Why are Indiana lawmakers trying to dismantle pass-fail grading systems? As the largest medical school in the U.S., Indiana University School of Medicine (IUSM) utilizes a pass-fail grading system, aligning with the majority of medical schools nationwide.
Now, Senate Bill 289 threatens to disrupt this policy — despite opposition from over 92% of surveyed IUSM students. According to the Association of American Medical Colleges, only 12 out of 155 U.S. medical schools still use traditional grading. Pass-fail grading is crucial for increasing collaboration, well-roundedness, and reducing burnout among future physicians —without compromising performance on national standardized exams. In fact, IUSM boasts a 99% residency placement rate, despite having the largest class sizes in the country, with approximately 360 students per year.
Research supports these outcomes: A 2009 study published in Academic Medicine found that switching to a pass-fail system in the first two years of medical school significantly improved psychological well-being among students without any decline in academic performance, residency placements, or standardized test scores. The 2023 study published in BMC Medical Education further supported these results, demonstrating that residents trained under a pass-fail system did not statistically differ in their performance compared to their peers who underwent graded evaluations in their clinical years of medical school.
This legislation seeks to reintroduce the unnecessary grading systems that should have been left in the past. It would require schools to switch to A-F grading systems or “another merit-based system” — leaving vague guidance that would eliminate true pass/fair grading that students currently benefit from. SB 289 affects all allied health education even beyond medicine (dentistry, nursing, etc). Such changes would undermine the proven benefits of the pass-fail system, increasing stress and reducing collaboration among students without clear academic advantages.
IUSM’s incoming class is among the most competitive in the country, with a 6% acceptance rate and an average GPA of 3.8, IUSM medical students are committed to succeeding. These students have already demonstrated academic excellence and continue to do so by passing rigorous courses and sitting for standardized exams for every subject.
Pass-fail grading does not reduce rigor but fosters deeper understanding and collaboration while reducing unnecessary stress. IUSM structures learning around small group exercises where students collaborate like they would on a health care team. Traditional grading systems pit students against each other and dampen collaboration with fears of seeming less capable. Increasingly, American medical schools have largely been transitioning to a pass-fail curriculum, with elite medical schools starting this trend. When prospective medical students are considering a school with a graded curriculum compared to a pass-fail curriculum, they are more likely to choose the latter option, one that allows them to take charge of their medical education and maintain a balanced life. Switching to a graded system reduces the potential number of talented students we can attract and retain in Indiana. This has direct implications and consequences for the health care of all Hoosiers across the state.
The physician shortage in the U.S. is no secret, and burnout is a major contributing factor. Physicians have a suicide rate of 28 to 40 per 100,000—more than double that of the general population.
Pass-fail grading allows future physicians to maintain balance, preventing them from entering residency already burned out. This difference is significant: instead of chasing letter grades, students demonstrate mastery of the material in less time while engaging in experiences that make them more well-rounded and connected to their communities. They can spend quality time with loved ones, participate in research, volunteer at free clinics to understand patient needs firsthand, or collaborate with physicians in their chosen specialties—building research skills and relationships that will make them not only stronger residency applicants but also more compassionate and effective doctors. In the end, this means better care for Hoosiers and a health care system supported by physicians who are not just academically prepared, but emotionally resilient and deeply engaged with their communities.
The future of medicine depends on training resilient, well-rounded physicians — not just test-takers. Pass-fail grading is a proven system that allows medical students to succeed academically while reducing burnout and increasing collaboration. Lawmakers should prioritize evidence-based policies that support future doctors, not outdated measures that threaten their education and mental health.
Indianapolis, IN
