Pass/Fail Versus Tiered Grades and Academic Performance in Undergraduate Medical Education: Crossover Study
Bibliographic record
Abstract
Background: The impact of Pass/Fail or Tiered grade assessment for exams in undergraduate medical education has caused much debate, but there is little data to inform decision-making. The increasing number of medical schools transitioned to a Pass/Fail assessment has raised concerns about medical students' academic performance. In 2018, during the undergraduate medical curriculum reform at the Faculty of Medicine, Aalborg University changed some exams from Pass/Fail to Tiered grade and vice versa for other exams. These changes provide an opportunity to evaluate the different assessment forms. Objective: This study aimed to evaluate medical students' academic performance at the final licensing exam in relation to the exam grading principle. Methods: This single-center cohort study at Aalborg University Medical School, North Denmark Region, assesses the change from 2-digit Tiered grade to Pass/Fail evaluation and vice versa of undergraduate medical students' exams after the 4th and 5th year clinical training modules from Autumn 2015 through Spring 2023. The primary outcome was (1) the average grades at the final licensing exam and (2) the number of students failing exams during the previous two years. Results: Among the total of 7634 exams, 7164 4th and 5th year clinical training exams were included in the comparisons, of which 3047 (42.5%) were Pass/Fail exams and 4117 (57.5%) were Tiered grade exams. The frequency of students failing exams was 3.3% (n=101/3047) at Pass/Fail and 1.97% (81/4117) with Tiered grade exams (P<.001). This difference was leveled out when counting the near-failure tiered grade as Fail. Tiered grade exams did not differ between semesters (P=.99) nor show a time trend at the 4th year (P=.66). The final licensing exam grades were unaltered (P=.47). Conclusions: Contrary to our expectation, Pass/Fail exams exhibited a higher fail rate compared to Tiered grade exams without lowering the final academic performance. These results suggest that a shift from Tiered grades to Pass/Fail assessment redirects the focus from rewarding high performance to ensuring standards are maintained among underperforming students.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".