A question that we’re asked quite frequently at Med School Tutors relates to the letters that have either plagued or overjoyed students for the last 17 years of their education: GRADES.

Medical school is in fact “school,” and just like every school, it relies on grades to stratify students into quartiles and ranks. This begs the question that so many medical students are asking: How important are my grades? Will a never-ending string of H’s make me a shoe-in for the program I want? Will obtaining a grade of “pass” in the clerkship of my chosen specialty interfere with my life-long dream of becoming a [insert specialty here]-ologist?

It would be easy to say that grades are of the utmost importance so you should do your best and get the highest grades you can. However, based on some objective data from the National Resident Matching Program (NRMP), the actual grades that you attain might not be as important as you thought they were. Let’s have a look inside the 2014 Program Director Survey to see what PD’s are really interested in, and where grades fall into the mix.

The Program Director Survey is conducted by the NRMP, the algorithmic black box company that determines the fate of 42,000 students and MD’s alike, all vying for coveted residency spots. The purpose of the survey is to answer questions like the one this article addresses, as well as other queries on students’ minds, like the importance of letters of recommendation, Step 1 score, dean’s letter, AOA status, etc. Now before we get into the actual data, here’s the thing to keep in mind: that seemingly bland statement above about doing your best on everything is actually quite important. Even if class grades weren’t as highly regarded as you thought, would you try less hard? If your letters of recommendation didn’t mean much when it came time to getting ranked, would you settle for less meaningful letters? No matter what, you will get farthest when you try hardest. Use the data from the survey as some simple food for thought, not as a guiding beacon to direct you on how to focus your efforts.

Where do grades fall in list of application factors? When it comes to getting an interview, clerkship grades fall a paltry SEVENTH on the list, being cited by only 70% of program directors! Class rank/quartile falls 11th on the list, while attaining honors in basic science courses is near the bottom of the list, only gracing the minds of one-quarter of program directors. So then, what is so important to the PDs when it comes to landing an interview? Topping the list are Step 1 score, letters of recommendation, dean’s letter, Step 2 score, and personal statement. Interestingly, the late third-year/early fourth-year time period becomes key, as this is the time when you will be compiling items like your letters of recommendation, your dean’s letter, your Step 2 score, and crafting your personal statement. Step 1 still reigns king, and that’s why we continually stress the importance of it. The better your Step 1 score, the better your chances.

When it comes time to getting ranked by a given program, grades are even less important, falling to 14th on the list, considered by less than 60% of PDs in their decision making. As you’ve probably heard before, once you score an interview, it is the general gestalt of how you are received by the residents, faculty, and staff that will determine how highly a program regards you. Topping this list are interacting with faculty, interpersonal skills, interacting with residents, and the residents’ thoughts of you. Again, it is crucial that you remember to be wonderful to everyone. The random person that you shared an elevator with on the ride in might be a decision maker, or someone like the chair’s administrative assistant. You cannot afford to be labeled as anything less than a pleasure to be around; this is far more important than that biochem test you aced (or bombed) from 3 years ago! Half of program directors aren’t even looking at your clerkship grades by the time you have attained an interview. The adage rings true: your hard work in medical school gets you the interview, and how well you interview gets you matched. Now you have the objective data to corroborate this notion.

In the end, grades are mostly important because they serve as a surrogate for your knowledge. It would be difficult to outperform peers on Step 1, the most cited factor on your application, if your grades are suffering. Learning as much as possible is what’s important, and those that strive to do so will often end up with the best grades. The other heavy hitters (letters of recommendation, dean’s letter, Step 2 score) will also shine brighter if your grades are great. On top of letting prospective programs know that you are a wonderful person, your letter writers can throw in your outstanding academic performance, if you excelled in your coursework. So don’t freak out about that high pass when absolutely needed to honor a clerkship. And if your first-year anatomy course was a rude awakening to medical school, and you only earned a pass, your dreams of being a surgeon are way more alive than your cadaver. If you are truly doing your best, no one can ask for anything more.