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?’