Abstract
BackgroundTo assess the impact of a change in preclerkship grading system from Honors/Pass/Fail (H/P/F) to Pass/Fail (P/F) on University of California, San Diego (UCSD) medical students’ academic performance.MethodsAcademic performance of students in the classes of 2011 and 2012 (constant-grading classes) were collected and compared with performance of students in the class of 2013 (grading-change class) because the grading policy at UCSD SOM was changed for the class of 2013, from H/P/F during the first year (MS1) to P/F during the second year (MS2). For all students, data consisted of test scores from required preclinical courses from MS1 and MS2 years, and USMLE Step 1 scores. Linear regression analysis controlled for other factors that could be predictive of student performance (i.e., MCAT scores, undergraduate GPA, age, gender, etc.) in order to isolate the effect of the changed grading policy on academic performance. The change in grading policy in the MS2 year only, without any corresponding changes to the medical curriculum, presents a unique natural experiment with which to cleanly evaluate the effect of P/F grading on performance outcomes.ResultsAfter controlling for other factors, the grading policy change to P/F grading in the MS2 year had a negative impact on second-year grades relative to first-year grades (the constant-grading classes performed 1.65% points lower during their MS2 year compared to the MS1 year versus 3.25% points lower for the grading-change class, p < 0.0001), but had no observable impact on USMLE Step 1 scores.ConclusionsA change in grading from H/P/F grading to P/F grading was associated with decreased performance on preclinical examinations but no decrease in performance on the USMLE Step 1 examination. These results are discussed in the broader context of the multitude of factors that should be considered in assessing the merits of various grading systems, and ultimately the authors recommend the continuation of pass-fail grading at UCSD School of Medicine.
Highlights
To assess the impact of a change in preclerkship grading system from Honors/Pass/Fail (H/P/F) to Pass/Fail (P/F) on University of California, San Diego (UCSD) medical students’ academic performance
In order to further explore academic outcomes associated with tiered and pass/fail grading, this paper presents educational outcomes associated with the grading policy change implemented at the UCSD School of Medicine during the 2010–2011 school year
Description of the UCSD School of Medicine curriculum and grading This paper summarizes the results of a comparison of two groups of medical students at the University of California, San Diego School of Medicine: students with H/P/F grading regime and students with P/F grading
Summary
To assess the impact of a change in preclerkship grading system from Honors/Pass/Fail (H/P/F) to Pass/Fail (P/F) on University of California, San Diego (UCSD) medical students’ academic performance. The researchers grouped the students into 10 groups based upon their numeric grades (i.e., a 1–100 continuous scale) in the first year of medical school They found a statistically significant association between performance in the first year of medical school and year 2 GPA, year 3 clinical examination grades, ratings of clinical competence in core clerkships, and medical school class rank [2]. The authors identified significant differences between the 10 groups in terms of performance on all three steps of the USMLE, and even on ratings of post-graduate clinical competence Based on their results, Gonnella et al argue that tiered grading systems are an important means of identifying students for whom additional instruction may be helpful, and that important information is lost when educators move from using an honors/pass/fail approach to a pass/fail approach
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