title: Encouraging an environment to nurture lifelong learning: an Asian experience.
abstract: BACKGROUND
  Within an Asian context, this study examines the effect of changing from traditional course grades to a distinction/pass/fail (D/P/F) grading system on medical student self-perceived stress levels and on student exam performance.
  
  
  METHODS
  At the end of the 2010-2011 academic year, the Perceived Stress Scale-10 (PSS-10) was administered to the cohort of students finishing their first year of medical studies. For the academic year 2011-2012, the grading system was changed to D/P/F for the first year of medical school. The PSS-10 was also administered to the subsequent cohort of first-year medical students at the same point in the academic year as previous. Qualitative comments were collected for both cohorts.
  
  
  RESULTS
  Stress as measured by the PSS-10 was significantly lower in the cohort that went through the year with the D/P/F grading system in place. Thematic analysis of qualitative responses showed a shift in sources of student stress away from peer-competition. There were no significant differences in overall exam performance.
  
  
  CONCLUSIONS
  Within an Asian context, switching to a D/P/F grading system can alleviate stress and peer competition without compromising knowledge. This may help foster a "learning orientation" rather than an "exam orientation," and contribute to inculcating lifelong learning skills.
authors.affiliation: National University of Singapore , Singapore.
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Jacobs
authors.forename: Dujeepa D
authors.initials: DD
authors.lastname: Samarasekera
authors.forename: Liang
authors.initials: L
authors.lastname: Shen
authors.forename: K
authors.initials: K
authors.lastname: Rajendran
authors.forename: Shing Chuan
authors.initials: SC
authors.lastname: Hooi
mesh_terms: D004504:Education, Medical, Undergraduate / Q000379:methods; D004521:Educational Measurement / Q000379:methods*; D006801:Humans; D007858:Learning; D012846:Singapore; D013315:Stress, Psychological; D013337:Students, Medical / Q000523:psychology*; D013732:Test Anxiety Scale