A reader asks, “I was just curious if grading in Med-school is like high school or college like letter grades or if its more of a pass/fail thing. I’m sure they use scores for rankings and internship and residency selection, but do you feel that they really represent your progress in becoming a doctor?”
There are two questions that need to be answered: 1. How are students tested? 2. How are students graded?
The majority of medical schools employ multiple-choice tests when examining students’ progress. The questions typically take the form of a clinical vignette such as, “a 34-year-old woman presents with upper abdominal pain of one hour’s duration. She stated that it began after eating chili. What is the first step you take?” These tests do a pretty good job of ensuring that students have properly studied the material. Granted, medical students can generally find reasons to complain about a particular exam, claiming that the wording was insufficient, that there were more than one correct answer choice, or that the material was never taught in class. And while I have seen some very poorly written tests, for the most part they do a good job in representing our progress to become doctors.
The difference occurs with the frequency at which tests are given as well as who writes the questions. You’ll find that some schools give exams every Friday. Others might give tests every two weeks on a Monday. While there are some that give exams only at the end of the semester and use it as the sole determining factor of your grade. Further, there seems to be a variety of sources where course coordinators can draw questions. My own university requires professors to submit three exam questions with each lecture they give. Other universities employ the Shelf exams to test students. Shelf exams are written by the National Board of Medical Examiners, the same group that puts out the Medical Licensing Exam. These tests are standardized and are given all across the country. When you apply for medical school, be sure to ask how students are tested, as there is no universal method employed by all universities.
As far as the grading mechanism, there is also much variability between schools. My own university uses a pass/fail system, where we are merely assigned a P or an F on the transcript. The school has set an exam score of 70 as the cutoff for passing. We are then internally ranked where students are placed into quartiles at the end of each year. No one will ever know his/her individual rank, but will be provided with his quartile standing.
Other universities use the old college system with an A-F grading scale. Using this method, students know exactly where they stand. Other universities use an awkward hybrid system with honors, high pass, pass, marginal pass, and fail that eerily resembles the A-F scale. Again, you’re on your own to discover which method is employed by each school.
Finally, almost every medical school as an honor system known as Alpha Omega Alpha (AOA). The students who belong to this group represent the top 12% or so of each graduating class. To claim AOA status is a universal distinction recognized by all residency programs. In short, if you are a member of AOA, you can pretty much write your ticket to any residency.