The Problematic Persistence of Tiered Grading in Medical School.

Area of Science:

• Medical Education
• Assessment and Evaluation
• Student Well-being

Background:

• Medical student evaluation is a critical, complex process integral to professional development.
• Tiered grading, a common norm-based comparison, has questionable pedagogical roots in American medical education.
• Evidence links tiered grading to student burnout, anxiety, depression, reduced cohesion, and racial biases.

Purpose of the Study:

• To critically examine the historical, psychometric, psychosocial, and moral dimensions of tiered grading in medical schools.
• To evaluate the evidence supporting tiered grading's effectiveness and its impact on medical students.
• To explore the need for alternative, non-tiered assessment methods.

Main Methods:

• Review of existing literature on medical student evaluation and tiered grading.
• Analysis of the psychometric and psychosocial effects of tiered grading.
• Examination of historical and ethical arguments for and against tiered grading.

Main Results:

• Tiered grading is associated with student distress, perceived unfairness, and biases against under-represented minorities.
• Correlation between tiered grading and residency performance is inconsistent.
• Arguments for tiered grading as a motivator lack robust data support.

Conclusions:

• The use of tiered grading in medical schools for academic performance assessment or residency applicant selection is questionable.
• The negative impacts on student mental health, diversity, and cohesion warrant re-evaluation.
• Transitioning to alternative, non-tiered assessment strategies is necessary.