Encouraging an environment to nurture lifelong learning: an Asian experience.

INTRODUCTION: Within an Asian context, this study examines the effect of changing from traditional course grades to a distinction/pass/fail (D/P/F) grading system on medical student self-perceived stress levels and on student exam performance. METHODS: At the end of the 2010-2011 academic year, the Perceived Stress Scale-10 (PSS-10) was administered to the cohort of students finishing their first year of medical studies. For the academic year 2011-2012, the grading system was changed to D/P/F for the first year of medical school. The PSS-10 was also administered to the subsequent cohort of first-year medical students at the same point in the academic year as previous. Qualitative comments were collected for both cohorts. RESULTS: Stress as measured by the PSS-10 was significantly lower in the cohort that went through the year with the D/P/F grading system in place. Thematic analysis of qualitative responses showed a shift in sources of student stress away from peer-competition. There were no significant differences in overall exam performance. DISCUSSION: Within an Asian context, switching to a D/P/F grading system can alleviate stress and peer competition without compromising knowledge. This may help foster a "learning orientation" rather than an "exam orientation," and contribute to inculcating lifelong learning skills.