Relationship of pass/fail grading and curriculum structure with well-being among preclinical medical students: A multi-institutional study

Darcy A. Reed, Tait D. Shanafelt, Daniel W. Satele, David V. Power, Anne Eacker, William Harper, Christine Moutier, Steven Durning, F. Stanford Massie, Matthew R. Thomas, Jeff A. Sloan, Liselotte N. Dyrbye

Research output: Contribution to journalArticlepeer-review

84 Scopus citations

Abstract

Purpose: Psychological distress is common among medical students. Curriculum structure and grading scales are modifiable learning environment factors that may influence student well-being. The authors sought to examine relationships among curriculum structures, grading scales, and student well-being. Method: The authors surveyed 2,056 first- and second-year medical students at seven U.S. medical schools in 2007. They used the Perceived Stress Scale, Maslach Burnout Inventory, and Medical Outcomes Study Short Form (SF-8) to measure stress, burnout, and quality of life, respectively. They measured curriculum structure using hours spent in didactic, clinical, and testing experiences. Grading scales were categorized as two categories (pass/fail) versus three or more categories (e.g., honors/pass/fail). Results: Of the 2,056 students, 1,192 (58%) responded. In multivariate analyses, students in schools using grading scales with three or more categories had higher levels of stress (beta 2.65; 95% CI 1.54-3.76, P < .0001), emotional exhaustion (beta 5.35; 95% CI 3.34-7.37, P < .0001), and depersonalization (beta 1.36; 95% CI 0.53-2.19, P = .001) and were more likely to have burnout (OR 2.17; 95% CI 1.41-3.35, P = .0005) and to have seriously considered dropping out of school (OR 2.24; 95% CI 1.54-3.27, P < .0001) compared with students in schools using pass/fail grading. There were no relationships between time spent in didactic and clinical experiences and well-being. Conclusions: How students are evaluated has a greater impact than other aspects of curriculum structure on their well-being. Curricular reform intended to enhance student well-being should incorporate pass/fail grading.

Original languageEnglish (US)
Pages (from-to)1367-1373
Number of pages7
JournalAcademic Medicine
Volume86
Issue number11
DOIs
StatePublished - Nov 2011

ASJC Scopus subject areas

  • Education

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