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Acad Med. 2009 May;84(5):655-62. doi: 10.1097/ACM.0b013e31819f6d78.

A change to pass/fail grading in the first two years at one medical school results in improved psychological well-being.

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Department of Cell Biology, University of Virginia School of Medicine, Charlottesville, Virginia 22908-0732, USA.



To measure the impact of a change in grading system in the first two years of medical school, from graded (A, B, C, D, F) to pass/fail, on medical students' academic performance, attendance, residency match, satisfaction, and psychological well-being.


For both the graded and pass/fail classes, objective data were collected on academic performance in the first- and second-year courses, the clerkships, United States Medical Licensing Examination (USMLE) Steps 1 and 2 Clinical Knowledge (CK), and residency placement. Self-report data were collected using a Web survey (which included the Dupuy General Well-Being Schedule) administered each of the first four semesters of medical school. The study was conducted from 2002 to 2007 at the University of Virginia School of Medicine.


The pass/fail class exhibited a significant increase in well-being during each of the first three semesters of medical school relative to the graded class, greater satisfaction with the quality of their medical education during the first four semesters of medical school, and greater satisfaction with their personal lives during the first three semesters of medical school. The graded and pass/fail classes showed no significant differences in performance in first- and second-year courses, grades in clerkships, scores on USMLE Step 1 and Step 2CK, success in residency placement, and attendance at academic activities.


A change in grading from letter grades to pass/fail in the first two years of medical school conferred distinct advantages to medical students, in terms of improved psychological well-being and satisfaction, without any reduction in performance in courses or clerkships, USMLE test scores, success in residency placement, or level of attendance.

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