Which Medical Schools are Graded? Which Rank Students?

Every medical school in the United States uses some form of grading policy to measure student performance. These systems can be complex, and it can be difficult to understand how your grades will impact your medical school career. However, it is important to take the time to familiarize yourself with the grading policy used by the schools you are considering. Each school has its own standards for what constitutes a “good” grade, and these standards can vary widely. As you research medical schools, take the time to understand how each school evaluates students so that you can choose the school that best meets your needs.

A shift in grading policies

The numeric system has been historically the most widely grading policy used in the U.S. In this system, each letter grade is assigned a numeric value, and GPAs are calculated by averaging these values. For example, an “A” is worth 4 points, a “B” is worth 3 points, and so on. The advantage of this system is that it allows for easy comparison between students.

However, the numeric system does not take into account factors such as class difficulty or improvement over time. As a result, some medical schools are moving towards a more holistic approach to grading. In this system, grades are viewed as just one part of the student’s overall application. Other factors, such as letters of recommendation and personal statements, are also taken into consideration. Ultimately, medical schools and residency programs are looking for well-rounded applicants who have demonstrated both academic excellence and a commitment to medicine.

The Pass/Fail grading policy is becoming more widely used by medical schools for preclinical courses

There are several different medical school grading policies in use today. Since the first two years of medical school are heavily focused on coursework, many schools have adopted systems that don’t include letter grading. This enables students to focus on learning difficult material rather than place energy on their class ranking. Many programs have also adopted these “alternative” grading policies to increase the well-being of their students. However, the rigors of medical school still require medical students to be at the top of their game to get that passing mark!

According to the AAMC Report of Grading Systems Used in Medical School Programs, the majority of schools since 2016 have uased a system in which students are graded on a pass or fail basis. Here, we break down the most common grading policies used in medical schools. Keep reading to find out more!

2-tier Pass/Fail Grading Policy(P/F)

• The Pass/Fail system is the most commonly used among MD programs in the U.S.
• Out of about 150 medical progams, approximately 100 schools have consistently used this grading policy.
• Pass-Fail grades typically do not contribute to a student’s overall GPA.
• A “Pass” grade has an average cutoff percentage grade of 68%. This means that all students who earn a cumulative grade of 68% or more get a final grade of “Pass” on their transcript.
• A “Fail” grade requires students to retake the course before advancing. Even if the student retakes a class in which they got an “F,” this mark will be recorded on their transcript.
• After retaking a course, students typically earn a “Remediated Pass” grade.

3-Tier Pass/Fail Grading Policy (H/P/F)

• This 3-tier system adds a layer of motivation for students to excel by including an “Honors” grade (Honors, Pass, Fail).
• A “Pass” grade is an average of 68% or more, similar to the 2-tier Pass/Fail system.
• A “Fail” grade also requires students to retake a course before they can move onto the next semester of classes.

Although these two Pass/Fail systems are similar, the 3-tier Pass/Fail system adds some complexity to grading. It is common for schools that employ a 3-tier Pass/Fail system to rank students in the top 20-25% of their class. These are typically students who recieve “Honors.” Some students may prefer a program with an Honors opportunity. However, others might see this grading policy as being too competitive between class members. It’s up to you to determine what helps you learn best!

…but the Pass/Fail grading policy is less common during clinical clerkship.

A clinical clerkship is a medical student’s opportunity to gain practical experience in patient care. Unlike the classroom environment of medical school, clinical clerkships take place in real-world medical settings such as hospitals and clinics. As a result, the stakes are higher and the pressure to perform is intense. For many students, the thought of not passing a clinical clerkship is simply too much to bear. Fortunately, the pass/fail grading policy is less common during clinical clerkships.

In most cases, students are graded on a scale of honors, high pass, pass, or fail. This allows for a more nuanced evaluation of student performance and gives students a better chance of success. As always, residency placement is highly competitive, but the clinical clerkship grade is just one factor that medical schools will consider when making their decisions. Ultimately, each student’s goal should be to gain the valuable experience and skills that they need to succeed in their future medical career.

The most common kind of grading policies during clinical clerkship are:

4-Tier Pass/Fail Grade System (Honors, High Pass, Pass, Fail)

• Most core clinical clerkships use this grading method.
• This grading policy adds a layer of grading to distinguish mastery of material during rotations.
• Like the other Pass/Fail systems, students must earn at least a “Pass” grade to continue their curriculum.
• Here, “Honors” is typically given to students who get a cumulative grade average of 88% or above. This percentage might differ by program or class. However, “Honors,” always highlights the top students of the class.
• “High Pass,” signifies that the student has done outstanding or above average, but is not quite at the top of their class.

4-Tier grading policy may contribute to an overal GPA by assignming a numeric value to each grade:

• Honors = +4 points
• High Pass = +3 points
• Pass = +2 points
• Fail = 0 points

Most grading policies will vary, so be sure to check with your program of interest!

Letter Grade System

You may already be familiar with the letter grading policy. Most four-year universities and colleges grade on a scale of A to F. However, the letter grading policy is one of the least used systems in medical schools. Because the last two years of medical school are the most complex and hands-on, letter-grading is often used to begin ranking students.

Letter grading usually employs the following 4-point scale, where each grade contributes to an overall GPA:

Most medical schools rank students in their last two years only.

How medical schools rank their medical students is a question with no easy answer. There are many different factors that can affect a student’s ranking, from their grades to their extracurricular activities. However, one of the most important factors is how well they perform on their medical school exams. Medical schools use a variety of exams to test students’ knowledge, from the preclinical medical school exam to the clinical clerkship exam. Each of these exams carries a different weight, and students who perform well on them will typically see a boost in their ranking. In addition, medical schools often take into account a student’s residency placement when making rankings. Those who are placed in prestigious residency programs are typically given a higher ranking than those who are not.

Ultimately, there is no single factor that determines how medical schools rank medical students. Instead, it is a combination of many different factors that contribute to a student’s final ranking. To encourage teamwork, collaboration, and a focus on learning clinical skills, some schools only release student rankings during the 4th year. These rankings are typically only disclosed by the Dean during residency applications.

However, schools that use a Pass/Fail system without a numeric assignment do not rank students until the last two years of medical school, or not at all.

Grading and student ranking systems vary by school. Here is a complete list!

Standardizing the grading policy allows students across different universities, with different levels of achievement, to be compared. Unlike traditional 4-year universities, however, medical schools do not rank their students on a standardized scale. Some medical schools have a Pass/Fail grading policy, while others have a 4-5 point grading policy. Medical school grading policies become even more complex because some medical schools rank their students while others do not. In the table below, we compare which allopathic (MD) medical schools grade their students and rank their students.

A list of U.S. Allopathic (MD) medical schools that compares ranking and grading systems for their medical students.

More Resources

• AAMC Curriculum Reports: Grading Systems Used in Medical School Programs
• AAMC Curriculum Reports: Assessment of Professional Behavior
• AAMC Curriculum Reports: Clerkships Most-Included Topics at Medical Schools

Further reading

• Secondaries Fees List | Medical School Applications 2023
• M.D. vs. D.O. School – Medical Degree Comparisons
• Update Letter Medical School Guide, Examples and Templates