There will be no competition for the top grade among first-year medical students this year at the University of Wisconsin School of Medicine and Public Health.

That's because the school is eliminating grades for first-year medical students in favor of a pass/fail system, a trend in medical education already embraced at Harvard, Stanford and the universities of Minnesota and Michigan, among others. The last three years of medical school will still be graded.

The measure still needs to pass a School of Medicine faculty vote, but it has already won unanimous approval among three committees across campus and the final vote is expected to be similar.

Administrators say the competition for high grades puts undue stress on medical students and they would prefer that students work together.

"Part of this is about creating cooperation rather than competition," said Christine Seibert, associate dean for medical education. "Those are things we want to establish in our curriculum and in our physicians."

The change also creates a level start for all students, Seibert said. Because the first year is so heavily based in science, it can lead to a disadvantage for students with more of a background in the arts or humanities.

Upperclassman said the lack of grades would likely cut down on pressure to get A's, but questioned whether they would have studied as diligently.

"There's part of me that's definitely jealous," said Katie Jacobson, a second-year medical student who just missed the policy change. "At the same time, I don't think I would have worked as hard. Grades push me, challenge me. I think there are things I wouldn't have learned as well."

'Motivated individuals'

Seibert said loss of drive was an issue administrators considered, but ultimately proceeded with the change because they think students are not driven by grades, but by the desire to be competent doctors.

"Our students, by this point of their educational careers, are really motivated individuals," she said. "The ultimate issue is, 'I need to know this to take care of a patient.' "

Studies support that argument. A University of Michigan report from 1995 found academic performance of first-year medical students was unchanged and "there was no evidence that the students learned only enough to pass in a pass/fail environment."

Under the new grading system, professors would determine whether students had mastered the material satisfactorily, a level set by previous classes of students. The benchmarks differ from course to course, but each falls around the 75th or 80th percentile. Students would still find out how well they did on exams, although the grades wouldn't count.

One argument against making the change is residency programs choose students based, in part, on class rank. That's why the school is retaining grades for the second year, Seibert said, when students continue to learn basic science, and the last two years, when students do their clinical rotations.

Johnny Tackett, a second-year medical student who is on a curriculum committee, said he was immediately in favor of the change because it would make the transition into medical school easier for first year students. But he acknowledged it decreases the amount of time that students would have to establish their credentials for residency programs.

"Grades in the second year matter that much more," Tackett said.

The fact that a number of other universities have turned to the pass/fail system is comforting to administrators too. They know residency programs are now familiar with similar-looking transcripts.

Other changes

Eliminating grades for the first year isn't the only major change to the medical school curriculum.

Gross anatomy, one of the seminal experiences of any first-year medical student, is now offered in the second semester, rather than the first semester. This is designed to combine the experience of dissecting a cadaver as students learn about the physiology of the body, Seibert said.

Administrators also shifted courses so that the credit load is only 16 credits during the first semester, rather than 20, and they are trying to better emphasize the public health part of the School of Medicine and Public Health.

At the orientation for new students last month, the first voices they heard were those of real patients with diseases, even before they heard from deans or other authority figures.

The students interviewed the patients about their experiences with the health-care system as they struggled with HIV, ovarian cancer or Alzheimer's, among other diseases.

"We're going away from the typical, 'Welcome to medical school. Congratulations'," said Chris Stillwell, student services coordinator. "We didn't want to talk about them. We wanted to talk about who they would serve."