Carl Parsons¹
Angie Nguyen² and Caroline Joyce³
1 Western Sydney University
2 UNSW
3 Western Sydney Univiersity

1. Background
Various grading approaches have been implemented in higher education, including multi-tiered and two-tiered grading systems, each with its own advantages and disadvantages. With a focus on evidence of professional competence (Spring et al., 2011), especially in medical education, the need to review and implement suitable marking and grading systems at the program level has become more critical than ever. 

2. Summary of work
The study investigates medical students’ perspectives on transitioning from a multi-tiered to a two-tiered grading system through eight focus group interviews at a cosmopolitan Australian university’s medical program. 

3. Results
The analysis of the respondents’ views shows mixed responses. The more students progressed through the program, the focus on grades was less but more on the learning goals to become a good doctor. 

4. Discussion

The review of changes in medical education assessment and grading policies over recent years indicates a preference for two-tiered grading systems, citing improvement in student well-being and a focus on assessing competencies (Ross et al., 2022). Detractors for this move question whether student motivation will be adversely affected and there are concerns that post-graduate opportunities for students will be compromised. Students raised concerns about their motivation to learn, the reliance on grades to inform them of their learning progress. Students’ opinions on this shift varied due to personal preferences, perceptions of motivation factors, and their current learning experience in the medical program. 

5. Conclusion
This study offers insights into different grading systems and the lessons learnt from students' perspectives on the move from multi-tiered grading to two-tiered grading system. 

6. Take-home messages / implications for further research or practice 
Although the medical education trend leans toward two-tiered grading systems emphasising competence and mastery, students’ perspectives vary based on personal preferences, perceived motivation factors, their current learning experiences. 

References (maximum three) 

Ross, S., Pirraglia, C., Aquilina, A. M., & Zulla, R. (2022). Effective competency-based medical education requires learning environments that promote a mastery goal orientation: A narrative review. Medical Teacher, 44(5), 527-534 

Spring, L., Robillard, D., Gehlbach, L., & Moore Simas, T. A. (2011). Impact of pass/fail grading on medical students’ well‐being and academic outcomes. Medical education, 45(9), 867-877. 

Caroline Joyce¹
Angie (Nga) Nguyen² and Carl Parsons¹
1 Western Sydney Univiersity
2 University of New South Wales

Background
There is growing evidence moving to a pass/fail grading system improves students’ relationship with assessments. In multi-tiered grading programs, the motivation to learn is to achieve high grades rather than engage in a holistic learning experience (1). The move to pass- fail grading is expected to improve well-being, increase collaborative learning and cohort cohesion without compromising learning outcomes (2). However, there is limited evidence on the impact of a pass/fail system on students’ motivation to learn. 

Summary of work
This longitudinal study aims to understand the impact of a pass/fail grading system on student motivation. The Motivation Strategy Learning Questionnaire (3) will be used to assess students’ motivation to learn and their learning strategies at four time points as a medical program transition to pass/fail grading. 

Results
Results from the first time point indicates in a multi-tiered grading system first year students exhibit higher levels of extrinsic motivation compared to students in later years of the program. Additionally, self-efficacy was higher in both first and final year students. 

Discussion
Preliminary analysis suggests first year students exhibit higher extrinsic motivation; this could be attributed to the highly competitive admissions process for entry into medicine emphasizing grades over holistic learning. In contrast, pass/fail grading may offer an avenue to increase student self-determination and emphasize competency achievement. Further analysis will help better understand how motivation is affected in a pass/fail grading system. 

Conclusions
Understanding the impact of moving to a pass/fail program on motivation to learning will allow for the development of targeted interventions to support student learning. 

Take-home messages/implications for further research or practice
Motivational factors in student learning may vary depending on the stage in the program. Understanding the impact of a pass/fail grading system on motivation to learn will help foster holistic learning and pedagogical approaches in medical education. 

References (maximum three) 

1. Chamberlin, K., Yasué, M., & Chiang, I.-C. A. (2023). The impact of grades on student motivation. Active Learning in Higher Education, 24(2), 109–124. https://doi.org/10.1177/1469787418819728 

2. Ange B, Wood EA, Thomas A, Wallach PM. Differences in Medical Students' Academic Performance between a Pass/Fail and Tiered Grading System. South Med J. 2018 Nov;111(11):683-687. doi: 10.14423/SMJ.0000000000000884. PMID: 30392003. 

3. Pintrich, P. R. (1991). A manual for the use of the Motivated Strategies for Learning Questionnaire (MSLQ). https://files.eric.ed.gov/fulltext/ED338122.pdf 

Debra Klamen¹
Molly Smith¹
1 Southern Illinois University School of Medicine 

Abstract 

The use of Pass-Fail grading in clinical clerkships in medical school is a hotly debated and timely topic with regard to medical education assessment. While numbers of clerkships using this assessment strategy have traditionally been low (11-13 schools in the U.S. using this methodology between 2016-2020), the recent COVID pandemic has driven this number to 24 (AAMC data 2020-2021). As schools now take a new look at this assessment methodology, this topic is often debated, with strong opinions on both sides. 

Proponents of tiered grading (Honors-Pass-Fail, or Honors-High Pass-Pass-Fail, etc.), argue that to separate from one's colleagues during the residency matching process is harder with the USMLE Step 1 exam going Pass-Fail, and thus the tiers are necessary. Others worry that without the external motivation of grades higher than pass, students will not try on their clerkships as hard as they might otherwise. Still others state that this is a traditional and time- honored process, and if it "ain't broke, don't fix it." 

Those in favor of Pass-Fail grading note the decreased competition within the class, and an overall decrease in stress. Further, the recognition that URM students are often under- represented in honors grades leads one to consider whether a Pass-Fail system is not superior because of less bias. 

Southern Illinois University School of Medicine (SIUSOM) dramatically changed its clinical clerkships in 2015-2016, and followed this change in the subsequent year with a move to Pass- Fail grading in its clinical clerkships. The change has been well-received by students and faculty. The sheer number of schools contacting SIUSOM in the past year wishing to discuss this assessment methodologic change demonstrates what a timely and important topic the use of Pass-Fail in clinical clerkships has come to be. 

Take-home message: Pass-Fail assessment methodology is clinical clerkships is a reasonable alternative to tiered grading which is supported by the literature. 

Learning Objectives
 At the conclusion of the session, participants will be able to:
 1) Articulate three reasons why tiered grading has persisted in clinical clerkships 

2) Articulate three reasons why Pass-Fail grading assessment methods in clinical clerkships might be worthwhile. 

3) Discuss some of the barriers to implementing Pass-Fail grading in clinical clerkships 

Session Plan
1) Intro and orientation to the topic - 10 minutes 

2) Group Discussion - Benefits and Risks of Pass-Fail. Is this a good idea? Why or Why not? - 30 minutes 

3) Presentation of data and arguments with respect to Pass-Fail in a clinical clerkship - 15 minutes 

4) Group Discussion - Is this something we want to take back to our home institution? Why or Why not? - 15 minutes 

5) Conclusion and Wrap-up - 5 minutes 

Who should participate - Anyone involved in clinical clerkships at any level Maximum number of participants - 40-50 

References (maximum three) 

1. AAMC data base 2020-2021. 

2. Smith JF, Piemonte NM. The Problematic Persistence of Tiered Grading in Medical School. Teaching and Learning in Medicine, 2022. 

Travis Haber¹
Jessica Stander¹, Karen Donald², Jessica Lees¹, , Deb Virtue¹, , Samantha Byrne¹, , Tamara Clements¹,  Bronwyn Tarrant¹, Anthea Cochrane¹,  Elaina Kefalianos¹,  Nicole Hill1¹,  Lauren Story¹, Lisa Cheshire¹ and Miki Maruyama¹
1 University Of Melbourne

Is mandatory attendance for practical classes a historic approach or is it based in sound pedagogy? This scoping review aimed to explore the evidence related to mandatory/ hurdle attendance at practical classes, simulations and skills labs and its association with performance in health professions education. 

Summary of work 

We undertook a systematic scoping review to ensure a systematic search, literature evaluation and descriptive synthesis of current research evidence for this topic (Peters et al., 2020; Tricco et al., 2018). Nine electronic databases (Medline, PsycINFO, CINAHL, Dissertation Abstracts, Education Full Text, ScienceDirect, ERIC, Google Scholar, and Web of Science) were searched using synonyms for the keywords: “academic performance” AND (medical OR dentistry OR health sciences) AND practical classes AND (attendance OR attendance-hurdle) AND “grades”. 

Results 

Nine studies were included in this review. Four studies in medical courses, two studies in health sciences and three studies in biology courses described the association between practical class attendance and student performance. One study in biology described the relationship between mandatory attendance policies on practical classes and performance. 

Discussion 

We found that attendance was positively associated with performance. However, these associations ranged from small to large, including between attendance and practical examination performance. We also found inconsistent associations between attendance hurdles and student performance. 

Conclusions 

This scoping review is the first to focus specifically on practical class attendance and performance. This scoping review may inform assessment design, policy review and organisational approaches to attendance hurdles within higher education. 

Take-home messages / implications for further research or practice
Further research should focus on perceived impacts of attendance hurdles on students and their beliefs about attendance hurdles in practical classes. Studies could determine the association of practical attendance with clinical performance. 

References (maximum three) 

Peters, M. D., Marnie, C., Tricco, A. C., Pollock, D., Munn, Z., Alexander, L., . . . Khalil, H. (2020). Updated methodological guidance for the conduct of scoping reviews. JBI evidence synthesis, 18(10), 2119-2126. 

Tricco, A. C., Lillie, E., Zarin, W., O'Brien, K. K., Colquhoun, H., Levac, D., . . . Straus, S. E. (2018). PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. In (Vol. 169, pp. 467-473).