To the Editor:
I believe that the beneficial effects of a change to pass/fail grading recently reported in Academic Medicine by Bloodgood and colleagues1 may well be generalizable to other medical schools. I base my view on the findings of a comprehensive study that I and others undertook in a New Zealand medical school that included all classes and used both a cross-sectional and a longitudinal design.2 Beneficial effects were found on students’ deep motives, deep strategies, and their intrinsic motivation for studying. As in Bloodgood and colleagues’ study, students’ performance on examinations and time spent in study did not change. But the New Zealand study showed that the proportion of discretionary study (i.e., study that students said they wanted to do rather than had to do) increased. Students identified themselves as feeling more like doctors after the change to standards-based (i.e., pass/fail) assessments.
The findings of both studies are consistent with self-determination theory,3 where individuals may regard their actions as either autonomous or controlled. Autonomous actions are associated with greater intrinsic motivation. For example, if a teacher does not agree that a student should pass an assessment, then the student can regard his or her behavior as being controlled by that teacher. In contrast, if a student is judged against a standard that is external to both teacher and student, this promotes autonomy and collegiality, even if the standard is higher. This may explain the beneficial effect on intrinsic motivation and why students took on a greater professional identity in the New Zealand study.
Clearly, both studies support the generalizability of changing to pass/fail grading, since they showed that such a change was associated with increased motivation and reinforced attributes that are expected in doctors after graduation.
Tim Wilkinson, MB, ChB, M Clin Ed, PhD, FRACP
Associate dean (medical education), University of Otago, Christchurch, New Zealand; ([email protected]).
References
1 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.
2 Wilkinson TJ, Wells JE, Bushnell JA. What is the educational impact of standards-based assessment in a medical degree? Med Educ. 2007;41:565–572.
3 Deci EL, Vallerand RJ, Pelletier LG, Ryan RM. Motivation and education: The self-determination perspective. Educ Psychol. 1991;26:325–346.
