Pass in core clerkship in field of interest

[PickleRick19]

Hey everyone,

First, some background. I'm a 3rd year med student with a 245 step 1 score, mostly high passes/honors in pre-clinicals (w/ one pass in a behavioral class), some research (one pub and another on the way), community involvement w/ volunteering at clinics, 2 mission trips, yada yada.

Now, my concern. A few weeks ago I finished up my internal med core clerkship, my first of 3rd year. I just found out I received just a "pass", barely missing high pass by a fraction of a percent. The problem is that I didn't do so hot on the shelf, scoring a 72% raw. While I'm definitely not trying to make excuses, I think the reason was I was placed at hard locations and couldn't balance study time well enough (it being my first rotation didn't help either). My evals were mostly fine, averaging an 89% (had some arguable ones but what can you do). The cutoff for "high pass" at my school in IM is 85%, but obviously residency programs won't care or see that I missed it by a minuscule amount.

My main question: I realized after doing IM that I may want to go into it. Will a "pass" in IM really look that bad given my other stats/will it automatically bar or filter me from matching to competitive residencies? Although it'd be nice, I don't care much for the top 10-20 programs, unless it's in Ohio (where I'm from) where I want to end up matching. I also don't want to end up at bottom tier programs. I know the general advice to honor the hell out of Sub-Is, 4th year clerkships in the field, etc etc, but I just can't seem to find advice about what a pass might mean for my matching goals (even in other fields) or what it looks like to PDs given the rest of my app. Any input?

TLDR; Got a "pass" in IM core clerkship (first one of 3rd year), decided I want to go into IM, 245 step, good/decent ECs, some research, what are my matching options for near top or mid tier residency programs and will anything I do make up for that pass.

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[Coupd'Cat]

That's rough. :| And I'm sorry you're in this bind. I'm afraid I don't know much about IM (MS4 applying into Psych), but the general advice I've heard has been definitely what you mentioned--do very well on your Sub-I. And maybe be prepared to talk about the circumstances around getting a Pass during your third year during interviews, if they ask.

Best people to ask might be your home institution's PD or any specialty advisors. Also, I know at least at my institution, at the end of the year the clerkship directors review all the grades and give a higher grade to students who were right on the cusp. So there's hope! Happened to me for a clerkship.

Take a deep breath--not the end of the world. You have a lot of good things going for you, and will work through this as well.

 

[Anicetus]

Unfortunately, honors in IM is another screening tool used by some places. It's applied to students that aren't from top med schools as a way to boost applicants that may be the top of those Lower ranked med schools. I wouldn't worry too much about it as this filter usually isn't an initial filter applied (like step 1) so you will definitely get looked at. And if going to an upper echelon residency isn't a thing for you then don't worry about it. The reason they use honors as a filter at these places is to help cut down the number of apps since IM is a gigantic pool of applicants unlike ones such as neurosurgery.

As far as the sub I: The truth is depending on where and when you're doing your sub-I you may not even get a grade in time for it. If you do it early enough for the grade to show up then definitely honor that clerkship.

 

[PickleRick19]

Thanks for the response guys, I really appreciate it. I guess the worst part is knowing that I'd have a HP had I gotten 2 points higher on the shelf, or if two 3s/4s on just one of my evals were 4s/5s instead. I know that the burden of the poor shelf is entirely on me and is not anyone else's fault. I spoke with my clerkship director and he said there wasn't really anything he could do about my grade, and that he couldn't really see anything coming out of meeting with my facilitators to try to get my evals slightly improved but that I could try. His biggest advice was to do really well on step 2 and improve on my other clerkships. He actually also advised caution with doing an away sub-i at a place I want to match, mostly b/c the system will be new and there is also a risk that I could hurt myself rather than help myself.

And if going to an upper echelon residency isn't a thing for you then don't worry about it.

What would you consider an upper echelon residency? One of the residencies I would apply to is top 20, and the others are top 30/40 which still sounds pretty high up there. Also, I happen to go to one of those lower ranked schools (not sure if that would work against me, even though the school is quite good actually), which has a reputation/relationships within the state and surrounding area but probably not further away.

 

[Redpancreas]

I feel you hard on this. I was in your position except HP to Honors in IM. I have a similar Step score. It will hurt and I think Anicetus explains the reality of the situation fairly well. To provide context, I have interviews thus far from several solid top 30-60 tier academic programs . Only one in the doximity top 30, but several seem to excite my PDs and many are excited to hear I've heard from such places and say they provide amazing training, etc.

I'm sorry to say this but when I received my Step score I thought I'd be in contention for top 10 schools. Then 3rd year happened and I didn't honor IM. Then I realized that evdicence of commitment to research was almost must for upper tier (top 10, possibly top 20 programs) and then I realized top schools was a major factor and that AOA was made as an equalizer and I didn't have that. Ultimately, you have to take a step back and realize how competitive IM is and reflect your goals? You ended up at a lower ranked MD school. That shows you valued time over the degree. Chances are your priorities haven't changed. Do you want a name brand residency so you can say you were a Hopkins-trained Internist? Or do you just want a residency that will provide you the highest quality of IM training and give you a reasonable chance at fellowship if you put the effort in? Most I know would be satisfied with the latter.

 

[Redpancreas]

Hey everyone,

First, some background. I'm a 3rd year med student with a 245 step 1 score, mostly high passes/honors in pre-clinicals (w/ one pass in a behavioral class), some research (one pub and another on the way), community involvement w/ volunteering at clinics, 2 mission trips, yada yada.

Now, my concern. A few weeks ago I finished up my internal med core clerkship, my first of 3rd year. I just found out I received just a "pass", barely missing high pass by a fraction of a percent. The problem is that I didn't do so hot on the shelf, scoring a 72% raw. While I'm definitely not trying to make excuses, I think the reason was I was placed at hard locations and couldn't balance study time well enough (it being my first rotation didn't help either). My evals were mostly fine, averaging an 89% (had some arguable ones but what can you do). The cutoff for "high pass" at my school in IM is 85%, but obviously residency programs won't care or see that I missed it by a minuscule amount.

My main question: I realized after doing IM that I may want to go into it. Will a "pass" in IM really look that bad given my other stats/will it automatically bar or filter me from matching to competitive residencies? Although it'd be nice, I don't care much for the top 10-20 programs, unless it's in Ohio (where I'm from) where I want to end up matching. I also don't want to end up at bottom tier programs. I know the general advice to honor the hell out of Sub-Is, 4th year clerkships in the field, etc etc, but I just can't seem to find advice about what a pass might mean for my matching goals (even in other fields) or what it looks like to PDs given the rest of my app. Any input?

TLDR; Got a "pass" in IM core clerkship (first one of 3rd year), decided I want to go into IM, 245 step, good/decent ECs, some research, what are my matching options for near top or mid tier residency programs and will anything I do make up for that pass.

Also a jump on CK will help but will be very hard to do. IM definitely looks at all your deans letter comments and letters. Try to make those distinguished by putting in the work. I know you said you have some research and I know finding a way to cram a publication in there will help, but don't kill yourself to get one.

 

[PickleRick19]

I was in your position except HP to Honors in IM.

I would take an HP any day, I'd say you still did well! I feel like HP still looks decently competitive outside of top 10-20 programs given the rest of the app is in order. The question is, does a P really look that bad for top 30-60 programs (like Loyola, Cinci, any of the Case Western Programs, etc) as long as I do better in my other rotations (not that I consider my grade being slightly under 85 bad at all) and do well on step 2? After all, it was my first rotation. Also, I'm hoping to have 3 pubs and good LORs by that time too. I already know 1 LOR will probably be very good.

Do you want a name brand residency so you can say you were a Hopkins-trained Internist? Or do you just want a residency that will provide you the highest quality of IM training and give you a reasonable chance at fellowship if you put the effort in? Most I know would be satisfied with the latter.

I would 200% be satisfied with the latter. I don't need to be at a high profile residency to be happy, but I also don't want to be short on options and shut out from a mid tier residency either because of a Pass grade in IM. The only reason I worry is because so many people make anything less than H/HP in a field of interest seem like career suicide, then they go on posting studies about how clerkship grades are the holy grail

Can't tell you how much I appreciate your post though. And it's still pretty early so I'm sure you'll get a wave of many more invites.

 

[NucleusO]

I would take an HP any day, I'd say you still did well! I feel like HP still looks decently competitive outside of top 10-20 programs given the rest of the app is in order. The question is, does a P really look that bad for top 30-60 programs (like Loyola, Cinci, any of the Case Western Programs, etc) as long as I do better in my other rotations (not that I consider my grade being slightly under 85 bad at all) and do well on step 2? After all, it was my first rotation. Also, I'm hoping to have 3 pubs and good LORs by that time too. I already know 1 LOR will probably be very good.



I would 200% be satisfied with the latter. I don't need to be at a high profile residency to be happy, but I also don't want to be short on options and shut out from a mid tier residency either because of a Pass grade in IM. The only reason I worry is because so many people make anything less than H/HP in a field of interest seem like career suicide, then they go on posting studies about how clerkship grades are the holy grail

Can't tell you how much I appreciate your post though. And it's still pretty early so I'm sure you'll get a wave of many more invites.

I find myself in the same position as you. Same stats from a state school. One point away from honoring. My school doesn't even have high pass as an option. The medicine director said that he'll write in my letter that I was 1 point away and how he doesn't think it's fair that my school's medicine clerkship is 4 weeks long. How did things end up for you? Did not honoring close any doors for you?