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Table of Contents
VIEWPOINT
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 43-44

It's time to abolish class rankings in medical education!


Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA

Date of Submission17-Apr-2020
Date of Acceptance27-Apr-2020
Date of Web Publication27-Jul-2020

Correspondence Address:
Dr. Kenneth D Royal
Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/EHP.EHP_8_20

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  Abstract 


Class rank is a commonly used measure to differentiate talent for potential selection in postgraduate training programs (e.g., medical residency, internship, etc.). However, class ranking is a norm-referenced approach in which students are assessed relative to the performance of their peers. This is in juxtaposition to competency-based/standards-based education which is the norm for most all medical training programs. Further, the education literature has repeatedly articulated reasons why differentiating students based on class rank is both inappropriate and detrimental to student learning. Thus, the purpose of this article is to argue for the abolishment of class ranking across all medical and health professions programs.

Keywords: Assessment, clinical education, evaluation, grading, medical education


How to cite this article:
Royal KD. It's time to abolish class rankings in medical education!. Educ Health Prof 2020;3:43-4

How to cite this URL:
Royal KD. It's time to abolish class rankings in medical education!. Educ Health Prof [serial online] 2020 [cited 2020 Sep 24];3:43-4. Available from: http://www.ehpjournal.com/text.asp?2020/3/2/43/290924



It is a common practice in medical education for training programs to calculate class rank for graduating students. The process of calculating rank may vary considerably across programs, although students typically are ranked according to their cumulative grade point average (GPA). The purpose of rank-ordering graduates, however, remains somewhat unclear given medical education is a competency-based endeavor. When asked “why do we continue to calculate class rank?” most will point out that residency and internship programs have a vested interest in class rank as it helps program directors and committees more easily choose the few graduates they plan to accept as part of their program.[1] Fundamentally, however, decisions about which graduates to admit to a residency or internship program are beyond the purview of educators in medical school training programs. Educators are primarily concerned with developing talent. Residency and internship program directors and committees, on the other hand, are concerned with selecting talent.[2],[3] To be clear, determining class rank has nothing to do with developing talent. It does not help students achieve higher levels of competency. Further, with the possible exception of top-ranked students, class rank also does nothing to improve the confidence of a learner or increase one's motivation for learning. In fact, class rank can actually be detrimental for a number of reasons. Therefore, why should educators be expected to sort talent when that is the job of residency and internship program committees?

Issues of professional role aside, there are a plethora of additional reasons to abolish class ranking. Perhaps, first and foremost is the fact that class rank says nothing about how much a student learned.[4] What's more, determining class rankings is a norm-referenced approach of evaluation. The education research literature has consistently discussed the perils of such norm-referenced approaches in which students are assessed relative to the performance of their peers. Further, research has indicated that norm-referenced assessments are incompatible with competency-based education in which students are assessed relative to performance standards.[4],[5]

Research has also noted that class ranking fosters unhealthy competition.[2],[4],[6] Ranking students conveys a message that performing well does not mean learning well; rather, it means outperforming one's peers. When learning environments are infected by unhealthy competition, it creates a ripple effect. Namely, unhealthy competition can discourage student collaboration, prohibit students from interacting and learning from one another, increase the likelihood of cheating, and it makes instructors hesitant to provide individual assistance to students due to concerns that other students might perceive the help as a way of biasing the competition. Further, unhealthy competition can denigrate the culture of an institution, generate feelings of resentment and hostility among students, inflame existing tensions, create undue stress, and cause some individuals to act inappropriately (e.g., rude, bullying, sabotaging others' work, etc.).[6],[7],[8],[9],[10],[11]

Certainly, competition has a place in medical training. In a healthy learning environment, students should not be competing against one another but rather working together and competing against rigorous performance standards. Competition against performance standards creates an opportunity to unite students and instructors with a common goal. Further, collaboration is encouraged as a student's chance of earning the highest grade possible is not diminished by his/her decision to work with a peer.

There also exist a number of statistical reasons to abolish class ranking. First, there is the problem of potential grade inflation, a well-documented phenomena across most health professions.[12] Grade inflation creates statistical “noise” that distorts the meaningfulness of grades by introducing measurement error. In most medical education programs, cumulative grade distributions are highly negatively skewed because there are so many high-performing students. When assigning class ranks to scores with such little variability, it is akin to “splitting hairs,” thus rendering the meaning of the ranking useless. For example, an institution that has an excessive number of graduates with a 4.0 GPA (or higher) could find that students with very respectable GPAs (e.g., 3.85) are ranked in the bottom 50% of their class. Such a ranking would be deceptive of a graduate's ability, but an undiscerning program director using class rank as a cutoff criterion for considering applicants might immediately dismiss the graduate from consideration. This is arguably the most serious concern of all, as the validity of the inferences is threatened and the consequence for a graduate is quite severe.

Finally, the lack of standardization across medical training programs creates an impossible challenge to meaningfully compare graduates. For example, a student ranked in the top 10% at one institution could conceivably be ranked in the bottom 50% at another. Given the enormous variation in curricula, instructional quality, instructor quality, course difficulty, and countless other factors, there simply is no way to equate all students' GPAs onto a common metric for a truly meaningful comparison. Finally, there also is no evidence that class rank correlates with performance in a medical residency training program.[13] It is for these reasons that educators have long encouraged persons charged with selection decisions to consider multiple and holistic criteria with limited emphasis on GPA, class rank, and other easily distorted measures.

In conclusion, there are a plethora of reasons to abolish class rank, and essentially no legitimate reason to retain its usage. Class rank is incompatible with competency-based education, does not align with training programs' goals or their educators instructional roles, does not benefit the overwhelming majority of students, has the potential to create unhealthy academic environments, and produces measures that are highly suspect and likely to be misinterpreted by undiscerning consumers (e.g., residency and internship selection committees). Perhaps, most concerning of all is the potential for misuse of class ranking information, as it could have very dire consequences for graduates. It is for these reasons that class rank should be immediately abolished in medical education.

Financial support and sponsorship

Nil.

Conflicts of interest

Dr. Royal is the editor-in-chief of Education in the Health Professions. All peer-review activities relating to this manuscript were independently performed by other members of the editorial board.



 
  References Top

1.
Benzinger R. From the desk of the program director: Show me the rankings! J Grad Med Educ 2014;6:413-4.  Back to cited text no. 1
    
2.
Guskey TR. Class rank weighs down true learning. Phi Delta Kappan 2014;95:15-9.  Back to cited text no. 2
    
3.
Royal KD. Clarifying the instructional role of faculty in medical and health professions programs. Educ Med J 2017;9:75-7.  Back to cited text no. 3
    
4.
Guskey TR. Five obstacles to grading reform. Educational, School, and Counseling Psychology Faculty Publications; 2011. p. 6. Available from: https://uknowledge.uky.edu/edp_facpub/6. [Last retrieved on 2020 Feb 05].  Back to cited text no. 4
    
5.
Royal KD, Guskey TR. On the appropriateness of norm- and criterion-referenced assessments in medical education. Ear Nose Throat J 2015;94:252-4.  Back to cited text no. 5
    
6.
Royal KD, Guskey TR. The perils of prescribed grade distributions: What every medical educator should know. J Contemp Med Educ 2014;2:240-1.  Back to cited text no. 6
    
7.
Krumboltz JD, Yeh CJ. Competitive grading sabotages good teaching. Phi Delta Kappan 1996;78:324-6.  Back to cited text no. 7
    
8.
Gray K. Why we will lose: Taylorism in America's high schools. Phi Delta Kappan 1993;74:370-4.  Back to cited text no. 8
    
9.
Williams SM, Arnold PK, Mills JN. Coping with stress: A survey of Murdoch University veterinary students. J Vet Med Educ 2005;32:201-12.  Back to cited text no. 9
    
10.
Hafen M Jr., Reisbig AM, White MB, Rush BR. Predictors of depression and anxiety in first-year veterinary students: A preliminary report. J Vet Med Educ 2006;33:432-40.  Back to cited text no. 10
    
11.
Weston JF, Gardner D, Yeung P. Stressors and protective factors among veterinary students in New Zealand. J Vet Med Educ Spri; 2017;44:22-8.  Back to cited text no. 11
    
12.
Fazio SB, Papp KK, Torre DM, Defer TM. Grade inflation in the internal medicine clerkship: A national survey. Teach Learn Med 2013;25:71-6.  Back to cited text no. 12
    
13.
Balentine J, Gaeta T, Spevack T. Evaluating applicants to emergency medicine residency programs. J Emerg Med 1999;17:131-4.  Back to cited text no. 13
    




 

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