This topic has probably been discussed ad nauseum in previous threads, but I was hoping that those that just matched into NS this year (but anyone, frankly) could shed some light onto my situation. I have come to the solid conclusion that I would like to go into NS, but I worry because I have not been doing so well in my classes. Just for background, I go to a fairly highly ranked US allopathic school (top 20) and am in my second year. My school is on a pass/fail/honors system, and I have only managed to honor 1 course which was ethics. I know that the overwhelming consensus is that preclinical grades matter very little or not at all. Looking at some of the students who have matched this year though, it seems that almost all did extremely well (honoring all or most MS1-2 courses). The trend seems to be moving towards more and more rigor, and I’m wondering if a solid step 1 score and research can really make up for my low grades (and thus, low class rank) at this point.

You are right, there have been a number of posts regarding this issue.

Here are a few.

I don’t think the advice has changed this year from last.  Preclinical grades are of little importance to most interviewers, so just make sure you do great on step 1, clinical grades, research, and away rotations.  Also, just out of curiosity, how were you able to go onto your second year of medical school if the only course you passed was ethics?  I thought medical schools required all students to pass all classes (or at least the vast majority) in order to be allowed to continue without having to repeat the year.

Surely you mean all you HONORED was Ethics, right? Barely passing your first year means you’d have trouble getting your degree let alone into neurosurgery!

I’m sure he means he only honored ethics. I think pre-clinical grades are one of the most overrated measuring sticks people try to use to estimate competitiveness in obtaining neurosurgical interview spots. Having said that, in my experience the better you do in your classes, the better you do on step 1 (which is probably not stressed enough as one of the most critical parts of your application). If you are not showing any improvements in your grades the entire first two years, you may want to figure out a new plan for doing well on the many tests that you will have during your clerkships, which depending on the school, can factor a great deal into your 3rd year grades (which are very important).

My apologies, I meant honored 1 course.

From what i gather, preclinical grades only seem to matter when it comes to AOA and if you’ve failed a class. Other than that, most programs seem to look at your step 1 score, since every school seems to have a different system in the first 2 years. Clinical grades, however, are much more uniform and matter a great deal in the interview process. Finally, make sure you ace Step 1 and the Shelf Exams as they often factor in a great deal in your clinical rotations grades.

Preclinical grades matter for the 4 following reasons

(1) They factor into AOA criteria...which is a pretty big deal (although not the be-all-end-all).
(2) Most people who do well in preclinical years have better Odds at preforming well on Step1.  This is not to say if you honored everything M1.M2 yr you are garunteed a 260...or visa versa....it just improves your odds as you probably know basic science stuff better.
(3) It gives you momentum going into clincal years
(4) It doesn’t allow people to “sniper” your resume during interviews...i.e. “Tell me about this ‘Pass’ in immunology”...etc

I would rate things with the following weight (this is my opinion and VERY subjective)

Preclinical- 10%
AOA- 15%
Clinical - 30%
Step1 - 30%
Research publications- 15%

Note: this can vary program to program, as some programs with a heavy academic focus (MGH, UCSF, UWash, JHU, Columbia, etc) will weight publications even more.

Hope that helps a bit.

proptosis - 12 April 2009 02:49 PM

I would rate things with the following weight (this is my opinion and VERY subjective)

Preclinical- 10%
AOA- 15%
Clinical - 30%
Step1 - 30%
Research publications- 15%

This ignores the importance of LORs and the “smoke filled room” aspect of neurosurgery.  I’d estimate that connections count for 33-50% of the total rating.

Since AOA is heavily based on preclinical grades (I’m assuming), it seems that in your estimation, first two year grades account for approximately 25% of the whole package? This seems like a very significant chunk to me.

proptosis - 12 April 2009 02:49 PM

Preclinical grades matter for the 4 following reasons

(1) They factor into AOA criteria...which is a pretty big deal (although not the be-all-end-all).
(2) Most people who do well in preclinical years have better Odds at preforming well on Step1.  This is not to say if you honored everything M1.M2 yr you are garunteed a 260...or visa versa....it just improves your odds as you probably know basic science stuff better.
(3) It gives you momentum going into clincal years
(4) It doesn’t allow people to “sniper” your resume during interviews...i.e. “Tell me about this ‘Pass’ in immunology”...etc

I would rate things with the following weight (this is my opinion and VERY subjective)

Preclinical- 10%
AOA- 15%
Clinical - 30%
Step1 - 30%
Research publications- 15%


Note: this can vary program to program, as some programs with a heavy academic focus (MGH, UCSF, UWash, JHU, Columbia, etc) will weight publications even more.

Hope that helps a bit.

CALCULATINGinfinity - 12 April 2009 03:34 PM

Since AOA is heavily based on preclinical grades (I’m assuming), it seems that in your estimation, first two year grades account for approximately 25% of the whole package? This seems like a very significant chunk to me.

proptosis - 12 April 2009 02:49 PM

Preclinical grades matter for the 4 following reasons

(1) They factor into AOA criteria...which is a pretty big deal (although not the be-all-end-all).
(2) Most people who do well in preclinical years have better Odds at preforming well on Step1.  This is not to say if you honored everything M1.M2 yr you are garunteed a 260...or visa versa....it just improves your odds as you probably know basic science stuff better.
(3) It gives you momentum going into clincal years
(4) It doesn’t allow people to “sniper” your resume during interviews...i.e. “Tell me about this ‘Pass’ in immunology”...etc

I would rate things with the following weight (this is my opinion and VERY subjective)

Preclinical- 10%
AOA- 15%
Clinical - 30%
Step1 - 30%
Research publications- 15%


Note: this can vary program to program, as some programs with a heavy academic focus (MGH, UCSF, UWash, JHU, Columbia, etc) will weight publications even more.

Hope that helps a bit.

OMG, you can’t be serious.  AOA of equal weight to research/publications?  In my opinion, that’s horseshit, especially considering how AOA is awarded at my school - the variability is such that it becomes completely meaningless.  If you get AOA, good for you.  If you don’t, seriously, don’t dwell on it.  In my experience this year, my (excellent) pre-clinical grades weren’t asked about one time in more than 150 individual interviews.

CALCULATINGinfinity - 11 April 2009 05:32 PM

This topic has probably been discussed ad nauseum in previous threads, but I was hoping that those that just matched into NS this year (but anyone, frankly) could shed some light onto my situation. I have come to the solid conclusion that I would like to go into NS, but I worry because I have not been doing so well in my classes. Just for background, I go to a fairly highly ranked US allopathic school (top 20) and am in my second year. My school is on a pass/fail/honors system, and I have only managed to honor 1 course which was ethics. I know that the overwhelming consensus is that preclinical grades matter very little or not at all. Looking at some of the students who have matched this year though, it seems that almost all did extremely well (honoring all or most MS1-2 courses). The trend seems to be moving towards more and more rigor, and I’m wondering if a solid step 1 score and research can really make up for my low grades (and thus, low class rank) at this point.

under the running board is their best album, followed by calculating infinity, then miss machine, and ire works. i hope this answers your question

Agree with the several reasons to try to do well in basic science courses above. RE AOA, depending on the institution, basic science may help more for junior AOA, less for Senior. My AOA status was not known by programs until I had invitations from most, so must not have been a deal breaker in terms of who they would consider for an interview, maybe unless you’re on the fence.

My attempt at criteria (assuming you made it to an interview):

22% Interview* (including personality and being able to talk engagingly about your ?research, and/or your life’s plan)
18% Step 1*
15% LORs* (including smoke)
13% Clinical Grades*
11% Publications
8% AOA
5% School of origin
4% Preclinical grades *
3% Personal statement*
1% Phase of the moon

* An impressively major screw-up on any star-labeled items can exclude you from consideration.

Stem Cell - 12 April 2009 09:09 PM

My attempt at criteria (assuming you made it to an interview):

22% Interview* (including personality and being able to talk engagingly about your ?research, and/or your life’s plan)
18% Step 1*
15% LORs* (including smoke)
13% Clinical Grades*
11% Publications
8% AOA
5% School of origin
4% Preclinical grades *
3% Personal statement*
1% Phase of the moon

* An impressively major screw-up on any star-labeled items can exclude you from consideration.

I really like Stem Cell’s breakdown especially for post-interview rank meeting assessment. I think it’s a bit different when programs are trying to decide who to invite for an interview. In this situation I would add the first two together to bring the importance of Step 1 to 40% (i.e., cut-off screening).

Many programs will, of course, give applications not making the Step 1 cut a second look for various things like MD/PhD, other research experience, etc. which may rescue them from the trash.

OMG, you can’t be serious.  AOA of equal weight to research/publications?  In my opinion, that’s horseshit, especially considering how AOA is awarded at my school - the variability is such that it becomes completely meaningless.  If you get AOA, good for you.  If you don’t, seriously, don’t dwell on it.  In my experience this year, my (excellent) pre-clinical grades weren’t asked about one time in more than 150 individual interviews.

Sounds like someones who is bitter....AOA is important even if you didn’t happen to get it, sorry.

Anyway, I should have been more clear.  I was rating mine on soley the purpose of GETTTING the interview.  I should have included LORs probably.
Preclinical- 6%
AOA- 8%
Clinical - 28%
Step1 - 28%
Research publications- 15%
LORs: 15%
Anyway, I whole heartedly agree that ONCE YOUVE GOTTEN the interview.  Your performance in it can drastically move you up or down, negting any 270 or 15 first author pubs you may have.

It is interesting to watch people try & guess about what goes on in the mind of various programs when selecting applicants to interview and the order of the rank lists. I am surprised that one of the potentially biggest factors has been omitted thus far: Sub-internships. Your performance on a Sub-internships at a program would constitute >50% of the criteria for determining where a program ranks you. I also really don’t think pre-clinical grades are important either since I know several people with unimpressive preclinical grades who were never asked about it.
The point of more emphasis placed on Step 1 for the interview than the rank list is valid and it is a significant chunk of the interview criteria. I would agree with stem-cell that after a sub-I (if one was done at the program), then your Interview is the next most important factor in determining rank list, and I agree with his relatively small percentages assigned to preclinical grades & Personal Statement but I think it is a very rare scenario where someone is rejected/or severely impacted by poor preclinical grades or a poor personal statement if their other areas all look good.

2009app - 13 April 2009 03:35 AM

It is interesting to watch people try & guess about what goes on in the mind of various programs when selecting applicants to interview and the order of the rank lists. I am surprised that one of the potentially biggest factors has been omitted thus far: Sub-internships. Your performance on a Sub-internships at a program would constitute >50% of the criteria for determining where a program ranks you. I also really don’t think pre-clinical grades are important either since I know several people with unimpressive preclinical grades who were never asked about it.
The point of more emphasis placed on Step 1 for the interview than the rank list is valid and it is a significant chunk of the interview criteria. I would agree with stem-cell that after a sub-I (if one was done at the program), then your Interview is the next most important factor in determining rank list, and I agree with his relatively small percentages assigned to preclinical grades & Personal Statement but I think it is a very rare scenario where someone is rejected/or severely impacted by poor preclinical grades or a poor personal statement if their other areas all look good.

I figured the “Clinical Grades” category included Sub-I’s.  I’m guessing that’s what people were assuming.