Frequently Asked Question - PF Grading System

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Frequently Asked Question - PF Grading System

Pass-Fail Grading System for
School of Medicine Years 1 and 2

Frequently Asked Questions (FAQ)

  1. Do many medical schools use pass/fail grading in the first two years?

    Yes. In the latest data from the AAMC, 23 of the top 25 ranked medical schools reported on their grading system in the first year. Of these 23 highly rated medical schools, 11 use P/F (48%), 6 H/P/F (26%), 2 use H/HP/P/F (9%) and 4 use A/B/C/D/F (17%). The vast majority of these schools used the same grading system for both the 1st and 2nd years.

  2. What will be the impact on admissions (class composition) of a change to pass-fail grading in the first two years?

    One might predict that the composition of the applicant pool and/or the entering class could be affected by the knowledge that UVa had ungraded 1st and 2nd years of the curriculum. Students who like the idea of pass-fail grading would be more likely to apply to and to accept an offer of admission from UVa. Students who preferred letter grades might be less apt to apply to and to accept an offer of admission from UVa.
    Beth Bailey, Director of Medical Admissions at UVa School of Medicine has compiled the feedback from applicants who were offered admission to UVa School of Medicine during the last two years but declined and subsequently indicated that our grading system was a factor in that decision.

    Entering Class of 2001
    I preferred the lack of grades at Harvard.
    I was somewhat hesitant about the A, B, C grading scale.
    I'm a fan of P/F grading.
    I believe a pass/fail system is preferable to a graded one.

    Entering Class of 2000

    I want a school with a less traditional curriculum and no grades.
    I wanted more problem-based learning, P/F system.
    I prefer a block approach and pass/fail grading
    I want more self-directed learning and less pressure from a "grades" system.
    The biggest minus, in my opinion, was the letter grading system (no pass/fail option)
    I really like the curriculum at U. Penn, which integrates more problem based approaches and takes advantage of the Internet; also, pass/fail grades more appealing.
    A-F grading system seems to generate more stress and competition compared with pass/fail programs.
    [UVA has] letter grade system. I am looking for something a little more progressive.
    I prefer pass/fail system.
    I prefer case-based learning and P/F.
    UVA is more traditional than I prefer (lots of lectures and letter grades).
    I was more interested in a pass/fail grading system.
    I would prefer pass/fail vs. competitive grading.
    The A-F grading system is a major drawback.
    I was very disappointed with the fact that UVA has letter grades still. I think that makes it a lot more stressful. Case Western has P/F grading.
    Grading policy not the best for non-competitive environment, vs. pass/fail or honors/pass/fail.

    These comments suggest that UVa School of Medicine lost some applicants that we wanted to other schools (Harvard, U Penn and Case Western Reserve were mentioned) based, at least in part, on our grading system. Beth Bailey, Director of Medical Admissions, estimates that, in 2000, approximately 13% of students who turned down our offer of admission (and also filled out the survey sent to them) declined the offer, at least in part, due to grading issues. The comparable figure for 2001 is about 5%. The total response rate to the surveys was 65% in 2000 and 52% in 2001.

  3. What would be the impact on the performance of medical students in first two years?

    Robins et al. (1995) studied the effect of a switch to pass/fail grading (in the first year only) at the University of Michigan Medical School in 1992-93. They compared the 1st year performance of the last class (1991-92) under the old grading system (honors, high pass, pass and fail) with the first class (1992-93) under the new pass/fail grading system. While they did not provide much of the data within the paper, the authors implied that student academic performance across the entire first year was not changed and claimed "there was no evidence that the students learned only enough to pass in a pass/fail environment." Only one course, Gross Anatomy, provided exact comparison data, as this was the only course that remained entirely unchanged under their new curriculum. The student performance of the pass/fail class in Gross Anatomy (85.0, SD 6.50) was at least as good as that of the previous class which was graded on the honors, high pass, pass and fail system (83.2, SD 7.92). In both classes, students who entered their final examinations with high pre-final scores also did well on their finals (using Pearson's correlations and a Fisher Z-test). The authors conclude that "this suggests that the students in the pass/fail system did not "slack off" when they were assured a passing score but continued to work towards greater mastery of material."

    Hall and Taft (1976) studied the effect of pass/fail versus A-F grading on student performance in a dental school setting. This study involved 66 junior dental school students taking a fixed prosthodontics junior clerkship. Virtually no other course competed for study time. Students were assigned to the graded or pass/fail sections of this course by alphabetical order. There was no statistically significant difference in the GPAs for the graded versus pass/fail groups. The grade results showed no significant difference between the two groups in achievement on three separate examinations.

  4. How will medical students receive feedback on their academic performance if all preclinical courses are graded on a pass/fail basis?

    The entire spectrum of course exams and quizzes and small group assessments will continue under the proposed pass/fail grading system. Students will continue to be provided with their numerical scores on exams and quizzes. We propose that they also be provided with a graph of the distribution of scores for the entire class or small group so that they can assess their performance relative to their peers.

  5. What would be the impact on the level of participation in lectures, labs and small group activities?

    This is not easy to predict. There is some evidence that students currently "vote with their feet" and fail to attend certain scheduled curricular activities when they perceive them not being quality experiences or of sufficient value to them or if they feel the need to study for an upcoming exam. One might predict that students would be less apt to skip classes in order to study for upcoming exams under a pass/fail grading system. One might predict that a pass-fail system in the 1st and 2nd years of the curriculum would put the onus on course directors and course faculty to provide a quality product that justifies the student's attendance. It is possible that having a pass/fail grading system could provide faculty with an opportunity to take risks in terms of innovative experiments in the curriculum. It could also be said that a pass/fail system could free 1st and 2nd year medical students to exercise some risk-taking behavior in terms of tailoring their own academic experience in the first two years of medical school based on their background and interests. For instance, students might well shift some of their time in the first two year to optional clinical activities; this might benefit some students in the long run.

  6. What would be the impact on performance on Part I of the USMLE?

    While we would predict little change in the performance of our medical classes on Part I of the USMLE as a result of changing to pass/fail grading in the 1st and 2nd years, we will not know for sure until the experiment is done. Obviously, if a significant decrease in performance on Part I of the USMLE were documented for the first class under the new pass/fail grading system, we would seriously consider terminating the experiment at that time. There is not a great deal in the literature about the correlation of 1st and 2nd year grading methods with performance on USMLE Part I. However, Hughes et al. (1983) did show the same average USMLE Part I scores for the three groups of residency applicants that they studied: a) those from A, B, C, D, F schools, b) those from high pass, pass, fail schools and c) those from pass/fail schools.

  7. What would be the impact on student participation in ungraded clinical activities during the first two years of medical school?

    One might predict that a pass/fail system in the first and second years would allow medical students to feel more comfortable in terms of participation in ungraded and volunteer clinical activities (such as shadowing a physician; following a patient through labor and delivery; volunteering at the Charlottesville Free Clinic) and hence that the amount of time devoted to these activities may increase.

  8. What other non-academic (psychosocial) impacts might be expected to result from a change to pass/fail grading?

    One of the reasons for performing a pass/fail grading experiment in the 1st two years of medical school is that we perceive that the 1st two years of medical school is a time of great change and a major transition in the lives of our students. Anecdotal and literature information suggest that stress, depression and competitiveness between students are all negative factors that can be experienced by medical students.

    Miller and Surtees (1991) studied first year medical students and found that half of them disclosed high levels of neurotic symptoms at the beginning of the academic year. Zoccolillo et al. (1986) reported that the incidence of major depression or probable major depression during the first two years of medical school was 12% (more than twice the general population). Parkerson et al. (1990) studied four classes of 1st year medical students at Duke University and found that although there was a worsening among all parameters of health and satisfaction during the course of the first year of medical school, the most marked change was in the increase in depressive symptoms. In a similar study of psychosocial changes during the first year of medical school, Wolf et al. (1991) found that "self-esteem, powerful other locus of control and uplifts" decreased while hassles increased during the year. Positive mood decreased (joy, contentment, vigor and affection) while negative mood increased (depression and hostility).... End-of-the-year first year students appear to be worse off psychosocially than when they entered." Lloyd and Gartrell (1984) studied psychiatric symptoms in medical students and found no significant difference in the level across the four years of medical school.

    Only one study was found that studied the relationship between depression and grades. Clark et al. (1988) concluded that "medical school grades [in the first two years] had no direct impact on depressed mood, and mood had no direct impact on grades."

    Wolf (1994) reviewed the literature on stress in medical school and concluded that the major stressor in the basic science years has to do with examinations. Robins et al. (1995) studied the switchover from a graded to a pass/fail system (in year one only) at the University of Michigan. When 1st year students were surveyed, the pass/fail students were significantly more satisfied with their evaluation and examination system than the graded students. Further, they were more satisfied with the learning environment than those in the former curriculum. In addition, the authors stated that: "The students' responses to the surveys included comments that pass/fail grading eased anxiety and reduced competition while encouraging the students' co-operation."

  9. What would be the impact on AOA selection of a pass fail grading system in the 1st two years?

    Pass/fail grading in the preclinical years may affect our AOA selection procedure. Under the current system, 6 students are selected for AOA after the 2nd year and approximately 18 more are selected after the 3rd year of medical school. 1st and 2nd year grades would no longer be available for AOA selection purposes at the end of the second year. Some medical schools delay all AOA selection until late in medical school in order to be able to factor in clinical performance in the 3rd year clerkships. This makes sense if one believes that clinical performance in clerkships is a better indicator of success as a resident than 1st and 2nd year grades. Clear data supporting this assumption can be found in Wagoner and Suriano (1999) who found that surveys of 1200 residency program directors in 14 specialties found that, of 12 resident selection criteria surveyed, clerkship grades was rated the most important and grades in pre-clinical courses the least important.

  10. What would be the impact on the Dean's letter?

    Dr. Richard Pearson, Associate Dean for Student Affairs and a member of the Grading Task Force, has stated that he does not utilize 1st and 2nd year course grade information in preparing the Dean's letter. However, it should be noted that, currently, a complete transcript is transmitted with the Dean's Letter and contains grades for years 1 to 3.

  11. What would be the impact on residency placement of ungraded 1st and 2nd years?

    1st and 2nd year performance should be reflected in USMLE Step I scores, which will still be available to residency programs. Schools such as Case Western Reserve, which has had a Pass/Fail grading system in the first two years of medical school for decades, perform very well in terms of residency placement. The literature speaks very clearly to the fact that preclinical grades are not given much weight in residency selection.

    Wagoner and Suriano (1999) surveyed 1,200 residency program directors in 14 specialties and asked them to rate the importance of each of 12 criteria in residency selection. Overall, "grades in preclinical courses" was rated as the least important criteria (while "grades in required clerkships" was rated as the most important of the 12 criteria). When the data for the 14 different types of residency programs were broken down, "grades in pre-clinical courses" was either the least important or the 2nd least important criterion (out of 12) for 13 out of the 14 types of residency programs.

    Crane and Ferraro (2000) studied selection criteria for 94 Emergency Medicine residency programs. Of 18 criteria listed on a survey of residency program directors, basic science grades was listed as the 3rd least important criterion while clinical grades was listed as the 3rd most important criterion for resident selection.

    Vosti and Jacobs (1999) studied the 1st year residency performance of two classes of graduates from Stanford University, who had gone all the way through medical school under a pass/fail grading system (both basic science and clinical courses). Residency directors were asked to quantify the 1st year residency clinical performance of each one of these Stanford graduates and to compare them to the clinical performance of their peer group. These authors found that the graduates of this one pass/fail medical school successfully matched with strong, highly sought after postgraduate training programs, performed in a satisfactory to superior manner and compared favorably with their peer group in the residency programs.

    Hughes et al. (1983) studied the impact of the medical school grading system on the selection of residents in internal medicine at Northwestern University. The applicants were divided into three groups based on medical school grading system: 11% came from P/F, 72% from pass/fail/honors, and 17% from letter grade systems. A number of variables were used to determine which correlated best with the average of the ratings assigned by the two faculty interviewers and the final rating of applicants by the residency program (decided by a seven member selection committee). The best predictors of the initial faculty ratings were NBME Part I, 3rd year medicine clerkship grade, academic honors and medical school reputation. The best predictors of the final residency program ranking of applicants were NBME Part I scores, academic honors, med school reputation and 3rd year medicine clerkship grade. The type of grading system as a factor did not make a significant contribution in either case. The study concluded, "the overall impact of the grading system as a factor in the selection of residents seems to be minimal."

    It is not surprising that medical school grades are poor predictors of residency performance and it may be appropriate that basic science grades are given little weight in residency selection given that abundant literature showing that little or no correlation exists between academic evaluation (grades) and career performance in the medical profession (Wingard and Williamson, 1973).


  • Clark, D.C., S.R. Daugherty, P.B. Zeldow, G.S. Gotterer and D. Hedeker (1988) The relationship between academic performance and severity of depressed mood during medical school. Comprehensive Psychiatry 29: 409-20.
  • Crane, J.T. and C.M. Ferraro (2000) Selection criteria for emergency medicine residency applicants. Academic Emergency Medicine 7:54-60.
  • Dupuy, H.J. (1984) The Psychological General Well-Being (PGWB) Index. IN: Assessment of quality of life in clinical trials of cardiovascular therapies (ed. N.K. Wenger, M.E. Mattson, C.D. Furberg and J. Elinson) New York: LeJacq, pp. 170-183.
  • Hall, D.L. and T.B. Taft (1976) Pass/fail versus A-F grading: a comparative study. J. Dental Education 40:301-303.
  • Hughes, Richard L. et al. (1983) The Grading System as a Factor in the Selection of Residents. Journal of Medical Education. 58:479?81.
  • Lloyd, C. and N.K. Gartrell (1984) Psychiatric symptoms in medical students. Comprehensive Psychiatry 25: 552-565.
  • Miller, P.McC. And P.G. Surtees (1991) Psychological symptoms and their course in first year medical students as assessed by the Interval General Health Questionnaire (I-GHQ). British Journal of Psychiatry 159:199-207.
  • Parkerson, G.R.,Jr., E.E. Broadhead and C.K. Tse (1990) The health status and life satisfaction of first-year medical students. Academic Medicine 65:586-88.
  • Robins, L.S., J.C. Fantone, M.S. Oh, G.L. Alexander, M. Shlafer and W.K. David (1995) The effect of pass/fail grading and weekly quizzes on first-year students' performances and satisfaction. Academic Medicine 70: 327-329.
  • Vosti, K.L. and C.D. Jacobs (1999) Outcome measurement in postgraduate year one of graduates from a medical school with a pass/fail grading system. Academic Medicine 74: 547-549.
  • Wagoner, N.E. and J. R. Suriano (1999) Program director's responses to a survey on variables used to select residents in a time of change. Academic Medicine 74: 51-58.
  • Wingard, J.R. and J.W. Williamson (1973) Grades as predictors of physicians' career performance: an evaluative literature review. J. Medical Education 48: 311-322.
  • Wolf, T.M., T.K. von Almen, J.M. Faucett, H.M. Randall and F.A. Franklin (1991) Psychosocial changes during the first year of medical school. Medical Education 25: 174-81.
  • Wolf, T.M. (1994) Stress, coping and health: enhancing well-being during medical school. Medical Education 28:8-17.
  • Zoccolillo, M., G.E. Murphy and R.D. Wetzel (1986) Depression among medical students. Journal of Affective Disorders 11:91-96.