If you’re looking to apply for medical school in the U.S., then you are very familiar with A-F grading and the 4.0 grade point system. Virtually all undergraduate programs assign you a letter grade for the majority of classes you take, and we all stress out about our GPA at the end of each semester. It can be tough to imagine any other grading scheme, but some medical schools try and buck the system. MEDICAL SCHOOL GRADING SYSTEMS Medical school grades are almost universally given in one of three ways. (It’s actually more like two different ways, but I’ll get into that later.) The more traditional programs stick to the 4.0, A-F grading scale that you’re the most familiar with. That’s right, your GPA nightmares will continue to haunt you every time you receive your end of semester grades in medical school. Alternatively, other schools use a binary Passor Fail scale to indicate whether or not you have acquired the minimum knowledge base to... well... err… pass. Pass/Fail medical schools have become increasingly common, but we’ll discuss below why this can very misleading. The final evaluation method is basically just a combination of these two systems. In addition to Pass or Fail, you can also receive a High Pass, or even Honors for each class. As you may have put together, this creates four-five convenient levels of performance. Schools feel that this is totally different than the five letters used in the A-F system, but don’t be fooled. This is why I feel like there are really only two grading systemsl: A-F, Honors-Pass-Fail,, and the very rare true Pass/Fail medical school. I found it surprising that more than half of programs in the U.S. claim to be Pass/Fail medical schools, while only less than 20% use the A-F scale. The binary grading system has seemed to take over medical education, as other systems are being phased out. There has to be some benefit, right? WHAT’S THE ADVANTAGE TO A PASS/FAIL MEDICAL SCHOOL? The main advantage to a true Pass/Fail medical school is the perceived lower level of competition between students. Supposedly, if you are not being ranked directly against your peers, and are instead only motivated to properly learn the material, you are more likely to work cooperatively with your fellow students. More importantly, you are theoretically LESS likely to sabotage or otherwise hinder the others in your class if you are not actively competing with them for a higher grade. More elite medical schools (UCSF, Harvard, Mayo etc.) attract some of the most intelligent and capable students in the world. Ranking their students against one another is counter-productive. We already know that these individuals are the best of the best, and an average student at UCSF is likely a stronger candidate than one of the top students at many other schools (at least that is the idea). In these situations Pass/Fail medical school grading systems make the most sense. However, for students who go to less prestigious schools, class rankings (although stressful) can allow you to stand out. Additionally, competition is a major stressor on both medical students and residents alike. Residencies in certain specialties are notoriously difficult to obtain, making every exam feel like a potential career ender. Resident performance can also doom your fellowship chances. Every year students and residents are overwhelmed by the pressure put on them to succeed, and every year students drop out or (worse) even commit suicide. As a student who went to a straight A-F grading medical school, I will give some support to the less competition is better argument. Only a small percentage of students at my program were able to achieve the highest evaluation in each class. Predictably, there was a lot of note hoarding, elite study groups that rejected weaker students, and even (a very small amount) cheating. I had friends who were on the edge of breakdowns due to the performance stress, and Although I do not have first hand experience, I can imaging that a school with no internal ranking system would be more cooperative and congenial. Obviously, there will always be stress and competition (this is medical school after all). However, taking grades out of the picture is probably one of the most effective solutions to combat the competitive atmosphere. What’s the catch? As the common phrase goes: “anything too good to be true, usually is”. There are only a very small fraction of true Pass/Fail medical schools without any internal rankings for the first two years. Yes, on interview day the dean will tell you that there are no grades and that their program is competition free and full of rainbows and sunshine. However, almost every school will still keep an internal ranking of their students based on test performance. When you go to apply for residency, your school will almost always use your class rank in comments on your MPSE (commonly referred to as the dean’s letter). Although your exact rank number may not be used in your letter, there is a reference to your relative performance. “Secret rankings” at a Pass/Fail medical school, in my opinion, completely sabotage the spirit of using the binary grading system. I imagine being even more stressed at not knowing where I fall on the academic achievement curve, but also knowing that my performance will impact my career. Unfortunately, it is not always clear as an applicant which schools keep Secret Rankings, and which do not. I would wager that if you are not going to one of the top 25 medical schools, you should assume that your class ranking will come up eventually. Which Schools Use Which Grading System? After some searching, I found that it was surprisingly difficult to find an updated list of the different grading systems used by each medical school. There’s an old AAMC survey from 2011, but I suspected that many have changed since that time. For a more accurate list, you can look at the Medical School Admissions Requirements (MSAR) page for yearly updates, average MCAT scores, and pretty much all the statistics you could ever want. Unfortunately, it costs $28 for access to all of the information. I know, it blows. But if you’re applying this year, it will probably be the best $28 you’ll spend. Save yourself $50 on a secondary to a school that doesn’t take out of state applicants and pay for this website. HOW IMPORTANT IS THE GRADING SYSTEM WHEN CHOOSING A MEDICAL SCHOOL? This can be a tough pill to swallow, but focusing on finding a true Pass/Fail medical school is simply not a useful solution for over 90% of applicants. Yes, the first two years may be significantly less stressful at these schools. Your colleagues will likely be less competitive and more willing to work together. But in reality, there preclinical curriculum is only a small part of the picture. If you are truly one of the most competitive students in the country, then perhaps you can afford to focus on applying to only Pass/Fail medical schools. However, for most of us the grading system will take second seat to actually getting an acceptance. Geographical location can also be a big factor: would you rather go to medical school in the city of your dreams (whether that be near family or as far away as you can get) that has A-F grading, or move 3,000 miles away to go to a Pass/Fail medical school? Overall, I wouldn’t worry too much about the curriculum during the preclinical years. Once (if) you have multiple acceptances, then you can focus on the details. Did you go to a Pass/Fail medical school? Why do you want that system? Let us know in the comments!