University of California, San Diego School of Medicine, 9500 Gilman Drive #0606, San Diego, CA 92093-0606, USA.
BMC Med Educ. 2014 Jun 30;14:127. doi: 10.1186/1472-6920-14-127.
To assess the impact of a change in preclerkship grading system from Honors/Pass/Fail (H/P/F) to Pass/Fail (P/F) on University of California, San Diego (UCSD) medical students' academic performance.
Academic performance of students in the classes of 2011 and 2012 (constant-grading classes) were collected and compared with performance of students in the class of 2013 (grading-change class) because the grading policy at UCSD SOM was changed for the class of 2013, from H/P/F during the first year (MS1) to P/F during the second year (MS2). For all students, data consisted of test scores from required preclinical courses from MS1 and MS2 years, and USMLE Step 1 scores. Linear regression analysis controlled for other factors that could be predictive of student performance (i.e., MCAT scores, undergraduate GPA, age, gender, etc.) in order to isolate the effect of the changed grading policy on academic performance. The change in grading policy in the MS2 year only, without any corresponding changes to the medical curriculum, presents a unique natural experiment with which to cleanly evaluate the effect of P/F grading on performance outcomes.
After controlling for other factors, the grading policy change to P/F grading in the MS2 year had a negative impact on second-year grades relative to first-year grades (the constant-grading classes performed 1.65% points lower during their MS2 year compared to the MS1 year versus 3.25% points lower for the grading-change class, p < 0.0001), but had no observable impact on USMLE Step 1 scores.
A change in grading from H/P/F grading to P/F grading was associated with decreased performance on preclinical examinations but no decrease in performance on the USMLE Step 1 examination. These results are discussed in the broader context of the multitude of factors that should be considered in assessing the merits of various grading systems, and ultimately the authors recommend the continuation of pass-fail grading at UCSD School of Medicine.
评估加利福尼亚大学圣地亚哥分校（UCSD）医学生学业成绩的预临床分级制度从优秀/及格/不及格（H/P/F）变为及格/不及格（P/F）的影响。
收集了 2011 年和 2012 年（固定分级班级）学生的学业成绩，并与 2013 年（分级变化班级）学生的成绩进行了比较，因为 UCSD SOM 的分级政策在 2013 年发生了变化，从第一年（MS1）的 H/P/F 变为第二年（MS2）的 P/F。对于所有学生，数据包括来自 MS1 和 MS2 年的基础临床前课程的考试成绩和 USMLE Step 1 成绩。线性回归分析控制了其他可能预测学生表现的因素（即 MCAT 分数、本科平均绩点、年龄、性别等），以隔离分级政策变化对学业成绩的影响。仅在 MS2 年改变分级政策，而不对医学课程进行任何相应的改变，这为评估 P/F 分级对绩效结果的影响提供了一个独特的自然实验。
在控制其他因素后，MS2 年 P/F 分级政策的改变对第二年成绩相对于第一年成绩产生了负面影响（与 MS1 年相比，固定分级班级在 MS2 年的成绩下降了 1.65%，而分级变化班级的成绩下降了 3.25%，p<0.0001），但对 USMLE Step 1 成绩没有明显影响。
从 H/P/F 分级到 P/F 分级的改变与基础临床前考试成绩下降有关，但 USMLE Step 1 考试成绩没有下降。这些结果在评估各种分级系统优点时应考虑的众多因素的更广泛背景下进行了讨论，最终作者建议 UCSD 医学院继续采用及格/不及格分级。
