UNGRADING AND ALTERNATIVE ASSESSMENT IN HIGHER AND HEALTH PROFESSIONS EDUCATION: A NARRATIVE REVIEW WITH REFERENCE TO THE INDIAN CONTEXT

Abstract

Ungrading challenges the dominance of letter grades, numerical marks and point-based evaluation by decentring grades in favour of feedback, self-assessment and revision. This narrative review examines the theoretical foundations, alternative grading models, empirical evidence and implementation experience of ungrading and related approaches in higher education, with particular reference to health professions education and the Indian context. The review draws on humanistic and critical pedagogy, self-determination theory and the distinction between assessment for and of learning, and describes a spectrum of approaches including specifications grading, contract grading, standards-based grading, pure ungrading and hybrid models. In medical education, pass/fail grading, the most widely adopted form of reduced grading, is consistently associated with better student well-being and lower burnout without adverse effects on licensing examination performance, although programme directors’ preferences for tiered grades and the “shadow economy of effort” raise concerns about residency selection. Ungrading aligns philosophically with competency-based medical education (CBME), and programmatic assessment, entrustable professional activities and narrative evaluation offer practical bridges between the two. Important challenges include student anxiety, faculty workload, institutional and credentialing requirements, the maintenance of standards, and the risk of reinforcing inequalities. In India, an examination-centric culture, high-stakes entrance and licensing examinations, large classes and faculty shortages are major barriers, while the CBME curriculum, workplace-based assessment and concern for student well-being create openings for change. A phased, evidence-generating approach to implementation and a research agenda focused on non Western and resource-constrained settings are proposed.