Many med schools have switched to pass/fail in the past couple of decades. In this article, we’ll discuss the schools that use each grading system and the pros and cons of each one.
Traditional grading in medical school refers to letter grades. A+ is the best, F is for “fail,” and so on. This lettered grading system is historically the most common system — most undergrad colleges still use traditional grading — so you’re probably used to it by now.
This traditional system ranks students’ performance. Many institutions want students to focus on learning in their first or second year, and so there is no class ranking through GPA. Many med schools incorporate letter grading or tiered P/F (both of which rank students) in clerkship years.
In medical school, traditional grading is sometimes used in the pre-clerkship years and occasionally through all four years of medical school. If it’s used, it’s most often used in the final two academic years of med school.
Letter grading typically follows a 4-point GPA scale, where each grade contributes to a score that gets thrown into your GPA:
Traditional letter grading:
Traditional letter grading systems:
Below are a couple of med schools that utilize the traditional letter grading system:
A true pass/fail grading system is when you are given a “pass” or “fail” at the end of the course – no letter grades.
A lot of institutions are switching over to a pure pass/fail system, but many schools are using tiered pass/fail grading, which is just an expanded P/F grading system. Tiered P/F grading typically uses the following scale:
If you retake a class you failed and then pass it, you may get a remediated pass. Remediation impacts your official transcript.
According to the Association of American Medical Colleges (AAMC), most medical schools have used some form of pass/fail grading system since 2016.
Pros of pass/fail grading include:
The pass/fail system:
Here are a few schools that use a pure pass/fail grading system:
A majority of U.S. medical schools use a tiered pass/fail system for at least two years of their curriculum:
Some schools may use a hybrid approach to grading. For example, they may use letter grading in elective classes, pass/fail for preclinical grading, and tiered P/F in third and fourth years.
The most common hybrid approach I’ve seen is this:
Generally, the advantage of this hybrid approach is that you prioritize comprehension in the early years and encourage incremental academic performance improvement in later years, in which students are ranked. This is what residencies prefer.
Some medical schools that use this hybrid approach include:
As pass/fail systems are becoming more common, you should understand how residency programs evaluate your course grades.
Residency programs may find it harder to assess the relative strengths of students from P/F systems, especially in healthcare specialties with a high number of applicants or a low number of open positions.
However, pass/fail systems can encourage students to focus on developing strong patient care and clinical skills, which are highly valued in residency.
How your pass/fail grades appear to residencies truly depends on the specialty you want to pursue.
The good news is that residency competitiveness tends to be based on factors like your Step 2 CK score and your research/publication history. If you’re going for a competitive residency and are concerned about P/F system impacts to your residency prospects, aim to score high on Step 2 CK and do plenty of relevant research.
Read Next: Medical School vs. Residency: What to Expect
There is no single “best” medical school grading system, as each has potential benefits and drawbacks.
Different students are stressed or relieved by different approaches. Prioritize your mental well-being in terms of which grading style you think will cause the least amount of anxiety.
Also, if you can look ahead far enough to residency, research how your ideal residency program views different grading systems.
The optimal grading system depends on your individual needs and the specific context of your medical school and future residency program.
Most residency programs “prefer” traditional letter grading to be used in med schools so that they can see the ranking of students within a DO or MD program. In the absence of a traditional grading system, however, residencies will put more weight on other factors such as:
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