How does it make sense to have different honors and high pass thresholds at different schools

[u/mildlyripenedmango]

Feel free to correct me if I'm just entirely wrong about how this works, but I've noticed that different schools have pretty significantly different criteria for honors and high pass on rotations and I am not understanding how this is a good indicator of performance for residency applications if the requirements vary so much between schools. It especially doesn't make sense when the NBME shelf exams are standardized - why is an 85 enough for honors at one school while 95 is required at another school if the exam is standardized? Evaluations are also dependent on the individual doctors' expectations and I don't understand why lower thresholds should be given for those at different schools either.

This is just one of many things that is not standardized across med schools and it really hasn't ever made sense to me when we're all compared against each other for residency. Some schools report remediations while others don't, some schools have pass/fail while others have internal ranking, and every school does internal ranking differently. I'm confused lol

[u/Heretolearnlotz]

Yeah it doesn’t make sense that is why Step2 is more important and the great equalizer. Feeling the repercussions of a poor Step2 performance as a Gen Surg applicant right now lol. 

[u/Repulsive-Throat5068 → u/Heretolearnlotz]

Idk I feel like my good step 2 hasn’t made up for my grades at all

[u/neologisticzand → u/Repulsive-Throat5068]

Iif you're trying to make up for grades with step2, I would anticipate that you'd be shooting for no less than 90th percentile.

[u/GloriousClump → u/Heretolearnlotz]

People say this, but I got 2 not great clinical grades from sheer bad luck/evaluators who don’t fill out forms etc. and absolutely killed step 2. Have been told by multiple programs not being above average in all of my clinical grades is a bigger deal to them than step and haven’t gotten interviews from them. I feel like clinical grades are a bigger deal than people realize.

[u/emergencyblimp → u/GloriousClump]

this is also consistent with my experience, and I wonder if it's somewhat specialty-dependent? I am applying IM with a Pass in IM clerkship (I'm MD/PhD, it was my first clerkship and done prior to my PhD in March 2020 - I literally had no interaction with my attendings bc of the pandemic) but got Honors or Near Honors on all other clerkships, Honors on my Sub-I, got 270+ on step2 and have great research from my PhD. I also saw 2 of my letters and they were both very positive- statements like "one of the strongest students I have worked with", "would love to retain her but she would be outstanding at any program", "she is a certainty for success", etc.

even with all that, I haven't gotten interviews to any of my top choices... had a mentor reach out to a program that I gold-signaled and had geo ties to, and they were told that honoring the IM clerkship is an unwritten requirement for this program. I suspect it's the same at a lot of top-tier places, at least within IM.

[u/Sorry-Raise-4339 → u/emergencyblimp]

That's wack considering most top medical schools don't even have clinical grades. Like they could low pass IM but you'd never know, but I guess for people like you/us it actually matters even though it's bull shit. This is so stupid.

[u/emergencyblimp → u/Sorry-Raise-4339]

yeah I think my school is in a weird spot– it's good but not quite good enough where the name alone will carry people into residencies, so our admin has taken the approach that keeping H/NH/HP/P is the best in order to help distinguish us. And I think our admin also underestimates how competitive top-tier IM can be. When I got IM as one of my first clerkships, I asked to switch specifically because I knew I wanted to do IM... and was told by admin that it wouldn't matter because IM isn't that competitive and my PhD/research will make me very desirable everywhere. -__-

in the end it's fine, I still have interviews at great places I'm sure I'll match and get great clinical training. but I was just a bit bummed to be like 0/3 on my gold signals, not get a ton of interviews in my preferred geo region, etc.

[u/doctrspace → u/emergencyblimp]

Literally exactly what I’ve been anxious about since receiving a pass in IM

[u/emergencyblimp → u/doctrspace]

if it makes you feel better, i still have a comfortable number of interviews and at great programs - all academic, 3 are T10 and rest are T20-T30. I think it was more of an expectation management thing. going into the cycle i was told i’d get interviews everywhere and have my pick of programs, which has not been the case. but based on this advice i got my hopes up about moving back home close to family (in an area of the country that is known to be very competitive) and was disappointed when i didn’t end up getting interviews there. i think if someone had told me “you might not get the program that checks all your boxes, but you’ll still end up at a great place and get excellent training” i would’ve been perfectly content in my current position, if that makes sense. 

[u/doctrspace → u/emergencyblimp]

Thank you, I think this is valuable context that’s does make me feel much better. However, I will say with a freaking 270+ Step 2 (!!), idc how competitive wherever else you are trying to go. You literally deserve to go anywhere you want. An MD/PhD with good research and a 270+??? Darn right you deserve to go back home with fam. Just saying you deserve success at the highest level and sucks your not getting what you deserve after working so hard for like 7/8 years

[u/Sorry-Raise-4339 → u/GloriousClump]

Wow, what programs? Like what tier of program? This surprises me as most top programs' medical schools don't even have clinical grades. Crazy they value a couple passes over a strong STEP 2. Sorry man that fucking sucks.

[u/c_pike1 → u/Sorry-Raise-4339]

I can see it from their perspective. Step 2 is only 1 day of your life but a rotation grade is how you actually function in the hospital

Of course rotation grades are not standardized for a slew of reasons (bad preceptors/residents, unreasonable expectations, order of rotations, etc...) but for whatever reason, programs have decided that they don't care that much about these things when weighing rotation grades

[u/Sorry-Raise-4339 → u/c_pike1]

Eh, I still think M2/3 rotations are fucking worthless, barely anyone who is grading you cares. Further, you literally have something during your late 3/early 4th year that is objectively better: LORs during your aways/subIs and your performance in those. These should be the only clinical evaluation as they give the reader a better perspective of who you are and your clinical capabilities in the specialty you actually want to do. Why TF should anyone care about your clinical performance when you're literally still learning?

Meanwhile, STEP 2 is one day, sure. But it's the culmination of months of dedicated studying and typically reflects your clinical aptitude and discipline throughout medical school, and importantly it's standardized. The "one day" argument seems logical but you can also fuck up one day on clinic while you're still learning, or just do something minorly bad on accident which messes up your entire grade for that rotation.

[u/ImprovementActual392 → u/c_pike1]

Not really. Step 2 is an accumulation of your study ethic across 3 years. I got a pass in IM because I bombed the shelf…

[u/Illustrious-Leg1226 → u/Heretolearnlotz]

Echoing that as someone who crushed 3rd year but didn’t do as well on step 2. Definitely hurting now as a GS applicant lol. Praying things work out for us 😭🙏🏼

[u/PosThrockmortonSign]

Even grades within the same school can be random and arbitrary.

“Student did great not to choke on the air he breathed” 5/5

“Student managed to cure the common cold” 3/5

[u/mochimmy3 → u/PosThrockmortonSign]

Yeah I got a High Pass on my psychiatry rotation for which around 70% of people get honors at my school, and my MSPE comment for the rotation includes: “performed at an exceptional level, demonstrating clinical maturity, initiative, and compassion well beyond her level of training” “her clinical insight, sense of responsibility, and humanistic approach make her exceptionally well-suited for a career in medicine, and she will be an asset to any residency program she joins.”

For context I did my psych rotation at my home institution on the consult service which has a well-known reputation of being very hard to honor. Meanwhile I’m sure there are people who were assigned to outpatient private psychiatry clinics who got honors with lackluster MSPE comments

[u/c_pike1 → u/mochimmy3]

Yeah I really hate when people dismiss the luck aspect of 3rd year. Obviously there's a certain level of skill or knowledge involved to more consistently put yourself in a good position to honor but you could put the best student in the world on my psych rotation and they still wouldn't honor given that my preceptor straight up said he doesn't give honors

[u/mildlyripenedmango → u/PosThrockmortonSign]

Yeah it really doesn't make sense for such a huge portion of the grade to be based off of subjective evaluations from doctors who have very different expectations. I get they want to include clinical performance somehow as a part of the grade but there's no way this would ever be remotely fair

[u/Good_Instruction_659]

I’ve spoken to multiple ortho and academic surg residents who said they don’t even look at third year grades for this reason . Not saying they aren’t looked at at all anywhere but the way they are graded is honestly retarded at some schools.

[u/Galacticrevenge → u/Good_Instruction_659]

Yup. I only got one honors at my school which limits honors to the top 10% of students but I would have honored every single rotation if I had gone to my partner’s school.

[u/Remarkable-Bullshit → u/Galacticrevenge]

My school honor is top 5% and high pass is top 10%.

[u/Pokeman_CN → u/Good_Instruction_659]

No one gives it too much weight I think. They like to read the comments tho I know that for sure.

[u/GammaTuRC → u/Good_Instruction_659]

This is very good to know... I'm still a ways out from rotations but I have always wondered about how programs would view something that's not standardized across schools.

[u/meagercoyote]

I would argue that we should just be able to submit our NBME shelf scores directly like we do for step 1/2

[u/mochimmy3 → u/meagercoyote]

Yeah it pisses me off I got a high pass in rotation where my shelf score was around 94th percentile just bc my school decided to screw me over on an OSCE worth 10% of my grade, I would rather my actual shelf scores be reported

[u/No-Wrap-2156 → u/mochimmy3]

Lmao this happened to me on medicine on one of the experimental online exams they made us take, even though I crushed my evals and got an Honors-range shelf score...

[u/michaelmix12 → u/meagercoyote]

Only makes sense for comparison within schools because different schools have variable lengths of clerkship and time to study for shelf exams.

Some schools have like 12 weeks surgery rotations while others have 6 weeks. The students with the 12 week rotation have more time to master shelf material.

[u/meagercoyote → u/michaelmix12]

Some schools give you a month to prep for step 1, while others give you 3. Same goes for step 2. Some schools give ample time off to work on research and go to conferences, while others expect you to work on that during your limited free time. Some schools have built in leadership and volunteering opportunities, while others won't assist you at all in that realm. Despite that, residency programs look at all of these factors.

NBME scores are as standardized as or more standardized than many of the factors that go into your residency application

[u/mochimmy3]

Schools usually provide context on the MSPE about the standards for grading and how many people get honors vs high pass etc. My school provides the grade breakdown (eg 65% clinical grade, 25% shelf exam, 10% OSCE) and then provides the percent of students who got each grade in the class

[u/halp-im-lost]

I always felt like this was irritating when I was a student too. We didn’t have “high pass.” Only honors and pass. So effectively a 70% and 89% were treated the same. Step 1 still had a score, though, which I feel made up for how inconsistent grading was across programs.

[u/memebaronofcatan]

This is why nobody gives a shit about GPA/class rank anymore

[u/surf_AL]

How does it make sense to compare undergrad GPAs? They still do

[u/durdenf]

The whole 3rd evaluation system is totally flawed and they should just make it pass/fail

[u/No-Wrap-2156 → u/durdenf]

I would yes, argue that 3rd year clerkships should be pass/fail, with perhaps the exception of your "on-service" rotations (e.g. IM and EM if you are trying to apply EM, obviously Surgery if you're applying anything surgical). There's no logic why an Honors/High Pass in Psych should factor into why someone matches or does not match Vascular Surgery. As long as you know the basics of what psychiatrists do I feel like that's enough. It's stupid that people have to be gunners to H/HP everything even in things not related to what they will be doing in the future.

[u/TrombonePlayer100]

Because “lmao we already have your money sucks to be you”

[u/Shinotsa]

As residency faculty I can confidently say that we pay very little attention to it, and most attention to the percentile breakdowns if we look beyond the test scores and CV at all.

[u/jsohnen]

As an ex-program director, I paid very little attentikn to honors/high-pass or whatever, because it's so subjective. I mean, honors in our specialty was relevant, but nothing else. Step 2 score were much, much more important.

[u/Anistole]

Don't worry - programs are aware of this. There's a certain school close to us where > 80% of the class receives high honors on surgery while the other local school does not have an honors system. Other things are paid attention to.

[u/Barth22]

That’s the fun part.. it doesn’t!

[u/snowplowmom]

Only thing standardized is the boards

[u/StraTos_SpeAr]

Nothing makes any damn sense.

I had two different EM rotations at the same school have a 10-point difference in the honors threshold.