Pass/Fail, but secretly not really...?

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Pacna

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I go to a school which is P(75%)/F. We're supposed to strive for "mastery" which is 85%. The school has a good talking to you if you're not mastering all of your courses.

However, it's getting around that the administration is recognizing the top 10% of the class differently in Dean's letters. I'm told that the wording is different but that residency directors know what to look for.

Is this a real thing common to P/F schools, unique to my own, or just a rumor? I haven't asked administration directly about this, but this was definitely not outlined to our class or the class above ours (who may be the source of these rumors).

Would it be ethical to deceive a student body in this way? I get that it keeps students from being cutthroat, but is that enough of a reason?

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Nevermind, just got an email back from administration. This is indeed true, and it's mentioned in the student manual which no one read. 😛
 
:smack:

So you go to a school that is not "true" Pass/Fail.

Yes, they're called "code words" in the MSPE. At the end of your MSPE (Dean's letter) that goes to residency, they will say, Pacna will make an "outstanding", "excellent", "Very good", "Good" candidate for your residency program. At the end of the MSPE is a rubric that tells the segment of the class you fall in.
 
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No matter how hard schools try to do P/F grading schema, the "mission creep" always sneaks in. I guess it's second nature to want to stratify your best and worst performing students.

:smack:

So you go to a school that is not "true" Pass/Fail.

Yes, they're called "code words" in the MSPE. At the end of your MSPE (Dean's letter) that goes to residency, they will say, Pacna will make an "outstanding", "excellent", "Very good", "Good" candidate for your residency program. At the end of the MSPE is a rubric that tells the segment of the class you fall in.
 
I go to a school which is P(75%)/F. We're supposed to strive for "mastery" which is 85%. The school has a good talking to you if you're not mastering all of your courses.

However, it's getting around that the administration is recognizing the top 10% of the class differently in Dean's letters. I'm told that the wording is different but that residency directors know what to look for.

Is this a real thing common to P/F schools, unique to my own, or just a rumor? I haven't asked administration directly about this, but this was definitely not outlined to our class or the class above ours (who may be the source of these rumors).

Would it be ethical to deceive a student body in this way? I get that it keeps students from being cutthroat, but is that enough of a reason?

My school sort of kept us in the dark about how we were evaluated/ranked until we had a presentation on it a couple weeks ago. Our preclinical grades play a role for AOA, but apparently a relatively minor one, and they don't factor into the Dean's Letter. My school doesn't have junior AOA. The largest influence on rank by far is 3rd year/early 4th year grades, with Step 1 score playing some role as well.
 
I feel like if you go to a school that isn't a top 30 school and it's P/F, it's a good bet that it's not true P/F

when you think about it, the only real schools that can actually have it work are the ones where the admission criteria are rigorous to the point where they can essentially leave the kids alone for 2 years and be fairly confident they will all be ready for the hospital. can't really do that with the avg student at crappy schools, only can do it with the avg student at stud schools
 
No matter how hard schools try to do P/F grading schema, the "mission creep" always sneaks in. I guess it's second nature to want to stratify your best and worst performing students.

From what our dean told us, they basically need to give residencies SOMETHING to work with in terms of stratifying students otherwise it's going to end being considered a negative when it comes to application time because they can't even find out where a student stands within their class. Step 1 is basically they only think they would have to work off from.
 
I think next to true P/F my school is great. H/P/F. You get a little bonus for doing exceptional on a test, but overall it doesn't matter much for everyone else as a Pass is a Pass. P = 2.0, all passes are equal so no stratifying the bottom 90% on an exam. Of course some people will get mostly honors and some will have honors mixed in, but I would hypothesize that at least 50% of the class will have all passes by 3rd year (+/- 1 Honor).
 
I feel like if you go to a school that isn't a top 30 school and it's P/F, it's a good bet that it's not true P/F

when you think about it, the only real schools that can actually have it work are the ones where the admission criteria are rigorous to the point where they can essentially leave the kids alone for 2 years and be fairly confident they will all be ready for the hospital. can't really do that with the avg student at crappy schools, only can do it with the avg student at stud schools
Exactly this. I just wish that there was some way to 'prove' your academic ability once in school so that you can just take standardized exams periodically and not have to worry about the day to day of class lecture and smaller exams. I feel that all the structured aspects of med school honestly just get in the way of real education.
 
This makes sense. I've been told by a dean that Residency Directors really dislike P/F grading.


From what our dean told us, they basically need to give residencies SOMETHING to work with in terms of stratifying students otherwise it's going to end being considered a negative when it comes to application time because they can't even find out where a student stands within their class. Step 1 is basically they only think they would have to work off from.
 
From what our dean told us, they basically need to give residencies SOMETHING to work with in terms of stratifying students otherwise it's going to end being considered a negative when it comes to application time because they can't even find out where a student stands within their class. Step 1 is basically they only think they would have to work off from.

I could see that. If it's all just pass fail with no stratification, then how would a residency know if the applicant from that school is solid or not. There's always the Steps, but anyone can do well/screw up on one test. If they can't tell what kind of applicant they are getting from the school, I would think they would stop accepting applicants from there. Especially if the first ones they accept don't meet their program's standards.
 
Exactly. Schools like Yale can get away with it...because they are Yale. But it's super annoying from the residency side (and forces us to rely almost entirely on the USMLE scores and reading the tea leaves in the LORS)

Is this for preclinical p/f or are these schools p/f 3rd year as well? Do you look at dean's recognition as a surrogate for top 10-15%?
 
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Is this for preclinical p/f or are these schools p/f 3rd year as well? Do you look at dean's recognition as a surrogate for top 10-15%?

Some schools (i'd assume most but I have nothing to back that up) usually have at least an honors option for 3rd year, if not more (high pass/low pass). I've never really heard of a true P/F 3rd year.
 
This makes sense. I've been told by a dean that Residency Directors really dislike P/F grading.

They dislike it because they want as much information as possible to stratify students, even if it's only of a little importance. If it were permitted to ask about pregnancy plans, or about what you plan to rank their program, many interviewers would do so. It's a different question whether this stratification is in the best interest of the students' education as a whole.

It's entirely unclear whether someone from an school with preclinical passes (under a P/F system without internal rank) would be viewed differently from someone from a similarly ranked school with all preclinical honors (under a H/HP/P/F system). I doubt it. I don't believe in this "residencies want it" argument to stick with preclinical grades. You still have ranking information from third year grades. You have Step 1 to measure preclinical knowledge. Pass/fail is now the most common (plurality) grading system for the preclinical years across all medical schools, especially among higher ranked schools.

The decision that administrations make about preclinical grading systems comes down to the question of non-competition/equality versus having a stratified system that will help those at the top at the expense of those at the bottom. For an unranked school, it is worth it in order to let your superstars shine a tiny bit brighter, even if it might mean raising the stress and anxiety of everyone and entrenching the bottom status of those below average based on preclinical courses?
 
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I could see that. If it's all just pass fail with no stratification, then how would a residency know if the applicant from that school is solid or not. There's always the Steps, but anyone can do well/screw up on one test. If they can't tell what kind of applicant they are getting from the school, I would think they would stop accepting applicants from there. Especially if the first ones they accept don't meet their program's standards.

Your premise is that preclinical grades are a more reliable indicator of the quality of student than their Step scores. However, preclinical performance is highly correlated with Step 1 score. (For instance, at Einstein, the correlation between numerical basic science grades and Step 1 score was 0.76. Source) So Step 1 is a reasonable proxy for grades. It's probably actually a better measure because 1) it's standardized to allow comparison across schools, 2) it has greater discriminatory power than grading systems that have only a few strata (H/P/F or H/HP/P/F where very few get P).

Preclinical grades are the LEAST important factors for residencies. See the http://www.nrmp.org/wp-content/uploads/2014/09/PD-Survey-Report-2014.pdf. There are MANY sources of information that are more important, such as Step 1, Step 2, clerkship grades, qualities demonstrated in interview, LORs, AOA/rank, research/ECs.
 
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Sorry I just do not understand why in this day on this board there are people still arguing about how residencies think about preclinical grading systems and why that matters. I need to make my points clearer. We are talking about PREclinical years only.
1) More schools are moving towards P/F. Any relative disadvantage that not having preclinical grades confers is rapidly diminishing.
2) Residencies have sufficient, better sources of information to stratify students. These include clinical grades and standardized exams, which can also serve as a basis for class rank and AOA status.
3) Program directors on average value preclinical grades the very least for the purposes of ranking applicants out of all factors surveyed by the NRMP in 2014.
 
To get back to the OP's question, yes it is common for lower tier schools who nominally have P/F preclinical years to omit announcement of how course performance contributes to class rank even if it doesn't show up on the transcript. The competitive students will read the student manual and know anyway. This is an insidious practice.
 
You're falsely categorizing this as a preclinical grades issue only
Nobody is seriously arguing we should get rid of clinical grades at this point. It's a common misperception that any schools have this or are moving towards this. Yale has clinical Honors. Stanford added its "pass with distinction" level several years ago to the clinical years.
 
I could see that. If it's all just pass fail with no stratification, then how would a residency know if the applicant from that school is solid or not. There's always the Steps, but anyone can do well/screw up on one test. If they can't tell what kind of applicant they are getting from the school, I would think they would stop accepting applicants from there. Especially if the first ones they accept don't meet their program's standards.

because if the person had the undergrad resume of a god, it's pretty likely they will excel similarly in medical school. if you can get into lerner I don't really think you have much else to prove to residencies. I would think getting into one of those elite schools + a good step 1 score would be more validation of a candidates likelihood to succeed than a class rank and a step 1 score. The people that get into those schools are like robots of win, they're not going to magically start sucking, they've been extremely dedicated and hard working to get to that point, so its extremely likely to continue
 
Sorry I just do not understand why in this day on this board there are people still arguing about how residencies think about preclinical grading systems and why that matters. I need to make my points clearer. We are talking about PREclinical years only.
1) More schools are moving towards P/F. Any relative disadvantage that not having preclinical grades confers is rapidly diminishing.
2) Residencies have sufficient, better sources of information to stratify students. These include clinical grades and standardized exams, which can also serve as a basis for class rank and AOA status.
3) Program directors on average value preclinical grades the very least for the purposes of ranking applicants out of all factors surveyed by the NRMP in 2014.

Which is hilarious because preclinical students freak out about grades so much. I understand the correlation to step which obviously is mega important but so many people are like omg I studied so much but didn't do so well on the exam. Alright well if you actually learned it, it'll show up on step 1 and you'll be great
 
because if the person had the undergrad resume of a god, it's pretty likely they will excel similarly in medical school. if you can get into lerner I don't really think you have much else to prove to residencies. I would think getting into one of those elite schools + a good step 1 score would be more validation of a candidates likelihood to succeed than a class rank and a step 1 score. The people that get into those schools are like robots of win, they're not going to magically start sucking, they've been extremely dedicated and hard working to get to that point, so its extremely likely to continue

As you state, this is fine if you're at a top school. But if you are not, then they would have to find some method to try and stratify where the individual sits within their class. Yes, elite school + solid step 1 is validating, but low-tier + ___ would potentially need more factors to determine where the individual sits within the class. Additionally, just because someone has a fantastic undergrad resume doesn't mean they are going to dominate med school. I've met plenty of people that had 3.9+ GPAs with mid 30 MCATs that struggled to do well in medical school. Not saying there isn't a correlation, just saying you can't automatically make the assumption they won't start sucking for whatever reason.


Your premise is that preclinical grades are a more reliable indicator of the quality of student than their Step scores. However, preclinical performance is highly correlated with Step 1 score. (For instance, at Einstein, the correlation between numerical basic science grades and Step 1 score was 0.76. Source) So Step 1 is a reasonable proxy for grades. It's probably actually a better measure because 1) it's standardized to allow comparison across schools, 2) it has greater discriminatory power than grading systems that have only a few strata (H/P/F or H/HP/P/F where very few get P).

Preclinical grades are the LEAST important factors for residencies. See the http://www.nrmp.org/wp-content/uploads/2014/09/PD-Survey-Report-2014.pdf. There are MANY sources of information that are more important, such as Step 1, Step 2, clerkship grades, qualities demonstrated in interview, LORs, AOA/rank, research/ECs.

I didn't say that preclinical grades are more important or even more reliable than Step 1 scores. I'm just saying that an applicant shouldn't be defined by their board score alone. There is no denying that there are some people that underachieve on the boards because of anxiety or illness.

I also never said the class rank/GPA should be used to compare applicants from different schools but can indicate where the individual sits within their own class. An applicant that passes everything but gets 2-3% above the passing score every time is a much different candidate than the person that gets high 90s on everything. Obviously there are other factors that are as important and even more important than class rank, but you can't deny that many residencies (especially certain specialties) use class rank/percentiles and board scores as cutoffs for who they will review as a serious candidate. You can't possibly believe that when there are 600 people applying for 4 positions they are going to review, in detail, all 600 applications.

I agree once they narrow down who they will actually interview, the class ranking becomes significantly less important and may even be negligible at some programs. However to create the initial cutoff they have to use an easily identifiable factor (non-essay/letter) to narrow the field to a reasonable number of candidates.
 
No matter how hard schools try to do P/F grading schema, the "mission creep" always sneaks in. I guess it's second nature to want to stratify your best and worst performing students.
Yup. I think schools should just be honest --- we want to decrease your stress level and save your mental health here as much as possible, but we also have a duty to residency programs to give them an idea of your level of performance: high, middle, or poor. Instead many choose to blatantly lie to their students and students don't find out until the beginning of MS-4, when they read their MSPE and see that they are a "good" student.
 
This pissed me off so much during interview season. "We are a pass/fail school: H/HP/P/LP/F." "We do not rank our students (except in the MSPE)." "We do not track grades *cough* just your rank *cough*."

Bastards.
The doublespeak of medical school administration can be galling if not outright lying.
 
My school sort of kept us in the dark about how we were evaluated/ranked until we had a presentation on it a couple weeks ago. Our preclinical grades play a role for AOA, but apparently a relatively minor one, and they don't factor into the Dean's Letter. My school doesn't have junior AOA. The largest influence on rank by far is 3rd year/early 4th year grades, with Step 1 score playing some role as well.
If preclinical grades play a role for AOA, then they might play a role for class rank/code word (you go to a "true" Pass/Fail school I believe). Obviously the biggest contribution to class rank are clinical grades, but that's the case at ALL medical schools.
 
From what our dean told us, they basically need to give residencies SOMETHING to work with in terms of stratifying students otherwise it's going to end being considered a negative when it comes to application time because they can't even find out where a student stands within their class. Step 1 is basically they only think they would have to work off from.
But there are some schools in which their Dean's letter is utterly useless and their students match great, for example, Cleveland Clinic Lerner College of Medicine.
 
This makes sense. I've been told by a dean that Residency Directors really dislike P/F grading.
From what our dean told us, they basically need to give residencies SOMETHING to work with in terms of stratifying students otherwise it's going to end being considered a negative when it comes to application time because they can't even find out where a student stands within their class. Step 1 is basically they only think they would have to work off from.
They have clinical grades for that.
 
You're falsely categorizing this as a preclinical grades issue only
I don't think anyone has said or argued that the clinical year should be Pass/Fail only as this doesn't even make sense to students. Even Stanford has gotten rid of this. Preclinical grades value to program directors in terms of actual residency performance is pretty low.
 
Which is hilarious because preclinical students freak out about grades so much. I understand the correlation to step which obviously is mega important but so many people are like omg I studied so much but didn't do so well on the exam. Alright well if you actually learned it, it'll show up on step 1 and you'll be great
The correlation of preclinical grades to USMLE Step 1 is highly overblown I think - mainly by medical schools themselves who have a dog in this fight. It is probably more true at the extreme ends of performance than those in the middle.
 
Sorry I just do not understand why in this day on this board there are people still arguing about how residencies think about preclinical grading systems and why that matters. I need to make my points clearer. We are talking about PREclinical years only.
1) More schools are moving towards P/F. Any relative disadvantage that not having preclinical grades confers is rapidly diminishing.
2) Residencies have sufficient, better sources of information to stratify students. These include clinical grades and standardized exams, which can also serve as a basis for class rank and AOA status.
3) Program directors on average value preclinical grades the very least for the purposes of ranking applicants out of all factors surveyed by the NRMP in 2014.
 
I agree once they narrow down who they will actually interview, the class ranking becomes significantly less important and may even be negligible at some programs. However to create the initial cutoff they have to use an easily identifiable factor (non-essay/letter) to narrow the field to a reasonable number of candidates.
And you would be wrong.
 
But there are some schools in which their Dean's letter is utterly useless and their students match great, for example, Cleveland Clinic Lerner College of Medicine.

I'm not saying that's the only factor. Lerner is also a well known name in the field. At a newer or less "name-brand" med school, my guess is that there's a bit more of an incentive to stratify students as much as possible in order to get your "top" performers to stand out even more. At a well known school with a history of turning out excellent students this is less of an issue because they have a good reputation anyway.
 
A vandy student just told me that they have dropped grades for all their core clerkships (which are now done in M2 year apparently).

I know there are some other schools that are pass fail in the clinical years and don't give any rank info in the MSPEs - I can't remember off the top of my head, but I've read them and our PD has commented on it at the rank meetings.
So if at Vanderbilt their preclinicals (it's 1 year now) are P/F and their clinicals are P/F, then the only things left are board scores and clerkship evaluation comments. What else is left? I guess publications and LORs also.
 
I'm not saying that's the only factor. Lerner is also a well known name in the field. At a newer or less "name-brand" med school, my guess is that there's a bit more of an incentive to stratify students as much as possible in order to get your "top" performers to stand out even more. At a well known school with a history of turning out excellent students this is less of an issue because they have a good reputation anyway.
Actually it's not. CCLCM is a relatively new school. Their MSPEs are useless for us to read as they don't have any grades and they don't have class rank. They do have a "student portfolio" in achieving certain competencies, as if residencies have time to read that ****.
 
Not sure. I was just talking to one of their students at an interview dinner. They were telling me about the new curriculum - this years' students applying aren't affected by it - it will be a couple of years still I think before students in the new program apply.
Yes, it's their new Curriculum 2.0 🙄:
 
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The main problem is that these non top 30 schools that do this aggressively and deceptively market themselves as "true P/F schools" when talking to applicants.

The reality is that they still rank their students, which for all intensive purposes is the same has having grades.

IHMO there isn't valid reason for grades during M1/M2. Yes, there is a significant difference between someone who scores 80% on most exams vs. someone who scores 95%. However, due to the variability of grading and curriculum between schools, its not possible to accurately and fairly compare applicants from 2 different schools using preclinical grades (which is the whole point of having grades/rankings for residency applications).

As long as the student passed the course and did well on step 1, that should be enough to assure understanding of the material. At the same time, if your goal is to stratify students, using standardized tests like the steps and shelf exams in addition to home rotation grades, audition rotation grades, and SLORs seems like the best option.
 
The main problem is that these non top 30 schools that do this aggressively and deceptively market themselves as "true P/F schools" when talking to applicants.

The reality is that they still rank their students, which for all intensive purposes is the same has having grades.

IHMO there isn't valid reason for grades during M1/M2. Yes, there is a significant difference between someone who scores 80% on most exams vs. someone who scores 95%. However, due to the variability of grading and curriculum between schools, its not possible to accurately and fairly compare applicants from 2 different schools using preclinical grades (which is the whole point of having grades/rankings for residency applications).

As long as the student passed the course and did well on step 1, that should be enough to assure understanding of the material. At the same time, if your goal is to stratify students, using standardized tests like the steps and shelf exams in addition to home rotation grades, audition rotation grades, and SLORs seems like the best option.
You mean they actually say they are "true" Pass/Fail? If so, I didn't realize medical schools went from lying by omission to outright deception.

You are correct though, M1/M2 grades are not really indicative or predictive of residency performance (in terms of actually clinical responsibilities, ward stuff) which is why as a whole, residency program directors don't really care about them and at least for basic science knowledge achievement, use Step 1 as a marker for this.
 
What's up with passing being 75%

Is that normal? At my school is 70
 
What's up with passing being 75%

Is that normal? At my school is 70
His school is Pass/Fail, so some schools, bc they know students will only aim for 70%, kick up the P to a 75% instead.
 
What's up with passing being 75%

Is that normal? At my school is 70

We have pass set at 70, but it's only a "marginal pass". Basically, if you consistently get less than 75 on your exams, they pull you aside and do...something. They never really said what they do, but from I've heard from MS2s and above, they'll make you delay graduation a year if your preclinical grades are consistently in the marginal pass zone and then you do a remediation year, although no one currently attending the school is doing this, so who really knows.

If preclinical grades play a role for AOA, then they might play a role for class rank/code word (you go to a "true" Pass/Fail school I believe). Obviously the biggest contribution to class rank are clinical grades, but that's the case at ALL medical schools.

Maybe. The way they presented it was that for AOA was that the most important things were 3rd year grades and Step 1, followed by research, followed by other ECs, followed by preclinical grades. They showed us an example of the Dean's Letter and there was blurb about how preclinical courses are P/F and internal ranking is kept only for AOA. It seems kind of odd where the class appears to be stratified into AOA and non-AOA. It's entirely possible that preclinical grades factor into ranking in some way beyond AOA and they're just not telling us.
 
We have pass set at 70, but it's only a "marginal pass". Basically, if you consistently get less than 75 on your exams, they pull you aside and do...something. They never really said what they do, but from I've heard from MS2s and above, they'll make you delay graduation a year if your preclinical grades are consistently in the marginal pass zone and then you do a remediation year, although no one currently attending the school is doing this, so who really knows.

Wow. That's bull IMO. I know quite a few people who would count as marginally passing anatomy/biochem.

It just seems like that would give the school too much leway
 
We have pass set at 70, but it's only a "marginal pass". Basically, if you consistently get less than 75 on your exams, they pull you aside and do...something. They never really said what they do, but from I've heard from MS2s and above, they'll make you delay graduation a year if your preclinical grades are consistently in the marginal pass zone and then you do a remediation year, although no one currently attending the school is doing this, so who really knows.

Maybe. The way they presented it was that for AOA was that the most important things were 3rd year grades and Step 1, followed by research, followed by other ECs, followed by preclinical grades. They showed us an example of the Dean's Letter and there was blurb about how preclinical courses are P/F and internal ranking is kept only for AOA. It seems kind of odd where the class appears to be stratified into AOA and non-AOA. It's entirely possible that preclinical grades factor into ranking in some way beyond AOA and they're just not telling us.
That's so nice that your med school is so transparent to your class. You're only eligible for AOA if you're in the top 25%, but to be actually nominated (based on however that chapter decides), the total number of people can't exceed 1/6th. Hence someone can be at the very top of the class in terms of academics, but still not get AOA - since AOA is an award, and is not an ordinal class ranking, or more commonly the "code word" designation at the end of the MSPE.
 
Wow. That's bull IMO. I know quite a few people who would count as marginally passing anatomy/biochem.

It just seems like that would give the school too much leway
Again, it's bc her school is Pass/Fail. If your school is letter graded then it's not an issue bc your performance is directly stated on the transcript.
 
Disclaimer!! This does NOT apply to my administration, but a Faculty member in grad school once told me "Deans are paid to lie".
LOL! What I don't understand is why LIE about a school policy? Or do they just not think it's lying or people will find out?

Y'know, this is actually NOT a bad idea! Colleagues of mine from multiple schools have commiserated with me that the people who are in that range (<75) consistently fail COMLEX and/or USMLE. I wish we had this policy.

We have pass set at 70, but it's only a "marginal pass". Basically, if you consistently get less than 75 on your exams, they pull you aside and do...something. They never really said what they do, but from I've heard from MS2s and above, they'll make you delay graduation a year if your preclinical grades are consistently in the marginal pass zone and then you do a remediation year, although no one currently attending the school is doing this, so who really knows.
 
Again, it's bc her school is Pass/Fail. If your school is letter graded then it's not an issue bc your performance is directly stated on the transcript.
I knew that OP s was, I didn't know that MedWonk ' s is as well
 
Disclaimer!! This does NOT apply to my administration, but a Faculty member in grad school once told me "Deans are paid to lie".
Ah, yes, Deans definitely do. I didn't mean actual faculty members.
 
I knew that OP s was, I didn't know that MedWonk ' s is as well
MedWonk's is "true" Pass/Fail I believe. So the incentive is there for students to only aim for 70%. So her school put in a policy in place to stop that. They likely don't advertise this to students though (not that any ask).
 
MedWonk's is "true" Pass/Fail I believe. So the incentive is there for students to only aim for 70%. So her school put in a policy in place to stop that. They likely don't advertise this to students though (not that any ask).
Interesting
 
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