Pass/Fail vs. H/HP/P/LP/F Grading System for Medical School

[787593]

If you had the option of attending one of two medical schools, all else being equal, would you choose the Pass/Fail school or the H/HP/P/LP/F school?

Why?

And does it really matter???

Thanks

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[787593]

Pass/Fail. The other one might as well be regular A, B, C grades. That said, I do prefer having grades or some form of more specific grading in 3rd year though.

But why pass/fail??

 

[freak7]

But why pass/fail??

One less thing to stress about when you're already super stressed.

 

[Lawpy]

Unranked P/F >>>>> ranked P/F >= A/B/C/F grades etc

From what i read, graded preclinicals are simply unnecessarily stressful. Why worry about getting an extra point to get the highest grade possible? In unranked P/F, you can worry about passing and doing well on your own pace, while also focusing on other things like research, hobbies, sports etc.

Ranked P/F though is deceptive and not really all that better than grades.

 

[Lawpy]

all US MD schools should simply take the low-stress approach and just universally adopt unranked P/F preclinical grades. and any new US MD school that forms would automatically use unranked P/F preclinical grading as requirement.

 

[Lannister]

Unranked P/F is obviously the best.
Ranked P/F (which is what my school does) is basically the same thing as the whole honors, high pass, pass system, but at least with ranked P/F you can pretend your ranking doesn't exist and just be happy about the fact that you passed.

 

[787593]

One less thing to stress about when you're already super stressed.

Is it really anything to stress about in the first place? How important are pre-clinical grades?

 

[ciestar]

Not even a question: pass/fail.
You take such a burden off of yourself to be "perfect". My 75%=to the 95% at my friend's school. Guess which one of us is more stressed out and hung up over getting honors in everything?

My class as a whole seems more relaxed than you think a med school class would be. But we don't sit there having to outdo each other and gunning has disappeared. All that matters is you passed and you can move on with your day. (Granted, we do get percentages back with our grades, so you do know if you're struggling, and it gives you a chance to do something about it).

We do have the honors/high pass/pass, etc for clerkships, but those matter so much more. What really defines your preclinical years is your step one score.

 

[ciestar]

Is it really anything to stress about in the first place? How important are pre-clinical grades?

They're important, yes, but trust me here, if you know you only "passed" and you can get attain a grade of honors instead, would you be content with that? Most of us wouldn't be. (A's used to be ALL that mattered).

 

[efle]

Preclinical grades can't be that important since every school in the top 20 except Penn has now abandoned preclinical grading. WashU was the last other holdout and ended it last year.

Class ranking is however very commonly cited as a factor for residency (matters for getting interviewed for 71% of PDs surveyed, with a big range from 40s-80s depending on specialty)

Basically I'd use other criteria to pick your school.

 

[787593]

They're important, yes, but trust me here, if you know you only "passed" and you can get attain a grade of honors instead, would you be content with that? Most of us wouldn't be. (A's used to be ALL that mattered).

That's a good point haha. Premed is ridiculously cutthroat lol

 

[Lannister]

Is it really anything to stress about in the first place? How important are pre-clinical grades?

They're not that important. When calculating our rank, my school weights M3 twice as much as M1 and M2 combined. But as an M1, they certainly feel extremely important to me right now.

 

[787593]

Preclinical grades can't be that important since every school in the top 20 except Penn has now abandoned preclinical grading. WashU was the last other holdout and ended it last year.

Class ranking is however very commonly cited as a factor for residency (matters for getting interviewed for 71% of PDs surveyed, with a big range from 40s-80s depending on specialty)

Basically I'd use other criteria to pick your school.

How do they determine class ranking if there are no grades?

 

[787593]

They're not that important. When calculating our rank, my school weights M3 twice as much as M1 and M2 combined. But as an M1, they certainly feel extremely important to me right now.

Thanks!

 

[mcatjelly]

If you had the option of attending one of two medical schools, all else being equal, would you choose the Pass/Fail school or the H/HP/P/LP/F school?

Why?

And does it really matter???

Thanks

I have to say, I attend an Honors/HP/P/F school (no low pass) and I haven't noticed any competition or added stress. In fact, my class is wonderfully collaborative, helpful, and supportive. I know what I expect of myself and I'm comfortable with that, and even if I were at a P/F school I'd still be striving to maintain that certain standard. But I think others are right in saying that P/F is generally a lower-stress approach to preclinicals.

 

[efle]

How do they determine class ranking if there are no grades?

Some places don't rank at all (Yale) while others will give loose ranking (an M4 at Wustl said the dean letters give upper/middle/lower third). My understanding is that how rank is actually determined will vary by school, as will criteria for AOA membership if the school has it. E.g. see Lannister above where it is a weighted average with preclinicals worth a lot less

 

[787593]

Some places don't rank at all (Yale) while others will give loose ranking (an M4 at Wustl said the dean letters give upper/middle/lower third). My understanding is that how rank is actually determined will vary by school, as will criteria for AOA membership if the school has it. E.g. see Lannister above where it is a weighted average with preclinicals worth a lot less

Thanks, this is good information to know.

 

[ciestar]

How do they determine class ranking if there are no grades?

I think I mentioned this, but as such, my school does release your percentage grade on a given exam, your final grade and every exam/class gives a class average. This could be how.

 

[TaroBubbleTea]

Some places don't rank at all (Yale) while others will give loose ranking (an M4 at Wustl said the dean letters give upper/middle/lower third). My understanding is that how rank is actually determined will vary by school, as will criteria for AOA membership if the school has it. E.g. see Lannister above where it is a weighted average with preclinicals worth a lot less

It was my understanding that most dean's letters do that to some degree, albeit ambiguously (ie they will use vague adjectives to describe a student's quartile without explicitly stating so).

 

[efle]

It was my understanding that most dean's letters do that to some degree, albeit ambiguously (ie they will use vague adjectives to describe a student's quartile without explicitly stating so).

I think the PDs on the other side have the secret decoder ring to tell them ̶t̶o̶ ̶d̶r̶i̶n̶k̶ ̶t̶h̶e̶i̶r̶ ̶O̶v̶a̶l̶t̶i̶n̶e̶ ̶ what the quartile was

 

[kamakazi5]

I can't believe I'm the only so far to vote the other way. I guess if I could see my exact scores and overall grades through the years I wouldn't care. For some reason I just like seeing the grades as separate.

 

[TaroBubbleTea]

I can't believe I'm the only so far to vote the other way. I guess if I could see my exact scores and overall grades through the years I wouldn't care. For some reason I just like seeing the grades as separate.

At my school, we are given grades as well as the median, mean, and highest and lowest percentages for each exam, so students still know where they stand, but on the transcript all that is recorded is either P or F.

edit: clarification

 

[kamakazi5]

At my school, we are given grades as well as the median, mean, and highest and lowest percentages for each exam, so students still know where they stand.

That would be perfect. What's really the difference between that and actual class grades then? This seems to be mostly mental.

 

[Neuroplasticity]

Just to give some arguments for the other side:
1. I have heard from a school's dean (possibly biased since this school wasn't true P/F) that in true P/F schools, you can still be compared to your peers behind the scenes. For example if 6 people from your class apply for ortho at XSOM and all 6 students' letters say the same thing (all passed), the residency program will call your school and ask "which of these students should we consider / who is at the top"
2. Some people say "if you know you just need at 70% to pass, you won't push yourself / learn as much as you would if you were being stratified"

 

[aalamruad]

Some people say "if you know you just need at 70% to pass, you won't push yourself / learn as much as you would if you were being stratified"

Average step scores at top-tier unranked P/F schools would beg to differ

Edit: of course there's a self-selection bias at those schools, but my point is that there's really no problem at those schools with students learning the material thoroughly enough

 

[WedgeDawg]

I always prefer true P/F. In my personal experience, after going through a full year and a half of unranked P/F, I think it is the best system. Not having your grade count for anything beyond passing took off a lot of stress from preclinical medical school and allowed me to also focus my energies on other things that I wanted to do concurrently. We had an extremely (extremely) collaborative environment (though that's not to say you can't have one at a school with a different grading system either).

For each test, we are given the median, the standard deviation, the score we needed to hit to pass, and are allowed to review the test at a later point to see what we got wrong (optional). But after the test was done, everything was thrown out, we weren't ranked, and our transcript / the dean only knows whether we got a P or F.

It also wasn't like passing was easy. You really had to know your stuff in order to pass. You'd have to be very good at test taking to half ass your way through. And our medians were all generally relatively high even though we were P/F, so it's not like (most) people were slacking off.

For us, AOA (and class rank which hasn't really been emphasized for us beyond AOA) is based on our clinical grades + subjective criteria - there is no pre-clinical component.

When I was a pre-med, I didn't really know much about how med school was graded and I didn't really care that much. The schools I was accepted to were all unranked P/F, so it didn't need to factor into my decision. However, I did interview at one school that was ranked P/F which I only found out about once I went to interview there, and had I gotten in, I don't think I would have gone there even though it was a highly ranked school (that wasn't the only reason - there were other reasons I didn't want to end up there).

This isn't a decision you should solely base your school choice on, but I think it should be a contributing factor and definitely should not just be totally ignored.

 

[xffan624]

That would be perfect. What's really the difference between that and actual class grades then? This seems to be mostly mental.

When the grades are put on your transcript they are still just pass/fail. The information they are describing is for informational purposes so you can decide where your strengths and weaknesses are. If you are close to failing or below the class average on a certain subject, that's important information especially when it comes to how hard you need to study for future exams or for what you need to focus on more for step 1 studying. It's about self directed improvement, not a rat race for honors. It is much more realistic of how you will be learning for the rest of your career. You will have assess yourself honestly and direct your own learning towards passing a high stakes standardized exam (step 1, 2, 3, boards, etc.).

 

[nejikon]

I thought unranked p/f was a myth lol seems like no matter what, you will get compared and that these systems are just for your peace of mind.

 

[787593]

Whatever the grading system, I'm still beyond blessed to have the privilege of studying medicine.

 

[mcloaf]

Whatever the grading system, I'm still beyond blessed to have the privilege of studying medicine.

Blink twice if there's an adcom standing behind you.

 

[787593]

Blink twice if there's an adcom standing behind you.

10/10

 

[ChEMD]

Just be aware, in schools that have unranked p/f preclinical years, you're entire class rank will be determined by clinical grading. And for those who haven't gone through it yet, clinical grading can be extremely subjective. It can leave some of the best students with lower grades just because they were unlucky enough to get an attending or group of residents that don't believe in giving high scores. It can lead to students who do the bare minimum receiving honors because they were lucky enough to get that attending that always gives honors. So while the better students will probably get more honors grades than passes, I personally would be very skeptical about having my entire class standing be determined by a system that is so subjective and flawed.

With all of that being said, p/f systems are definitely less stressful and allow you to enjoy your preclinical years a bit more. And it is the way most schools are trending towards. Just don't say you haven't been warned. You may end up looking back as you're getting ready to apply for residency and wish that your standing amongst your peers was at least partially determined by an objective system (pre-clinical grades) and not solely by the luck of the draw and the handful of people that evaluated you over one year.


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[787593]

Just be aware, in schools that have unranked p/f preclinical years, you're entire class rank will be determined by clinical grading. And for those who haven't gone through it yet, clinical grading can be extremely subjective. It can leave some of the best students with lower grades just because they were unlucky enough to get an attending or group of residents that don't believe in giving high scores. It can lead to students who do the bare minimum receiving honors because they were lucky enough to get that attending that always gives honors. So while the better students will probably get more honors grades than passes, I personally would be very skeptical about having my entire class standing be determined by a system that is so subjective and flawed.

With all of that being said, p/f systems are definitely less stressful and allow you to enjoy your preclinical years a bit more. And it is the way most schools are trending towards. Just don't say you haven't been warned. You may end up looking back as you're getting ready to apply for residency and wish that your standing amongst your peers was at least partially determined by an objective system (pre-clinical grades) and not solely by the luck of the draw and the handful of people that evaluated you over one year.


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This is a really interesting point. Thanks!

 

[mcloaf]

Just be aware, in schools that have unranked p/f preclinical years, you're entire class rank will be determined by clinical grading. And for those who haven't gone through it yet, clinical grading can be extremely subjective. It can leave some of the best students with lower grades just because they were unlucky enough to get an attending or group of residents that don't believe in giving high scores. It can lead to students who do the bare minimum receiving honors because they were lucky enough to get that attending that always gives honors. So while the better students will probably get more honors grades than passes, I personally would be very skeptical about having my entire class standing be determined by a system that is so subjective and flawed.

With all of that being said, p/f systems are definitely less stressful and allow you to enjoy your preclinical years a bit more. And it is the way most schools are trending towards. Just don't say you haven't been warned. You may end up looking back as you're getting ready to apply for residency and wish that your standing amongst your peers was at least partially determined by an objective system (pre-clinical grades) and not solely by the luck of the draw and the handful of people that evaluated you over one year.


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Personally, I think this trade off is well worth it. You still have objective evidence of your standing in the form of step scores.

 

[787593]

Personally, I think this trade off is well worth it. You still have objective evidence of your standing in the form of step scores.

Hmm true

 

[FlowRate]

Slightly different answer:

All medical schools give residency committees an idea of where their student would be ranked, even if they claim they don't. I've read enough applications from Harvard and Stanford to know which students were really at the top. It's more of a qualitative thing at those schools, though (how many superlatives in how many different competencies?). Harvard actually gives HD/H/P/F or whatever in clinicals, so that's obviously ranked anyway.

I think my ideal system would be everything P/F. Your evals will usually spell out how you did, even if you don't have a grade.

The more explicit the ranking system, the higher the stress, generally. BUT if you're at a low ranked institution, you want to be able to show that you were superior to your cohort. If you're at a high ranked institution, the average and below-average students want it to be difficult for people to discern where you were exactly within the cohort. That is, unless you're confident you'll be the best of the best. In which case ranks don't matter to you, you're #1 anyway.

 

[Lawpy]

Just be aware, in schools that have unranked p/f preclinical years, you're entire class rank will be determined by clinical grading. And for those who haven't gone through it yet, clinical grading can be extremely subjective. It can leave some of the best students with lower grades just because they were unlucky enough to get an attending or group of residents that don't believe in giving high scores. It can lead to students who do the bare minimum receiving honors because they were lucky enough to get that attending that always gives honors. So while the better students will probably get more honors grades than passes, I personally would be very skeptical about having my entire class standing be determined by a system that is so subjective and flawed.

With all of that being said, p/f systems are definitely less stressful and allow you to enjoy your preclinical years a bit more. And it is the way most schools are trending towards. Just don't say you haven't been warned. You may end up looking back as you're getting ready to apply for residency and wish that your standing amongst your peers was at least partially determined by an objective system (pre-clinical grades) and not solely by the luck of the draw and the handful of people that evaluated you over one year.


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Slightly different answer:

All medical schools give residency committees an idea of where their student would be ranked, even if they claim they don't. I've read enough applications from Harvard and Stanford to know which students were really at the top. It's more of a qualitative thing at those schools, though (how many superlatives in how many different competencies?). Harvard actually gives HD/H/P/F or whatever in clinicals, so that's obviously ranked anyway.

I think my ideal system would be everything P/F. Your evals will usually spell out how you did, even if you don't have a grade.

The more explicit the ranking system, the higher the stress, generally. BUT if you're at a low ranked institution, you want to be able to show that you were superior to your cohort. If you're at a high ranked institution, the average and below-average students want it to be difficult for people to discern where you were exactly within the cohort. That is, unless you're confident you'll be the best of the best. In which case ranks don't matter to you, you're #1 anyway.

Confused. Why does ranking among peers matter for residency program directors? Aren't good Steps 1 and 2 scores, good letters/evals, good research and perhaps some solid networking more than sufficient?

 

[----x----]

The school I plan to attend does H/P/F.
Anyone with >90% gets H. Otherwise normal P/F. Like I said unranked, so literally the whole class could get honors if they all got >90%.

I guess the reasoning is to have something to work for, but still not be stressed out as there is no ranking.
I don't mind this, as getting honors doesn't matter too much in pre-clinicals anyway.

clinical grading is rotation dependent.

 

[FlowRate]

Confused. Why does ranking among peers matter for residency program directors? Aren't good Steps 1 and 2 scores, good letters/evals, good research and perhaps some solid networking more than sufficient?

I can't speak for PD's, as I'm not one, but I think it's just another data point along with all of those other things.

It is an easy way to get a handle on what the grades on a transcript mean, without having to sort through the histograms.

 

[Hello Again]

Some schools that are Honors/High P/P/LP/F put "full satisfactory performance" for pass and above. I know one school that does this and also is unranked for pre-clinical years. Talking to current pre-clinical students there, it seems like the "grades" above pass are just for students to shoot for.

 

[WhittyPsyche]

So of my acceptances so far. I have an acceptance with full scholarship to a school that has letter grades (A/B/C/D) and two that are P/F.

All the schools that I'm waiting for are also P/F.

What would you guys do? Would the money be worth the academic stress?


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[xffan624]

So of my acceptances so far. I have an acceptance with full scholarship to a school that has letter grades (A/B/C/D) and two that are P/F.

All the schools that I'm waiting for are also P/F.

What would you guys do? Would the money be worth the academic stress?


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It's not even close. Full scholarship hands down. P/f is preferable but students survive having grades every year. Just keep in perspective that residencies care very little about your preclinical grades and do your best without stressing too much about the result.

 

[ChEMD]

Confused. Why does ranking among peers matter for residency program directors? Aren't good Steps 1 and 2 scores, good letters/evals, good research and perhaps some solid networking more than sufficient?

You're right, having all of those things you listed will get you into residency, but I guarantee you there will be applicants that have all of those things and are also in the top quartile and AOA. So it really just matters what your goals are. If you're shooting for a competitive specialty or a highly sought after program in any specialty, you're going to want to try and be in the top half, if not top quartile, of your class. And for me personally, having experienced how subjective and and random third year grades can be, I would just think twice before saying that unranked p/f for the only purely objective part of medical school is unanimously better than having a grading system.

With all of that being said, p/f is definitely less stressful. But going to a school with a grading system that uses percentage cutoffs isn't the worst thing in the world, and it could actually help you if you're able to perform well. Now if a school uses a bell curve system, that's a different story, and I would absolutely avoid that. But the idea that having grades automatically makes the environment less collegial and more competitive isn't necessarily true.


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[WhittyPsyche]

What is the tuition, if you weren't scholarshipped?

With the master's it's around 200k.


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[WhittyPsyche]

How did you like the school/location compared to the other schools? Besides the grades, do you think you will be happy there? Any cons that particularly stuck out to you?

It's "home" 20 mins from where I've lived since HS and where all my family are. Love everything about the school and the MD/MPH curriculum and opportunities. I really don't have any cons besides the letter grades. Everything else is a good fit.


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[ScottTenorman54]

Now if a school uses a bell curve system, that's a different story, and I would absolutely avoid that.

Does any med school actually do this? Just reading that makes me feel a little sick.

 

[Whyamionhere]

Does any med school actually do this? Just reading that makes me feel a little sick.

Yes....the Albany tour guide said they do this. I almost left the damn tour right then and there.