June 20, 2003

School of Medicine introducing pass/fail system

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From left, Christo Venkov, David Plieth, Carol Xu, Dr. Eric Neilson, and Tsutomo Inoue. (photo by Dana Johnson)

School of Medicine introducing pass/fail system

Beginning July 1 Vanderbilt University School of Medicine will replace its current traditional letter grading system with a pass/fail system — a move the administration hopes will eliminate student pressure and promote content learning.

Students will be evaluated on both the acquisition of knowledge and skills as well as professional development and values.

Vanderbilt will join several other elite medical schools, including Johns Hopkins, Washington University and Stanford University in changing over to a pass/fail system.

“We’re not inventing the wheel. We’re not even re-inventing the wheel,” said Dr. Bonnie M. Miller, associate dean for Medical Students and one of several members of a committee that investigated the new grading system. The committee included students and Dr. Steven G. Gabbe, dean of VUSM.

“When we looked into our grading system, Vanderbilt was one of the only private top-tier schools still using letter grades,” Miller said. “This served as an incentive to reconsider our grading policies. We find a lot of our first-year students, in particular, struggle as they adjust to medical school, a new city, a new school and new friends. In courses like biochemistry and anatomy, many of our students have to learn a whole new language and vocabulary. We have students with diverse backgrounds, with undergraduate majors in areas ranging from Japanese to molecular biology, so the first year is not exactly a level playing field. This is a way of leveling the playing field.”

The School of Medicine has established a series of learning objectives for its educational program that will be clustered into seven categories: knowledge, skills in assessing information, skills for the diagnosis and management of patient problems, clinical reasoning skills, skills in communication and interpersonal relations, professional development, and professional values.

“Our students are some of the best in the country,” Miller said. “They have been intensely competitive for a long time. We just feel it’s in their best interest to get away from the external reward system of working for grades. We want them to work for learning and learn for the love of learning, the love of medicine, and for the sake of the patients they’ll be serving.”

The system will work like this: final grades for all in the first year will be Pass (P), Pass* (P*) or Fail (F).

A P will be given if the student’s performance is completely satisfactory in all aspects of course work. A P* will be given to students whose work is marginal. A student with two or more P* grades will receive a special review by the Promotion Committee which may recommend the student undertake remedial activities. The P* grade may be applicable for academic credit in an individual course only after the approval by the student’s Promotion Committee and endorsement by the Executive Faculty. If the student does not receive the endorsement, the P* will be lowered to an F. An F grade is given for unsatisfactory work. A student with one or more F grades will receive a special review by the Promotion Committee and must be required to undertake remedial activities or be subject to dismissal.

Final grades for all courses in the second year will be Honors (H), Pass (P), Pass* (P*) or Fail (F).

An H grade will be given to students for superior performance in all aspects of the course. A student must meet standards in all categories of professional values to be given an H grade. Ordinarily, honors grades will be given to no more than 25 percent of the class.

Third- and fourth-year students will receive Honors (H), High Pass (HP), Pass (P), Pass* (P*), or Fail (F). Honors will be given to students for superior or outstanding achievement in all of the categories, to no more than 25 percent of the class. A high pass grade will be given to students demonstrating better than average but not superior achievement in a category. The honors categories will be used to determine induction into AOA, the medical student honor society, and to select the Founder’s medalist (first honors) for the graduating class. The Founder’s medalist will be chosen by vote of the course directors from a small group of candidates selected on the basis of their grades.

Equally important as grades at VUSM will be professional development and professional values, and although professionalism has always been emphasized at VUSM, the school is more formally incorporating it into the evaluation of pre-clinical courses.

“The issue of professionalism in medical education has always been part of the goals of our medical school program, but there’s been a lot of attention placed on professionalism at the national level in recent years,” said Dr. Gerald S. Gotterer, senior associate dean for Faculty Affairs. “The six competencies of the Accreditation Council on Graduate Medical Education (ACGME) include the area of professionalism. Other medical schools are focusing on the professional development of the student and the resident physician beyond the knowledge and skills that have typically been the focus of the program.

“We’ve incorporated issues relating to professionalism into the evaluation scheme for a variety of reasons, but mainly to emphasize to students that we as a faculty feel that development of their professionalism is as important as other aspects of their professional education in medical school.”

Miller said that professional skills should be developed and improved during medical school. Students should “come to the table” with many of the professional values.

Professional values include honesty, trustworthiness/accountability, relationship with patients and families, and relationships with faculty, staff and peers. Students will be given the grades of: Meets Standards (MS), Some Concern (SC), Major Concern (MC) or Not Observed (NO).

“A major concern would be cheating on a test,” Gotterer said. “A grayer area would be not being able to work in a group. We would hope that the new system would identify early a student who is consistently unable to work with their peers in a group.”

Miller and Gotterer said the change in grading systems has been met with varied enthusiasm by the student body. “Some students prefer grades,” Gotterer said. “Grades motivate them. Some students are looking forward to the pass/fail system.”

The administration is “cautiously optimistic,” Miller said. “We will evaluate this new system over the next four to five years to see whether it has been successful. We’ll look at residency placements. If we see a big drop, we’ll worry. The bottom line is we want our students to be well-motivated, lifelong learners, learning for the love of knowledge. We hope this will be a positive change, but if we evaluate it and find we’ve hurt our students in any way, we won’t keep the pass/fail system.”

Gotterer believes the pass/fail grading system is an advance. “Its success will depend on how readily the students can shift their attitudes about learning from the undergraduate experience where grades are most important and the sole measure of their success, to where there’s an internal measure of their success.”