For the majority of my preclinical years, I was an advocate of and beneficiary from the pass/fail curriculum. From the point of Step 1 dedicated period and now into my clerkships I have increasingly started to see the potential value-grades could have had for me as I was developing my knowledge base and habits.
During my preclinical years, I drew assurance from the fact that I was meeting my institution’s expectations and took that to mean I was progressing in accordance with my peers both locally and across the nation. This in conjunction with my penchant for trivia and a genuine love of medicine allowed me to convince myself I was doing just fine. It was only with the reintroduction of grades in the form of Step scores that I realized I was not at the level of knowledge and capability that I wished myself to be. Through enormous hard work during, I was able to improve a great deal from this point but still fell a bit short of my goals and my sense of my genuine potential. My early clerkships have emphasized this sense where I have been praised for exceptional ability in patient interaction and professionalism but still fall short of my goals on end-of-rotation exams.
The exceptions to this narrative where I have received honors to this point were Anatomic and Clinical Pathology and Infectious Disease Consultation service. As I thought about these successes in the midst of other challenges I also realized that these are also two realms in which I took graded electives during my preclinical years that pushed me to master the material of a higher degree. That I had to perform to justify taking the courses for a grade in the first place helped to bolster this sense.
While I am sure many people do just fine mastering medicine in the pass/fail format all this has made me realize that perhaps grades offer a better environment for me.