To the Editor:
We appreciate the excellent commentaries by Durning et al1 and Krupat and Dienstag2 of our recent report3 on the impact of a change to pass/fail grading in the first two years at our medical school.
We would like to offer some additional insights about pass/fail grading at our school. Durning et al were disappointed that we found no improvement in students' performance with a change to pass/fail grading. However, the prevailing belief of the faculty at the time of the change was the strong fear that the new grading system would lead to poorer student performance, an outcome not demonstrated by the data. That outcome has greatly strengthened faculty support of pass/fail grading, and there is currently no faculty interest in returning to the previous five-interval grading system.
Regarding our report, Krupat and Dienstag noted that “much to the relief of those of us who have a nongraded preclinical curriculum … the change had no demonstrable deleterious effect on several different measures of learning and effort.” However, they wondered if the change in grading was accompanied by any other changes in the curriculum or teaching that would have confounded these results. Fortunately, the curriculum and teaching methods remained the same for the two classes involved in our study, ruling out the curriculum and teaching methods as confounding factors. Krupat and Dienstag also noted that pass/fail grading has the potential to limit the faculty's opportunity to identify and help students who are in the marginal range just above passing. This is not the case: Before, during, and after the study, we have had the same procedures in place to identify the lowest 10% of students in terms of performance on formative course exams, to counsel those students, and to provide tutoring and other interventions. We believe these procedures are compatible with pass/fail grading.
The commentaries by During et al and Krupat and Dienstag provide valuable insights about student self-regulation and the complex role of assessment in medical education. We appreciate being a small part of this important dialogue.
Jerry G. Short, PhD
Associate dean, University of Virginia School of Medicine, Charlottesville, Virginia.
Robert A. Bloodgood, PhD
Professor of cell biology, University of Virginia School of Medicine, Charlottesville, Virginia; ([email protected]).
References
1 Durning SJ, Artino AR, Holmboe E. Commentary: On regulation and medical education: Sociology, learning and accountability. Acad Med. 2009;84:545–547.
2 Krupat E, Dienstag JL. Commentary: Assessment is an educational tool. Acad Med. 2009;84:548–550.
3 Bloodgood RA, Short JG, Jackson JM, Martindale JR. A change to pass/fail grading in the first two years at one medical school results in improved psychological well-being. Acad Med. 2009;84:655–662.
