MD Pre-Clerkship Grades Really Matter at some schools

[Redpancreas]

All this, while strongly stated, is an opinion:


So if you're currently a second year who's not done too hot in classes and are about to start preparing for Step this is virtually useless and you may as well look elsewhere for your UFAP procrastination because doing well on Step trumps what I'm about to talk about.

I just want to speak to the first years and those incoming M1s who are watching these forums.

Myth: Pre-Clinical Grades are not important because there's a bunch of other factors that come before them according to a bunch of studies and the NRMP survey.

Guess what? One of the top factors is class-rank. Also, AOA which is a huge boost to any application. Also, not only does class rank carry weight for residency, but it will for any fellowship applications down the road.

At my school, you're placed into 5 categories based on your M1/2 grades and your OVERALL clinical performance is either good or honor (based on a point system where clerkships are weighted by months). All that honoring clinical performance does is potentially bump you up in category (unless you're in the first/last category).

So...share if your experience is any different but M1/2 grades seem to determine most of your class rank and I think it's agreed that class rank is important.

Also, this has been talked about but if you are choosing a school for the pass/fail reasoning, make sure it's pure P/F (many top schools are)... and not P/F on transcripts and internal rank because those will count one-day if you're from a lower tiered school looking to apply to apply up and adcoms at top schools can afford to split hairs. Really do your research on this point, I've seen tour guides for multiple schools give false info to students. "Yeah, we're P/F, it's so collaborative with a great atmosphere, everyone shares study guides"...1 year later, you find out you're internally ranked for class-rank purposes.

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[MSTP18]

Really do your research on this point, I've seen tour guides for multiple schools give false info to students. Yeah, we're P/F, it's so uncompetitive, everyone shares study guides...1 year later, you find out you're internally ranked for class rank purposes.

Surprised that this still needs to be said. This seemed like common knowledge (that some - emphasis on the some, it's certainly not all - p/f schools still use pre-clinical grades to rank you) back when I was looking at schools in 2009. This was a question that was asked straight up by someone or directly addressed at every interview I went to.

 

[Redpancreas]

Surprised that this still needs to be said. This seemed like common knowledge (that some - emphasis on the some, it's certainly not all - p/f schools still use pre-clinical grades to rank you) back when I was looking at schools in 2009. This was a question that was asked straight up by someone or directly addressed at every interview I went to.

Still needs to be drilled in for some, but a lot now know. I personally didn't learn this until I failed my first Anatomy practical and went on an SDN search.

 

[Anicetus]

All this, while strongly stated, is an opinion:


So if you're currently a second year who's not done too hot in classes and are about to start preparing for Step this is virtually useless and you may as well look elsewhere for your UFAP procrastination because doing well on Step trumps what I'm about to talk about.

I just want to speak to the first years and those incoming M1s who are watching these forums.

Myth: Pre-Clinical Grades are not important because there's a bunch of other factors that come before them according to a bunch of studies.

Guess what? One of the top factors is class-rank. Also, AOA which is a huge boost to any application. Also, not only does class rank carry weight for residency, but it will for any fellowship applications down the road.

At my school, you're placed into 5 class categories based on your M1/2 grades and your clinical performance is either good or superb (based on a point system that makes it so you have to honor half your year or a few more difficult paths to achieve superb). All that clinical (supposedly the most important grades) honor does is bump you up one class rank category (unless you're in the last category).

Therefore, class rank at my school is mainly determined by your year 1/2 performance.

Also, this has been talked about but if you are choosing a school for the pass/fail reasoning, make sure it's pure P/F (many top schools are)... and not P/F on transcripts and internal rank because those will count one-day if you're from a lower tiered school looking to apply to apply up and adcoms can afford to split hairs. Really do your research on this point, I've seen tour guides for multiple schools give false info to students. Yeah, we're P/F, it's so uncompetitive, everyone shares study guides...1 year later, you find out you're internally ranked for class rank purposes.

The only people who don't believe this are ostriches sticking their heads in the ground and thinking that if they don't believe it then it isn't true. Plus it helps them sleep at night.

All in all they do matter. Some students are bias and don't like to believe their admin lies about the lack of internal ranking system strictly for the benefit of their mental health. And honestly, med students are so unhinged that they are better off being disappointed in fourth year finding out the truth instead of finding out first year and killing themselves or dropping out because they are bottom of the class and need AOA from their low tier MD school in order to be considered for their beloved dermatology. Before the NRMP junkies get on me, yes I know only xx% of people who match (insert competitive subsurgical specialty) are AOA but what they don't tell you is how the prestige of the med school is accounted in that. Literally anyone from a not top MD school needs the higher quartile on their dean letter or AOA to break into the most desired specialties.

A caveat. The schools with no internal rankings: if the school isn't at least top 50 in the U.S., your admin is lying to you and you'll just have to find out come fourth year.

 

[PhillyMed777]

Doing well pre-clinically was the MOST important thing I could have done. It helped me nail step 1. It helped me nail pimping during clerkship. It helped me nail shelf exams. And it will prob have contributed directly and indirectly to a likely AOA selection. It is helping me on my AIs currently with random pimping. Studying that hard the first few years also improved my ability to study on the whole and soak information in a quality way and understand it quickly.

A lot of people who didn't study hard the first few years of med school and constantly ridiculed me for trying hard are currently wishing they had put the work in. Don't take shortcuts, and don't be unwilling to grind from day one of med school.

I recommend all students to take pre-clinical classes seriously.

 

[750335]

How common is it to do very well in M1/2 and then do meh on Step?

Just seems like very good preclinical grades would relate well with Step 1 scores.

 

[yungspleen]

A caveat. The schools with no internal rankings: if the school isn't at least top 50 in the U.S., your admin is lying to you and you'll just have to find out come fourth year.

I mean...wouldn't the fourth years say something to the incoming students? It's not like the admin and M4's are in on it together to screw over the new students...

 

[PhillyMed777]

How common is it to do very well in M1/2 and then do meh on Step?

Just seems like very good preclinical grades would relate well with Step 1 scores.

Totally common if you "let up" on the intensity, particularly if towards the end of M2/step studying time. A lot of doing well in med school comes from consistently doing well and not dropping your guard ever. I treated every little quiz and obstacle as a game changer. It was a terrible way to live mentally, but success-wise it definitely worked. It has happened year after year at my school. People that did well in one part of school tended to do better/well in all other parts of med school.

 

[mw18]

How common is it to do very well in M1/2 and then do meh on Step?

Just seems like very good preclinical grades would relate well with Step 1 scores.

I'm sure it's highly correlated because people who do well, do well. It never hurts to do well and learn as much as possible. But there are many schools, mine included, that just don't teach a huge percentage of what is on step and it is possible to do very well on stop while being decent in the preclinical years. This population of people are those that don't take preclinical classes seriously intentionally. Those that struggle with them, very well may struggle with Step by the corollary of my first sentence.

 

[Redpancreas]

Doing well pre-clinically was the MOST important thing I could have done. It helped me nail step 1. It helped me nail pimping during clerkship. It helped me nail shelf exams. And it will prob have contributed directly and indirectly to a likely AOA selection. It is helping me on my AIs currently with random pimping. Studying that hard the first few years also improved my ability to study on the whole and soak information in a quality way and understand it quickly.

A lot of people who didn't study hard the first few years of med school and constantly ridiculed me for trying hard are currently wishing they had put the work in. Don't take shortcuts, and don't be unwilling to grind from day one of med school.

I recommend all students to take pre-clinical classes seriously.

I mean...wouldn't the fourth years say something to the incoming students? It's not like the admin and M4's are in on it together to screw over the new students...

Admissions is not looking to try and screw anyone. Some schools are just looking to do things like attract candidates and hearing P/F in pre-clerkship will cause many interviewees to check that box and put them at false ease coming in. Most 4th years are checked out and don't regularly interact with M1s. I know...more neuroticism is just what we needed on SDN.

 

[750335]

I'm sure it's highly correlated because people who do well, do well. It never hurts to do well and learn as much as possible. But there are many schools, mine included, that just don't teach a huge percentage of what is on step and it is possible to do very well on stop while being decent in the preclinical years. This population of people are those that don't take preclinical classes seriously intentionally. Those that struggle with them, very well may struggle with Step by the corollary of my first sentence.

Totally common if you "let up" on the intensity, particularly if towards the end of M2/step studying time. A lot of doing well in med school comes from consistently doing well and not dropping your guard ever. I treated every little quiz and obstacle as a game changer. It was a terrible way to live mentally, but success-wise it definitely worked

That makes sense. I can understand not fretting over 87 vs 90 in preclinicals but I think just aiming for whatever pass is at your institution might mean having to do that much more work for step prep..or am I thinking about incorrectly?

 

[username456789]

Doing well pre-clinically was the MOST important thing I could have done. It helped me nail step 1. It helped me nail pimping during clerkship. It helped me nail shelf exams. And it will prob have contributed directly and indirectly to a likely AOA selection. It is helping me on my AIs currently with random pimping. Studying that hard the first few years also improved my ability to study on the whole and soak information in a quality way and understand it quickly.

A lot of people who didn't study hard the first few years of med school and constantly ridiculed me for trying hard are currently wishing they had put the work in. Don't take shortcuts, and don't be unwilling to grind from day one of med school.

I recommend all students to take pre-clinical classes seriously.

I could've written this verbatim.

Busting my ass in M1/M2 was absolutely the best thing I ever did in medical school. It paid countless dividend, not the least was the ability to dominate Step 1. Clerkships, shelves, pimping, Step 2, AOA, etc. So so much easier to excel in further endeavors, often with much less effort than would have otherwise been needed

Lay the foundation. Busting your ass for two years it is absolutely worth it to make the rest of your medical school career, and more importantly, the rest of your life much much easier.

The people who claim they prefer to "just pass" because of some idea of "work/play balance" during those two years are extremely short sighted. I put in the work for those two years so that I have now set myself up to have an excellent work/life balance for my entire career.

 

[Gorne]

You're still ranked at what I believe must be almost every school. At my school AOA gets decided at the beginning of M4 so you need to at least be top 20% of the class from the first 3 years to be considered.

The whole p/f takeover has more to do with student mental health and fostering a more collaborative environment among the students than the grades actually not mattering.

 

[mw18]

That makes sense. I can understand not fretting over 87 vs 90 in preclinicals but I think just aiming for whatever pass is at your institution might mean having to do that much more work for step prep..or am I thinking about incorrectly?

I think it's good to get a strong understanding of the overall concepts, but much of the tests are on these little details that will have escaped your mind completely when Step comes around. Escaped my mind, at least. But not having to spend much time re-learning bigger concepts has been valuable.

 

[NucleusO]

Should we trust the MSAR if it says that the school does not rank its students or should we ask current students about whether or not they're actually ranked?

 

[MSTP18]

You're still ranked at what I believe must be almost every school. At my school AOA gets decided at the beginning of M4 so you need to at least be top 20% of the class from the first 3 years to be considered.

The whole p/f takeover has more to do with student mental health and fostering a more collaborative environment among the students than the grades actually not mattering.

Almost every school ranks because almost no schools do M3 p/f. At my school, AOA is just Step 1 and M3 grades.

 

[MSTP18]

Should we trust the MSAR if it says that the school does not rank its students or should we ask current students about whether or not they're actually ranked?

I would ask not because I think they are lying on MSAR but because I don't know how MSAR actually gets that data.

 

[Redpancreas]

Should we trust the MSAR if it says that the school does not rank its students or should we ask current students about whether or not they're actually ranked?

I wouldn't. While the MSAR is a great resource for things like MCAT and picking places to apply to, back when I was pre-med they couldn't even get tuition info right, forget P/F.

 

[theonlytycrane]

Is it common for students to slack by with minimum pass during m1/m2? Or do most students at your schools seem to be grinding hard?


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[sovereign0]

This might be a bit of a strange opinion, but at my school we are true P/F with no internal ranking. Class rank and AOA are decided SOLELY on M3 clerkship grades - no consideration to Step 1 either.

In this scenario, I almost wish that my pre-clinicals and Step 1 counted toward class rank. I've heard too many nightmare stories about random/subjective evals and cruddy situations with evaluators (not giving good feedback then wrecking you on the eval). I almost wish we had some more objective measurements factoring into AOA/Class rank other than the shelves. My understanding is that the weight of the shelves in our clinical grades also depends on the rotation.

Can't help but feel that the influence of chance weighs a bit too heavily on my grades than actual merit. But I hope this isn't the case, of course. I'm sure there is some response bias when it comes to all the crappy evaluators... right?

 

[Redpancreas]

Is it common for students to slack by with minimum pass during m1/m2? Or do most students at your schools seem to be grinding hard?


Sent from my iPhone using SDN mobile app

Well, no one really slacks or else they fail but it's common for new students who aren't happy with the intermediate between their goal (90%+) and min passing. Just trying to point out that the P=M3 approach won't help you match competitive specialties.

This might be a bit of a strange opinion, but at my school we are true P/F with no internal ranking. Class rank and AOA are decided SOLELY on M3 clerkship grades - no consideration to Step 1 either.

In this scenario, I almost wish that my pre-clinicals and Step 1 counted toward class rank. I've heard too many nightmare stories about random/subjective evals and cruddy situations with evaluators (not giving good feedback then wrecking you on the eval). I almost wish we had some more objective measurements factoring into AOA/Class rank other than the shelves. My understanding is that the weight of the shelves in our clinical grades also depends on the rotation.

Can't help but feel that the influence of chance weighs a bit too heavily on my grades than actual merit. But I hope this isn't the case, of course. I'm sure there is some response bias when it comes to all the crappy evaluators... right?

The grass is always greener on the other side I suppose. I definitely think in your situation shelves need to serve as a objective counterbalance to clinical evaluations especially since they're the only source.

 

[turayza]

Is it common for students to slack by with minimum pass during m1/m2? Or do most students at your schools seem to be grinding hard?

My school is like @sovereign0 , true pass/fail not internally ranked for M1/2 and class rank/AOA candidacy determined solely by M3 required clerkship grades.

I definitely didn't work as hard in M1/2 as I would have if it were not true pass/fail. The work life balance was awesome! I just studied enough to feel like I understood the material to the level that satisfied my curiosity and called it good. Based on class averages though, there were a good number of my classmates that were slacking way harder and enjoying their lives (hopefully) outside of medicine.
This did not end up hurting me for step 1 - I worked my ass off during dedicated and exceeded my target score.

 

[DocWinter]

Keep in mind that hard work =/= better grades or higher class rank. Lots of students put in 100% and end up mid class rank. Those at the bottom of the class - they're not busting their butt to stay in this? There is a lot to be said for previous experience/education and natural ability.

 

[MSTP18]

This might be a bit of a strange opinion, but at my school we are true P/F with no internal ranking. Class rank and AOA are decided SOLELY on M3 clerkship grades - no consideration to Step 1 either.

In this scenario, I almost wish that my pre-clinicals and Step 1 counted toward class rank. I've heard too many nightmare stories about random/subjective evals and cruddy situations with evaluators (not giving good feedback then wrecking you on the eval). I almost wish we had some more objective measurements factoring into AOA/Class rank other than the shelves. My understanding is that the weight of the shelves in our clinical grades also depends on the rotation.

Can't help but feel that the influence of chance weighs a bit too heavily on my grades than actual merit. But I hope this isn't the case, of course. I'm sure there is some response bias when it comes to all the crappy evaluators... right?

If your school is like mine, fear not: the shelf ends up being the single most important part of your grade because the distribution of shelf scores is much larger than the distribution for the other 80% of stuff that makes up your grade.

 

[mw18]

Is it common for students to slack by with minimum pass during m1/m2? Or do most students at your schools seem to be grinding hard?


Sent from my iPhone using SDN mobile app

For me, it wasn't like what you may be picturing it being like. You eventually settle into a rough understanding of "I've definitely done enough to pass" but it only comes with time. There is so much material that you would have to be comfortable failing and retaking a test to truly slack off. Any one test can vary enough that you need to be working. Now don't get me wrong, I took days off and had a great balance in preclinical times; but it took a while to get comfortable and I still never walked in knowing that I was going to do particularly well. The caveat being that I only know my experience at my school.

 

[OnePunchBiopsy]

Did you know that Step 1 score is another factor looked at when being considered for AOA?

Having just applied and matched into gen surg, I went on 12 interviews and NOT ONCE did an interviewer bring my preclinical grades into question. I even made straight B's and a couple of C's. As long as you don't fail then you should be fine. Preparing for Step 1 is of utmost importance and trumps pre-clinical grades across the board if you are choosing between the two.

I was told several times (about 10-12 times if I recall) that my Step 1 and Step 2 scores were on par and made me a good applicant.

It was brought up once that I did not honor surgery.

TLDR:
Step 1 is king, preclinical grades only matter if you fail them, AOA has Step 1 cut-offs as well.

 

[Lawpy]

Did you know that Step 1 score is another factor looked at when being considered for AOA?

Having just applied and matched into gen surg, I went on 12 interviews and NOT ONCE did an interviewer bring my preclinical grades into question. I even made straight B's and a couple of C's. As long as you don't fail then you should be fine. Preparing for Step 1 is of utmost importance and trumps pre-clinical grades across the board if you are choosing between the two.

I was told several times (about 10-12 times if I recall) that my Step 1 and Step 2 scores were on par and made me a good applicant.

It was brought up once that I did not honor surgery.

TLDR:
Step 1 is king, preclinical grades only matter if you fail them, AOA has Step 1 cut-offs as well.

But doesn't doing well in preclinical courses help a lot for crushing Step 1?

 

[username456789]

But doesn't doing well in preclinical courses help a lot for crushing Step 1?

Yes. OnePunchBiopsy's post completely misses the mark. Although there are certainly explicit benefits to doing well in the preclinical years, many/most of the benefits are indirect results of excelling.

Also, AOA selection is different at every school. The only consistency from school to school is that no more than 25% of a given class may be eligible. Usually this is the top 25% as ranked by preclinical/clinical grades, although there are some schools out there that may use other criteria to determine the "top 25%." Either way, how much weight (if any) Step I is given varies wildly from school to school.

Yes, if you have a choice between only doing well in class or only doing well on Step I, a high Step I score looks better. But it's not a zero sum game, and by excelling in both, it ensures you will likely continue to excel throughout school and residency - often times with much less effort than you would have otherwise needed to expend.

 

[OnePunchBiopsy]

Yes, if you have a choice between only doing well in class or only doing well on Step I, a high Step I score looks better. But it's not a zero sum game, and by excelling in both, it ensures you will likely continue to excel throughout school and residency - often times with much less effort than you would have otherwise needed to expend.

Good to see we agree on one point. There is a reason I stress the importance of Step 1 prep over preparation for pre-clinical grades. This is because I was a student who could not have both. Yes, if you are very intelligent and can make all A's in class and crush step 1, then by all means do it! However, many medical students do not have the mental fortitude to put 100% of their efforts into both pre-clinical grades and Step 1 prep. I definitely didn't, therefore I always stress Step 1 prep over class prep.

But doesn't doing well in preclinical courses help a lot for crushing Step 1?

You are correct, it can. However some medical schools do not teach the most high-yield material. Certain organ blocks can be a joke (some were at my school).

I have no evidence to back this up, but I believe if medical students studied for Step 1 with pre-clinical classes/exams alone and avoided using Qbanks, FA, Pathoma, etc, then the failure rate among US students would explode.

Additionally, at my school at least, the only factor positively correlated with increased Step 1 score was number of Qbank questions completed. Class rank & pre-clinical grades were not correlated with higher scores. These data were created from 9 years of classes and about 120-190 people per class.