half-baked idea: pass/fail pre-clinical years

Changing MUSC's grading system to honors/pass/fail was a great first step, but let's take it another step further - full on pass/fail. Several other schools already use P/F. Here's a quick list: Yale, Stanford, Columbia, UChicago, Harvard, UVA. Of those schools, UChicago is 100% unranked, which means the administration does not keep any internal rankings for future dean's letters. And Stanford also uses P/F in the clinical years. Wow that is bold. 

mecca

So why switch, what's the purpose of pass/fail? 

The idea is that pre-clinical learning is important, but only marginally so. In the skyscraper that will compose your medical knowledge, basic sciences are the foundation. At the same time, can't we cut out some of the syllabus? Is it really necessary to know every infant stage of development? How many pentose phosphate pathway enzymes do you remember? I definitely remember zero. I don't even really remember what PPP does. And you know what? It won't ever matter. 

I'm for any idea that lowers the stress level of med students. Producing more mentally sane healers has to be good for medicine. I also believe stress level can be lowered without losing quality. Happier doctors will produce better patient care. And that should be the ultimate end goal. Not having smarter doctors.

sidenote - story time - I took the MCATs twice. Before the first time I studied to the max, stressed out, and did less than I expected. I was pissed. I deserved to do well. The second time, five months later, I studied a couple times, then the night before the exam I hung out with one of my best friends and drank several beers. I went in the next day with a good attitude, probably a small hangover, and scored 3 points higher. 

This anecdote speaks volumes of the pre-med personality. There's a masochistic side to our personality that wants to feel intense. A part that believes that working hard and being intense makes us deserving of excelling. Unfortunately, that's not the way of the world. Hard work =/= success, that turns out to be one of the biggest misconceptions of our generation. The level of cortisol that allows optimal brain function isn't that high. Getting my results on the MCAT the second time around sold me on the value of not stressing too hard. I'd rather do well than try hard. 

In the right environment I can get pretty cutthroat and I don't mind competing, but I'm also a firm believer that there's enough cake for everyone. For better or for worse, we are in this together. If us doctors are expected to work together, they need to cut down competition in med school. The easiest way to do that? Get rid of grades. Pass/fail. 

The obvious problem to P/F is that students will be less motivated without honors. By the eye test, you'd expect super driven med students to overcome this problem. Most med students and pre-meds that I know are the types that can't turn off their drive. As it turns out, there's good hard data to back the eye test. 

UVA switched over from A-F grading to pass/fail and compared how their students performed under both systems. Under both systems, the students scored similarly on tests, clinical rotations, USMLE Step 1, and residency matching. Interestingly, the same number of students still attended class. The kicker - the P/F group scored lower on tests of anxiety and depression, while they scored higher on tests of general health and self-control. On top of all this, the P/F group reported a higher satisfaction with the quality of their medical education. 

Unfortunately, both groups of students reported similar stress levels the semester before USMLE Step 1. It's just a question of - is that stress really necessary for an entire two years? or can we just make do with one semester. The result that both groups scored similarly on Step 1 speaks for itself. 

I can say personally I would not work any more or less hard under a pass/fail system. I can also say that I stress out over the honors/pass difference during exam week. If we want docs to start cooperating better, isn't med school the place to start?

Could you see MUSC changing to a full pass/fail system?

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.