Three citations, from experience at Michigan, Mayo, and UVA:
- White, C. B. & Fantone, J. C. Passfail grading: laying the foundation for self-regulated learning. Advances in Health Sciences Education 15, 469477 (2009).
- Rohe, D. E. et al. The benefits of pass-fail grading on stress, mood, and group cohesion in medical students. Mayo Clin. Proc. 81, 14431448 (2006).
- Bloodgood, R. A., Short, J. G., Jackson, J. M. & Martindale, J. R. A change to pass/fail grading in the first two years at one medical school results in improved psychological well-being. Acad Med 84, 655662 (2009).
Thanks for the citations. I only briefly skimmed through the articles (studying for finals kinda prevents me from spending more time on them at the moment), but I think one of them stated something in its discussion along the lines of students making a conscious choice (in the P/F) program to either aim to do really well and aim to just pass. And the students who aimed to do really well had similar findings as the graded system students. This comes back to what I was saying in my previous post -- no matter what system you're in, if you're a particular type of student (ex. high-achiever), you will do the same thing no matter where you go.
Besides that, I won't address any of the shortcomings of the papers, including being single-institution, comparing different years' students, using surveys, etc.
Yes, I am aware that this evidence is not an argument in favor of pass-fail. It's simply to counter the suggestions of grading proponents that grading is necessary for step 1 performance.
And I would argue that the approach to Step 1 is quite different from the approach to classes. You can do poorly in class and do well on Step 1 or you can do really well in class and still do well on Step 1. And vice versa. This, again, has very little to do with the school's curriculum or grading system. It comes down to the individual student and their study habits.
Many people find cramming to suffice.
This is stupid. Cramming isn't restricted to schools with a grading system or people who want to do well on an exam. Especially considering the number of excellent resources we have at our fingertips (ex. Pathoma, Gojan, etc), I would be willing to bet that most people in med school get the "big picture" just fine.
The evidence doesn't support this. After changing to pass-fail, there are generally few significant differences in exam grades. Citation: the above three papers plus another one from Michigan when it only changed its first year to pass-fail: Robins, L. S. et al. The effect of pass/fail grading and weekly quizzes on first-year students performances and satisfaction. Acad Med 70, 327329 (1995). In these papers, the authors indicate that exam averages were 1) roughly the same as before, 2) well above passing, and, from the old Michigan paper, 3) "higher cumulative pre-final scores did not predict lower, "just passing" achievement on final examinations." As you suggest, most people in medical school have a good amount of internal drive, and the maintenance of course scores under pass-fail regimes reflects that reality. Again, this isn't an argument for pass-fail per se, just that pass-fail doesn't cause students to perform worse.
Haven't looked at the paper, so I'll refrain from commenting. Again, just to point out, there are multiple limitations of this study as well, especially using a survey to assess satisfaction.
That's a reasonable argument. I think about it this way. Step 1 provides a kind of external motivation that is a scaffold for students' intrinsic motivation. If you're studying review books first semester of first year, your exam date is too far off for someone who is purely externally motivated to really care. Someone who is not self-regulated will procrastinate because the rewards of studying now are far off and uncertain. Grading proponents typically say that grades are a necessary kick in the rear to stay on track for step 1. However, someone who is good at self-regulated learning will be able to stay on track without having to rely on grades for continuous external regulation.
Now I'm confused. Wasn't one of your arguments earlier that P/F schools value internal motivation while graded systems value external motivation (that whole internal vs. external thing you had on your list). Now, you're arguing that external motivation is good? How is using wanting to do well on Step 1 as an external motivation not the same as using wanting to do well on an upcoming exam as an external motivation?
Knowing that Step 1 is coming up is a kick in the rear for most students to stay on track, whether there are graded exams along the way or not. You say that someone who is "not self-regulated (I still don't understand what the heck that really means) will procrastinate because the rewards of studying now are far off and uncertain" -- um, isn't that describing P/F schools where the only thing that matters is Step 1, which comes at the end of two years, compared to graded systems with frequent exams? Who's more likely to procrastinate -- someone who doesn't have to really worry about anything for two years or someone who has graded exams coming up every month? I would argue it's the former.
This is a claim that's hard to quantify. There are as many people at P/F schools that claim that they would surely be more competitive with grading, and that their friends at graded schools experience more competition. There are no real studies yet on the effect of pass/fail on perceived competition. However, it would be very reasonable to hypothesize that discriminating grading causes students to be more likely to 1) perceive the goal of academic experiences to be performance oriented, 2) perceive the goal of assessment to be stratification, and 3) measure their own achievement by that of others.
No. Just no.
I disagree. A master of the most important information covered in course won't perform well on exams if the exams test 1) trivia of biomedical knowledge, or 2) nuances specific to the manner in which material is presented in course materials/lecture/old exams. I've had tons of exam questions on biochemical trivia. I've had questions that asked, essentially, about a weird metaphor or example made during lecture, which requires rote memory of lecture contents rather than the material per se. Conversely, someone who performs well on exams is not necessary a true master if she has a superficial understanding or short-term retention. There are plenty of ways to do this, like memorizing old exams from which the professor recycles or adapts questions.
Then you and I have different definitions of what true mastery means.
Also, why the heck are you making things black and white? Why can you ONLY understand the concepts or ONLY memorize minutiae without knowing concepts? That's a very idiotic way to look at things. You can definitely have a solid conceptual understanding of a topic AND memorize minutiae along the way. There are a ridiculous number of resources in existence that make understanding the "big picture" pretty easy actually. I would argue that the top scorers in my class understand the big picture just fine (if not better than others) and know more minutiae than the average scorers. I'm sorry if you go to a school where there's such a dichotomy that you either understand the conceptual basis of something or you only memorize and regurgitate. That's something your school needs to address. And it is not generalizeable to all schools.
Material success is deriving satisfaction from the grade in itself, rather than from the knowledge that you have understood new concepts or mastered new skills. The two aren't mutually exclusive, but they are competing values.
With that logic, isn't doing well on Step 1 "material success?" Again, Step 1 is an exam. How is it any different to want to do well on Step 1 vs. an in-class exam? Isn't that what the people attending P/F schools focus on?
Nothing specific like that. I mean more like procrastination, not reviewing the questions you get wrong on an exam (if those concepts tested are worthwhile), not participating because you're afraid of looking stupid, avoidance of seeking academic help. Before you say that graded students would be more likely to seek help (which I don't know is true), let me make a related observation that at a graded school that 1) students' perceptions that their academic structures aim for mastery/competence DECREASED from first to second year, that 2) perceptions of mastery goal structures were significantly negatively correlated with procrastination and avoidance of help seeking. Source: Artino, A. R. et al. Achievement Goal Structures and Self-Regulated Learning. Academic Medicine 87, 13751381 (2012).
Again, you seem to think that things like procrastination are limited to only graded systems. That's not true at all! Procrastination is rampant everywhere. All I have to do is ask my friends who attend P/F schools (with internal ranking, though) and they have pretty much the same class profile as my school does -- some people who want to do well in everything, some people who want to do the bare minimum, and most people who're somewhere in between.
Thanks for the study/survey. I'll consider it more seriously when larger-scale studies come out confirming this. At the moment, there isn't convincing evidence that one system is "better" than the other.
You're right, kind of. There are no studies of whether medical school grading promotes competitive and maladaptive behaviors. However, it is sillier to say P/F schools promote an environment of laziness and doing the bare minimum, because of the aforementioned evidence of academic outcomes not being compromised after moving to pass-fail. I'm just saying philosophically, grading is incongruent with promoting cooperation but P/F is consistent with learning (because of other sources of motivation to learn).
No, it's just as silly as saying that graded schools promote competitive and maladaptive behavior.
Let me clarify before you strawman and hyperbolize my statement to oblivion. I did not mean that all dermatologists are less altruistic than inpatient internists or surgeons. Dermatologists help people in ways that are very important. I was speculating that lots of people who do well during medical school are only then drawn towards the lifestyle-friendly and lucrative specialties. Because they can get in and the prestige/wealth/comfort associated seems consistent with the high grades that they and those specialties value. You probably get more people like the above poster who said he didn't like sick patients. In spite of their reasons for entering medical school in the first place, which was likely more altruistically-motivated, or in spite of their initial specialty interests. I don't want to make too much of this point because I'm not at all confident that it's causal. It's just an interesting way to conceptualize two phenomena related to extrinsic motivation.
Thanks for reiterating that you don't think derm is an altruistic field
rolleyes
. At least, not as altruistic a field as whatever you're planning on going into.
You have no idea what motivates people to come to med school, let alone decide which field they want to pursue.
I'm sorry you don't feel like your medical education has any impact on you besides a transfer of knowledge and technical skills. I tend to think medical education is a process of socialization into a culture, one that can deeply affect your attitudes, beliefs, motivations, and well-being.
Please. The preclinical years of med school are the exact same as everything else in college so far. Yea, there's more material, but that's really about it. Still do the same exact things: study, take exams, hang out with friends, watch football, etc. What's there in the first two years that can "deeply affect your attitudes, beliefs, motivations, and well-being?" From glancing at your MDApps, you're in the first semester of M1 year -- I honestly don't know what you can say has significantly changed you as a person during the course of this one semester.
I'm sure the clinical years will certainly impact me more deeply, but we're talking about preclinical years here. And you can stop being so pretentious. There's no need to justify why you went to a P/F school or denigrate others who attend a graded system. Again, like I previously mentioned, focus on yourself and stop worrying so much about what others are doing.
