Keep this in mind that this is coming from a 3rd year with probably more questions than you, but from what I've heard is that surgery grades do matter, good evaluations in general don't mean that much... UNLESS it is a good eval from an orthopod. If you've gotten to know your program director for Ortho and he writes a truly personal and positive letter, then this can open doors. Another factor which I'm starting to hear about is how connected all the PD's are with one another and that they like to talk about rotators and applicants to programs.

Joints,

I think it depends on a lot of things like what are your other grades? There seems to be consensus that Medicine is the other important one to Honor besides surgery. I caught a glimpse of the cover sheet of my application at one of the interviews (U of Wisc) and there were two boxes next to 'clerkship grades' for medicine and surgery where they could write in your grade. AOA status and step one scores were also on that sheet. So there's some objective evidence that those two grades are important (as well as other objective measures--word is U of Wisc only offers interviews to those with either >230 Step I with AOA, or >235 without AOA) and I'm sure many if not all programs are more or less interested in applicants' performance in those clerkships because they really cover about all of medicine.

So my general opinion is that an application is a dynamic thing and comprised of so many different variables and that it's difficulut to really evaluate its quality by just culling out one statistic such as a clerkship grade, or a board score, or whatever. Having said that, there seems to be a hierarchy of things and the oft referred to JBJS article about resident selection gives some insight into what those are...check it out. Basically clinical grades trump preclinical grades, step I by far trumps step II (except probably in circumstances where you blew step I and then redeemed yourself with awesome step II), letters from orthopods (generally) trump letters from other disciplines, etc, etc. You get the idea.

So in your specific case you have to look at your overall application to determine just how much a High pass or pass or whatever you got will hurt you. You (should) know your application best. Talk to your PD about it also if you can. Hopefully some of the residents that have been posting on here (sjaellander, Two fingers, and others) recentily can give their opinions for your benefit, especially the ones evaluation applications for interviews. I think that unless you can parlay your evaluations into a strong letter of recommendation, or something else productive besides a couple of lines in the dean's letter then you'll have to count on your grade as it is with whatever implications it carries (Once again, I'm unqualified as to what those implications, if any would be to a program). But, as someone said to the XX applicant about her failing 2 M1 courses, take responsibility for it and don't make excuses unless the circumstances were extreme if and when it comes up in interviews. I wouldn't bring it up on my own either in the personal statement or interview unless asked specifically. Good luck and do yourself a favor and put it behind you and just look for other ways to shore up your application ie rock the rest of your clerkships, AIs, etc. Good luck

OF