A Ranking Reflection

Hi everyone:

The rank lists are in, so all that’s left to do is wait. I spent February staring at spreadsheets, balancing metrics, and accepting the truth that we don’t have room for all the amazing applicants. Here’s a peek into my ranking process:

1. Grades: It’s hard to gauge medical school performance, especially with some schools going pass/fail and others giving nearly everyone “honors.” Some schools report performance milestones, while others just offer a hodgepodge of cryptic comments. For example, if a student is said to have a “growth mindset,” is that considered praise, or is it a signal that the student struggled? If a letter says a student’s “greatest strength” was their “ability to connect with patients,” is that evidence of compassion or an attempt to convey a lack of clinical skills? By withholding grades, schools force program directors to divine meaning in adjectives. Is “excellent” really excellent, or is it a backhand way of saying a student is less than “outstanding?” Hopefully one day, schools will give program directors reliable, objective performance measures. For now, we make our best guess.
2. USMLEs: Now that Step 1 is pass/fail, and given the vagaries of grades, we pay extra attention to Step 2, which is the sole objective measure that allows us to compare students across schools. Step 2 also allows students from less well-known schools, including international schools, to stand out.*
3. Diversity and Distance Traveled: The Supreme Court decision overturning Affirmative Action had no impact on our diversity efforts. We ranked many talented applicants who identify as underrepresented in medicine, many who identify as LGBTQ+, large numbers from diverse geographic and socioeconomic backgrounds, and many applicants committed to caring for marginalized and vulnerable populations. We also gave points for “distance traveled,” for example prioritizing students who overcame discrimination, violence, and poverty.
4. Scholarship and Extracurriculars: Our core mission is to train leaders in academic medicine, so we give points for advanced degrees, time spent in research, and publications. We also award points for service, for example for time spent directing student clinics, chairing interest groups, and serving in national organizations like the SNMA, LMSA, AMWA, AMSA, the AMA, and the ACP. Not all students have equivalent opportunities, so we account for resources available where students train.
5. Interviews: The main purpose of interviews is to help students learn about Yale. Of course, interviewers provide scores and valuable comments, which feed into the rank list. I have to tweak some interview scores to account for tough and easy graders.
6. Personal statements: We value good writing and communication, so we award points for personal statements that convey motivation, excitement, and a compelling vision.
7. Special attention: Potential isn’t always captured in traditional metrics. For example, a dean may write that a student’s grades don’t reflect their true ability, or a faculty member may tell us that a student’s values resonates with ours. Sometimes it’s a snippet of information, like a sentence in a letter or an anecdote in a personal statement, that screams “don’t let this student get away.”
8. “Nicer than most”: I don’t have a systematic way to measure kindness, but I do look for comments about warmth and compassion. The truth is most applicants are nice people, and we trust that those who value kindness will find a home at Yale.
9. The formula: Over many years, I’ve crafted a formula to account for all these measurements. The formula generates a composite score and a rank number. Here it is:

=F2:F579*100+(G2:G579^2)*50+((H2:H579)/2)^1.25+(I2:I579^1.75)*15+(J2:J579^1.75)*15+(K2:K579^1.75)*10+L2:L579*5+M2:M579*10+N2:N579*10+O2:O579*10+(P2:P579^1.75)*125+Q2:Q579*200+R2:R579*75+S2:S579*125+T2:T579*25+U2:U579*25

I can never really know how well my system differentiates one applicant from another, but I do know that every resident who matches here does well, no matter where they are on our list. Perhaps this reflects the uncertainty of the ranking process, but more likely it reflects our applicants’ extraordinary talent.

So now it’s time to sit back and wait for Match Day, March 15, when we’ll finally meet the newest members of our residency family.

Enjoy your Sunday everyone. It’s time for me to head out into the sunshine.

Mark

*For similar reasons, Yale University recently announced that it was going back to requiring standardized test scores for undergraduate admissions.