MD Terrible clerkship grades and good shelf exams, mediocre step score

[deleted587934]

I am a 3rd year medical student, and I have been having a hard time getting good grades on my rotations. Currently, I have received grades for my first three of the seven cardinal rotations my 3rd year. I am currently in my 5th rotation. So far, I have received evaluations that are down the middle of the rubric (so, "meets expectations,"), but apparently worse than those of my peers. On every rotation I have had so far, I have received a P, which is for the bottom 30% of the class. I have done family medicine, internal medicine, psychiatry, and neurology. I do not yet have a grade for neurology. I want to go into psychiatry, and unfortunately I was quarantined my whole rotation due to COVID-19. I had to complete the whole rotation on zoom, while the other students I was rotating with were at the hospital or outpatient clinic. My school gives separate grades on our transcripts for shelf exams. I got a P in family medicine, which means I did <50th percentile. I have H's in IM, Psychiatry, Neurology, which means I did >75th percentile nationally. My step 1 was a 230. I have had no lapses of professionalism on my evaluations, no seriously negative comments, mostly generic things like "read more," "expand differential," etc. Preclinical grades were P/F

How much does this hurt me when applying for residency? I am terrified I am going to fall through the cracks and not match (although I have some positive things going for me). The available match data is not too enlightening because it does not address people such as myself who have persistently poor grades. Let me know if I posted this in the wrong place.

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[FalconSlice]

I am a 3rd year medical student, and I have been having a hard time getting good grades on my rotations. Currently, I have received grades for my first three of the seven cardinal rotations my 3rd year. I am currently in my 5th rotation. So far, I have received evaluations that are down the middle of the rubric (so, "meets expectations,"), but apparently worse than those of my peers. On every rotation I have had so far, I have received a P, which is for the bottom 30% of the class. I have done family medicine, internal medicine, psychiatry, and neurology. I do not yet have a grade for neurology. I want to go into psychiatry, and unfortunately I was quarantined my whole rotation due to COVID-19. I had to complete the whole rotation on zoom, while the other students I was rotating with were at the hospital or outpatient clinic. My school gives separate grades on our transcripts for shelf exams. I got a P in family medicine, which means I did <50th percentile. I have H's in IM, Psychiatry, Neurology, which means I did >75th percentile nationally. My step 1 was a 230. I have had no lapses of professionalism on my evaluations, no seriously negative comments, mostly generic things like "read more," "expand differential," etc. Preclinical grades were P/F

How much does this hurt me when applying for residency? I am terrified I am going to fall through the cracks and not match (although I have some positive things going for me). The available match data is not too enlightening because it does not address people such as myself who have persistently poor grades. Let me know if I posted this in the wrong place.

Depends on what specialty you are wanting to apply for. Straight passes is not a bad or terrible thing especially if you're going into FM or psych.

 

[calivianya]

I had thought you were going to say you failed some clerkships. Hard to imagine a pass is a bad grade anywhere. I think most places know that rotation grading varies a lot from place to place, which will probably help you out with what you’re saying about your school’s grading scale.

I was just talking somewhere else a few days back about how my school only has honors/pass/fail for rotation grades, and you have to be almost perfect to get honors. I missed it by getting a 4.3/5 on one aspect of my preceptor eval, when my eval was 4.8/5 overall.

If some schools can have students averaging a 4.8/5 when evaluated and those students are only earning a pass, it’s hard to imagine that a pass is going to hurt anyone.

 

[deleted587934]

I had thought you were going to say you failed some clerkships. Hard to imagine a pass is a bad grade anywhere. I think most places know that rotation grading varies a lot from place to place, which will probably help you out with what you’re saying about your school’s grading scale.

I was just talking somewhere else a few days back about how my school only has honors/pass/fail for rotation grades, and you have to be almost perfect to get honors. I missed it by getting a 4.3/5 on one aspect of my preceptor eval, when my eval was 4.8/5 overall.

If some schools can have students averaging a 4.8/5 when evaluated and those students are only earning a pass, it’s hard to imagine that a pass is going to hurt anyone.

Thank you! To be clear, for the clinical stuff, they only "Pass," the bottom 30% of students, but the rubric we are graded on is standards based. So I am "meets expectations" essentially, but most students are "above expectations." So I am consistently below average (of my class) as rated by my attendings.

 

[deleted587934]

Depends on what specialty you are wanting to apply for. Straight passes is not a bad or terrible thing especially if you're going into FM or psych.

Thanks! I just worry that because it is my evaluations specifically (and not my shelf scores), psych programs will think I can't talk to people, which is something they obviously do not wish to see.

 

[LunaOri]

From the comments you have quoted, it seems as though your issues are academic, not interpersonal. When preclinical grades are P/F, it's easy to get into the mindset of doing just enough to get by. In clinicals, they are expecting you to delve deeper and think more. Be a more active participant, and ask the attendings what you can do to improve your performance. Often, it's as little as spending a little more time, asking an occasional question, and showing an interest.

 

[NotAProgDirector]

I think you should try to figure out why you're being evaluated in the bottom quartile of your class. If it's not due to a shelf exam, then what is the issue? Fix that.

 

[LunaOri]

If it helps, here's what separates my "honors" students from my "pass" students:
1. The honors students consistently show up on time, and stay as long as they need to. They aren't asking for time off or slacking somewhere that I can't find them.
2. They show a sincere interest in the specialty. Even if they don't plan to apply, they want to learn how this specialty impacts the one they choose.
3. They demonstrate a good fund of knowledge. They don't have to be super advanced, but they need to show a good foundation. They can answer questions about disease processes, and use their knowledge to create a differential diagnosis. Given some clues, they can reach the right diagnosis.
4. They relate well to other people.
5. They ask questions not to show off their knowledge, but to learn. (Yes, we can tell the difference).,
6. They look for ways to help the other team members.
7. They look for ways to go beyond what is required, and are happy to be offered a project to work on, even if it won't lead to a publication.
8. If I ask them to present a case at tumor board or develop a presentation for a teaching conference, they do it.
9. They show enthusiasm for learning.

 

[deleted587934]

I think you should try to figure out why you're being evaluated in the bottom quartile of your class. If it's not due to a shelf exam, then what is the issue? Fix that.

It breaks my heart that I have given the impression that I have not tried to do that. Good advice of that kind is hard to find on the internet because it is necessarily general - I have been following up with my past attendings, going through my evaluations, etc. I do have some idea why I have not been doing well. But I wanted to come here to know how this affects my career.

 

[deleted587934]

If it helps, here's what separates my "honors" students from my "pass" students:
1. The honors students consistently show up on time, and stay as long as they need to. They aren't asking for time off or slacking somewhere that I can't find them.
2. They show a sincere interest in the specialty. Even if they don't plan to apply, they want to learn how this specialty impacts the one they choose.
3. They demonstrate a good fund of knowledge. They don't have to be super advanced, but they need to show a good foundation. They can answer questions about disease processes, and use their knowledge to create a differential diagnosis. Given some clues, they can reach the right diagnosis.
4. They relate well to other people.
5. They ask questions not to show off their knowledge, but to learn. (Yes, we can tell the difference).,
6. They look for ways to help the other team members.
7. They look for ways to go beyond what is required, and are happy to be offered a project to work on, even if it won't lead to a publication.
8. If I ask them to present a case at tumor board or develop a presentation for a teaching conference, they do it.
9. They show enthusiasm for learning.

Thank you.

I have been diligent about going back to past attendings, seeking feedback (even since the start of my first rotation), etc. All my evaluations note some variation of "good at seeking feedback," but it is frustrating because it can be hard to actually effect changes.

 

[deleted587934]

If it helps, here's what separates my "honors" students from my "pass" students:
1. The honors students consistently show up on time, and stay as long as they need to. They aren't asking for time off or slacking somewhere that I can't find them.
2. They show a sincere interest in the specialty. Even if they don't plan to apply, they want to learn how this specialty impacts the one they choose.
3. They demonstrate a good fund of knowledge. They don't have to be super advanced, but they need to show a good foundation. They can answer questions about disease processes, and use their knowledge to create a differential diagnosis. Given some clues, they can reach the right diagnosis.
4. They relate well to other people.
5. They ask questions not to show off their knowledge, but to learn. (Yes, we can tell the difference).,
6. They look for ways to help the other team members.
7. They look for ways to go beyond what is required, and are happy to be offered a project to work on, even if it won't lead to a publication.
8. If I ask them to present a case at tumor board or develop a presentation for a teaching conference, they do it.
9. They show enthusiasm for learning.

Would you mind if I sent you a message to continue this conversation?

 

[LunaOri]

Would you mind if I sent you a message to continue this conversation?

Okay

 

[Opomfrog]

sometimes they may just stop at the grade and not continue to look at the rest