Pass/Fail Grading Systems in Medical School

By Sumitra Miriyala, Ph.D., Assistant Professor, LSU Health – Shreveport, and CECA Committee Member

If you recently completed your anatomical or basic sciences graduate degree and are ready to begin your career as junior faculty in medical school, you may have a surprise waiting for you in terms of grading!
Prior to teaching in a medical school, it’s likely that the majority of the classes you taught or took used the traditional A to F letter-grading system for evaluating  academic performance. However, most medical schools use the Pass-Fail grading system to quantify student achievement of established learning objectives, with an institution-defined threshold for a passing grade.

Data from the LCME Annual Medical School Questionnaire from 2013-2014 through 2017-2018 shows that opting for the pass/fail grading system strives for a reduction in student stress and anxiety.  Reports of academic stress related to grades led many medical schools to opt into the pass/fail grading system with the goal of reducing student stress and anxiety. This, in turn, creates a less-competitive atmosphere, leading to an increase in overall well-being.

The principal attraction of implementing a pass/fail grading system lies in the expectation of improving students’ mental health and promoting supportive learning. A growing body of evidence supports decreased perceived stress and greater satisfaction for students in pass/fail grading systems. Many schools also find that pass/fail systems nurture a greater sense of teamwork and collaboration among students, while lessening competitiveness.

One area of concern when considering a shift from letter grades to a pass/fail grading system is the potential impact on USMLE Step 1 and 2 scores, and successful residency placement. However, this concern has been shown to be unfounded. The rewards of this pass/fail grading system far outweigh any potential downsides. The pass/fail, two-interval, grading system is widely adopted in medical schools across the United States.  In fact, benefits may extend beyond the matriculated students themselves, as the reduced focus on letter grades and grade point average may also enable schools to attract the finest and brightest applicants to their institution, fostering improved mental health and collaboration in medical school graduates and newly-minted physicians.


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