University of Michigan Medical School, Ann Arbor, 48109, USA.
Adv Health Sci Educ Theory Pract. 2010 Oct;15(4):469-77. doi: 10.1007/s10459-009-9211-1. Epub 2009 Dec 12.
Traditionally, medical schools have tended to make assumptions that students will "automatically" engage in self-education effectively after graduation and subsequent training in residency and fellowships. In reality, the majority of medical graduates out in practice feel unprepared for learning on their own. Many medical schools are now adopting strategies and pedagogies to help students become self-regulating learners. Along with these changes in practices and pedagogy, many schools are eliminating a cornerstone of extrinsic motivation: discriminating grades. To study the effects of the switch from discriminating to pass-fail grading in the second year of medical school, we compared internal and external assessments and evaluations for a second-year class with a discriminating grading scale (Honors, High Pass, Pass, Fail) and for a second-year class with a pass-fail grading scale. Of the measures we compared (MCATs, GPAs, means on second-year examinations, USMLE Step 1 scores, residency placement, in which there were no statistically significant changes), the only statistically significant decreases (lower performance with pass fail) were found in two of the second-year courses. Performance in one other course also improved significantly. Pass-fail grading can meet several important intended outcomes, including "leveling the playing field" for incoming students with different academic backgrounds, reducing competition and fostering collaboration among members of a class, more time for extracurricular interests and personal activities. Pass-fail grading also reduces competition and supports collaboration, and fosters intrinsic motivation, which is key to self-regulated, lifelong learning.
传统上，医学院校倾向于假设学生在毕业后以及随后在住院医师和研究员培训中“自动”有效地进行自我教育。实际上，大多数在实践中的医学毕业生都感到自己没有准备好自学。许多医学院正在采取策略和教学法来帮助学生成为自我调节的学习者。随着实践和教学法的这些变化，许多学校正在取消外在动机的基石：区分成绩。为了研究从第二年医学院的区分成绩到通过/失败评分的转变的影响，我们比较了具有区分评分量表（荣誉，高分，及格，不及格）的第二年班级和具有通过/失败评分量表的第二年班级的内部和外部评估和评估。在我们比较的措施中（MCAT，平均绩点，第二年考试的平均值，USMLE Step 1 分数，住院医师安置，其中没有统计学上的显着变化），只有两项第二年课程的统计学显着降低（通过/失败的成绩较低）。另一门课程的表现也显着提高。通过/失败评分可以满足几个重要的预期结果，包括为具有不同学术背景的新生“公平竞争”，减少竞争并促进班级成员之间的合作，为课外兴趣和个人活动提供更多时间。通过/失败评分还减少了竞争，支持了协作，并激发了内在动机，这是自我调节，终身学习的关键。
