Pass–fail grading: laying the foundation for self-regulated learning

Abstract

Traditionally, medical schools have tended to make assumptions that students will "automatically" engage in self-education effectively after graduation and subsequent training in residency and fellowships. In reality, the majority of medical graduates out in practice feel unprepared for learning on their own. Many medical schools are now adopting strategies and pedagogies to help students become self-regulating learners. Along with these changes in practices and pedagogy, many schools are eliminating a cornerstone of extrinsic motivation: discriminating grades. To study the effects of the switch from discriminating to pass-fail grading in the second year of medical school, we compared internal and external assessments and evaluations for a second-year class with a discriminating grading scale (Honors, High Pass, Pass, Fail) and for a second-year class with a pass-fail grading scale. Of the measures we compared (MCATs, GPAs, means on second-year examinations, USMLE Step 1 scores, residency placement, in which there were no statistically significant changes), the only statistically significant decreases (lower performance with pass fail) were found in two of the second-year courses. Performance in one other course also improved significantly. Pass-fail grading can meet several important intended outcomes, including "leveling the playing field" for incoming students with different academic backgrounds, reducing competition and fostering collaboration among members of a class, more time for extracurricular interests and personal activities. Pass-fail grading also reduces competition and supports collaboration, and fosters intrinsic motivation, which is key to self-regulated, lifelong learning.

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

“…It allows them to pursue areas that are of most interest and relevance to them, rather than focusing only information that will be tested [4]. In turn, this intrinsic motivation lays a foundation for the self-direction and self-regulation required in nursing and all health care disciplines [4].…”

“…Rather than decreasing motivation, discretionary grading can increase students' desire to perform well academically [4]. Relationships between grades and short term learning, as well as between grades and extrinsic motivation, or motivation emanating externally from others beyond oneself, have been established [30].…”

“…The first approach, where students are assigned pass/fail or satisfactory/ unsatisfactory, evaluates overall understanding and competence [1] [2] [3]. The second approach, discretionary grading, where students are assigned letters such as F− to A+ or numerical values between 0% and 100% integrates more discriminative information [4]. Lee Cronbach's seminal definition of learning emphasizes that learning is demonstrated when a change in behavior occurs as a result of experience [5].…”

The Effects of Formative and Summative Assessment on Student's Connectedness, Satisfaction, Learning and Academic Performance within an Online Healthcare Course

“…As the landscape of healthcare in the United States transforms, there is an opportunity to evaluate the effectiveness of assessment practices utilized in traditional educational systems. In order to better prepare healthcare graduates a paradigm shift is needed, which necessitates an examination of assessment methods, perhaps focused around one's' collaborative ability as a student; which ultimately fosters an effective clinician in a multidisciplinary setting (White & Fantone, 2010).…”

“…An example of providing an opportunity to demonstrate this new knowledge is encouraging the resubmission of past assignments, this then completes a cyclical pattern of effective formative assessment and self-regulated learning methodologies (Nicol & Macfarlane-Dick, 2006). Self-regulated learning is the primary way that healthcare practitioners will stay current with an ever changing medical profession, consequently building these skills as a student is important for future professional growth (White & Fantone, 2010).…”