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If an applicant were to fail a subject in a P/F grading medical school curriculum, what is the most likely impact on competitiveness in the residency application process?

Program Director 1 Response
If everything else is OK, be prepared to discuss dispassionately and take responsibility. Blaming means you're not low maintenance. Excuses mean you're not low maintenance. If they don't bring it up, you should. It may mean they missed it initially and it will come out during ranking when you have no ability to respond. A student who says, "I screwed up and didn't know how to prepare for that course/rotation, and now I know. Look at my rotation where I applied where I learned from my experience" will never get tanked because of it. Sometimes interviewers will go to the mat for someone who failed and came back better for it.

Program Director 2 Response
Failing grades anywhere is not good and can impact your competitiveness greatly. But if you are selected to interview, you should have a good, well thought-out explanation for the failure and what you have learned and what you are doing differently as a result of it.

Program Director 3 Response
Failure of a clinical clerkship rotation is a big red flag to me. I can be more forgiving of a basic science course, especially if USMLE scores and clerkship grades are strong. Failures should be addressed in the personal statement if there is a contributing explanation, and should also highlight your subsequent successes. A story of overcoming adversity can be inspiring provided it's not overplayed.

Program Director 4 Response
Any failure should be explained by both the MSPE (Medical Student Performance Evaluation - the Dean's Letter) as well as by the applicant (in the personal statement). If there were extenuating circumstances, say so. If there weren't, say what your response was to the failure....good or bad. Show some honesty and insight into the imperfect life of humans.

Program Director 5 Response
A failing grade in any class or rotation will certainly stand out in an application and is not looked upon favorably. However, if this is a one-time occurrence and the rest of the credentials are strong, it is usually not a reason to screen out the application or exclude the applicant from interviews. Program directors understand that there frequently are extenuating circumstances that can explain an anomaly on an application.

Program Director 6 Response
An 'F' on the transcript will compel the program director to closely scrutinize the Dean's letter to see if there is an explanation. Hopefully, the Dean will provide some insights and be aware of extenuating circumstances. The student should therefore meet with the Dean to ascertain what will be stated regarding that particular rotation.