Pass/Fail Key Points for Year 1 and 2 Medical Students

Why implement a pass/fail system? A major benefit of implementing a pass/fail system is greater medical student well-being. According to a study conducted by Bloodgood, Short, Jackson !artindale "#$$%&' ()he data from the current study indicate that the major benefit to be deri*ed from a change from a fi*e-inter*al "A,B,+,,,-& to a two-inter*al "pass/fail& grading system in the first two years of medical school curriculum lies in the area of psychological well-being.. "p.//$&

Student sur*ey responses indicated that switching from a four- or fi*e-inter*al grading system to a pass/fail system eased an0iety, reduced competition between students, and encouraged cooperation and collaboration' (1students in the pass/fail class felt that pass/fail grading reduced competition among medical students as well as stress on indi*idual medical students. "Bloodgood, Short, Jackson !artindale, p.//2&.

3iterature consistently found that a pass/fail system pro*ided students with greater satisfaction with their personal life during the first three semesters. )his effect disappeared during the fourth semester of medical school as did the increase in o*erall well-being. )he fourth semester typically includes preparation for 4S!35 Step 2 and course e0ams. )herefore, it is not surprising that student stress and an0iety will impact their satisfaction and o*erall well-being during the fourth semester.

,ata from Bloodgood et al. re*ealed a statistically significant impro*ement in a *ariety of psychological factors, such as' an0iety, depression, positi*e well-being, self-control, *itality, and general health during the first three semesters of medical school "p.//#&.

Students in schools using grading scales with three or more categories "such as A, B, +, ,, -& were found to ha*e higher le*els of stress, emotional e0haustion, depersonali6ation and were more likely to ha*e burnout. Additionally, students in grading scales schools were more likely to ha*e considered dropping out of school in comparison with students in a pass/fail program "7eed, Shanafelt, 8ower, 5acker, 9arper, !outier, ,urning, !assie, )homas, Sloan ,yrbye, #$22, p. 2:/%&.

7eed, et al "#$22& e0plains' (1it seems the more time students spent taking e0aminations, the lower their well-being measures were. )hese findings suggest that medical schools that emphasi6e testing and grades may be culti*ating learning en*ironments that e0acerbate an0iety and stress. "p.2:;$&.

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What impact does a pass/fail system have on student academic performance? <n schools that transition to a pass/fail system, a re*iew of literature finds no difference in student academic performance on' "2& courses in the first two years of medical school= "#& 4S!35 Step 2 e0am scores= ":& 4S!35 Step # +> scores= or "?& clerkship grades "Bloodgood, Short, Jackson !artindale, p.//$&.

Bloodgood, Short, Jackson !artindale "#$$%& found that a change from a fi*e-inter*al system to a pass/fail system did not result in a decline in' "2& academic performance= "#& attendance at academic acti*ities "including lecture&= or ":& residency placement.

References: Bloodgood, 7.A., Short, J.@., Jackson, J.!., !artindale, J.7. "#$$%&. A change to pass/fail grading in the first two years at one medical school results in impro*ed psychological well-being. Academic Medicine, 84 "A&, /AA//#. 7eed, ,.A., Shanafelt, ).,, Satele, ,.B., 8ower, ,.C., 5acker, A., 9arper, B., !outier, +., ,urning, S., !assie, -.S., )homas, !.7., Sloan, J.A. ,yrbye, 3.D. "#$22&. 7elationship of pass/fail grading and curriculum structure with well-being among preclinical medical students' A multi-institutional study. Academic Medicine, 86 "22&, 2:/;-2:;:.

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