75% or 70%, but given that I'd need to average a B+/A equivalent on our exams (which are all cumulative) just to make it out of this classification, I'm not sure what I can do. I don't think residency programs get to know the class's average percentage that determines our rank, but do they?

(In case this information helps: I think it's too early to tell what I'm interested in, but I'm leaning toward IM, though I also have one eye on a competitive specialty that I would like to not be shut out of due to this.)

With Step 1 going to P/F, people will be forced to look more at preclinical grades, so I'd say they will matter more. Is that fair? Maybe not. But it was a terrible idea eradicating the numerical Step 1.