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.