Grades – How Important Are They?

by Justine Beck, Pharm.D., PGY1 Pharmacy Practice Resident, Walter Reed National Military Medical Center

The type of evaluation system used by an academic institution, pass/fail versus assignment of grades, has been a point of controversy for decades.  I hadn’t put much thought into this issue, since all of my education was completed at institutions that utilized a traditional grading system and where the overall performance was determined by calculating a grade point average (GPA).  However, this year I was no longer an applicant but rather a participant in the residency selection process.  When reviewing and compiling the information on the residency applications, I came across a few pharmacy schools that use a pass/fail evaluation system and, therefore, do not report a GPA.  At first I was taken aback, unsure how to compare the academic performance of the applicants from these schools to applicants who were graduating from more traditional programs.  My natural instinct was to question whether an applicant who ‘passed’ pharmacy school would perform the same in a residency program as an applicant who had a numeric GPA.

With an overwhelming number of applicants to pharmacy residency programs¹, an applicant from a program that uses the pass/fail grading system may be at a disadvantage when competing against applicants who have a GPA.  Admittedly, the most important criterion used when making selection decisions for residency programs is the personal interview.  However, there are several pre-screening hurdles that applicants must jump over before an interview is offered.

While there is a paucity of literature available specific to pharmacy regarding the impact of pass/fail grading, there is some data related to medical residency programs.  Dietrick et al. polled general surgery residency program directors to determine whether pass/fail versus competitive grading systems affected an applicant’s ability to compete for a residency training position.  The results demonstrated that 89% of program directors in general surgery preferred a transcript with grades over a pass/fail evaluation system. Also, 81% of the survey respondents thought that the medical students’ ability to compete for a residency position was adversely influenced by the pass/fail method of evaluation. Interestingly, 72% of the respondents stated letters of recommendation most frequently misled them in choosing a candidate for a residency position.²

Another survey conducted in Ontario found that 66% of program directors felt that students applying to their program from a school that used a pass/fail system would be disadvantaged.³   Moss et al. reported that the application performance index of residents from medical schools that reported grades performed significantly better than those from schools that used a pass/fail system.  Additionally, no residents from a school that used a pass/fail system ranked above the 87^th percentile, and 82% of those who ranked below the 15^th percentile came from pass/fail schools.⁴

Advocates for a pass/fail grading system reason that grades discourage collaboration and rely too heavily on external motivation.  Intrinsic motivation is learning prompted by true interest and enjoyment, whereas extrinsic motivation is based on external rewards, such as grades and honor society inductions.  Further, they argue, pass/fail grading systems improve student well-being by reducing stress, anxiety, and depression. Interestingly, over the years, many schools that adopted the pass/fail grading system have reverted back to multi-tiered grading systems (i.e. pass/fail/honors/high honors).⁵   Despite the potential benefits of pass/fail grading, it seems that the preference is an evaluation system that can differentiate students.

Inevitably, grades matter.  The much maligned GPA is the only way to sum up a student’s academic achievement in a quantifiable form.  Peter Filene wrote in The Joy of Teaching that, “grades can be used as a pedagogical whip to reinforce the mentality of working-to-get-a-grade, or they can be used in creative ways as carrots to encourage learning.” ⁶ I believe the real challenge is finding ways to use grades as a means to stimulate learning rather than a quantifiable measure of success or failure.  Students need feedback to help stimulate self-improvement.  Developing unique and creative ways to evaluate students would help achieve the dual aims of differentiating performance while cultivating intrinsic motivation to learn.

References

1. National Matching Services Inc. 2012. ASHP Resident Matching Program, Match Statistics. Accessed March 17, 2013.

2. Dietrick JA, Weaver MT, Merrick HW.  Pass/fail grading: a disadvantage for

students applying for residency. Am J Surg 1991;162(1):63-66.

3. Provan JL, Cuttress L. Preferences of programme directors for evaluation of candidates for postgraduate training. CMAJ 1995;153(7):919-923.

4. Moss TJ, Deland EC, Maloney JV Jr. Selection of medical students for graduate training: pass/fail versus grades. N Engl J Med 1978;299(1):25-7.

5. Spring L, Robillard D, Gehlbach L, Moores Simas TA. Impact of pass/fail grading on medical students’ well-being and academic outcomes. Med Educ 2011;45:867-877.

6. Filene P. The Joy of Teaching: A Practical Guide for New College Instructors. Chapel Hill: University of North Carolina Press, 2005. Chapter 8, Evaluating and grading; p.93-111.

Open-note vs. Closed-book Exams

by Bonnie Li, Doctor of Pharmacy Candidate, University of Maryland School of Pharmacy

Open-note, cheat sheet, or closed-book exams---which test format is best for students? In December 2012, Neal Conan from NPR’s Talk of the Nation spoke with associate professors of psychology Afshin Gharib and William Phillips from Dominican University of California about an experiment they conducted.  It all started over an argument about what kind of exam is best.¹ One professor preferred administering open-note tests while the other let his students use a “cheat sheet.” During the experiment, students were given either an open-book, a cheat sheet, or a closed-book exam in an introductory psychology course.²  An unannounced closed-book quiz was given two weeks later to test retention of the content. The students were also asked about their anxiety level before each exam. The results found that while initial grades were higher in the open-book group, the retention scores across all three exam formats were not statistically different.  Additionally, the researchers found that while the students’ level of organization on their cheat sheet correlated with higher initial test scores, it did not correlate with higher scores on the follow-up pop quiz. Good students still out performed poor ones regardless of exam type. This might be because weaker students spent more time looking up notes and reading rather than actively completing the test. The findings confirm the results from an older experiment by Agarwal that found no real differences in retention a week after administering either an open- or closed-book exam.³  While the results of these studies are prone to type II error due to their small sample sizes, none-the-less, they raise interesting questions about the benefits of open-note and “cheat sheets” permitted exams. Why not alleviate student anxiety by allowing open-notes if the results are not significantly different from closed-note tests?

Benefits and Pitfalls

There are some pitfalls to open-note exams.  Because students are allowed to use class notes and textbook resources during the exam, students might use them to look for pre-built answers like a “scavenger hunt” rather than synthesizing concepts from class.⁴  This kind of behavior can be prevented if instructors write complex or scenario-specific questions. Another disadvantage is that teachers would likely need to spend more time grading exams and writing complex questions every year.  Allowing students to use computers with internet access during a test also runs the risk of students communicating with one another to obtain answers.

Liska and Simonson from the University of Wisconsin described the positive results from using open-textbook and open-note exams in a business statistics class.⁵ The authors found it helpful that teachers were challenged to write questions that required interpretation, analysis, and critical thinking. The students were less anxious, even though open-note exams were not easier than closed-books exams. Open-note exams emphasized applying concepts and critical thinking.

There can also be benefits to using “cheat sheets” during exams.  Unlike open-note exams, cheat sheets contain a limited amount of information. Maryellen Weimer contends that that these condensed versions of their notes force students to prioritize and organize content from the class.⁶  In creating these sheets in preparation for the test, students may engage in discussions with each other (and possibly the professor) about the material, thereby further solidifying their understanding of the course content.  In other words, the creation of cheat sheets may enhance learning!

Anecdotal Experience

Throughout pharmacy school, I have taken closed-book, open-note, cheat sheet, take-home, and even group exams. In classes with open-note exams, I felt less pressure in class to vigorously jot down notes, and I spent more time actively listening to the presenter.  I felt I was applying information and learning during an open-note exam.  Indeed, knowing how to apply information actually felt more enjoyable than regurgitating memorized facts.  My self-esteem was better if I did well on an open-book verses closed book exam too.

There are teachers who believe that an exam should assess students’ knowledge – the stuff stored away in their heads – and no more.   In these circumstances, the closed-book exam is probably best.  For example, it’s important to know the pathophysiology of atrial fibrillation and the mechanism of action of beta blockers, so a closed-book exam would require me to memorize this information. However, when it comes to therapeutics, for which the answer is not always black and white, an open note exam might be a better option. As a future pharmacist, I will need the skills to discriminate one side effect from a list of ten on Micromedex, or which drug-drug interactions really need to addressed in a patient on multiple drugs. In a world where content is readily available, the most important skill health professionals must possess is the ability to find and interpret information from the right sources. I understand that there will always be situations where we have to think on our feet, but I also see the need to ask the right questions and double-check information from the right places. I think that open-note exams can help prepare pharmacy students by encouraging them to find and analyze information in a time sensitive manner.

So the next time you think about creating a test, consider your objectives. Do you want to test students on their recall of content or its application?

References

1. Cheat Sheet Or Open Book: Putting Tests To The Test : NPR [Internet]. Talk of the Nation. National Public Radio, 2012.  Accessed April 17, 2013.

2. Gharib A, Phillips W, Mathew N. Cheat Sheet or Open-Book? A Comparison of the Effects of Exam Types on Performance, Retention, and Anxiety. Psychology Research. 2012;2(8):469–478. 

3. Agarwal PK, Karpicke JD, Kang SHK, Roediger HL, McDermott KB. Examining the testing effect with open- and closed-book tests. Applied Cognitive Psychology 2008;22(7):861–876.

4. Golub E. PCs in the Classroom and Open Book Exams. Ubiquity 2005;6(9):1–4.

5. Liska T, Simonson J. Open-Text and Open-Note Exams. The Best of The Teaching Professor. Madison, WI: Magna Publications; 2005. p. 83.

6. Weimer M. Crib Sheets Help Students Prioritize and Organize Course Content.  Faculty  Focus [Internet], 2013. Accessed April 17, 2013.