BACKGROUND. Most medical school graduates perform well as residents. However, the authors' annual surveys have shown that a few graduates from each class at their school fail to meet residency directors' expectations. METHOD. The medical school records of the 20 of the 153 graduates from the class of 1983 at the University of California, San Francisco, School of Medicine who received poor evaluations from their residency directors in the first and/or second year of residency were compared with the records of 20 of their best-received classmates. The poorly received graduates did not necessarily receive poor numerical ratings of their knowledge, skills, or overall performances, but they did receive negative or ambivalent responses to the following question: “Knowing what you now know about this resident, would select him or her again? Please explain.” The two groups of graduates were matched for sex, racial-ethnic identification, and residency discipline. RESULTS. The groups were quite similar with respect to qualifications for admission to medical school, overall academic achievement, and performance on standardized national examinations. There were minor differences in performances on clinical clerkships. CONCLUSION. As indicated by residency directors' ratings and comments, most of the poorly received graduates' problems during residency appear to have been personal and motivational rather than skills- or knowledge-related. With but few exceptions, the medical school records contained little evidence that might have predicted the graduates' poor reception as residents.