APPE Rotations Grading System - Pass/Fail vs GPA

[BC_89]

About to start my 3rd APPE rotation and was curious what others thought (especially those working with students) -

How relevant / important is it to distinguish a students evaluation (per rotation) based on a GPA approach? I'm coming from a program that takes the approach of a Pass/Fail system. That is, you've improved/progressed to a point that you are deemed competent enough to advance [ PASS ] or you simply lack clinical-med review judgment compared to your peers and its the professional opinion of the preceptor that you remediate [ FAIL ].

How do you differentiate a student on a rotation with an "A" or a "B"? Something as involved as oncology vs ambulatory care would be a bit hard to stack up against other peers if some students never actually get an oncology rotation (meaning an easier bump in GPA). I also think it would serve as more of a distraction on a students ability to be more focused in actually learning and applying concepts rather than thinking of the "grade."

Either you can be trusted as a student or you can't. Just clump each evaluation rating (skills vs appearance vs professionalism) in a P/F format and see if they hit all the main points. Am I missing something? What do current preceptors or others think of each approach?

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[WorthlessOxygen]

Not a preceptor myself but I always thought pass/fail made more sense for practical coursework. APPEs should be making sure you're competent enough to go on to take your boards and practice which just seems to lend itself to a P/F system.

I guess you lose some nuance in comparing to other students but that more accurately reflects real life as far as I'm concerned.

 

[lord999]

By the way @BC_89, if you drew Portland VAMC there a decade ago, you would have had likely had this guy as your preceptor for inpatient, and I doubt you would have had a happy time. Preceptors are too mercurial that they can wreck a student's career (and in this guy's case, especially if you were on his bad side).

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I've preferred the P/F system myself. When I was a student, I had two really bad preceptors (one of which was openly racist and religiously bigoted and the other gloriously incompetent) who it would have been a real problem if I had stayed. For those who have grades, I have a rubric to grade them on that I go over with them on first day though my rotation is elective. I also think that those who are trying to manipulate their grades choose easier rotations if they A/F and that's precisely what we don't want you to do. Take risks with your rotations in practices that you may never experience again. My own was an accidental assignment to Cardinal in Tempe. If you could choose which rotations you get, I think A/F is workable, but the arbitrariness of the assignment makes P/F a better system.

Also, not enough preceptor fail students in either system. I've never been afraid to, and there's some schools that cannot send to sites for that reason.

 

[owlegrad]

I would love a pass/fail system. Grades are so arbitrary on rotations IMO. Like lord I go over the grading scale the first day of rotation and in my case I make getting an A extremely easy - I want the students to focus on learning and getting experience, not on how to get an A.

I have had students get less than an A and it is mostly “professionalism” issues - tardiness usually.

 

[Rockinacoustic]

Prefer pass/fail myself but am stuck with the letter grade system for the school i precept. Because of this, when reviewing residency applicants the letter grade on rotations is something I barely pay attention to.

 

[KidPharmD]

I prefer letter grades on rotation. To me there is a big difference between the students that get A's and the students that get C's on my rotation. However, I don't actually have that much control over their grade. All the schools I precept for have a final evaluation rubric that calculates the grade. I am honest on that rubric and the student gets what is calculated. For the most part, it means I hand out a lot of A-'s and B's with only a few A's and a very rare C. I know about how it works, so I generally know what the student is headed towards at midpoint. I don't think I have ever surprised a student with their grade.

My problem with pass/fail is not being able to differentiate from the students that do the bare minimum and those that go above and beyond. Sure, I can write LOR's for those that do really well, but I'm not always a great choice for that.

When reviewing, I rarely pay attention to grades in specific courses. I mostly skim for F's, W's, and I's just in case. We also use a pretty aggressive GPA cutoff, but I don't really care how they got to that GPA.

 

[BC_89]

I prefer letter grades on rotation. To me there is a big difference between the students that get A's and the students that get C's on my rotation. However, I don't actually have that much control over their grade. All the schools I precept for have a final evaluation rubric that calculates the grade. I am honest on that rubric and the student gets what is calculated. For the most part, it means I hand out a lot of A-'s and B's with only a few A's and a very rare C. I know about how it works, so I generally know what the student is headed towards at midpoint. I don't think I have ever surprised a student with their grade.

My problem with pass/fail is not being able to differentiate from the students that do the bare minimum and those that go above and beyond. Sure, I can write LOR's for those that do really well, but I'm not always a great choice for that.

When reviewing, I rarely pay attention to grades in specific courses. I mostly skim for F's, W's, and I's just in case. We also use a pretty aggressive GPA cutoff, but I don't really care how they got to that GPA.

I can understand trying to differentiate a C student vs an A student (especially in terms of professionalism and communication).

I suppose my overall wonderment deals with students who really do try to absorb and learn. For example, If a lot of A- and B+ ratings are given, could the difference between each student really be that obvious in terms of skill level and overall performance ( Let alone an A vs A-)?

Our program uses a lot of scaled questions rated from 1 to 4 with 4 being "excellent" to 1 being "incompetent." An example is the use of the interface / patient record system for 6 weeks. I wouldn't expect to be perfect in finding pertinent information within a computer system at a rapid pace, but I would expect to be improving over time. Some could argue I could be given a "2 or 3" at mid-evaluation up to a "3 or 4" at my final-eval. I could only imagine that some could even argue that some 3's could really be 4's and some 4's perhaps 3's.

These one step survey ratings could mean the difference between letter grades and it just seems difficult (student perspective) to understand what an "A" vs an "A-" really means in the long-run - especially for those willing to take on difficult rotations and get as much exposure as possible.

 

[Rockinacoustic]

You're thinking about rotations wrong- the only one who will care about an A vs an A- is you (and maybe your preceptor, because again, schools force us to use rubrics that calculate a grade and make us feel we have to play the game).

I will hold a 'B' student who has a journal club, patient case presentation, or project completed during their rotation in higher regard that the 'A' student who just did topic discussions. I probably already have done this multiple times, because I rarely look at individual grades and go straight for the CV and LOR when I'm spending 3 minutes glancing through an application.