Jill Allenbaugh, Lewis Katz School of Medicine at Temple University Katie Cronin, Lewis Katz School of Medicine at Temple University Judith Litivin, Lewis Katz School of Medicine at Temple University Karen Lin, Lewis Katz School of Medicine at Temple University Denise Salerno, Lewis Katz School of Medicine at Temple University
PURPOSE: Studies have demonstrated that implementing pass/fail (P/F)
grading in preclinical curricula improves medical students’ well-being and
learning experience. However, with the transition of USMLE Step 1 to P/F
scoring, students report increased pressure to distinguish themselves through
research, extracurriculars, or gap years. These evolving stressors have
sparked discussion about reinstating tiered preclinical grading to provide
differentiation among applicants. This study examines medical student
attitudes, preferences, and behaviors regarding P/F versus tiered preclinical
grading in the context of the Step 1 scoring change.
METHODS: An anonymous electronic survey was emailed to all medical students
at the Lewis Katz School of Medicine asking student perspectives on P/F, or
Tiered grading in multiple domains.
RESULTS: A total of 359/930 (38.6%) students responded to the survey. When
comparing pass/fail grading to tiered grading, 327, (91.1%) felt it reduces
academic stress, while 317, (88.3%) felt it encourages collaboration over
competition and 233, (64.9%) noted less study time is needed to be satisfied
with their course performance. Motivation to study was split, with 159
(44.3%) reporting tiered grading encouraged more motivation, while 25.1%
chose pass/fail and 25.1% felt both encouraged motivation equally. Finally,
261, (72.7%) noted that pass/fail grading offered both the opportunity and
the need for research and extracurricular activities in addition to their
coursework. Overall, 305/359 (85%) of students preferred pass/fail grading to
tiered grading 40/359 (11.1%).
CONCLUSIONS: Students expressed a strong preference for P/F preclinical
grading, citing meaningful benefits to wellbeing and the learning
environment. Most respondents reported that P/F grading reduced academic
stress, and required less overall study time. However, the data also
highlight a clear trade-off: students felt that tiered grading provided
stronger motivation to study and prompted students to seek alternative ways
to distinguish themselves, with most indicating increased need to engage in
research and extracurricular activities.