More than 80% of U.S. MD-granting medical schools now use pass-fail only grading in preclerkship courses, according to data recently published in JAMA®.
For students entering medical school after years spent in letter-grade classrooms, the move to pass-fail can be both liberating and disorienting. What does this shift mean for your learning and long-term success? How might approaches change when entering graded portions of the curriculum?
Mark Meyer, MD, is senior associate dean for student affairs at the University of Kansas School of Medicine (KU). An AMA member, Dr. Meyer offered a few tips for medical students on navigating pass-fail assessment.
When is pass-fail most common?
Medical school pass-fail grading is most common in preclerkship courses, but it extends throughout the curriculum with varying frequency at other phases of training. According to the JAMA data, pass-fail is used as such:
- Preclerkship courses—80.3% of medical schools use pass-fail grading.
- Electives—42.3%.
- Core clinical clerkship—21.1%.
- Fourth-year selectives and subinterships—12.2%.
Alternatives to pass-fail highlighted in the JAMA data include a tiered grading system with students earning honors/high pass/pass/fail grades and a system that only has three classifications: honors, pass or fail. The three-tier system is similar to what KU employs in latter phases of training.
At KU, those who perform exceptionally well on objective components—such as the National Board of Medical Examiners’ subject exams and standardized patient OSCEs—receive a designation of "pass with distinction" on their transcript and Medical Student Performance Evaluation, commonly referred to as the Dean’s Letter. The medical school uses pass-fail grading in preclerkship assessment.
Understanding your baseline
A national movement toward pass-fail medical education assessment has been underway for more than a decade, and it was done with student well-being in mind, Dr. Meyer said.
“To a certain degree, students find it less intimidating because the goal is to learn, pass and not compete with other students for a higher grade or for individual points,” Dr. Meyer said.
Even in pass-fail systems, students receive formative feedback with their scores, the class average, and the range. This allows them to know where they stand relative to their peers and the class overall.
“It does give them objective data on which to make adjustments,” Dr. Meyer said. “So they're not flying blind.”
The University of Kansas School of Medicine is a member of the AMA UME Curricular Enrichment Program, which provides on-demand education through a micro-learning approach to help medical students distinguish themselves for residency and succeed in medicine. Educators can assign specific elements such as health care business fundamentals and developing leadership skills and receive reports on student progress, track via a dashboard, send reminder emails and customize reports. Schedule an introductory call now.
Adjusting when needed
If you’re barely passing, don’t ignore it. Take action to improve. Dr. Meyer said medical students should seek feedback from academic coaches, peer mentors or educational specialists to develop new strategies.
“It’s formative. When students who struggle out of the gate see data that says they’re just barely passing and the other members of the class are performing better, they do need to adjust their approach,” Dr. Meyer said.
Often referred to as drinking from a fire hose, the first year of medical school is daunting for many students.
“Initially, students may struggle with some exams,” Dr. Meyer said. “They may actually fail an exam, but after a couple [academic] blocks, they have acclimated to the rigors of medical school and by spring semester, first year, the majority of students are performing close to their peak level.”
Failures often related to focus
Failing an exam is one thing. Failing a course is another thing all together. In the preclerkship phase of medical school, students can take their eye off the ball—often attempting to focus on extracurriculars that will help them build their portfolio as a residency applicant.
“Our messaging to students is always achieve a degree of security with respect to your academic performance,” Dr. Meyer said. “Once you have established that, then begin venturing into research, leadership and service.
“I always tell students, you generally never receive a grade for research, service or leadership. You do receive a grade for your academics and that lives with you forever. If you fail a course, that is on your transcript for the rest of your life.”
