So the tiered grading (honors, pass with commendation (PC), pass, and fail) is based entirely on cutoffs that are set by the prior year. For our year, the cutoff for honors is a 91 for all the main courses and that was because the top 25% of the class last year scored a 91% or above. But for my year, if every single person got a 91 for a course grade, they would all get honors. There's no competition within your year for grades and therefore everyone is very collaborative. Having tiered grading does affect how you approach the classes since if you're capable or near the cutoff of getting honors or PC, you're going to push for it. Having pass/fail entirely would be nice but maybe with step 1 going pass/fail, having the ability to distinguish yourself could be good, but it'd for sure be a lower ranking measure compared to research, letters of rec, clinical grades.