Are Grades Failing Students?

Illustration of a student surrounded by stacked books and stressing over grades.

More pharmacy schools are considering pass/fail grading systems, hoping to return to the original intention of letter grades: motivation.

By Athena Ponushis

Shortly after Dr. Gary Pollack arrived at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences and assumed his position as dean, he began discussions with the faculty about how to nurture student success through a new grading system that would emphasize learning concepts over the attainment of letter grades. He was interested in systems that would support students rather than label them. Over the course of the 2022 spring semester, he and his team strategized and met with faculty members to share thoughts and ideas. After a three-day curricular retreat in early summer 2022, faculty and staff finalized a system design and last fall, he and his team introduced an honors/satisfactory/unsatisfactory (modified pass/fail) grading system. His hope is to reduce student stress while strengthening intrinsic motivation. “Redirecting students’ primary focus from the grades they earn to what they actually learn is of the utmost importance,” Pollack said.

In his opinion piece for The New York Times, “Pass-Fail Raises the Question: What’s the Point of Grades?” Jack Schneider, professor of education at the University of Massachusetts, quoted American economist and sociologist Thorsten Veblen. More than 100 years ago, Veblen observed that the pursuit of grades “progressively sterilizes all personal initiative and ambition that comes within its sweep.” Today, some professors of pharmacy education continue to see students consumed with earning an ‘A,’ disregarding their innate desire to discover more.

The original intention of letter grades may have been to motivate students, giving them a prized ‘A’ to work toward and claim, but somewhere along the way, the grade eclipsed the learning. Pharmacy schools, like Buffalo, looking to shift the focus away from grades and back to intrinsic learning, are adopting pass/fail grading systems. The vast majority of medical schools (more than 75 percent) use a form of pass/fail grading, compelling more pharmacy schools to contemplate the move as a means to promote student well-being, motivation and collaboration, and lower anxiety, stress and competition.

Pollack has been questioning the implications of letter grades for 20 years and said there are four aspects that have guided his thinking. The first, which may be more salient now than ever, is mental health. A traditional letter grading system involves a full complement of pluses and minuses, creating 12 or so grade designations. This places most students within a few points of a grade boundary, which puts them in a state of perpetual stress in every course. “We just don’t need to be piling on additional stress for no learning gain,” Pollack said.

Second, faculty are often troubled that their discussions with students are dominated by concerns about their grades, not content. Students ask faculty if their grades can be changed, “and we incentivize students to do that because they think, ‘If I only get a point here or a point there, I can improve from one letter category to another,’” he added.

Third, letter grades instigate competition. “It’s the perception and sometimes the reality that each grading category has a limited number of slots, so a student sitting in class may glance at the student sitting in the next seat and think, ‘Your failure is my opportunity,’” he pointed out. Meanwhile, student pharmacists are taught that the provision of healthcare is a team sport and that they must collaborate as members of a team, not compete.

Lastly, Pollack said faculty members can use grades as labels. “We often talk to each other about our students like, ‘This is an ‘A’ student,’ or ‘This is a ‘B’ student,’ and that label confers a different level of competence or mastery of the material,” he noted. But when a grade of 90.0 earns a student an A minus and an 89.9 earns another student a B plus, how do you distinguish a meaningful difference in the two students’ capability? “We are not being honest with our students and we are not being honest with the people who evaluate student transcripts by pretending there are meaningful differences in what those two students can do.”

Those four factors drove Pollack to work with the faculty to look for another system. He assembled three teams at the UB School of Pharmacy to embark on a curricular revision that included faculty, staff, alumni and students. One team was charged with studying evidence-based approaches to teaching and learning to restructure a Pharm.D. curriculum with a clean slate. Dr. William Prescott, department chair, pharmacy practice, led that team and found their mission liberating: “We were able to say, if we could design a curriculum from scratch, this is what we would do.”

The idea for a modified pass/fail approach to grading came from that group. They looked at the literature, examples of medical schools, including UB’s own, as well as other schools of pharmacy. They saw no difference in board pass rates or residency match rates but found better on-time graduation rates. Then they thought about the metrics they cared about. “We want to graduate pharmacists who provide high-quality patient care, engage in research and scholarship and take a leadership role in advancing the practice of pharmacy,” Prescott said. “Letter grades are not always an accurate measure of learning and can be a source of stress for students. We believe a pass/fail system will help us cultivate the pharmacists we want to graduate by fostering intrinsic motivation and shifting students’ focus from the grade they received to, ‘What did I learn, what did I not learn and what content do I need to revisit to better understand the material?’”

UB may have just launched the new grading system for its first year Pharm.D. class—giving honors for an overall score of 90 percent or higher and satisfactory for an overall score of 70 or better—but Prescott has already seen a shift. The school runs exam reviews and students who do not perform well on an assessment are required to attend so they can see the material again and ask instructors questions. “In the past, when I and other faculty have run an exam review the questions tend to be nitpicky about the exam questions themselves, about the validity of the items,” Prescott said. “The exam reviews we held last semester felt different. Questions from students were based on gaining a better understanding of the material, instead of trying to boost their grade.” Anecdotal as it may be, Prescott found it refreshing to hear students ask, ‘Why did I get this wrong?’ versus, ‘Is there any way I can get more points for this question?’


We want to graduate pharmacists who provide high-quality patient care, engage in research and scholarship and take a leadership role in advancing the practice of pharmacy. Letter grades are not always an accurate measure of learning and can be a source of stress for students.

Dr. William Prescott

Collaboration, Not Competition

Since its inaugural class in 2017, the Medical College of Wisconsin School of Pharmacy has used a satisfactory/unsatisfactory assessment across its curricula, but it was during the 2022 October white coat ceremony honoring the Pharm.D. class of 2025 having completed one academic term, when founding dean and professor Dr. George MacKinnon saw its fruition. “Students crossed the stage and stepped up to the mic to give gratitude to those who helped them get to where they are, and as I stood there and listened to them, it struck me, many of the students were thanking their peers, recognizing each other as their support,” MacKinnon said.

He believes the pass/fail curriculum has helped foster such a collaborative spirit and was given further validation recently. MCW School of Pharmacy requires an interprofessional education rotation in its IPPE model that consists of seven required IPPEs (totaling 560 hours), placing student pharmacists with non-pharmacists so they see healthcare from someone else’s lens and identify opportunities for medication-related areas for pharmacists to be involved. MacKinnon recalled two students telling him, ‘I’m not sure I would have been ready for my IPE with my nurse practitioner had I not experienced the way we work as a team here, because I did not have to come in and be all-knowing, but I had to know what role I could contribute to the team.’ MacKinnon trusts his students felt comfortable doing that because of their pass/fail curriculum, and that’s the result he wants to see.

“When they finish their pharmacy program with us, I want my graduates to know what team-based care is, I want them to know their role in team-based care, and maybe even more importantly, I want them to know when they don’t see a team, what to do and how to get a team formed,” MacKinnon said. He also wants to nurture intrinsic learners. After each exam, his students are given a strength and opportunities report, which identifies where they did well or didn’t do well. “Here’s the quandary, and that is even in a letter grade system, if a student gets an 80 percent and that might be a ‘B,’ OK great, but what 20 percent didn’t you know? To me, that’s the philosophical area I really struggle with.” Even in a pass/fail system, the passing level could be 70 percent, but again, what 30 percent did the student not know?

MacKinnon proposed a way for his students to see and understand what they may have missed on the exam: “You take your exam in the first hour of class. When you are done, you walk to another room, sit down at a table and take the same exam over again, now as a team. The four of you must come up with one answer that you submit for each question,” he explained. “At that point in time, you would be able to identify areas maybe you didn’t know, but now through the team, you identify the correct answer.”

MacKinnon remembers the moment he thought of the idea, before his school even launched its Pharm.D. program. He was walking down the hallway and heard two medical students who had just taken a pharmacology exam. “They were asking, ‘Well, what did you put for that one?’ ‘Here’s what I put, I thought it was this.’ They were teaching each other,” MacKinnon said. “What I wanted to do was capture that conversation from the hallway and put it in the classroom.”

They’re not alone: UB implemented collaborative testing this past fall semester in parallel with its pass/fail system. “This was another recommendation that originated from our curricular revision team. We know peer-to-peer teaching is effective and have been using team-based learning for years, but never applied that concept to higher stakes examinations,” Prescott said. “We’re pilot testing it this year, comparing student performance in the traditional and collaborative testing environments.”


In schools of medicine, they have found that going to a pass/fail grading system has increased well-being, motivation and collaboration among student groups and decreased competition, anxiety and stress. Those are the things they have identified, so why wouldn’t we see the same in academic pharmacy?

Dr. George MacKinnon

What Does a GPA Mean?

Karen MacKinnon, director of outreach and assistant professor at MCW School of Pharmacy, published an article in the American Journal of Pharmaceutical Education, “Survey of Pass/Fail Grading Systems in US Doctor of Pharmacy Degree Programs,” in June 2021. Along with colleagues she identified 10 Pharm.D. programs using pass/fail grading systems, gathered data from eight and found that the minimum pass level also varied by institution, ranging from 70 percent to 90 percent.

“In schools of medicine, they have found that going to a pass/fail grading system has increased well-being, motivation and collaboration among student groups and decreased competition, anxiety and stress,” George MacKinnon said. “Those are the things they have identified, so why wouldn’t we see the same in academic pharmacy?”

The AJPE article generated so much interest that the MCW School of Pharmacy held a pass/fail education forum in January 2022, led by Karen MacKinnon. “We have 142 schools of pharmacy in the Academy and we had 70 schools attend our virtual forum wanting to hear more about pass/fail education,” she said. She and others gave an overview of what medical schools have done, then focused on learning from pharmacy schools that presently have pass/fail educational programs. Attendees were grouped into breakout sessions where they openly discussed four topics: curriculum, assessment, recruitment as well as preceptor and faculty development.

“We asked the groups what should our next steps be, what do you want to focus on, and they said, ‘We want to further investigate the different types of assessments,’” she said. She hosted a follow-up session in April, opening up the conversation to other colleges that wanted to explore questions such as the minimum passing level, grade designations (honors, pass, fail, satisfactory unsatisfactory) and whether to share numerical scores with students and calculate a GPA. Realizing one obstacle was the lack of data pass/fail schools could provide to resident program directors, Karen MacKinnon and her colleagues met with the American Society of Health-System Pharmacists (ASHP) and continue to educate resident program directors on pass/fail systems, asking them to evaluate candidates from a holistic view and making sure they know what a GPA is derived from.

George MacKinnon has seen elements of the Pharm.D. curriculum gravitating to pass/fail grading. “Preceptors don’t like to hear students groveling for extra points to raise their grades,” he said, so some APPEs and IPPEs, mostly evaluated by outside volunteer preceptors, have already moved to pass/fail scores. Lab skills can also be difficult to assess by letter grades, so the laboratory approach to pass/fail appears to be on the rise. “What might end up happening,” George MacKinnon clarified, “is that a GPA may only reflect a student’s didactic knowledge and not the full complement of an individual’s skills and abilities in a Pharm.D. program.”

MCW School of Pharmacy has produced three cohorts of graduates, matching or exceeding the national level for NAPLEX and exceeding the national placement rate for residents. The MacKinnons believe the pass/fail system supports the pharmacists they want to graduate. Graduates are comfortable speaking up in teams, advocating for patients, and are intrinsically motivated, lifelong learners, which is what the profession needs. “There are so many drug classes and ways in which we treat patients that have evolved since I graduated from pharmacy school, and I’ve had to learn that on my own,” George MacKinnon noted. “I didn’t get any letter grade at the end of it. As a pharmacist, I just had to know it.”

Back at UB, Pollack and his team are phasing in their modified pass/fail system over four years, collecting data to assess its impact on student stress and academic performance. Faculty will take a look at board pass rates and residency match rates among the students who participated in the pass/fail grading model and the class before them to ensure that the changes are having the desired impact.

Pollack feels confident in UB’s move. “Academic health professions often look to medicine as the gold standard in a variety of ways and there has to be a reason why the vast majority of medical schools in the United States use a modified pass/fail system for grading,” he said. “It’s a little bit surprising to me that academic pharmacy has not moved in the same direction much earlier than this, so I would suggest that my dean colleagues look to academic medicine and look at what they are doing.”

Athena Ponushis is a freelance writer based in Ft. Lauderdale, Florida.