The current first-year medical school class at the University of Virginia is the initial class to be exposed to the pass/fail grading system: what has become the academic trend among the nation's premiere schools of medicine. In recent weeks, considerable attention has been given to the implementation of this system. Some of this interest has focused on concerns that educational expectations and the performance and preparation of medical students will be diminished by the lack of letter grades. While earlier opinions have been quick to forecast the rapid decline in medical education at Virginia, it is essential to understand the factors that have influenced the change in grading system.
To begin, it is critical to understand the difference between a change in curriculum and a change in assessment. Programs around the country in both secondary and undergraduate education who have adopted Outcome Based Education (OBE) have made significant changes in their curriculums (including in some cases the implementation of a pass/fail grading system) in an effort to equalize the educational experience of all students. In contrast, the recent changes made at the University of Virginia School of Medicine merely reflect a shift in the methods of assessing student performance; the curriculum has remained identical to that of previous classes. Medical students in the current first year class are expected to master the same quantity of information and take the same number of examinations as prior classes. Certainly, mastery of the basic sciences is important to the practice of medicine; the necessity of the knowledge gained during the first two years cannot be understated, as it will serve as a foundation from which students can begin effective treatment and care for patients.
However, when looking at the factors that make a competent physician, including entrance into a top residency program and ability to care for both the sick and healthy, actual grades during the first two years of medical school reside at the bottom of the hierarchy. To put it simply, they are not good indicators of who will become excellent physicians. Couple this with the fact that every medical student in every program across the nation is required to pass all four parts of the United States Medical Licensing Exam in order to practice medicine in this country, and it is clear that at this stage of our education, letter grades are no longer essential; stress and pressure are applied via the necessity to learn information and perform effectively in the treatment of others.
What the elimination of stringent grades does is reduce competition and foster an overall environment of cooperation. This rationale mirrors that of other top medical schools in the country like Harvard, Yale and Stanford who adopted a pass/fail system long before Virginia did. Students in the medical school are constantly assisting each other in performing to the highest of everyone's individual abilities. The importance behind this type of preparation cannot be emphasized enough. With the dynamic nature of medicine, working as a team is no longer an option; it is a requirement. Furthermore, eliminating the stress in academia has shown no correlation to diminished capacity as a practicing physician. Learning at this stage of the educational process has little to do with the hope of attaining a stellar grade and everything to do with acquiring the knowledge that will facilitate exemplary patient care.
Before jumping to any conclusions about the program, why not see how current medical students do in their first two years under the pass/fail system. The members of the first year medical school class were selected for admission to the University of Virginia based on a number of criteria including an ability to be self-motivated learners. The eradication of traditional letter grades has had no impact on how hard the students of the Class of 2007 work and how much they learn. As proof of this, results from the first round of exams revealed no significant difference between the first year class and the classes of the past two years. As expected, the new pass/fail system is working correctly.
(David Ryan is the president of the Medical School Class of 2007. Jeffrey Vergales is a first-year student in the Medical School)
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