Promotion of a Mastery Orientation to Learning in Medical School: Implementation of the Not Yet Pass Grade

Problem: Using pass/fail (P/F) course grades may motivate students to perform well enough to earn a passing grade, giving them a false sense of competence and not motivating them to remediate deficiencies. The authors explored whether adding a not yet pass (NYP) grade to a P/F scale would promote students' mastery orientation toward learning. Approach: The authors captured student outcomes and data on time and cost of implementing the NYP grade in 2021 at the University of Utah School of Medicine. One cohort of medical students, who had experienced both P/F and P/NYP/F scales in years 1 and 2, completed an adapted Achievement Goal Questionnaire-Revised (AGQ-R) in fall 2021 to measure how well the P/ NYP/F grading scale compared with the P/F scale promoted mastery orientation and performance orientation goals. Students who received an NYP grade provided feedback on the NYP process. Outcomes: Students reported that the P/NYP/F scale increased their achievement of both mastery and performance orientation goals, with significantly higher ratings for mastery orientation goals than for performance orientation goals on the AGQ-R (response rate = 124/125 [99%], P ≤ .001, effect size = 0.31). Thirty-eight students received 48 NYP grades in 7 courses during 2021, and 3 (2%) failed a subsequent course after receiving an NYP grade. Most NYP students reported the NYP process enabled them to identify and correct a deficiency (32/36 [89%]) and made them feel supported (28/36 [78%]). The process was time intensive (897 hours total for 48 NYP grades), but no extra funding was budgeted. Next Steps: The findings suggest mastery orientation can be increased with an NYP grade. Implementing a P/NYP/F grading scale for years 1 and/or 2 may help students transition to programmatic assessment or no grading later in medical school, which may better prepare graduates for lifelong learning.