If the Med school classes are Pass/Fail and the Step 1 is going to be Pass/Fail, how do residency programs know who stands out?

Step 2CK will still report a score. Residency directors will likely use that score instead of Step 1 scores. In fact, Residency PDs indicated in recent survey that’s exactly what they’re going to do.

Also not all med school are pass/fail. Some report grades using a variety of grading schema.

And even at school that use P/F grading on the transcript, there is an underlying grade that all instructors report for internal use. That grade is used as part of the MSPE (Medical Student Professional Evaluation) aka “Dean’s Letter” which ranks the student standing within the class. The MSPE stratifies students into quintiles (Top 20% of the class, etc) based on academic performance and clinical evaluations. Class rank is also typically included in the MSPE.

The MSPE–which typically runs in 20-25 page range – is EXTREMELY detailed about a student’s strengths and weaknesses. Beside a description of a student performance in the pre-clinical curriculum, the MSPE includes all the written evaluations a student has received from every clinical preceptor a student has worked worked with, and their numerical NBME score for every clinical subject. NMBE --aka “boards”-- is a national standardized exam on clinical topics that students take during every non-elective (and some elective) clinical rotation during med school.

Internal class ranks are also used to qualify students for honor societies like Alpha Omega Alpha (MD equivalent of Phi Beta Kappa) and the Gold Humanism Honor Society (GHHS). To qualify for AOA, students need to be academically at/near the top their class. (AOA has other qualifiers too–scholarship, leadership, professionalism, community service, research.)

Some medical schools offer the option for student to write an honors research thesis–which is another way to demonstrate academic prowess.

Research experiences and publications are another measure of academic strength. For the more competitive specialties, specialty-specific research is pretty much a requirement. Journal publications, invited poster presentations at national conferences, invited talks at national conferences–all help a med student stand out.

Beside the MSPE, medical students often do away/visiting rotations at programs other than their home program. Letters of evaluations from residency directors at the away rotations get uploaded to a residency applicant’s ERAS file. For some specialties, having these standardized LOEs from away rotations in a residency application are mandatory.

Additionally, some PDs consider evidence of leadership (offices in med student organizations, student interest groups, national specialty organizations).

So even without a STEP 1, there are plenty of ways for a med student to distinguish themselves.