Focus
Student Scene
October 30, 2000
Students Evaluate Pass–Fail
By Sean Amos
"Pass." A few weeks after their first final at HMS, students saw this unfamiliar word on their exams. To many students the change from the traditional grading scale to pass–fail seems foreign, almost awkward. For some this change begins a new way of learning. As students have adjusted to seeing a "pass" on their exams, many have shifted their educational goal from grades to knowledge and understanding. Student responses to this system range from excitement and relief to wishes for the traditional A, B, C, D, and F. But for most students the pass–fail system is unbeatable.
From elementary school through college, grades symbolize mastery of the material. For students, grades can be a ticket to continue study in their field of choice and at their school of choice. But grades also have the unfortunate consequence of creating competition among students (remember the stories of the sabotaged "O-Chem" experiments?) and encouraging learning material simply to do well on exams. The use of grades as an evaluation tool is equally complicated, if not more so, during medical school.
Roots of the System
The issue of using traditional grades versus pass–fail in medical education has been hotly debated for more than 30 years. Serious challenges to the traditional approach began to take form in the late 1960s and early 1970s when widespread objection to letter grades by students was reinforced with influential research on the topic. This research showed no significant correlation between grades in medical school and performance as a physician. In 1968 HMS replaced traditional grades with a pass–fail system, primarily to reduce stress and academic competition among students. Faculty members believed this change would also allow students the flexibility to pursue a more self-directed learning style.The existence of grades in medical school creates challenging questions: is learning medicine to get the best grade healthy and productive? When medicine is becoming increasingly interdisciplinary isn't the need for cooperation among future colleagues greater than the need to compete for grades? At what point in the medical student's path should the primary motivation for learning shift from getting the best grades to a desire to learn so that the best patient care can be given?
The answers to these questions suggest reasons why pass–fail is so popular with students at HMS. Medical students generally enjoy learning and want an academic structure that will allow them to become exceedingly competent physicians. But students feel that their education should not come at the expense of having to compete with classmates. Second-year student Scott Bermudez explains, "[The pass–fail grading system] has not only enabled me to develop the self-discipline and intellectual curiosity essential for success as a life-long learner, but has also allowed me to avoid the drudgery and unnecessary stress inherent in more competitive, traditional grading systems."
Students are also in favor of pass–fail because it gives them time to become broader both intellectually and emotionally. The pass–fail system allows the flexibility to pursue particular subjects of interest in greater depth, as well as extracurricular activities such as community service projects and research. Students also believe that pass–fail fosters emotional development. Another second-year student says having a pass–fail system "...helps to cultivate the humane and compassionate side of our future doctors."
A Is for Against
But the use of a pass–fail system in medical schools remains controversial. Unfortunately, there is a shortage of literature that clearly distinguishes students at schools that employ the pass–fail system from those that employ traditional letter grades. Those who support the traditional grading system contend that differentiation of medical students is needed, and the pass–fail system does not suffice to separate the good from the best. Opponents of the pass–fail system also believe that students at pass–fail schools are put at a disadvantage when applying to competitive residency programs.HMS itself wavered on its 1968 commitment to pass–fail grading. In 1973, amid pressure from faculty who denounced the pass–fail system after HMS slipped from first to third in rankings on Step 1 of the National Board Examination, Harvard's preclinical pass–fail policy was changed back to the letter-grading system. It was not until 1991 that the pass–fail system that exists today was re-implemented.
There is also no consensus among students that pass–fail is right for everyone. A second-year student explained, "For certain people, their motivation stems from their desire to stand out above their peers. In that situation, being graded would spur them on to new levels of performance and excellence." But these students who thrive on learning in an academically competitive environment seem to be the exception more than the rule.
For many, having a pass–fail system is a highly important characteristic of studying at HMS. Bermudez adds, "I consider the pass–fail grading system to be one of the greatest strengths of a Harvard medical education."
Sean Amos is a second-year student at HMS.