Impact of pass/fail grading on medical students’ well-being and academic outcomes

Abstract

Medical Education 2011:45: 867–877 OBJECTIVES Many medical schools are currently undergoing curriculum reform. When considering the means by which students will be evaluated in a revised curriculum, the need to reduce the prevalences of depression and anxiety associated with academic stress must be weighed against the importance of academic outcomes. Pass/fail evaluation, as compared with tiered grading, is commonly presented as a means to adequately assess student performance while minimising stress and anxiety. The purpose of this literature review was to determine the impact of pass/fail grading on medical student well‐being and academic outcomes. METHODS A systematic search was performed of the available literature published between January 1980 and August 2010, using the PubMed, Ovid Medline, Ovid PsycINFO and ERIC databases. Eligible papers assessed the impact of pass/fail grading on medical student well‐being, academic outcomes or both. Academic outcomes included but were not limited to objective measures, such as performance on the US Medical Licensing Examination, and subjective measures, such as student desirability by residency programmes. Reference lists in identified papers were searched and all identified papers were run through a citation index. RESULTS Four papers met the inclusion criteria for both well‐being and academic outcomes. An additional five papers met the inclusion criteria for academic outcomes only. The four papers that focused on well‐being reported improvement in specified areas. No significant difference was identified in any of the five papers examining objective academic outcomes or in those papers that examined the quality of residency programmes attained. Results from two studies suggested that some programme directors believe pass/fail grading creates disadvantages for students in attaining a residency, whereas a third study yielded mixed results about its impact on residency attainment. CONCLUSIONS Student well‐being is enhanced and objective academic performance is not adversely affected by a pass/fail evaluation system, but students’ ability to obtain a desired residency programme may be hindered by individual programme directors’ preferences for tiered grading systems. There is an overall paucity of literature on this topic and additional study is needed.

Effect of Advanced Pharmacy Practice Experience Grading Scheme on Residency Match Rates

“…5 Evidence for an actual detrimental impact on postgraduate match rates has been demonstrated in other health disciplines but not in the pharmacy literature. 6,7 Given a lack of evidence in this regard, perceptions may influence decisions by schools of pharmacy regarding which grading scheme to use for APPE courses. The objective of this study was to examine if use of letter grading for APPEs is associated with higher residency match rates.…”

Pass/Fail and Discretionary Grading: A Snapshot of Their Influences on Learning

“…Students who have excelled and demonstrated remarkable achievements may not be recognized or differentiated from those who simply met the requirements to pass [19]. This approach may not depict an accurate picture of the specific learning objectives that were mastered and those that need improvement [28].…”

“…While healthy competition with peers and oneself may not be problematic, anxiety, depression and inability to absorb material can result when students become overly focused on their grades [1] [19]. Although both letter and numeric discretionary approaches provide a range of grading options, faculty tend to cluster their scores around a portion of the scale instead of utilizing the whole scale [32].…”

“…Pass/fail grading is believed to exert positive influences on learning by supporting students' psychological health and wellbeing [19] [20] [21]. For example, with medical students, this approach has been found to reduce student stress and promote group cohesion [22].…”

“…Additional negative influences can include the subtle suggestion that only the bare minimum is needed to pass; a possible decline in student classroom attendance; weakening of academic performance; and a potential decrease in pass rates for regulatory licensing examinations [19] [21] [23].…”