Medical Education Blog

Welcome. I’m Sheila Harding, the Associate Dean of Medical Education in the College of Medicine at the University of Saskatchewan. For the next few minutes, I’ll be speaking with you about the Pass/Fail grading system that was implemented in our undergraduate MD program with the Class of 2007. It has been phased in year-by-year with that class, which has just begun the clinical clerkship phase of the program. I’ll provide some of the historical reasons for the change, and describe some of the hypothetical advantages and concerns of the Pass/Fail grading system when compared and contrasted with the traditional system. I’ll tell you about our experiences and observations to date, and look to the future.

The literature addressing the dissatisfaction of teachers and students with traditional grading systems goes back decades. It was recognized as early as the 70’s that a medical student’s performance in traditional evaluation systems was unrelated to that student’s subsequent performance in internship, what we now call PGY-1, or the first postgraduate year of training. Thus, traditional grades have been given more weight than they should carry in making promotion and recruitment decisions. By the 90’s, many North American medical schools had switched to some version of Pass/Fail, either in the pre-clinical years alone, or throughout the MD curriculum, and this has become the norm in Canadian medical schools.

There are many hypothetical advantages in a Pass/Fail approach to the evaluation of medical students. To quote the literature, this approach seeks “to establish a partnership of trust between educators and students in a joint educational effort to foster excellence through the creation of mature and sophisticated physician learners.” It shifts students from competition to collegial cooperation. It provides flexibility for self-directed learning and the use of different learning styles. It emphasizes the attainment of durable learning directed toward good patient care, rather than the attainment of short-term learning directed toward good grades through the unhealthy practice of “academic bulemia”. It eases student’s anxiety.

Many express the concern that a Pass/Fail grading system will erode standards; that instead of working hard and striving for excellence, medical students will settle for mediocrity. Another concern is that the lack of finely tuned grades will prevent the appropriate recognition of academic excellence. Some worry that this will make the graduates of a Pass/Fail program less competitive in the pursuit of postgraduate positions. Happily, both the literature and our own experience demonstrate that students in a Pass/Fail program continue to work hard and to earn their core competencies at least as well as they did in a traditionally graded program, by any available measures. Programs have been creative in finding ways to recognize both academic excellence and excellence in other qualities that characterize exceptional physicians. Now that Pass/Fail systems have become the norm, there is no evidence that students in such a system are disadvantaged in the pursuit of postgraduate positions, except in individual programs where the local program personnel remain convinced of the importance of grades despite the evidence to the contrary.