JMIR Publications

ABSTRACT

Background:

The impact of Pass/Fail or Tiered Grade assessment for exams in undergraduate medical education causes much debate while there is little data to inform decision making. The increasing number of medical schools transitioned to Pass/Fail assessment has raised a concern about medical students’ academic performance. In 2018, 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:

To evaluate medical students’ academic performance at the final licensing exam in relation to exam grading principle.

Methods:

This single-centre cohort-study at the Aalborg University Medical School, North Denmark Region assess the change from 2-digit Tiered Grade to Pass/Fail evaluation and vice versa of undergrade medical students’ exams after the 4th and 5th year clinical training modules from Autumn 2015 through Spring 2023. The primary outcome was the number of students failing clinical training exams, and the final licensing exam grades.

Results:

Among the total of 7,634 exams, 7,164 4th and 5th year clinical training exams were included in the comparisons of which 3,047 (42.5%) were Pass/Fail exams and 4,117 (57.5%) were Tiered Grade exams. The frequency of students failing exams was 3,3% (n=101/3,047) at Pass/Fail and 1.97% (81/4,117) with Tiered Grade exams (p<0.001). This difference was levelled out when counting the near failure tiered grade as fail. Tiered Grade exams did not differ between semesters (p=0.99) nor show a time trend at the 4th year (p=0.66). The final licensing exam grades were unaltered (p=0.47).

Conclusions:

Despite our expectation, Pass/Fail exams exhibit a higher fail rate compared to Tiered Grade exams without lowering the final academic performance. These results suggest that a shift from tiered grading to Pass/Fail assessment redirects the focus from rewarding high performance to ensuring standards are maintained among underperforming students.