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Background To assess the impact of a change in preclerkship grading system from Honors/Pass/Fail (H/P/F) to Pass/Fail (P/F) on University of California, San Diego (UCSD) medical students’ academic performance. Methods Academic performance of students in the classes of 2011 and 2012 ( constant-grading classes ) were collected and compared with performance of students in the class of 2013 ( grading-change class ) because the grading policy at UCSD SOM was changed for the class of 2013, from H/P/F during the first year (MS1) to P/F during the second year (MS2). For all students, data consisted of test scores from required preclinical courses from MS1 and MS2 years, and USMLE Step 1 scores. Linear regression analysis controlled for other factors that could be predictive of student performance (i.e., MCAT scores, undergraduate GPA, age, gender, etc.) in order to isolate the effect of the changed grading policy on academic performance. The change in grading policy in the MS2 year only, without any corresponding changes to the medical curriculum, presents a unique natural experiment with which to cleanly evaluate the effect of P/F grading on performance outcomes. Results After controlling for other factors, the grading policy change to P/F grading in the MS2 year had a negative impact on second-year grades relative to first-year grades (the constant-grading classes performed 1.65% points lower during their MS2 year compared to the MS1 year versus 3.25% points lower for the grading-change class, p  < 0.0001), but had no observable impact on USMLE Step 1 scores. Conclusions A change in grading from H/P/F grading to P/F grading was associated with decreased performance on preclinical examinations but no decrease in performance on the USMLE Step 1 examination. These results are discussed in the broader context of the multitude of factors that should be considered in assessing the merits of various grading systems, and ultimately the authors recommend the continuation of pass-fail grading at UCSD School of Medicine.

Traditionally, medical schools have tended to make assumptions that students will “automatically” engage in self-education effectively after graduation and subsequent training in residency and fellowships. In reality, the majority of medical graduates out in practice feel unprepared for learning on their own. Many medical schools are now adopting strategies and pedagogies to help students become self-regulating learners. Along with these changes in practices and pedagogy, many schools are eliminating a cornerstone of extrinsic motivation: discriminating grades. To study the effects of the switch from discriminating to pass–fail grading in the second year of medical school, we compared internal and external assessments and evaluations for a second-year class with a discriminating grading scale (Honors, High Pass, Pass, Fail) and for a second-year class with a pass–fail grading scale. Of the measures we compared (MCATs, GPAs, means on second-year examinations, USMLE Step 1 scores, residency placement, in which there were no statistically significant changes), the only statistically significant decreases (lower performance with pass fail) were found in two of the second-year courses. Performance in one other course also improved significantly. Pass–fail grading can meet several important intended outcomes, including “leveling the playing field” for incoming students with different academic backgrounds, reducing competition and fostering collaboration among members of a class, more time for extracurricular interests and personal activities. Pass–fail grading also reduces competition and supports collaboration, and fosters intrinsic motivation, which is key to self-regulated, lifelong learning.

Globally, the number of COVID-19 cases continues to rise daily despite strict measures being adopted by many countries. Consequently, universities closed down to minimise the face-to-face contacts, and the majority of the universities are now conducting degree programmes through online delivery. Remote online delivery and assessment are novel experiences for many universities, which presents many challenges, particularly when safeguarding academic integrity. For example, invigilated assessments, often considered as more secure, are not an option given the current situation and detecting any cheating would be significantly challenging. This paper reviews assessment security in the digital domain and critically evaluates the practices from different universities in safeguarding academic integrity, including associated challenges.

Content assessment has broadly improved in e-learning scenarios in recent decades. However, the e-Learning process can give rise to a spatial and temporal gap that poses interesting challenges for assessment of not only content, but also students’ acquisition of core skills such as self-regulated learning. Our objective was to discover students’ self-regulated learning processes during an e-Learning course by using Process Mining Techniques. We applied a new algorithm in the educational domain called Inductive Miner over the interaction traces from 101 university students in a course given over one semester on the Moodle 2.0 platform. Data was extracted from the platform’s event logs with 21,629 traces in order to discover students’ self-regulation models that contribute to improving the instructional process. The Inductive Miner algorithm discovered optimal models in terms of fitness for both Pass and Fail students in this dataset, as well as models at a certain level of granularity that can be interpreted in educational terms, which are the most important achievement in model discovery. We can conclude that although students who passed did not follow the instructors’ suggestions exactly, they did follow the logic of a successful self-regulated learning process as opposed to their failing classmates. The Process Mining models also allow us to examine which specific actions the students performed, and it was particularly interesting to see a high presence of actions related to forum-supported collaborative learning in the Pass group and an absence of those in the Fail group.

Background: Traditional grading including points accumulation, averaging performance over the course, and grading behaviors may be inequitable since they may benefit more privileged students. Bias-resistant, equity-based grading that emphasizes learning is recommended. Method: Faculty at different universities in undergraduate and graduate nursing courses designed and implemented two types of alternative grading projects. Faculty and student feedback on these grading practices were reviewed. Specifications grading provides opportunities to demonstrate achievement of learning outcomes allowing learners to select the grade and assignments and revise unsatisfactory work. Labor-based grading is particularly suitable for writing assignments that involve iterative processes, as it provides a fair grading structure accommodating students at various skill levels and evaluates student progress in developing writing skills. Results: In the exemplars provided, learners achieved course outcomes. Learners and faculty were satisfied with the experience. Conclusion: Specifications and labor-based grading demonstrate potential to assess learners' achievement of learning outcomes more equitably.

Objective. To understand how US schools and colleges of pharmacy use pass/fail grading systems in Doctor of Pharmacy degree programs. Methods. An electronic survey with 15 selected response items and six open-ended questions was developed to gather qualitative and quantitative data. The convenience survey was distributed in 2020 to the 10 academic pharmacy programs known to use a pass/fail grading system for the majority of their courses. Results. Leaders from eight of the 10 programs identified responded to the survey. Programs varied regarding the types of courses for which they used a pass/fail grading system and whether they shared numerical scores with their students. A variety of grade designations (honors, pass, no pass, fail, satisfactory, etc) were used, and the minimum pass level varied by program, ranging from 70% to 90%. For those institutions that used post-course remediation, the majority of remediation occurred immediately following the academic term or in the summer. The type of information shared with residency program directors (eg, GPA, class rank, overall percentile, qualitative comments) varied between programs. Conclusion. How pass/fail grading systems were used was inconsistent across the cohort. Programs that use a criterion-based grading system might benefit from engaging in conversations with other schools that do the same to determine whether and how consistency in terminology, passing level, percentages, grade point averages, and progression might be achieved. Additional insights on postgraduate training requirements and honorary societies are warranted should the use of pass/fail grading expand as it has in medical education. Further research on this topic is needed.

Objective While medical student wellness has been a subject of recent study and discussion, current efforts may fail to address possible underlying, harmful cognitive distortions regarding academic performance. The authors sought to examine dysfunctional thoughts (maladaptive perfectionism, impostor phenomenon) and negative feelings (shame, embarrassment, inadequacy) that may contribute to poor mental health in pre-clinical medical students. Methods A survey was administered to first-year medical students at Saint Louis University that included assessments for maladaptive perfectionism, impostor phenomenon, depression, and anxiety, as well as questions about feelings of shame, embarrassment, inadequacy, comparison, and self-worth. Results A total of 169 students (93%) participated. Students who met criteria for maladaptive perfectionism were significantly more likely to report greater feelings of shame/embarrassment and inadequacy ( P  < 0.001) than their peers who did not; similar associations were observed in students who reported high/intense levels of impostor phenomenon ( P  < 0.001). Furthermore, students who reported feelings of shame/embarrassment or inadequacy were significantly more likely to report moderate/severe levels of depression symptoms ( P  < 0.001) and moderate/high levels of anxiety symptoms ( P  = 0.001) relative to students who did not report these negative feelings. Conclusions These preliminary data support a model for how negative thoughts may lead to negative emotions, and depression and anxiety in medical students. The authors propose strategies for preventive interventions in medical school beginning in orientation. Further research is needed to develop targeted interventions to promote student mental health through reduction of cognitive distortions and negative feelings of shame, embarrassment, and inadequacy.

Following the recent change to pass-fail scoring in the United States Medical Licensing Examination Step 1 exam, medical students pursuing careers in surgery must focus on alternative areas to distinguish themselves. In particular, preparation and success in surgical clerkships have both become critical. However, the optimal pre-clinical preparation to enhance medical students' surgical skills prior to active clinical involvement currently remains unclear. We tested the hypothesis that a student-driven, mixed-modality surgical skills program would increase surgical skills, promoting readiness for clerkships and interest in surgery. This study assessed the efficacy of a student-led interest group which organized weekly in-person morning longitudinal skills sessions and in-person quarterly long-form evening skills workshops for pre-clinical students in their first and second years of schooling. Fifty-five participants were prospectively recruited and engaged in these skills events over an 18-month period. Students were surveyed anonymously using Likert scale qualitative instruments to assess the effectiveness of skills training, interest in surgery, and clerkship readiness. Confidence in hand skills increased significantly (suturing: p = 0.0046; knot-tying: p < 0.001) after engaging in the interest group, with responders reporting that skills acquisition motivated attendance. All students reported improved clerkship readiness and either \"slightly\" or \"greatly\" increased interest in Surgery. Furthermore, 90.4% of participants considered the sessions \"very important\". This student-led, mixed-modality curriculum improved skill confidence, anticipated clerkship readiness, and career interest in surgery. The model may guide other student groups preparing trainees for surgical careers.

Background Despite widespread efforts to create wellness programming in medical schools, there is a paucity of literature examining students’ perception of wellness and perceptions of these programs. With the inaugural class at the Arizona campus of Mayo Clinic Alix School of Medicine (MCASOM-AZ), an opportunity arose to establish an empirically evaluated wellness curriculum that most inclusively and effectively enables medical students to flourish for years to come. The initial wellness offerings included mental health, academic success, and disability services, curriculum-embedded seminars, wellness committee driven programming, and student-proposed wellness activities. We aimed to improve the relevance and impact of medical school wellness curricula by soliciting in-depth and longitudinal perspectives of medical students themselves. As MCASOM-AZ opened in 2017, the student body at the time of study consisted of first- and second-year medical students. Methods Employing a mixed methods analysis of qualitative and longitudinal quantitative data, first- and second-year students at a MCASOM-AZ were invited to respond to an anonymous, online year-long survey (baseline, six months and 12 months) during the 2018–2019 academic year and participate in a structured, in-depth and in-person, peer-to-peer interview about their conceptions of wellness and the MCASOM-AZ wellness curriculum and resources. Qualitative data was coded for themes using thematic analysis strategies by independent raters. Results Nearly half of eligible students completed the baseline survey,1/3 completed all 3 time-points, and 1/5 participated in an in-depth interview. Participant age, gender, and year of school were representative of the larger student body. Although individual conceptions varied, Wellness was consistently highly valued. Family, Academic Performance, and Friends emerged as most important to well-being across time-points. Academic work arose as the largest barrier to wellness. Analysis of qualitative data revealed five themes. Despite individual differences in approaches to wellness, wellbeing was interrelated to the learning environment; mandatory wellness efforts that didn’t address the medical culture met with skepticism. Conclusions Interview responses provided understanding and context by which to interpret questionnaire responses. Academics was critical to students’ identity and wellness, while also the largest barrier. Suggested curricular improvements include restructuring academic work, seamlessly integrating wellness within coursework, and offering optional individualized approaches.

Purpose The United States Medical Licensing Examination (USMLE) Step 1 exam changed from a 3-digit score format to pass/fail in 2022. The current study aimed to examine how medical students perceive this change, factors associated with those perceptions, and determine their preferred exam scoring format. Design and Methods A cross-sectional survey of US medical students was distributed from March through June 2024. The survey gathered data including demographic and school information, desired specialty, research involvement, and Step 1 scoring preference. Results The survey was completed by 192 students from 18 different US allopathic schools. Of students surveyed, 65.5% preferred pass/fail scoring, while 34.5% preferred a 3-digit-score format. Older age increased likelihood of preferring a 3-digit score (β = 0.345, P = .047, odds ratio [OR] 1.41). A later graduation year decreased the likelihood of preferring a 3-digit score (β = −0.576, P = .020, OR 0.56). Gender (β = 0.293, P = .320, OR 1.34), specialty competitiveness (β = −0.095, P = .776, OR 1.10), and research productivity (β = 0.0047, P = .990, OR 1.00) had no significant effect on Step 1 scoring preference. Conclusion Medical students seem to prefer a pass/fail Step 1 regardless of gender, desired specialty and research productivity. However, pass/fail preference differed by graduating class year and age, with younger class years and students preferring pass/fail. While prior literature largely surveyed preference among medical educators, student sentiment on Step 1 scoring supports recent changes to the USMLE Step score format.