Pass/Fail Medical School Grading Improves Students' Psychological Well-Being, U.Va. Study Finds

May 21, 2009 — University of Virginia School of Medicine researchers have shown that taking some of the stress and competition out of medical school helps students maintain better mental health without sacrificing academic performance.

Researchers at U.Va. followed two classes of medical students in their first two years of coursework. The first class was graded on a five-interval scale (A, B, C, D, F) and the second class was graded on a two-interval scale (pass/fail).

Published in the May 2009 edition of Academic Medicine, the results of the study showed no reduction in performance in courses, national certification examinations, class attendance or the quality of residency placement.

"Medical students are, for the most part, extremely self-motivated. They have a drive to succeed, and that's partly how they get into medical school," said Robert Bloodgood, professor of cell biology and leader of the study. "However, they also experience a great deal of stress and anxiety that comes with medical school. Part of that stress, we felt, was due to the traditional grading methodology."

Bloodgood said medical students in a graded curriculum have more incentive to compete with their classmates and are "driven" to achieve honors. With medicine being practiced in more of a team approach, he said, the feeling was that eliminating grades would better facilitate team learning and an increase in support among students, since they would not be competing against each other.

"With no statistically significant variations between the two classes, we were able to show that the students under a pass/fail system brought just as much intensity to their studies, but without the associated stress," Bloodgood said.

The one time period in which stress levels of both classes were the same was the fourth semester of medical education. This is the time when medical students are preparing for Step I of the United States Medical Licensing Exam, a very high stakes national exam that is part of the overall medical licensing process. This exam is the first of three national exams used to measure students' grasp of basic sciences and clinical education.

"We were not able to counter the stress of the impending USMLE exam, with the pass/fail grading system," Bloodgood said with a smile.

Participating in the study with Bloodgood were Jerry Short, associate dean for medical education support; John Jackson, director of educational technology; and James Martindale, assistant professor of medical education and an expert at statistical analysis.

The full study is available in the May issue of the journal Academic Medicine.