This study examines the effects of changing the clerkship grading system at our institution from a traditional tiered scale to Satisfactory/Unsatisfactory grading. Scores on the National Board of Medical Examiners (NMBE) subject examination in Clinical Neurology are an objective measure that could reflect how changes in the grading system may impact learning. 

Medical schools are continually undergoing innovative changes for curriculum improvement including revision of grading systems. In an attempt to reduce student anxiety and stress, many academic institutions have transitioned from traditional tiered grading to a satisfactory/unsatisfactory grading system. It is unclear what effect this change has had on learning and academic outcomes, specifically, end of clerkship national examinations.

A retrospective analysis was performed on available data two years prior to implementation of the Satisfactory/Unsatisfactory grading system from 2018 to 2020 and two years after from 2020 to 2022. The academic outcomes assessed were first-attempt fail rate, one standard deviation below equated percent correct national means and mean NMBE Clinical Neurology scores per academic year.

The first-attempt fail rate prior to implementation of the satisfactory/unsatisfactory evaluation system was zero, but afterwards the first-attempt fail rate increased to 2.4% in the 2021-2022 academic year. The one standard deviation below equated percent correct national mean score more than doubled between 2018-2019 and 2021-2022 academic years. Full results for mean NMBE score will be available once data collection is complete.

Academic outcomes as measured by shelf exam scores appear to have been adversely affected following adoption of a satisfactory/unsatisfactory grading system. Future analysis will include United States Medical Licensing Examination board certification results to obtain additional objective data.