Authors Eric Warm, MD, and David Hirsh, MD, and medical student Kate Jennings join host Toni Gallo to discuss the unintended consequences of the shift to pass/fail grading in undergraduate medical education and current challenges in the residency application and selection process. They explore the feedback culture and incentives for pursuing clinical excellence in medical school. They also present the complex adaptive system model as a framework to consider the dynamics at play and ways to improve the transition to residency. Read the article discussed and access the episode transcript at academicmedicineblog.org.