SUBCOMMITTEE ON ASSESSMENT
FINAL RECOMMENDATIONS REPORT
CURRICULUM 2010
February 29, 2008
Committee Members:
Cheryl Aspy, PhD
Robert Blair, PhD
Sheila Crow, PhD (Chair)
Molly Hill, PhD
John Holliman, PhD
Sarah Passmore, DO
Ronald Saizow, MD
Rhonda Sparks, MD
Phebe Tucker, MD
In the fall of 2007 a subcommittee on assessment was formed and charged with 1)
studying the grading policies of the College of Medicine, 2) developing options for
changing the letter grade system, 3) developing options for remediation, and 4)
developing consequences for not meeting the system standards. This report provides a
brief overview of the process used to study the charges and provides a set of final
recommendations.
A. Grading Policies
The current system of letter grading for medical students at the University of Oklahoma
College of Medicine has been in place for nearly 35 years. As currently written, the
Grading, Promotion, and Graduation Standards (section 401) contain the following
provisions as they relate to freshman and sophomore medical students:
1. In order to be eligible for promotion or graduation, a student must maintain a
minimum of a 2.0 cumulative grade point average (based on a four-point scale).
2. A student who receives a D grade in any course may have the opportunity to
remediate at the discretion of the Student Promotions Committee. If the student
passes, the final grade may be no higher than a C.
3. A student shall not be promoted from either the first, second, or third year with an
F grade being the grade of record for any course taken during that year to be
applied toward satisfaction of graduation requirements.
B. Findings
To begin this discussion, the Subcommittee reviewed the grading system, integration of
exams, and remediation process for 11 randomly selected medical schools with an
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integrated-systems curriculum. A list of the schools reviewed is located in Appendix A.
The Subcommittee found that 10 of the 11 schools studied use a pass / fail variation. A
report from the AAMC curriculum directory suggests that 25% of US medical schools
use a Pass / Fail system, 23% use a Honors / Pass / Fail, and 25% use a Honors / High
Pass / Pass / Fail grading system. Overall, nearly 75% of US medical schools use a pass /
fail variation.
The type of evaluation system a medical school should adopt for its students has been a
point of controversy for many years. The literature suggests that supporters of pass / fail
grading argue that it promotes genuine learning while deemphasizing exam scores,
enhances student-teacher relations, reduces competition, and encourages cooperation
among students. Opponents assert that pass / fail grading does not reduce students’
anxiety, particularly among academically borderline students, that it blurs distinctions
among students of differing abilities, and that it dampens students’ motivation for
academic excellence.1
The plan to implement a newly designed integrated-systems curriculum in 2010 requires
the College to address whether the traditional letter grading system currently in place is
the most appropriate method of student evaluation. The Subcommittee struggled with
many of the same issues and concerns that other medical schools have debated over the
years. We wondered, for example, what the impact would be on the knowledge
acquisition of medical students in the first two years, how medical students would receive
feedback on their academic performance, AOA selection, and perhaps most importantly,
the impact on the residency selection process.
To begin to address these concerns, the Subcommittee randomly surveyed 77 medical
student class officers and student senate officers on the Oklahoma City and Tulsa
campuses. Students were asked:
1) What do you think are the pros and cons of a pass / fail grading system in the first
two years of medical school?
2) When you were a medical school applicant to OU would you have preferred a
pass / fail type system?
3) From your perspective as a current student, do you think a pass / fail system is a
good idea in the first two years of medical school at OU?
Students also had the opportunity to give narrative feedback regarding grading system
issues.
Thirty-eight (49%) students responded to the survey. A majority (76%) reported they
would have preferred a pass / fail type system and 73% thought a pass / fail system was a
good idea in the first two years of medical school at OU. Major themes were identified in
the student comments. Students overwhelmingly thought that a pass / fail system was
less stressful than a letter grade system. They also suggested that students would be more
likely to learn for retention rather than memorizing for a test. Less competition was also
a strong motivator for a pass / fail grading system. The negative comments regarding
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pass / fail grading included the risk of a minimum or reduced academic effort by students,
difficulty discriminating among students by residency programs, and no public reward for
hard work.
In addition, the Subcommittee surveyed the more competitive residencies at OU,
including Dermatology, Ophthalmology, Orthopedic Surgery, Neurosurgery,
Anesthesiology, and Radiology. The Residency Program Directors were asked:
1) To what extent do you consider first and second year grades in your selection
process?
2) Do you prefer a numeric grading system, a letter grading system, honors / pass /
fail system, or a pass / fail system?
3) Do you feel that students applying to your program from a school that used a pass
/ fail system would be at a disadvantage compared with students from schools that
used a letter grade or numeric rating system?
The responses were varied. Several program directors considered first and second year
grades to be very important and thought that a pass / fail grading system would put
students at a disadvantage, while others thought a pass / fail system would not present a
problem. In general, the literature suggests that preclinical grades are not given much
weight in residency programs, although that was not necessarily the consensus of the
residency program directors at OU.
The issue of a two-interval system (Pass / Fail) versus a three-interval system (Honors /
Pass / Fail) was discussed at length. Student survey comments regarding this issue were
mixed. A number of students felt the two-interval system was more likely to reduce
competition between students. Other students suggested that a three-interval system was
the best approach since it allowed for academic distinction. The Subcommittee was clear
that it did not want to implement a grading system of Honors / Pass / Fail that was
essentially an A / B / C system.
Designing options for student remediation of a grade less than a pass was initially a
challenge when the 2010 curriculum was to be completed in 18 months. The
Subcommittee specifically examined the remediation process for Baylor School of
Medicine – since they are perhaps only 1 of 2 schools with a true 18 month pre-clinical
curriculum – and North Dakota School of Medicine, which organizes their curriculum
around 8 week blocks of learning. The decision by the Curriculum Coordinating
Committee (CCC) to recommend a curriculum that included a summer break gave the
Subcommittee on Assessment more flexibility in designing its remediation options.
C. Proposal to Change Grading System for Years 1 and 2
The Subcommittee on Assessment recommends the following features for a new
freshman / sophomore grading system.
1) All freshman and sophomore students are graded “Honors”, “Pass”, or “Fail”.
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2) An award of “Honors” is reserved for students in the top 15% of the medical
school class. An Honors Committee will be responsible for making a final
determination regarding the award of “Honors”.
3) Failure to achieve a “Pass” on one or more components of assessment in an
individual block will result in remediation of the deficit during the following
week in the afternoon. Successful remediation will result in a “Pass” grade for
the block. Unsuccessful remediation will result in a failing grade and will not
affect participation in the subsequent block; however, the student will be
responsible for remediation of the deficit area at a designated time during winter
break or summer break following the academic year in which the deficiency
occurred.
4) During Year 1 or Year 2, any student who is unsuccessful at remediation of a
block would be given the grade of “Fail” for that block.
5) A student shall not be promoted from either Year 1 or Year 2 with a “Fail” grade
being the grade of record for any block taken during that year. Students earning a
“Fail” grade must repeat the year.
6) A student who receives two “Fail” grades in an academic year will be placed on
probation and a dismissal hearing will be held.
References
1. Robins, L.S., Fantone, J.C., Oh, M.S., Alexander, G.L., Shlafer, M., & Davis, W.K.
The effect of Pass/Fail Grading and Weekly Quizzes on First-year Students’
Performances and Satisfaction. Academic Medicine, 70 (1995):327-329.
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Appendix A
List of Medical Schools
1) Baylor College of Medicine
2) Duke University School of Medicine
3) Georgia School of Medicine
4) Harvard Medical School
5) University of Missouri-Columbia School of Medicine
6) University of New Mexico School of Medicine
7) University of North Dakota School of Medicine and Health Sciences
8) Keck School of Medicine of the University of Southern California
9) Southern Illinois University School of Medicine
10) Wake Forest University School of Medicine
11) Yale School of Medicine
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