This month, the IAMSE Publications Committee review is taken from the article titled “To Grade or Not to Grade (the Quiz): The Impact of Two Formative Assessment Grading Approaches on Summative Assessment Outcomes in an Integrated Pre-clinical Curriculum,” published in Medical Science Educator (7 May 2024) by Eileen Cowan and colleagues.
This timely study investigates a common dilemma in medical education: should quizzes intended primarily as learning tools also contribute to course grades? As part of a curricular shift to support student wellness, the authors examined the impact of removing grading from weekly formative quizzes while keeping them mandatory. Using data from three medical school cohorts across five integrated pre-clinical blocks, the investigators evaluated whether removing course credit from mandatory quizzes influenced summative examination performance.
The findings challenge common assumptions about assessment and motivation. While quiz scores declined after grading was removed, summative exam performance across most blocks remained largely unchanged. For several course blocks, differences in examination performance fell within a predefined “region of indifference,” suggesting little meaningful effect on knowledge acquisition. Even when stratified by MCAT score, gender, and underrepresented in medicine status, results held steady, with only inconclusive variations in some blocks.
These results suggest that removing course credit from quizzes designed to reinforce ongoing learning may not hinder academic outcomes and could support efforts to reduce student stress in high-pressure learning environments.
The study also raises important questions about the role of grades as motivators in medical education and about whether meaningful learning can occur in lower-stakes assessment settings.
For educators exploring assessment design in integrated curricula, this article offers compelling insight into how mandatory, low-stakes quizzes may balance accountability with learner wellness. This article will be of particular interest to medical educators seeking evidence-based approaches to assessment, learner motivation, and wellness-focused curricular innovation.
Komal Marwaha, MBBS, MD, PhD
Associate Professor,
Department of Health Science Education and Pathology,
University of Illinois College of Medicine Peoria