Valid argument against pass/fail grading?

[CyberMaxx]

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I was recently interviewing at a school which has a very 'up-to-date' curriculum (systems based with a lot of PBL) but has chosen to maintain a traditional grading scheme rather than any form of pass/fail. During the Q and A time the dean was asked about this and he admitted that the school had gone back and forth on this issue quite a bit. Ultimately they believed that it was better to have traditional pre-clinical grades for two reasons:

1. They would have to internally rank students anyway for AOA consideration

2. More importantly, because otherwise the only other real academic metric on residency applications would be Step I. While Step I will be very important regardless, he argued that having traditional grades gave students who achieved a less impressive Step I score a chance to show that they were strong academically.

Do you guys (especially those who prefer pass/fail) think that his reasoning provides a valid argument against pass/fail grading?

 

[Barcu]

Not sure how much it would help, but good pre-clinical grades could only help (and every little bit can be important for residency).

My opinion is that pass/fail grading is not a good metric to decide between two schools (unless they are equal in every respect- location, cost, curriculum, clinical curriculum). Pre-clinical grades are very low on the list of factors that residency programs look at. If you do well on Step 1, the fact that you got all passes isn't going to be a huge deal. If you only do average, I think strong pre-clinical grades could only help you.

That's the real point: pre-clinical grades can help you more than hurt you. If you are going into something very competitive, getting all pre-clinical honors helps, especially if you go to a lower ranked school. Students from the top schools (who tend to have true P/F grading) don't need the extra boost like someone who goes to a mid-tier school would. It's low on the list, but it is something PDs look at.

 

[PingPongPro]

I love going to a school that is truly pass/fail.

Preclinical grades are not very important for residencies, and I think the little value they may provide is outweighed by the competitiveness between students and stress it brings.

 

[LizzyM]

To me, it sounds like one of two things is going on:
the administration is setting up a mechanism by which inflated grades in the pre-clinical years may improve the prospects of its students in matching to residency programs
and/or
grading in the pre-clinical years can be used to demonstrate mastery of material by students who do not do well in high stakes exams (SAT, MCAT, Step I) but who are otherwise competent.

So, you have the med school equivalent of a 4.0/27.... what does that tell you about an applicant compared to one withn from the same school/same major with a 3.9/39 or a 3.3/34 or a 3.1/27? Now imagine you had only the MCAT scores 27, 39, 34, 27? Do you feel that decisions makers would like to have gpa in addition to MCAT? It may be working the same way for residency directors. On the other hand, competition for grades could create a toxic environment in medical school. But if there is quite a bit of grade inflation, then you have the competition for grades (until the students catch on that everyone gets an A or A-) with none of the ability to distinguish among students because everyone has a gpa of 3.9-4.0 regardless.

I can see why this is a frequent topic for discussion at a school where grading hasn't been abolished... but where some faculty think that it should be.

 

[NickNaylor]

Almost every anecdote and medical education study will show you that pre-clinical grades, in the big scheme of things, are near irrelevant when it comes to both interviewing and ranking for the match.

At the end of the day you should go to the school you think you will do best at, not the school you think will get you into the best residency possible. Things like this seem important to you now because they're within your control, however I assure you that once you start medical school you'll quickly realize how irrelevant they become in the context of the big picture.

 

[alpinism]

Almost every anecdote and medical education study will show you that pre-clinical grades, in the big scheme of things, are near irrelevant when it comes to both interviewing and ranking for the match.

At the end of the day you should go to the school you think you will do best at, not the school you think will get you into the best residency possible. Things like this seem important to you now because they're within your control, however I assure you that once you start medical school you'll quickly realize how irrelevant they become in the context of the big picture.

This. The reality is that the vast majority of PDs in most specialties don't care about preclinical grades (as long as you pass) thus it won't help or hurt either way (despite what some people like to think). Any faculty member who says otherwise is either misinformed or has another real reason to want grades (motivates students to study harder yada yada - also not true)

Saying that having strong grades will allow some students to make up for sub par step 1 scores is flat out wrong. Many residency programs use step 1 scores as cutoffs for granting interviews, thus you could have a straight 4.0, but if your step 1 is below the cutoff you wont get an interview.

In addition, preclinical grades are not the only academic metric on your application. You still have M3 grades and M4 audition rotation grades/evaluations.

 

[mcloaf]

I was recently interviewing at a school which has a very 'up-to-date' curriculum (systems based with a lot of PBL) but has chosen to maintain a traditional grading scheme rather than any form of pass/fail. During the Q and A time the dean was asked about this and he admitted that the school had gone back and forth on this issue quite a bit. Ultimately they believed that it was better to have traditional pre-clinical grades for two reasons:

1. They would have to internally rank students anyway for AOA consideration

2. More importantly, because otherwise the only other real academic metric on residency applications would be Step I. While Step I will be very important regardless, he argued that having traditional grades gave students who achieved a less impressive Step I score a chance to show that they were strong academically.

Do you guys (especially those who prefer pass/fail) think that his reasoning provides a valid argument against pass/fail grading?

I think that's BS, for pretty much all the reasons alpinism listed.

1. You can still do AOA without ranking in the preclinical years. We do it based on Step 1 and clinical grades.

2. If you have a low Step, nobody is going to care at all that you had good preclinical grades. The preclinical years are only a means to score well on the exam. If you blow that, nobody is impressed that you honored histology.

 

[histidine]

Regarding competitiveness, the schools that I've seen that have traditional graded preclinicals have all been uncurved. The whole class can get As if they all worked for it. In this system, there is still incentive to collaborate with your fellow peers.

Alternatively, there have been a couple schools that are P/F, internally ranked, and curved. I don't see how that helps collaboration, as you are literally competing against your classmates to get that top internal grade and avoid the bottom 5% (failing threshold).

 

[armybound]

Regarding competitiveness, the schools that I've seen that have traditional graded preclinicals have all been uncurved. The whole class can get As if they all worked for it. In this system, there is still incentive to collaborate with your fellow peers.

Alternatively, there have been a couple schools that are P/F, internally ranked, and curved. I don't see how that helps collaboration, as you are literally competing against your classmates to get that top internal grade and avoid the bottom 5% (failing threshold).

this is how my school was, and I really liked it.

I personally don't see the point of P/F, but if people like it, by all means go for it.

 

[Espadaleader]

I interviewed at both kind of schools. The people at strict pass/fail (no internal ranking) schools were the most fun. They didn't worry about passing because they felt it was pretty safe they would pass so they put their time into other things like research, service etc. The traditional schools were to busy trying to get honors etc.

The schools at the forefront of medical education understand that students are adults and responsible enough to make decisions. I want to be in a system that treats me in that fashion.

 

[SN12357]

Regarding competitiveness, the schools that I've seen that have traditional graded preclinicals have all been uncurved. The whole class can get As if they all worked for it. In this system, there is still incentive to collaborate with your fellow peers.

Alternatively, there have been a couple schools that are P/F, internally ranked, and curved. I don't see how that helps collaboration, as you are literally competing against your classmates to get that top internal grade and avoid the bottom 5% (failing threshold).

Do you mind posting or PMing the schools that were P/F but curved? I didn't even think to ask that; I assumed that at all P/F schools there was just a straight cutoff...

I doubt I'm going to choose a school based off its grading scheme. But I do think that forced curves (only a certain proportion of the class can get a certain grade) is ridiculous in any context. A good evaluation system should allow for the possibility that everyone is great OR that everyone is terrible.

 

[pietachok]

1. They would have to internally rank students anyway for AOA consideration

You can still assign AOA without traditional grading. Schools can track exam performance internally even though they assign you P/F. So, to me, this argument doesn't hold water.

2. More importantly, because otherwise the only other real academic metric on residency applications would be Step I. While Step I will be very important regardless, he argued that having traditional grades gave students who achieved a less impressive Step I score a chance to show that they were strong academically.

Metric for whom? Residencies? Many have strict, published cutoffs for Step 1 score -- nothing is going to make them budge on that. Beyond that, everything I've seen and heard leads me to believe that Step 2 score, clinical grades and evaluations, and LORs are going to be more important than your performance in didactic years.

As a student, I don't see any merit to having traditional grading as opposed to P/F during didactic years, and I believe it would have created a lot more unnecessary testing anxiety and generally hurt students' attitude towards peers and academics. Also, keep in mind that nobody signs up to be the bottom student in the class -- you're in a class full of highly intelligent, motivated people, and yet one of them is going to have the lowest rank, and 1/4 will be plagued by being in the bottom quartile. As much as this has the ability to show you can do better than your Step 1 score, it can also *not* show that more so than P/F grades.

 

[QuantumJ]

Any thoughts on p/f for 3rd and 4th year? One of my top choices has this and it seems like it would be great in that there's no subjective grading during the clinical years.

 

[Goucher2013]

1. They would have to internally rank students anyway for AOA consideration

I heard the same thing from a med school dean, and it was perhaps the thing that turned me off that school. As alpinism and mcloaf already said, there are clinical grades and Step 1 scores to go off of. It seemed downright weird for the dean to ignore that. He also insisted that every school secretly ranks students during pre-clinical years, which seemed rather insulting towards other schools.

Moral of the story: a good friend of mine ended up at that school. He's a fantastic learner, 4.0 student, 36 MCAT, but has repeatedly sent me messages about how he no longer has a life and didn't expect things to be so hard, despite there being a very collaborative student body and no curve. Meanwhile, people at my school are taking 3-day and 4-day weekends but still rock the Step exams and get fantastic matches.

A graded environment still works best for a subgroup of students, but there's a reason P/F is taking over.

 

[sinombre]

Any thoughts on p/f for 3rd and 4th year? One of my top choices has this and it seems like it would be great in that there's no subjective grading during the clinical years.

P/F for clinical years? Clinical grades actually do matter quite a bit... most schools make it possible to honor clerkships for a reason (because it matters to PDs). Maybe someone who goes to a school with P/F grading for 3rd and 4th year can chime in, but I don't think there are very many schools that do this.

 

[NickNaylor]

Any thoughts on p/f for 3rd and 4th year? One of my top choices has this and it seems like it would be great in that there's no subjective grading during the clinical years.

In contrast to pre-clinical grades, MS3 grades ARE typically thought of as important. I have no idea how residencies view a true P/F MS3 year because such a thing is pretty uncommon, but the argument I see is that schools do need to have some assessment of your clinical acumen, which is purportedly difficult without grades. Whether or not that actually is legitimate enough to make a difference, who knows.

 

[pietachok]

Any thoughts on p/f for 3rd and 4th year? One of my top choices has this and it seems like it would be great in that there's no subjective grading during the clinical years.

They literally only have P/F as grades during clinical years? Most P/F clinical years are actually some combo of honors, high pass, pass, low pass, fail. I probably wouldn't pick a school based on this, but I suspect there is some benefit to having something other than a binary grading system in clinical rotations. However, when you apply to residencies, there is a packet that your school sends with your transcript that clarifies how to interpret your grades (what proportion of students earn each of those grades in which rotations, etc.). Hopefully this keeps students from being penalized for the grading system -- if the match list looks ok, I wouldn't worry about it.

 

[QuantumJ]

Yes it is honors high pass pass marginal pass and fail the first 2 and p/f the last two. This is actually my #1 for a variety of reasons but i was simply wondering what (if any) pros or cons this system had. I was surprised myself because it was the first ive ever seen. I did ask about shelfs and they do take them so perhaps there is some internal ranking going on.

 

[mehc012]

Personally, when I'm in a P/F course, my performance falls to match the lowered expectations. I do not really want a pass/fail system because I would be less likely to push myself to really learn as much as I could. Now, maybe that doesn't matter in the long run, but I see no particular utility in P/F for me personally.
However, very few grade systems irritate me as much as the F/P/HP/H system. If you're going to grade, just DO it. Don't try and shade it in by re-naming all of the letters.

 

[pietachok]

Yes it is honors high pass pass marginal pass and fail the first 2 and p/f the last two. This is actually my #1 for a variety of reasons but i was simply wondering what (if any) pros or cons this system had. I was surprised myself because it was the first ive ever seen. I did ask about shelfs and they do take them so perhaps there is some internal ranking going on.

Personally, I would not want H/HP/P/LP/F in the first 2 years, because it is the same as being graded -- it's just different designations for A, B, C, D, and for reasons given above, I don't think that is optimal. That's more bothersome to me than the P/F in clinical years. In those last 2 years, you have evaluations and LORs to really detail your performance, and although there is some benefit perhaps to having a greater range of grades in clinical years, I think most people can tell you that the grading can be disturbingly arbitrary on rotations -- one person gets honors doing nothing while another person works his/her butt off and gets pass, because of different expectations among attendings -- so all schools probably *should* be P/F for 3rd and 4th years, but they aren't. As I mentioned above, your school will send out an explanation of grades with your residency application, so I wouldn't worry too much about this school's clinical grading system as long as the match list is acceptable to you. I would be more concerned with the grading system in the first 2 years.

 

[mcloaf]

Personally, when I'm in a P/F course, my performance falls to match the lowered expectations. I do not really want a pass/fail system because I would be less likely to push myself to really learn as much as I could. Now, maybe that doesn't matter in the long run, but I see no particular utility in P/F for me personally.
However, very few grade systems irritate me as much as the F/P/HP/H system. If you're going to grade, just DO it. Don't try and shade it in by re-naming all of the letters.

P/F in undergrad isn't the same as medical school. Studying to pass isn't coasting anymore.

 

[notbobtrustme]

The fact that the school is graded shouldn't be a turnoff. It's a PBL school, which is a huge red flag IMO. PBL is spending 3 hours for a 1 hour subject and then patting yourself on the back.

Graded vs Pass/Fail is basically meaningless because residencies don't care either way. So passing at a graded school vs passing at a pass/fail school is identical. The only difference is psychological and if you can get over that hurdle, then you'll be fine.

Things that are much more important are clinical sites, mandatory attendance for lectures, protected time for Step 1, etc etc.

 

[mehc012]

P/F in undergrad isn't the same as medical school. Studying to pass isn't coasting anymore.

I understand that, but what I'm saying is that gradewise I tend to aim for the lowest necessary for my goals. I try to avoid it, but it's one of my biggest flaws as a student. If my goal is an 'A', then when I $%^ up I end up with a B. If my goal is 'P' then if the $#!7 hits the fan, I end up with an 'F'.
I'm working on improving on this aspect in general, and I think I'll be fine either way, but...I just feel more comfortable and happy with grades to challenge myself with.