Pass/fail medical schools are institutions in which students receive either a passing or failing designation instead of traditional letter grades (A-F), or tiered distinctions like honors/high pass/pass/fail. This grading model has become increasingly common in the preclinical years of US allopathic medical schools, as faculty and staff aim to reduce stress, promote collaboration, and improve student well-being.
While the trend towards pass/fail medical schools is well intentioned, students who attend them often wonder if it places them at a disadvantage when it comes time to apply for residency, and what they can do to strengthen their application. If you’re in this situation, we can help! In this post we’re going to give you eight ways residency applicants that attended pass/fail medical schools can stay competitive.
To put our discussion in the right context, let’s begin by reviewing the trend towards pass/fail medical schools in a bit more detail, and what the pros and cons of it are for students.
At pass/fail medical schools, graded exams like Step 2 become increasingly important to showcase your abilities to residency programs. To help you prepare, try out the combined Step 2 & Shelf Exams Qbank with 5,500+ practice questions that most closely match what you’ll see on your actual exam!
The Trend Towards Pass/Fail Medical Schools
Over the past twenty years, allopathic medical schools across the US have had a slow but steady shift toward a pass/fail (P/F) grading system, particularly in the preclinical years. This trend towards pass/fail medical schools has been driven by a growing body of research linking traditional tiered grading systems to increased student stress, burnout, and decreased well-being that carries on even after the completion of their medical degree.
The majority of US medical schools have already implemented P/F grading for preclinical coursework, and some are expanding it into the clinical years. Data from the Association of American Medical Colleges (AAMC) suggests that more than 80% of medical schools now utilize some sort of pass/fail system in the preclinical curriculum, compared to just a fraction two decades ago.
The Impact of Pass/Fail Grading
The trend towards pass/fail medical schools has even affected national exams. For instance, in 2022, the United States Medical Licensing Examination (USMLE) Step 1 transitioned from a numerical score to pass/fail. Step 1 was previously known as the biggest exam for medical students, as its score played a large part in determining their residency plans and future medical career. By transitioning to pass/fail, this move reinforced the idea that medical education in the coming years would prioritize competency and a wide array of skills and professional development, and not just grades.
There has been more and more published research that shows traditional grading systems (A to F or honors, high pass, pass/fail) contribute to higher levels of anxiety, depression, and burnout among medical students. This is one of the biggest reasons for the shift towards pass/fail medical schools, as P/F grading reduces the stress of maintaining grades, thereby promoting a more supportive learning environment.
Pros and Cons of Pass/Fail Medical Schools
Pros
1. Improved Student Well-Being
Medical school is inherently demanding, and traditional letter grading systems (A-F or tiered systems) contribute to significant anxiety, competition, and burnout. Studies show that P/F grading reduces stress, anxiety, and depression among medical students by alleviating concerns about class rank and competition.
2. Encourages Collaboration
Without competition for high grades, students at pass/fail medical schools are more likely, in theory, to work together, share resources, and support their peers.
3. Focus on Mastery of Material
Students at pass/fail medical schools can concentrate on truly understanding medical concepts rather than memorizing and regurgitating information for a letter grade.
4. Reduces Academic Pressure in Preclinical Years
Students at pass/fail medical schools can better focus on personal and professional growth by participating in extracurriculars such as research, leadership, and shadowing.
5. Equitable Learning Environment
P/F systems help mitigate disparities among students with different educational backgrounds or resources they have to spend on expensive preparation materials such as paid private tutors.
Cons
1. Limited Differentiation Among Students
In a P/F system, all passing students appear similar on transcripts and MSPE letters, making it harder to distinguish high achievers from average performers.
2. Increased Emphasis on Other Metrics
With clinical or preclinical grades removed as a differentiator, residency programs may rely solely on standardized test scores (e.g., Step 2) for objective ranking. This places added pressure on students to perform on Step 2.
3. Potential for Reduced Motivation
Students who attend pass/fail medical schools may be less motivated to go beyond the minimum required to pass, which could impact study habits and long-term learning.
4. Residency Program Challenges
Competitive residency programs may struggle to assess candidates from pass/fail medical schools, leading them to place more weight on clinical evaluations and extracurricular achievements. However, residency programs are increasingly moving toward a holistic review process rather than solely focusing on grades. P/F grading supports this shift by emphasizing other aspects of medical education, such as clinical skills, leadership, research, and professionalism.
While P/F grading has clear benefits, challenges remain,particularly in differentiating students for residency applications. That’s why excelling in clinical rotations, research, leadership, and standardized exams is more critical than ever.
Now lets take a look at what you can do to ensure your residency application is competitive given the trend towards pass/fail.
8 Ways Students at Pass/Fail Medical Schools Can Strengthen Their Residency Applications
1. Excel in clinical rotations.
Although preclinical years may be P/F, clinical rotations (third and fourth years) often use tiered grading systems, such as honors/high pass/pass/fail. Strong performance in these rotations demonstrates your clinical competence, communication skills, medical knowledge and work ethic. Securing honors in core rotations—especially in the specialty you’re applying to—can be a major asset on your application.
Even if your school is entirely pass/fail, doing well in clinicals will impress the attending physicians you rotate with, which can yield beaming letters of recommendation. Remember that part of doing well on rotations is not only the clinical experience and patient care aspect, you also need to perform well on the NBME shelf exams.
2. Build strong relationships for letters of recommendation.
Since residency programs won’t see a class rank or GPA from a P/F system, letters of recommendation (LoRs) become even more critical. Develop strong relationships with faculty members, attendings you rotate with, and mentors who can write detailed and compelling letters about your clinical skills, professionalism, and teamwork.
3. Engage in research and scholarly activities.
Research experience, especially in your desired specialty, can set you apart in residency applications. Seek out opportunities to contribute to ongoing studies, present at conferences, or publish papers. Research involvement highlights your intellectual curiosity and commitment to advancing medicine.
4. Demonstrate leadership and extracurricular involvement.
Residency programs value well-rounded applicants who display leadership and initiative. Involvement in student organizations is good, but leadership is even better. Serving on and leading committees, interest groups, or advocacy cohorts can showcase your ability to work on teams and take on responsibility.
Leadership positions within groups related to your specialty of interest are particularly valuable. For example, if you plan to apply to orthopedic surgery, then serving as the president of the orthopedic interest group (rather than being a member of the general medicine interest group at your school) will be a huge boon. Furthermore, there are generalized leadership positions that will be helpful such as class president, etc.
5. Perform well on Step 2 and other standardized exams.
Since Step 1 is now P/F, your Step 2 score is one of the key things residency programs look at. Prioritize studying for Step 2 (and other standardized exams) to ensure an adequate score for your speciality of interest.
If you need help preparing for Step 2, be sure to check out this post for our ultimate guide!
6. Pursue meaningful clinical and volunteer experiences.
Residency programs value applicants who go beyond their required coursework to engage with medicine in meaningful ways. In fact, the ERAS (Electronic Residency Application Service) application has a dedicated section just for this. Such experiences demonstrate commitment to medicine outside of the structured curriculum. Residency programs value this, as it can provide hands-on patient interaction, improve communication and clinical reasoning skills, and highlight an applicant’s passion for service and advocacy.
Shadowing Physicians
Shadowing a physician allows you to experience different specialties without as much commitment as a full clinical rotation. This can help you refine your career interests as you’ll have insight into physician workflow, patient interactions, and decision-making.
Volunteering at Free Clinics or Community Health Programs
This provides direct patient interaction, especially in underserved communities. It also shows your commitment to healthcare equity, a quality many residency programs seek. Finally, you’ll gain experience in taking histories, patient education, and even basic procedures under supervision.
Serving on Medical Mission Trips or Global Health Initiatives
These kinds of activities demonstrate a dedication to public health and medicine beyond the hospital setting. You can also get exposure to resource-limited environments, which fosters adaptability and problem-solving skills. Plus, these activities encourage cultural competency, which is increasingly valued in healthcare.
Mentorship and Education Initiatives
Leading workshops, tutoring pre-med or junior medical students, or mentoring underserved youth shows leadership and commitment to education. Pipeline programs, student-run clinics, and health education outreach are highly regarded.
Showcase any of the experiences above on your ERAS application. Be specific about your role, responsibilities, and impact on patients or the community. Highlight long-term commitment—a few meaningful, sustained experiences are more valuable than many short-term ones. Reflect on what you learned and how these experiences shaped your goals for residency and future practice.
7. Craft a strong personal statement.
If you’re going to a pass/fail medical school, your personal statement is an opportunity to tell your story and provide context to your application. Use it to highlight your motivation for medicine, significant experiences, and future career aspirations in your desired specialty. A well-written personal statement can leave a lasting impression on program directors and give them a reason to invite you for an interview.
To see some examples of good personal statements, check out this post!
8. Network and seek mentorship.
Connecting with faculty, residents, and alumni in your field of interest can provide valuable insights and open doors for mentorship and opportunities. Attending conferences, specialty interest groups, and networking events can help you build relationships that support your career trajectory as well as give you a deeper understanding of your field of specialization.
Final Thoughts
While a pass/fail grading system may initially seem like a disadvantage for residency applications, it shifts the focus toward more holistic applicant evaluations. Implementing the tips above for clinical rotations, letters of recommendation, engaging in research, and demonstrating leadership can create a compelling application that allows you to stand out.
Residency programs are increasingly looking for well-rounded individuals with diverse experiences, and by taking strategic steps, you can position yourself for success and secure that coveted residency interview in any specialty. Good luck, and be sure to reach out if you need assistance!
