Pass/Fail Grading in Pharmacy Education

Katie Zimmerman, PharmD, MS
PGY-1 Pharmacy Resident
MedStar Harbor Hospital

The current grading system used in education has origins in the grading scale implemented by Yale president Ezra Stiles in 1785 and was based on the descriptions Optimi, Second Optimi, Interiores, and Perjores1 . Prior to that time, assessments were used as a formative learning tool instead of an evaluative one - meaning that they were used to identify gaps in a student’s learning and assess how to address them moving forward in a student’s education1 . In the early 1900s, American education began to prioritize standardized communication between different academic institutions which led to the A-F grading system being adopted in many schools, including pharmacy schools, across the country1,2. Systems like this, which can induce a spirit of competition between students as well as which can cause students to focus solely on their grade instead of the ongoing learning process, have been debated by scholars for as long as grading has been practiced. 

In more recent years, there has been a movement toward a pass/fail or a modified pass/fail grading system in the pharmacy school setting. The aim of this shift in practice is to emphasize student learning over attainment of letter grades. In fact, the University of Buffalo School of Pharmacy just launched a new modified pass/fail grading system in its school with the goal of “graduating pharmacists who provide high-quality patient care, engage in research and scholarship, and take a leadership role in advancing the practice of pharmacy” because “letter grades are not always an accurate measure of learning.”3 Educators at this institution hope that by shifting the focus from a grade to what was learned and what needs to be reviewed students will be better able to understand and apply the information moving forward3 . On top of the emphasis on learning, students in schools which have transitioned to pass/fail grading systems have increased well-being, increased motivation, and collaborate better with their fellow students while having a decreased sense of competition, anxiety, and stress3,4.

A recent study surveyed US pharmacy schools which utilize pass/fail grading. Of the eight schools which responded, all of them used a pass/fail system for introductory pharmacy practice experience (IPPE) courses with the majority (88%) also using them for didactic, elective, laboratory, and interprofessional courses as well as advanced pharmacy practice experiences (APPEs)4 . The institutions used differing language (ex. pass, no pass, satisfactory, unsatisfactory, etc.) within each of their pass/fail systems as well as had varying minimum pass levels ranging from 70% to 90%4 . One institution calculated a GPA based on each student's numerical grade while other institutions provided class rank, overall percentile, or comments from APPE preceptors4 . The individual schools all had their own processes to address student failure/remediation to determine student progression within the program4. 

A concern some in the field have from this pass/fail system is whether or not a graduate is adequately prepared for what comes after their PharmD program. Are they looked upon poorly for residency consideration? Are adequately prepared for the North American Pharmacist Licensure Examination (NAPLEX)? The survey respondents also differed in how information was communicated to residency program directors with some calculating a GPA and others including more qualitative information or an explanation of how the pass/fail system worked at their institution4 . The Medical College of Wisconsin School of Pharmacy has graduated three cohorts using the pass/fail system which have exceeded the national average for residency placement rates3 . With regard to passing licensing exams, these students have also matched or exceeded the national level for NAPLEX pass rates3. 

While the adoption of pass/fail grading systems in US pharmacy schools lacks standardization, it does not inhibit students’ prospects as they move forward into pharmacy careers. Students also experience less stress and anxiety while increasing their collaboration with others during their time in school. Given these facts, all pharmacy schools should consider a shift to pass/fail grading in their institutions for experiential learning as well as didactic and laboratory courses. Adoption of these methods in more schools will increase data surrounding best practices to allow schools to continue to adjust their pass/fail systems for the benefit of their students. 

References: 1. Lee C. What is the history of grading? Turnitin. October 14, 2020. Accessed September 30, 2023. https://www.turnitin.com/blog/what-is-the-history-of-grading. 2. McNutt C. A Brief History of Grades and Gradeless Learning. Human Restoration Project. August 8, 2022. Accessed September 30, 2023. https://www.humanrestorationproject.org/writing/a-brief-history-of-grades-andgradeless-learning. 3. Ponushis A. Are grades failing students? American Association of Colleges of Pharmacy. 2023. Accessed September 30, 2023. https://www.aacp.org/article/aregrades-failing-students. 4. Spiess JP, Walcheske E, MacKinnon GE, MacKinnon KJ. Survey of Pass/Fail Grading Systems in US Doctor of Pharmacy Degree Programs. Am J Pharm Educ. 2022;86(1):8520. doi:10.5688/ajpe8520