Building a student learning-focused assessment and grading system in dental school: One school's experience

Purpose/objectives: As health professions education moves toward competency-based education, there has been increased focus on the structure of assessment systems that support student competency development and learning. This has been buoyed by a growing body of research supporting assessment for learning processes to promote student growth and learning rather than relying on assessment systems primarily to measure performance. This paper presents the rationale and evidence for moving to an assessment for learning system and the results of a quasi-experimental interrupted time series study using data from 2015 to 2022 to evaluate the impacts of these changes. Methods: Columbia University College of Dental Medicine faculty voted to implement assessment for learning system changes beginning in 2017 with the graduating class of 2021. These changes included moving from using a grading system for didactic courses with Honors, Pass, and Fail as available grades to a grading system with only Pass and Fail as available grades, as well as creating synthesis and assessment weeks, weekly problem sets, post-exam review sessions, exam remediation opportunities, and formative progress exams throughout the curriculum. The revised assessment and grading system changes were communicated to residency program directors, and programmatic competency data about student performance across the curriculum were shared with programs in Dean's Letters. Results: Once assessment system changes were implemented, it was found that student exam failure rates were lower, course exam scores were the same or higher, and performance on board exams improved compared to the national average. Students reported positive perceptions with regard to well-being and learning climate that they associated with the adoption of Pass/Fail grading. Match outcomes, including student satisfaction and program director ratings, have remained consistently positive. Conclusion: As dental educators, our goal is to nurture students to become life-long learners. Adopting a grading structure that is Pass/Fail and an assessment system that fosters learning allows students to shape learning practices that favor long-term retention and application of information, also enhancing the learning environment and student well-being. These system changes may also facilitate the inclusion and support of students whose backgrounds are underrepresented in dentistry.