title: Relationship of pass/fail grading and curriculum structure with well-being among preclinical medical students: a multi-institutional study.
abstract: OBJECTIVE
  Psychological distress is common among medical students. Curriculum structure and grading scales are modifiable learning environment factors that may influence student well-being. The authors sought to examine relationships among curriculum structures, grading scales, and student well-being.
  
  
  METHODS
  The authors surveyed 2,056 first- and second-year medical students at seven U.S. medical schools in 2007. They used the Perceived Stress Scale, Maslach Burnout Inventory, and Medical Outcomes Study Short Form (SF-8) to measure stress, burnout, and quality of life, respectively. They measured curriculum structure using hours spent in didactic, clinical, and testing experiences. Grading scales were categorized as two categories (pass/fail) versus three or more categories (e.g., honors/pass/fail).
  
  
  RESULTS
  Of the 2,056 students, 1,192 (58%) responded. In multivariate analyses, students in schools using grading scales with three or more categories had higher levels of stress (beta 2.65; 95% CI 1.54-3.76, P<.0001), emotional exhaustion (beta 5.35; 95% CI 3.34-7.37, P<.0001), and depersonalization (beta 1.36; 95% CI 0.53-2.19, P=.001) and were more likely to have burnout (OR 2.17; 95% CI 1.41-3.35, P=.0005) and to have seriously considered dropping out of school (OR 2.24; 95% CI 1.54-3.27, P<.0001) compared with students in schools using pass/fail grading. There were no relationships between time spent in didactic and clinical experiences and well-being.
  
  
  CONCLUSIONS
  How students are evaluated has a greater impact than other aspects of curriculum structure on their well-being. Curricular reform intended to enhance student well-being should incorporate pass/fail grading.
authors.affiliation: Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55901, USA. reed.darcy@mayo.edu
authors.forename: Darcy A
authors.initials: DA
authors.lastname: Reed
authors.forename: Tait D
authors.initials: TD
authors.lastname: Shanafelt
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Satele
authors.forename: David V
authors.initials: DV
authors.lastname: Power
authors.forename: Anne
authors.initials: A
authors.lastname: Eacker
authors.forename: William
authors.initials: W
authors.lastname: Harper
authors.forename: Christine
authors.initials: C
authors.lastname: Moutier
authors.forename: Steven
authors.initials: S
authors.lastname: Durning
authors.forename: F Stanford
authors.initials: FS
authors.lastname: Massie
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Thomas
authors.forename: Jeff A
authors.initials: JA
authors.lastname: Sloan
authors.forename: Liselotte N
authors.initials: LN
authors.lastname: Dyrbye
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000458:organization & administration*; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010549:Personal Satisfaction; D012307:Risk Factors; D012577:Schools, Medical / Q000458:organization & administration; D013315:Stress, Psychological; D013337:Students, Medical / Q000523:psychology*; D013647:Task Performance and Analysis; D014481:United States; D055815:Young Adult