Does a Bad Grade Mean That My Medical Career Is Over?

Geoffrey A. Talmon, MD

Disclosures

December 16, 2010

Question:

I nearly failed my first 2 anatomy exams. What does this mean for my future, particularly with respect to residency? Is there anything I can do to save my grade?

Response from Geoffrey A. Talmon, MD
Assistant Professor, Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska

Even before starting medical school, a good friend of mine knew that he wanted to be a neurosurgeon. He had spent a great deal of time during college shadowing a family friend who was a neurosurgeon, and he had worked in this physician's office during his summers. He had heard that neurosurgery residencies were competitive, so he felt that he needed to excel at everything in order to have a chance. The first class he faced was gross anatomy. I never knew anyone who worked harder: he was the first to arrive at the lab in the morning and the last to leave at night. Unfortunately, he got a very low score on the first exam, putting him at risk for failing the core class. For the second exam, he prepared even harder, but his score improved only marginally. I remember him saying that those 2 anatomy exams ruined his aspirations for being a neurosurgeon, and he began to question whether he should be in medical school at all.

My friend's experience is not uncommon. Many medical students become disheartened about their future after receiving just 1 or 2 bad exam scores or course grades. The reasons for this are somewhat intuitive. Medical students are selected for their achievements, and many are perfectionists. As a result, they may never have struggled academically. In addition, a first-year medical student is now surrounded by people of similar academic caliber, which can be a significant factor at schools that assign grades based on class performance.

When an exam or course goes badly, medical students tend to catastrophize the implications and make dire predictions about their future. A common mindset, especially if the difficulty is faced early in their first year, is that they may not "have what it takes" to make it through medical school.

An important point to remember is that once you are admitted to medical school, statistics show that you are highly likely to graduate. Overall, the long-term retention and graduation rates in medical school are around 90%-95%. Almost no institution intends to "wash out" students, and most invest a great deal of time and money assuring that the accepted applicants complete their training.

It is important, especially in the preclinical years, to maintain perspective on the breadth of experience and evaluations that you will receive in medical school. Grades are only 1 factor that a residency program evaluates when making selections; others include board scores, the Dean's letter (which summarizes clinical rotation evaluations), letters of recommendation, and the strength of your personal statement. For most specialties, these other factors may provide a stronger indication of the applicant's strength than 1 or 2 low grades received in the first 2 years.

What can medical students do to mitigate the stress that a bad grade generates? First, it is important to seek help early, especially as you make the transition from undergraduate education to medical school. Nearly all institutions have academic support programs, including faculty advisors, counselors, and tutors, whose goal it is to help students succeed. These individuals help the student hone the unique study skill set needed for medical education and provide tools for time management and stress abatement. Early use of these resources is key; if 1 bad exam score is followed by another, it may become more difficult to salvage a good (or even passing) grade in a course. There is a tendency for medical students to be too self-reliant and believe that they can remedy their poor performance by simply working harder. The reality is that "putting your nose to the grindstone" works for only a subset of students. And students should not worry about any stigma associated with seeking help. At our institution, more than one third of each class uses the offered study services.

It is also critical that medical students stay focused on their own performance. At schools where grades are based on class averages, there is a tendency to become overly concerned with other students' performance, setting academic goals on the basis of comparative z-scores rather than simply trying to improve one's own performance on each exam. A mantra to keep in mind is, "I cannot dictate how the person next to me performs, only how I do."

If you receive a bad exam score or course grade, is it the end of your career aspirations? Decidedly not. My friend who failed the anatomy course sought help (admittedly late) from the academic resources at our institution, remediated the course over the summer, and performed in a stellar fashion throughout the rest of the year. He is now almost finished with his neurosurgery residency, just like he wanted.

Remember, medical schools want students to succeed, and they are willing to invest a great deal of effort to help them do so. For the student, it is important to maintain perspective, seek help early if a course is going badly, and concentrate on your own performance.

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