As a teacher at a podiatry school and also a program director at a residency, I’m acutely aware of the two sides of a very challenging coin. On one side are the students. Medical school is very stressful, and any way to decrease the anxiety and allow students to focus on actually learning – such as changing grading to pass/fail – may be an improvement. On the other side of that coin, I run a residency and am looking for the best way to evaluate applicant quality and their likelihood to be successful residents at my program. Often grades, for a variety of reasons, do not help with that picture. For example, a high grade at one school might not translate to the same grade at another college. The two sides of this coin make for a highly unsatisfactory podiatric student environment, one that has an opportunity for improvement.

The question we're going to look at here is “Does a pass/fail grading system in medical school improve students’ well-being and academic outcomes in comparison with a tiered grading method?”

I hadn’t previously researched this topic, and I’m going to attempt to reduce the risk of confirmation bias (finding evidence that supports an already-held belief) by being as prospective in my research as possible. To that end, I’ve provided below a running list of the studies I found during my research. For each study I listed the methods, results, and conclusions. By no means is this a systematic review (that’s beyond the capabilities of this editorial format) so feel free to take my analysis with a grain of salt. For those of you desiring the detail behind the rest of this discussion see the references list below. For the rest of you, let’s move on to discuss the themes pulled from these studies.

According to the results of these studies, several conclusions may be drawn when schools change from a graded system with three or more levels (usually either pass/fail/honors or A-F scale for most of the schools studied) to a simpler pass/fail grading system.

When medical schools switch from grades to pass/fail...

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“I vote ‘yay’ to change our schools to pass/fail and the boards to percentile grades”

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There are a few things for us in the podiatry community to consider about this research. First, all the studies looked at medical and not podiatric students which challenges the generalizability of these studies to podiatry. Second, there are exactly zero studies on this potential change for podiatric medical students. Third, board examinations for medical students are graded whereas the podiatric version is pass/fail.

Based on my research, I recommend with confidence the following changes to our podiatric education community.

The benefits to these changes appear pretty obvious. Our students would experience less stress and may also be able to focus a bit more time on other personal development activities such as extracurricular involvement. There’s a chance that performance may actually improve since the decreased stress may allow for better study focus.

A pass/fail system would also benefit our students in terms of residency applications. Much of the subjectivity and potential grade inflation would be eliminated while allowing residencies to use a standardized national examination that all students take at the same time as a comparison of academic skills. As it stands right now, grades and board examination scores tell us very little about how residency applicants compare to each other. One school’s 3.0 GPA is another school’s 2.5. As a program director, I’m forced to disregard these characteristics to a large degree and use additional factors such as class rank to determine what a particular GPA means within each school.

Of course, it’s clear that the recommended changes above must occur simultaneously. We can’t change to a pass/fail college grading and leave the board exam as pass/fail for the same reasons stated above.

In this aspect, the podiatry community is lagging far behind much of the allopathic medical community in which some of the best medical schools in the world, such as the University of California San Francisco, converted years ago to pass/fail grading. If it’s good enough for our MD colleagues, why is it not sufficient for the podiatry community? I vote “yay” to change our schools to pass/fail and the boards to percentile grades, and I vote to make that change immediately for the good of the students and our profession.