YuLin Zhen, Photography Editor

The core philosophy of the Yale System of Medical Education has remained the same since the 1920s. 

The crux of the educational model at the School of Medicine — YSM — prioritizes student intellectual freedom and values collaboration over competition. To this end, the School of Medicine incorporates a mix of no grades and a pass/fail system. 

During the first 18 months of learning, also known as the pre-clerkship period, neither grades nor class ranking is assigned to students. During this time, medical students build clinical reasoning through integrated basic and science courses, with emphasis on small-group learning sessions over traditional lectures. Examinations become pass/fail in the 12 months that follow, which form the clerkship period. During this phase, students participate in 12-week interdisciplinary clerkship blocks that expose them to different medical disciplines. 

Clerkship block topics include The Medical Approach to the Patient, The Surgical Approach to the Patient, Women’s and Children’s Health and the Biopsychosocial Approach to Health. In the eyes of the School of Medicine, a critical marker of students’ learning progress, more so than grades or ranking, is their achievement of the nine competencies outlined by the Yale System of Medical Education. 

“[T]he YSM curriculum is built upon a foundational set of competencies, including the ability to engage in clinical reasoning and critical thinking, skills such as teamwork and effective communication with patients and families, and an approach to medicine grounded in scientific inquiry and life-long learning,”  Dr. Jessica Illuzzi SPH ’06, deputy dean for education and Harold W. Jockers Professor of Medical Education and professor of obstetrics, gynecology and reproductive sciences, wrote in an email to the News. 

Rather than assessing students based on quantitative test scores, YSM’s holistic grading approach emphasizes the development of skills that will extend beyond the classroom into medical practice. 

However, a no-grades and pass/fail system also raises questions about how students will navigate this freedom in their studies and stay motivated to learn. 

“If you don’t have a strong self-motivated system to figure out how you learn and how you prepare best, it can be easy to fall behind,” acknowledged Josh Brenne MED ’28. “That is a minor drawback because almost all my classmates are highly motivated, we’re all hard workers, and keeping grades out of that equation really helps us individualize our learning.”

Apart from empowering student learning, YSM’s grading system also helps better prepare students for the realities of medical practice. 

“How you learn how to treat patients and cure patients is not by getting questions right on a multiple choice exam, it’s by thinking through things critically, working with your teammates, and coming to a consensus conclusion on what’s the best treatment for this patient,” Brenne said. 

According to Brenne, the focus on medical competencies rather than grades not only values collaboration over competition, but also places students in the shoes of physicians making life-changing decisions. Without students competing for class rank, students learn teamwork and build an overarching sense of camaraderie with one another. 

However, the lack of class rank does make it more difficult for students to stand out academically. 

“For residency, it makes it more difficult to distinguish yourself because a lot of other schools have honors and high honors for their clerkships,” Kaelan Yao MED ’26 told the News. 

Despite this drawback, the power of the Yale System really shines in its impact on student morale, creating a relaxed, low-stress learning environment, Yao noted. 

“People in our clerkships are a lot healthier and happier med students,” Yao sai. 

Recent years have seen other medical schools shift toward pass/fail grading in the preclerkship phase and the clerkship phase as well. 

“In 2020, we shifted the clerkship period from a graded system to a pass/fail system,” wrote Illuzzi. “Several medical schools have moved to pass-fail in the pre-clerkship period, and some have moved to pass-fail for the clerkship period as well.” 

Harvard, Stanford, Columbia and Johns Hopkins are among the medical schools that have adopted the pass/fail system for the pre-clerkship phase. 

However, what sets Yale apart is the absence of a class ranking system, which helps avoid the pressure of competition. 

“Although a lot of schools, especially in the preclerkship phase, are still pass/fail, some schools still have internal ranking systems, and having that knowledge there does still create that undercurrent of competitiveness,” Brenne noted. 

More information about the Yale School of Medicine’s grading system is online.

EDIS MESIC
Edis Mesic covers the Yale School of Medicine for the SciTech desk. He is a first year in Saybrook from San Jose, California.