Making the Grade in a Pass/Fail Environment: What It Means for Students

Dr. Richard ValachovicIn this month’s letter, ADEA President and CEO Dr. Rick Valachovic begins a two-part consideration of the merits and challenges of pass/fail grading.

Although the number of pass/fail dental schools has remained fairly stable over the decades, the concept itself has gained renewed attention in recent years, most notably through the National Board Dental Examinations’ (NBDE) 2012 move to pass/fail grading for dentistry and dental hygiene licensure exams. While this switch has been generally well received, especially by students, the shift away from a graded exam has raised some questions. Chief among these are: How can advanced dental education programs best evaluate candidates in the absence of a numerical grade on a standardized exam? And, What are the implications of pass/fail board exams for students who count on high exam scores to gain entry into competitive programs?

This month, I want to examine these issues from the point of view of students, especially those attending pass/fail schools. Next month, I will take a deeper look at the concerns of advanced dental education programs and share some of the ways ADEA is assisting them in adapting to the new testing landscape.

Most of you will remember that the Joint Commission on National Dental Examinations (JCNDE) elected to move to a pass/fail grading system because of concerns about the misuse of exam scores and the security of the questions on the NBDE. The purpose of the NBDE is to help state boards determine whether individuals are qualified to obtain licenses to practice dentistry or dental hygiene. The JCNDE has made clear that the exams are not valid instruments for determining differences in knowledge and ability among test takers who score within the range of passing grades. Nevertheless, board scores were widely used in the past to screen candidates for admission to advanced education programs or even to rank predoctoral programs. By moving to pass/fail grading on the NBDE, the JCNDE put an end to the misapplication of scores for these alternate purposes.

As it happens, I attended one pass/fail school (University of Connecticut School of Dental Medicine) and later taught at another (Harvard School of Dental Medicine [HSDM]). At pass/fail schools, students receive numerical grades on their assignments just as they would elsewhere, and faculty average these to determine a grade for each course. The difference comes in how these grades are reported. Typically, schools set a cutoff for passing, and sometimes grades above a higher threshold receive an honors designation.

I didn’t consider each school’s grading policy when I decided where to attend dental school, and grading is not necessarily a paramount concern for students choosing schools today. But in talking with two students on the ADEA Council of Students, Residents and Fellows (ADEA COSRF) Administrative Board, I learned that grading does factor into the equation for some students when choosing where to earn their predoctoral degrees.

“It was one of the things I was most interested in when applying to dental school,” said Alex Brao, ADEA Board Director for Students, Residents and Fellows. “As a prehealth major in college, there was an overwhelming sense of everyone battling each other. There was never any camaraderie. People were always thinking, how much higher can my grade be?”

Alex is in his fourth year at the University of California, San Francisco, School of Dentistry (UCSF SOD), where he says he has found the teamwork and cooperative learning environment he was seeking. He has also found opportunities for recognition within the school’s pass/fail framework. “Everyone is good at different things—perio, prosthodontics, hand skills—so it is not always the same people earning honors,” Alex told me, and, he added, honors can be earned through initiative as well as through performance. Work in the community or leadership activities, such as participation in ADEA governance, can also garner honors recognition at UCSF SOD.

From my perspective, the pass/fail approach has a lot to recommend it. By eliminating the competition for class rank, pass/fail grading creates an environment that is conducive to learning rather than rote memorization. Exams are designed to assess each student’s competency rather than to assess students’ achievements relative to one another. When people talk about the downsides of pass/fail grading, I often hear others point to the need for students at pass/fail schools who want to pursue advanced dental education to find ways of distinguishing themselves in the absence of numerical grades.

Alex is applying to GPR programs and appears confident that he will gain admission, in part because UCSF SOD has an excellent record of placing its graduates. At the same time, he is sympathetic to the concerns of students who are applying to highly competitive specialty programs. “You can no longer go to someone and say, I have a 4.0 GPA and 200+ board scores,” Alex told me. “There are a lot more questions and fewer assurances. I can understand someone’s frustration.”

In 2012, a group of researchers at HSDM surveyed students to try to quantify the impact of the move to a pass/fail NBDE, and they presented their findings at the 2014 ADEA Annual Session & Exhibition. By a ratio of 3-to-1, survey respondents felt the move to pass/fail grading decreased their chances of getting into a specialty residency, and 80% wanted another objective measure to differentiate themselves to specialty program directors.

Cameron Reece, a fourth-year dental student at the Roseman University of Health Sciences College of Dental Medicine – South Jordan, Utah (Roseman CODM), is among those students who favor the creation of a new test designed specifically for graduate admissions purposes. Roseman CODM is one of eight dental schools that currently use pass/fail grading.

“I think something is needed—an exam or a standardized portfolio—to give us a way to show how good we are as students,” Cameron told me, and he believes a lot of Roseman CODM students share this view. Cameron was drawn to Roseman CODM by the school’s innovative curriculum and his belief that he would thrive in a pass/fail environment. He credits pass/fail grading with allowing him to focus his energies on learning and to achieve more than he would have otherwise. But he also feels that pass/fail grading puts him and his classmates at a disadvantage in applying to advanced dental education programs.

“A lot of people put a lot of stock into class rank,” he believes. “Graduating from a pass/fail school does affect which programs will look at you. Some programs have said they will not interview pass/fail applicants.”

Would the creation of a new exam address these concerns? Both Cameron and Alex told me that this question has become a perennial topic at ADEA COSRF meetings. Cameron would like to see proponents of a new exam advocate more strongly on behalf of this goal. Alex is less certain. “After all these meetings I’ve been to, I don’t know what the right answer is,” Alex confided. “I’m not in favor of more exams and more requirements, but I feel for the students who want to enter the specialty programs.”

While students and others deliberate this question, the American Dental Association is developing an admissions test for advanced dental education programs, which it expects to release in 2016. The precise scope of its content is still unclear, but the test will likely suit some programs better than others. It will be up to individual programs to decide whether or not the test will be a valuable admissions tool to add to those they already use.

Meanwhile, it’s important to remember why pass/fail systems emerged in the first place. They came about because most of us agree that (1) numerical grades are not necessarily reflective of the competencies needed to be a successful professional or resident, and (2) selection for advanced dental education programs should be based on additional qualities other than the ability to earn a high score on a high-stakes exam.

Pass/fail grading of courses and exams may indeed place new demands on students to find other ways to distinguish themselves from their peers, but I see a system that encourages students to take time for research, community service, leadership activities and the like, as all to the good. As Alex noted, the people who put forth the effort, succeed. “It takes a little bit more—externships, fellowships—but it makes them better applicants overall because they really know what it is they want to do.”

Developing the attributes graduate programs are seeking—commitment, compassion, leadership and teamwork skills—enriches students and, ultimately, the profession. Next month I will talk about the challenges that advanced dental education programs face in selecting the best candidates for their programs.

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