A question everyone asks
Draft · not yet reviewed by AlexGrades vs boards: which matters more in medical school?
The short answer
Treat them as one goal, not two. Board prep builds the long-term knowledge that also lifts class grades, while cramming for grades fades before boards. How much grades matter depends on your school: at pass/fail schools they weigh less, but at schools that report numerical grades they shape your class rank.
Everyone feels this
Do grades or board scores matter more?
Board scores are the bigger lever for most residency applications. Grades still matter, though, and how much depends on how your school reports them.
That's why the question is a little misleading. Grades and boards aren't two separate projects. The knowledge you build for one carries over to the other, as long as you build it for the long term.
How does my school's grading system change the answer?
Find out exactly how your school grades before deciding how much to invest in class-specific detail.
- Pass/fail schools: grades usually have less direct impact on your application. You have more room to study primarily from board resources.
- Schools that report numerical grades: this is a chance to stand out, and also a risk. Strong grades show up clearly, and so do misses. Grades feed your class rank, which is part of your application.
My school was the second kind. That raised the stakes on every exam, which is part of why I cared so much about doing well on both.
Why can good grades still lead to weak boards?
Because cramming works for a single exam and fails over two years. You can earn excellent grades by learning everything the week before and forgetting it the week after. Boards test what stayed.
The reverse is also true. Students who lean into board materials sometimes give up a little on class-specific detail and still do very well when it counts most.
How do I study for both at the same time?
Make board resources the backbone and use class materials to fill the gaps:
- Learn each topic from your board resources first. In second year that usually meant UWorld, First Aid, Sketchy and Pathoma for me.
- Skim the lectures for what your school specifically tests. Faculty sometimes emphasize details the board resources skip.
- Use Anki to keep the material from fading between the class exam and dedicated. See Anki for medical school.
- Start questions early. You don't have to finish a question bank before dedicated, but you should be doing questions throughout second year.
The full story of how I made the switch is in class vs board materials.
What if I've been studying only from lectures?
Integrate board prep now, not later. You don't need to blow up your whole system in a week, though that's what I did. Start by learning your next block from a board resource and see how your next exam goes.
If you've gone the other way and started board prep separately from class, watch that you don't fall behind on coursework. A failed or weak class creates a problem that a good board score has to work to undo.
Should I aim for perfect grades?
Aim high, but aim for consistency over perfection. Early on most of us want a perfect score on everything. As you learn your limits, set realistic benchmarks for each exam and adjust them as you go.
Steady results matter more than swinging between great exams and bad ones. And the people who do best at the end of medical school aren't always the ones who started at the top. Early exams lay the groundwork for boards, and boards prepare you for rotations. Treat each one as a stepping stone, not a verdict.
If an exam goes badly, run the Exam Debrief and move on.
Pass/fail doesn't mean it doesn't count
Key takeaways
- Grades and boards are one goal. Study for the long term and both improve.
- Know how your school reports grades before deciding how much class-specific detail to chase.
- Cramming can protect a grade and still leave you starting boards from zero.
- Make board resources your backbone and use lectures to fill the gaps.
Everyone also asks
Do preclinical grades matter for residency?
It depends on your school. At pass/fail schools they carry less direct weight. At schools that report numerical grades, they feed your class rank, which is part of your residency application.
Can I ignore class and only study for boards?
You can lean heavily on board resources, but don't neglect class. Falling behind on coursework creates its own problems, and at graded schools a weak class can stand out.
Do good grades mean good board scores?
Often, but not always. Grades earned by short-term cramming don't carry over well to boards, which reward long-term retention.