By Samir P. Desai, M.D., and Rajani Katta, M.D.
While there are significant differences in medical education across the country, there is one area in which educators and students nationwide are in full agreement. Medical school is hard. Not just challenging, not just anxiety-provoking, but downright hard. In response, many educators and students have shared their experiences and hard-won insights on an important subject: how to succeed in medical school. Our new book focuses on this topic in depth. Utilizing evidence-based advice based on an extensive review of the literature on medical education, along with published accounts and insights gained from discussions with hundreds of students, residents, and faculty colleagues, this book has one major goal: to help preclinical students make the most of their medical education and succeed in the face of multiple challenges. Below is an excerpt from our new book.
Preclinical Grades: 9 Key Points about their Importance
In a study of medical students at the University of Colorado, University of Utah, and Vanderbilt University, participants were asked to rate the importance of sixteen residency selection criteria. Forty-two percent of survey participants rated “grades in first two years” as extremely or moderately important. Below, we discuss the importance of preclinical grades based on a review of the literature.
1. In a 2006 survey of over 1,200 residency program directors across 21 specialties, grades in preclinical courses were found to be twelfth in importance among a group of fourteen academic residency selection criteria.2 The authors surmised that preclinical grades are not highly valued “because there is considerable variability in the naming and content of courses in medical schools in the preclinical curriculum, perhaps making grades difficult to interpret.”
2. In another survey of program directors, while preclinical grades were not an important factor in the residency selection process, receiving a failure in a preclinical course was an area of concern. Program directors were asked to rate the importance of a preclinical course failure on a scale of 1 (no concern) to 5 (very concerned). The mean score was 3.73.
3. While failing a course is a potential red flag, many students who’ve failed have ultimately matched. Since clerkship grades and other selection criteria are more highly valued, students who fail a preclinical course can overcome this obstacle by strengthening the rest of their application.
4. Preclinical grades may have an impact on class rank. While your individual grade in a preclinical course may have little impact in the residency selection process (assuming you don’t fail), preclinical grades are used by some schools in the determination of class rank. In one survey of program directors, class rank was found to be seventh in importance among a group of fourteen academic residency selection criteria, with competitive specialties generally attaching more important to this factor than noncompetitive specialties.2 At the start of med school, learn your school’s policy regarding class rank. Does your school have a class ranking system? If so, how is rank determined? Are preclinical grades used to determine class rank? How much weight do these grades carry relative to clerkship grades?
5. Exceptional preclinical performance can lead to medical school academic awards. In Dr. Green’s survey, medical school awards were ranked 10th in importance in the residency selection process, below clerkship grades, USMLE step 1 and 2 scores, and letters of recommendation. Although not as important as other criteria, winning an award can strengthen your overall residency application, and allow you to stand out from your peers.
6. Medical school academic scholarships awarded to second and third-year students are often based on superior academic performance in preclinical courses.
7. Preclinical grades may be used for AOA determination. In 1902, William Webster Root and five other medical students founded the Alpha Omega Alpha Honor Medical Society (AOA) at the College of Physicians & Surgeons in Chicago. Today, over 120 medical schools in the United States and Canada have AOA chapters. Individual specialties and residency programs attach varying degrees of importance. In the 2006 survey of over 1,200 residency program directors, AOA membership ranked eighth among a group of fourteen academic selection criteria. (2) Of note, AOA was more important to competitive specialties, including plastic surgery (ranked second), neurosurgery (ranked fourth), ophthalmology (ranked fifth), radiology (ranked sixth), and urology (ranked sixth). Students may be elected to AOA either in their junior or senior year of medical school. Election as a junior medical student is often heavily weighted towards academic criteria, including preclinical grades and USMLE Step 1 scores.
8. In a recent article offering advice for students interested in dermatology, arguably the most competitive of all specialties, the authors wrote about how preclinical grades may be viewed by programs. “Conventional wisdom is that preclinical grades are relatively unimportant in the application process. Whereas they may be less important as a stand-alone factor, the benefits of a sound preclinical performance trickle down to other key aspects of the application. In schools with non-pass fail grading systems, high grades may be an important factor in class ranking and for nomination to the Alpha Omega Alpha Honor Society. Additionally, because the vast majority of dermatology applicants are outstanding, there is no need to take students with low basic science grades.”
9. A variety of grading systems are used by U.S. medical schools during the preclinical years. In recent years, a number of schools have moved to pass/fail grading, hoping that this change in grading will reduce stress and anxiety, decrease competition among classmates, and promote collaborative learning. Students at schools that have adopted pass/fail grading are concerned about the effects that this system may have on their competitiveness as a residency applicant. In one study, University of Virginia researchers found no significant difference in academic performance, clerkship grades, board scores, or residency placement following a change in grading form A/B/C/D/E to a pass/fail system. They did find that the pass/fail system improved psychological well-being.
1. Brandenburg S, Kruzick T, Lin C, Robinson A, Adams L. Residency selection criteria: what medical students perceive as important. Med Educ Online 2005; 10: 1-6.
2. Green M, Jones P, Thomas J. Selection criteria for residency: results of a national program directors survey. Acad Med 2009; 84(3): 362-7.
3. Wagoner N, Suriano J. Program directors’ responses to a survey on variables used to select residents in a time of change. Acad Med 1999; 74: 51-8.
4. Alikhan A, Sivamani R, Mutizawa M, Felsten L. Advice for fourth year medical students beginning the dermatology residency application process: Perspectives from interns who matched. Dermatol Online J 2009; 15(10): 3.
5. Bloodgood R, Short J, Jackson J, Martindale J. A change to pass/fail grading in the first two years at one medical school results in improved well-being. Acad Med 2009; 84(5): 655-62.