So... personally, grades are stupid. I actually believe in the principle of the Results Only Work Environment (ROWE) or in the principles discussed in Dan Pink's "Drive." And before I say what I do, I am going to preface it with literally EVERYONE will disagree with me because its awkward, odd, and moves against everything in medical education have come to believe. But I think we have sabotaged ourselves. We reward the wrong behavior with the wrong incentives for the wrong reason. The product is Gunners, competition, and hateful anonymity on the internet accusing one another of cheating.
That being said, here is what I do with my medical students and the rationale.
I give everyone honors. And I tell them, on day 1.
The thing that motivates medical students far too often is the grade. They perseverate on beating their classmates. They have to be in the top 25% of their class, they have to get AOA, they have to get the residency of their dreams in Urology / Derm / Anesthesia / Optho. They search every day for a way to impress their residents or worse, destroy their colleagues, believing that if their competitors look bad, they look better in comparison.
Only unsatisfied needs motivate.
Since I believe the thing that drives a medical student should be the quest for improvement, helping the team, participating in patient care, and heaven forbid, actually learning a little medicine, and NOT the grade, I take that off the table. "Drive" talks about
paying people honestly and fairly. Remove the extrinsic motivator from the equation. The idea is "you are having your survival needs satisfied, now go do good work." Versus the traditional model "if you do good work, I will satisfy your survival needs." So I pay them fairly. I just get that extrinsic motivator off the table altogether. Your grade is fixed. And its awesome. Move on.
Intrinsic Motivators provide creativity and growth
What's interesting, and what many people refuse to believe because it IS cutting edge, it IS different, is that people do BETTER WORK when they are freed from the survival drive. When we attend to their internal motivators, that is,
autonomy,
mastery, and
purpose (-Dan Pink) people who do right brain, abstract work (like "taking care of patients" and "developing a differential diagnosis), expand their creativity, they come up with complex solutions, they do better work. Additionally, their desire to work becomes exponentially increased. People WANT to be given the authority to practice on their own, to try, to fail (with a safety net), and belong to a higher purpose.
The problem is that we have been, as a society, socialized into the "grades grades grades" mentality. And initially, people recoil at this new "autonomy and mastery" idea. The reply goes something like this: Yo
u mean to say, that I WANT TO FAIL at this lumbar puncture? Like IN FRONT OF OTHER PEOPLE?... I have this inner desire to look like an idiot? I mean, really? You actually believe that?
Yes. The reason why people don't like to fail in front of others is because they think (consciously or unconsciously) it will hurt their grade. If approached instead with the perspective "you don't know how to do this. you will. go learn. Ill be here to watch. try. here's how. now you" instead of the "SUCCEED OR FAILZ!?" perspective, students interest increases, their involvement increases, the bus-throwing decreases, the lying decreases, and the nonsense that plagues medical education on the wards similarly falls.
There is more to this than can be written in a single internet thread. I, as I often do, have rambled longer than most people care to read. But realize that when given operational parameters, the expectation of routine evaluations (self and by superiors) for improvement (not a grade), and a clearly defined goal, students' performance improves.
It takes a
major paradigm shift to move from what we all encountered as medical students (and even some of us in residency) to a ROWE. But I promise you, the results are astounding. No, i don't have data, just anecdotes, but so far, the results have been brilliant. Never have I once had to go back on my word. Never have I felt abused, cheated, or that a student was using my "generosity" against me.
ROWE > Our current system.