The authors examine the role of grades in the admission decisions at a group of 19 highly selective medical schools by analyzing over 8, 000 applications from Cornell University students for the entering medical school classes of 1982 through 1989. The results illustrate the great influence of the grade-point average (GPA) on the admission decision. Between the GPA levels of 3. 0 and 3. 8, the chance of acceptance increased by a factor of about two for each increment of. 2 in the GPA. For a subset of the nine most selective of the 19 institutions, the chance of acceptance increased by a factor of five for each increment of. 2. At these nine schools, of 1, 157 applications with a GPA of less than 3. 4, only four were approved. The authors suggest the evidence indicates that students often receive encouragement to continue the application process even though the chances of eventual acceptance are negligible.