I think one of them stated something in its discussion along the lines of students making a conscious choice (in the P/F) program to either aim to do really well and aim to just pass. And the students who aimed to do really well had similar findings as the graded system students. This comes back to what I was saying in my previous post -- no matter what system you're in, if you're a particular type of student (ex. high-achiever), you will do the same thing no matter where you go.
If you read it more carefully, you'll see that it was saying that UVA had "cumulative honors" for the top 20% at the end of two years (i.e. not true pass-fail). Some people aimed for cumulative honors and others did not. The ones who strove for cumulative honors reported that they were more stressed while the ones who did not consciously aim for cumulative honors said they were less stressed. This system was not recommended by the committee that recommended changing to pass-fail and was only added to appease some department chairs who wanted to recognize excellence. Under the reasoning that such a system adds unnecessarily to student stress, UVA dropped the cumulative honors system after two years and finally had a true pass-fail system. The point here is not whether you'll do the same things no matter what system you're in, but how stressed you feel and whether that benefits you.
Besides that, I won't address any of the shortcomings of the papers, including being single-institution, comparing different years' students, using surveys, etc.
There are limitations of any study - the question is whether they're enough for a reasonable reader to doubt the conclusions. Here is a multi-institution study: Reed, D. A. et al. Relationship of pass/fail grading and curriculum structure with well-being among preclinical medical students: a multi-institutional study. Acad Med 86, 13671373 (2011). Across seven medical schools and twelve campuses, they found that students under 3+-interval grading had greater stress, emotional exhaustion, depersonalization, burnout, and were more likely to consider dropping out compared to peers at pass/fail schools. Although it's somewhat hard to account for differences in entering student ability, the authors also concluded that "most medical schools in this study had similar mean USMLE Step 1 scores, although grading scales varied across campuses" so "transitioning to pass/fail grading during the
first two years of medical school is unlikely to adversely affect students academic achievement."
Comparing different years' students is fallacious if there is a time trend for a given outcome caused by outside factors. I'll grant that Step 1 scores tend to increase ever so slightly every year. It's not going to be that significant though in the absence of other curricular reforms. These studies were at schools that didn't reform significant parts of their curricular content, only the assessment policy, during the study.
There's nothing wrong with using surveys. Surveys are the best way to get at subjective psychological metrics like anxiety and burnout. The studies are complemented by objective data like course exam scores and step 1 scores that are not self-reported.
And I would argue that the approach to Step 1 is quite different from the approach to classes. You can do poorly in class and do well on Step 1 or you can do really well in class and still do well on Step 1. And vice versa. This, again, has very little to do with the school's curriculum or grading system. It comes down to the individual student and their study habits.
Exactly right. That's why schools that switched to pass-fail found no difference in step 1 scores. The difference is in student well-being. There might also be a difference in the learning environment (e.g. group cohesion or perceived goals).
This is stupid. Cramming isn't restricted to schools with a grading system or people who want to do well on an exam. Especially considering the number of excellent resources we have at our fingertips (ex. Pathoma, Gojan, etc), I would be willing to bet that most people in med school get the "big picture" just fine.
I never said that. I said the continuous emphasis on performance metrics makes cramming economically worthwhile, more so than a system in which task/competence mastery was the primary goal.
Haven't looked at the paper, so I'll refrain from commenting. Again, just to point out, there are multiple limitations of this study as well, especially using a survey to assess satisfaction.
I'm really curious how you would assess satisfaction other than asking people if they were satisfied.
Now I'm confused. Wasn't one of your arguments earlier that P/F schools value internal motivation while graded systems value external motivation (that whole internal vs. external thing you had on your list). Now, you're arguing that external motivation is good? How is using wanting to do well on Step 1 as an external motivation not the same as using wanting to do well on an upcoming exam as an external motivation?
Knowing that Step 1 is coming up is a kick in the rear for most students to stay on track, whether there are graded exams along the way or not. You say that someone who is "not self-regulated (I still don't understand what the heck that really means) will procrastinate because the rewards of studying now are far off and uncertain" -- um, isn't that describing P/F schools where the only thing that matters is Step 1, which comes at the end of two years, compared to graded systems with frequent exams? Who's more likely to procrastinate -- someone who doesn't have to really worry about anything for two years or someone who has graded exams coming up every month? I would argue it's the former.
I did say internal motivation was good. I wasn't saying that external motivation was good or bad. I was saying that the kind of external motivation that Step 1 provides is less strong in the sense of less immediate gratification. It kind of sits in the background for most of your preclinical education as a thing you know you should kind of be working towards. But doing well on step 1 is not going to motivate you to stay up to 2am studying before one anatomy exam instead of going to sleep at midnight. You simply don't know that it'll make a difference because step 1 is so far away in time you can't get much concrete feedback. In that sense, I consider step 1 a scaffolding kind of external motivation, one that points you in the right general direction for you to apply your internal motivation. In your words, it keeps you on track. It's like a bunch of railroad tracks that's only going slightly downhill (it'll become steeper the close you get to Step 1 time). You're the train. You still need fuel to get to your destination in time.
Yes I was describing P/F schools. You got it. My point was that the P/F system rewards people who can self-regulate their learning, while a graded system reduces those rewards by compensating with external regulation.
No. Just no.
Then you and I have different definitions of what true mastery means.
Ok.
Also, why the heck are you making things black and white? Why can you ONLY understand the concepts or ONLY memorize minutiae without knowing concepts? That's a very idiotic way to look at things.
I'm not. I never said that. You're pretty rude. I won't say you're idiotic. I think you don't understand much of what I'm saying though. Or you intentionally misrepresent what I say as a rhetorical strategy.
Thanks for the study/survey. I'll consider it more seriously when larger-scale studies come out confirming this. At the moment, there isn't convincing evidence that one system is "better" than the other.
I think that's a good attitude. We do need more evidence-based medical education. You should go into it.
No, it's just as silly as saying that graded schools promote competitive and maladaptive behavior.
Ok.
Thanks for reiterating that you don't think derm is an altruistic field
rolleyes
. At least, not as altruistic a field as whatever you're planning on going into.
You have no idea what motivates people to come to med school, let alone decide which field they want to pursue.
[/quote] Christ. Fine. You really like to stretch what I say, don't you. I'll go ahead and just say what you want me to say. I hypothesize that students who choose dermatology espouse less-altruistic beliefs regarding health care compared to those who choose a primary care specialty. See Jeffe et al. Primary Care Specialty Choices of United States Medical Graduates, 1997--2006. Academic Medicine. 2010;85(6):947-958.
Many of your assumptions about me are incorrect. I don't plan on going into a field I consider more altruistic than dermatology. I don't go to a true pass-fail school. I don't go to a school where there is a dichotomy between mastering material and doing well on tests. And our administration is great and takes these concerns and evidence seriously, unlike you do. I'm not denigrating anyone, but unfortunately you perceive it that way.