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Table of Contents
ORIGINAL RESEARCH
Year : 2020  |  Volume : 3  |  Issue : 3  |  Page : 116-120

Veterinary medical students' perspectives on traditional and pass-fail grading models in preclinical training


Department of Clinical Sciences, North Carolina State University, Raleigh, NC, USA

Date of Submission27-Nov-2019
Date of Acceptance22-Aug-2020
Date of Web Publication6-Nov-2020

Correspondence Address:
Dr. Kenneth Royal
1060 William Moore Dr, Raleigh 27607, NC
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/EHP.EHP_34_19

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  Abstract 


Background: There is current debate about the merits of traditional (e.g., A, B, C…; 4.0, 3.0, 2.0…, etc.,) versus pass-fail (P/F) (e.g., P/F) grading models in medical education. The purpose of this study was to explore veterinary students' perspectives about the pros and cons of traditional and P/F grading approaches. Methods: This study involved a census sample of 3rd and 4th year veterinary medical students at one veterinary college in the United States. Results: Students held widely different opinions about the two popular grading models. Students favoring traditional grading tend to cite reasons such as increased motivations to learn, more precise and accurate measures, improved feedback quality and advantages when applying for internships and residency. Students favoring P/F grading tend to cite reasons such as improved health and wellness, more genuine learning, reduced competition among students, training would better imitate veterinary practice, and P/F grading would overcome problems associated with inaccurate grading. Conclusions: Some students' perceptions about grading are not rooted in research evidence. Thus, this study not only identifies common beliefs about popular grading models, but also identifies potential concerns that policy-makers will have to contend with should institutions elect to revise their grading policies.

Keywords: Assessment, grading, learning outcomes, measurement, medical education, veterinary education


How to cite this article:
Royal K, Hedgpeth MW, Flammer K. Veterinary medical students' perspectives on traditional and pass-fail grading models in preclinical training. Educ Health Prof 2020;3:116-20

How to cite this URL:
Royal K, Hedgpeth MW, Flammer K. Veterinary medical students' perspectives on traditional and pass-fail grading models in preclinical training. Educ Health Prof [serial online] 2020 [cited 2020 Dec 1];3:116-20. Available from: https://www.ehpjournal.com/text.asp?2020/3/3/116/300078




  Introduction Top


There is current debate about the merits of traditional (e.g., A, B, C…; 4.0, 3.0, 2.0…, etc.,) versus pass-fail (P/F) (e.g., P/F) grading models in medical education. All grading systems are intended to summarize students' performance, distinguish the levels of performance, and serve as an indicator to external consumers (e.g., residency program directors, employers, etc.,) that a student has a sufficient fund of knowledge and/or skill to complete a particular course of medical training.[1] However, despite the common purposes, P/F and traditional grading models have been shown to offer the different advantages and disadvantages.

Since the late 1960s, educators have been exploring P/F models in medical schools.[2],[3],[4] Stanford University's School of Medicine has employed a P/F model since 1968 and has continually reported its students' are both successful at matching with prestigious residency programs and being consistently rated as satisfactory or superior relative to their respective peer groups.[5] A study of medical students at 96 allopathic medical schools showed that preclinical P/F grading was noninferior to tiered grading in terms of predicting United States Medical Licensing Examination Step 1 scores.[6] The American Medical Association created the Accelerating Change in Medical Education Consortium in 2013 and a survey of 27 members in 2016 showed that 74% had adopted P/F grading in preclinical courses.[7] On the other hand, there are the examples of other prestigious medical schools such as Harvard that moved to a P/F model and found students' performance declined so they returned to a traditional grading model.[3]

The debate of P/F versus traditional grading largely re-emerged in 2011 when a systematic review by Spring and colleagues was published.[8] The authors noted the benefits of P/F grading on medical students' well-being, no negative effects on achievement, but indicated there were some concerns with respect to residency program selection.[8] However, one multi-institutional study showed that how medical students were evaluated had a greater impact on well-being than the other aspects of the curriculum. More specifically, students evaluated with a P/F grading scale reported the lower levels of perceived stress than students in curricula using three or more grading scales.[9] The fallout from these debates generally has resulted in two polarized views among medical education faculty. Wilkinson noted advocates of traditional grading perceive P/F grading as “a “new age” move that will inevitably dumb down the education of our students,” whereas the advocates of P/F grading see it as “a move along the continuum toward recognizing students as adults and helping them prepare for a life of ongoing learning.”[10]

Currently, there is no published research that provides a summary of the grading models used across veterinary programs in the United States or North America. Thus, it remains unknown how many institutions utilize a traditional grading model such as letter grades/scales, or P/F grading as part of the preclinical curriculum. Further, opinions about grading models are often divided and contentious. Despite the aforementioned opinions often expressed by faculty, little is known about how students in health professions training programs feel about traditional versus P/F grading models. Thus, the purpose of this study was to explore veterinary students' perspectives about grading. In particular, we sought to understand (1) the perceived advantages and disadvantages of traditional versus P/F grading models according to students who had recently completed the preclinical portion of their medical training program and (2) which grading model students believed would be most beneficial for future students enrolled in the preclinical portion of their training program.


  Methods Top


Setting and context

In many Doctor of Veterinary Medicine (DVM) training programs, students devote the first 3 years to completing didactic training and the 4th year is dedicated to the clinical practice. Given the clinical (4th year) portion of training is significantly different from preclinical training we opted to focus this study on grading models in the preclinical training years of a DVM program. At (Anonymous University), veterinary students experience three different grading scales. Most required courses in years 1–3 are graded using a traditional model (A, B, C, D, and F letter grades) modified to create a 9-point scale with ± grades. Selective courses (special elective-type courses completed during the last 2 weeks of each semester during years 1–3) are graded on a P/F model. Senior students are graded with an honors/pass/marginal/fail scale for their clinical rotations. Most students receive a Pass grade. Thus, participants in the present study have some experience with both traditional and P/F grading models.

Participants and procedures

Participants in this study included all 3rd-year (n = 95) and 4th-year (n = 95) students enrolled in the DVM program during the 2016–2017 academic year. A statistical summary of participants' demographic characteristics is presented in [Table 1]. Students were administered electronic surveys approximately 3 weeks before the conclusion of the spring 2017 semester. Third-year students received an end-of-year survey that asked them to reflect on the previous 3 years of didactic training, indicate their current perspectives about a variety of curricular issues, and discuss their future plans. Fourth-year students received a similar end-of-year survey that asked them to reflect on their collective educational experience, provide perspectives about the clinical year curriculum, and discuss their future plans. Both surveys are part of a series of longitudinal program assessments administered each year in the college. All data collected through the surveys are anonymous and treated with strict confidentiality by the college's assessment team. The surveys were required of all students, thus a 100% response rate was obtained for each cohort. The study was approved by the University's Institutional Review Board.
Table 1: Summary of demographic characteristics

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Instrumentation

Two key items about grading were presented on the survey. Question #1 defined traditional and P/F grading models for students and then asked which model would best serve future students during the preclinical portion of the curriculum. Specifically, the question stated: There are two predominant grading models in medical education. The traditional model assigns grades of A, B, C, D and F to identify distinctions in student performance. The P/F model simply assigns a P or F to indicate if the student performed sufficiently well to pass a course. Which grading model do you believe would best serve future DVM program students during the years of preclinical training (i.e., years 1–3) of their veterinary medical training? Question #2 asked: Please comment on why you believe a particular model (traditional vs. P/F) would be best for the preclinical years (i.e. years –3).

Data analysis

Data analysis consisted of calculating descriptive statistics and Chi-square analyses to determine if statistically significant differences existed between the cohorts and subgroups within each cohort. Statistical procedures were performed using the SPSS statistical software (version 24.0) (IBM, Armonk, NY, USA). A grounded theory content analysis was performed on the qualitative data by extracting and quantifying the common themes emergent in the data.


  Results Top


Overall, approximately 58% of exiting 3rd-year students and 63% of exiting 4th-year students reported the traditional grading model would best serve future students in the preclinical portion of the DVM program [Table 2]. When comparing the responses for each class cohort by key demographic variables, Chi-square tests indicated no statistically significant differences (P < 0.05) were discernible based on gender or race/ethnicity.
Table 2: Response distribution for grading model that would best serve future preclinical doctor of veterinary medicine program students

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Students were asked to elaborate on their response. A total of 61 students (64.2% of all participants) from the 3rd-year sample and 49 students (51.5% of all participants) from the 4th-year sample provided comments. Reasons cited for traditional grading included the following themes: increased motivations to learn; more precise and accurate measures of performance; improved feedback; and advantages when applying for internships and residency programs. Reasons cited for P/F grading are summarized into the following themes: improved health and wellness, increased likelihood of genuine learning, reduced competition among students, training would better imitate actual practice as veterinarians, and P/F grading would overcome problems with inaccurate grading.


  Discussion Top


Overall, students' responses indicate a slight favorability for a traditional grading model when asked which grading model would be in the best interest of future students in the preclinical portion of a DVM program. Specific arguments for a traditional grading model included the following themes: Increased motivation to learn, more precise and accurate measures of performance, improved feedback, and advantages when applying for internships and residency programs. More specifically, with respect to increased motivation to learn, students perceived a traditional grading model would not only make them take the course more seriously (compared to a P/F course), but also increase the likelihood that they put forth maximum effort. Contrasting to P/F grading, students expressed fears that a P/F model might encourage students to do the bare minimum and create a cohort of marginally competent students. Decreased study effort might also encourage students to focus less on species of lesser interest to them, which could negatively impact performance on the North American Veterinary Licensing Exam, a comprehensive examination usually taken during senior year that requires a passing score to practice veterinary medicine.

Many students perceived traditional grading models provide more precise and accurate measures of performance. Further, students perceived traditional grading may improve the accuracy of class rankings and offer students better feedback to discern their individual strengths and weaknesses. Students noted a belief that a traditional grading model also would likely better serve students interested in pursuing postgraduate opportunities such as internships and residencies.

Arguments for P/F grading included the following themes: Improved health and wellness, increased likelihood of genuine learning, reduced competition among students, training would better imitate actual practice as veterinarians; and P/F grading would overcome problems with inaccurate grading. More specifically, with respect to health and wellness, students perceived a reduction in pressure and stress would likely lead to improved mental health and a better veterinary school/life balance. Students also perceived P/F grading would reduce competition and the tensions associated with striving for perfection. Further, students perceived P/F grading would help students feel less “inadequate” and “dumb” when they experience a disappointing performance and would reduce the feelings of imposter syndrome.[11],[12]

Many students perceived P/F grading would increase the likelihood of developing “enduring understandings”[13] of material. That is, the reduced stress would have a liberating effect on how students go about learning, as students would shift their focus from achieving top grades to truly learning and retaining information long after the course is over. Students noted classroom behaviors likely would also change, as students would spend less time taking detailed notes and paying partial attention and more time engaging with the instructors and trying to understand not only the “big picture” concepts, but how one should actually think as a practicing veterinarian (e.g., clinical reasoning and problem-solving).

Final arguments for P/F grading pertained to flaws associated with traditional grading models. Students noted some assessments that were not necessarily the most accurate measure of student ability, and when grades were perceived as inaccurate, it angered students. In other instances, students noted virtually everyone performed extremely well in some courses, thus traditional grading offered nothing different from P/F in such situations. Finally, students noted that they often know more than their examination scores indicate, thus P/F grading would be an effective way to offset perceptions of potentially invalid grades in some situations.

When contrasting the perspectives in favor of each model, it was apparent that a number of assumptions, many often erroneous, were made. For example, the most common reason cited for not moving to a P/F model was that it would lower standards and expectations of student performance. This, in turn, would presumably affect students' motivations to learn and result in decreased learning. This cognitive error is common place among both educators and students alike. That is, when both educators and students envision a P/F curriculum, there typically is a misunderstanding of where P/F distinctions will be made. For example, suppose a traditional grading model requires students to achieve a minimum grade of a “B” in each course to remain in good standing with the program. Instances in which students receive a “C” or worse would typically result in remediation, failure of a course, and/or possibly dismissal from the program. A P/F model could easily retain this score meaning. For example, performance that would normally be deemed a “B” or better would be rendered a “P,” and performance that would normally be deemed a “C” or lower would be rendered an “F.” In fact, performance standards may actually be raised in a P/F curriculum, a fact that often is lost on many.

It also was interesting that a considerable proportion of students believed each grading model could result in better score accuracy and learning than the other could. Of course, it is important to keep in mind that students had considerably greater experience with a traditional grading model and lesser experience with a P/F model during the DVM preclinical training experience so the amount of familiarity and experience with each model could impact students' perceptions. It is possible that some students preferred the P/F model because they viewed it better than the alternative, whereas some students may have preferred the current traditional model because they did not have any discernible problems with it.

Limitations and future research

There are three particularly noteworthy limitations of this study. First, this study surveyed 3rd-year and 4th-year students in one DVM program in the United States. Although the 100% response rate and large sample size were sufficient to make valid inferences about the data at one institution, it remains unknown if the findings are generalizable to other programs where students may have experienced a different type of curriculum. It is important to note that the perspectives provided by students in this sample were presumably based on their experiences at this specific veterinary school. It is possible that variation in factors such as curricular content and focus, institutional environment (e.g., competitiveness), instructor quality, and student ability could have some bearing on students' perspectives about traditional versus P/F grading. Finally, we did not account for individual's future plans for residency and/or internship as a confounding variable for how students might respond. Although some students did comment that because of plans for postgraduate training, they believed the traditional grading model would best serve future DVM students, we are unable to speak to exactly how many students feel this way. We suspect most students seeking postgraduate training would find the traditional grading model preferred over the P/F model, but do not have empirical data to support this claim.

There are a number of avenues for future research with respect to grading. First, it would be helpful to have a census study exploring the various grading models used at accredited veterinary schools. Such a study should include both preclinical and clinical grading schemas. Further, future works should similarly explore students' perceptions of traditional versus P/F grading, but the samples should consists of students who have experience with both formats. Rephrasing the research question to also ask which model they would prefer to have experienced during their veterinary training could also yield interesting results. Finally, future studies should also explore the perceptions of faculty and consumers in postgraduate roles such as employers and residency/internship program directors. Insights from these studies could inform how individuals later use the grades assigned during veterinary medical training.


  Conclusions Top


Third and 4th year veterinary students' perceptions of traditional versus P/F grading varied considerably. Students favoring traditional grading tend to cite reasons such as increased motivations to learn, more precise and accurate measures, improved feedback quality and advantages when applying for internships and residency. Students favoring P/F grading tend to cite reasons such as improved health and wellness, more genuine learning, reduced competition among students, training would better imitate veterinary practice, and P/F grading would overcome problems associated with inaccurate grading. It is important to note, however, that some perceptions about grading are not rooted in research evidence. Thus, this study not only identifies common beliefs about popular grading models, but also identifies potential concerns that policy-makers will have to contend with should institutions elect to revise their grading policies. More research is needed to understand the true merits of traditional and P/F grading models.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Wilkinson T. Pass/fail grading: Not everything that counts can be counted. Med Educ 2011;45:860-2. doi: 10.1111/j.1365-2923.2011.04018.x.  Back to cited text no. 10
    
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