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Q. In medical schools with pass/fail system, how do residencies discriminate the good candidates from the bad ones?A2A:Can a Pass/Fail Grading System Adequately Reflect Student Progress?Selection criteria for emergency medicine residency applicants.Effect of USMLE on US Medical Education (aamc.org).Pass-fail is here to stay in medical schools. And that's a good thing.Grading Systems in Medical School: Pass/Fail or A-F Scale?A Medical School goes Pass/Fail only: Why this is an Excellent Change!Can a Pass/Fail Grading System Adequately Reflect Student Progress?At Vanderbilt University because we maintained four grading intervals in the clinical years, we experienced no measurable change in the outcomes of our residency match. For schools that use a pass/fail only system throughout the 4-year curriculum, program directors rely more on qualitative measures, such as the comments recorded on clerkships assessment forms, letters of recommendation, and the nature of student leadership and scholarship accomplishments. With a sense that these subjective measures are less reliable than the objectivity of grades, program directors also tend to rely more heavily on Step 1 scores and the reputation of the medical school.Selection criteria for emergency medicine residency applicants.Acad Emerg Med. 2000 Jan;7(1):54-60.Survey of program directors in Emergency Medicine.Most important: EM rotation grade, interview, clinical grades, and recommendations.Moderate emphasis: elective done at program director's institution (USMLE) step II, interest expressed in program director's institution, USMLE step I, and awards/achievements.Less emphasis: (AOA) status, medical school attended, extracurricular activities, basic science grades, publications, and personal statement .Of the 94 respondents, 37 (39.4%) had minimum requirements for USMLE step I (195.11 +/- 13.10), while 30 (31.9%) replied they had minimum requirements for USMLE step II (194.27 +/- 14.96).Results are compared with those from previous multispecialty studies.Curriculum Inventory in ContextJuly 2016 Volume 3, Issue 7Click to view complete chart onlineEffect of USMLE on US Medical Education (aamc.org)Pre-clerkship curricular enhancements in medical education are undermined by medical students’ focus on their USMLE Step 1 scores and the threat of not acquiring a residency position. Fears of the licensure examination also thwart medical school efforts to created patient-centered care from day one.Medical educators are challenged continuously on issues around enhancing student learning, providing them with support throughout medical school, preventing and addressing burnout, and much more. We struggle with how much content to expect students to master in medical school, how to balance new content with foundational content, and how to help students become self-directed learners for life. The Curriculum Inventory reveals that over 90% of US medical schools have changed their curricula recently or currently are planning or implementing change. These curricular and pedagogical changes require a large investment of resources on the part of medical schools and their faculties. We hope the returns on those investments are medical students who acquire the knowledge, skills and behaviors necessary to ease seamlessly into their clerkships and graduates who are prepared to transition into residency and the supervised practice of medicine.For decades, schools have focused attention on reducing the competitiveness that the pre-medical system required of students in order to get into medical school. We recognize that these behaviors are unhealthy for student wellness, for their learning and for patient care. We know that the best learning, patient care, research and administrative leadership emerges from high functioning and diverse teams— the antithesis of the “cut-throat pre-med.” According to the Curriculum Inventory, dichotomousPass/Fail grading has been implemented at 60% of medical schools as an effort to encourage collaboration and teamwork among students. It largely has been effective. When our school converted to P/F grading in 2003, we realized a more collaborative and supportive learning environment with no statistically significant change in performance on assessments and no change in USMLE Step 1 scores. We did see a statistically significant improvement in student well-being until the semester prior to the taking of USMLE Step 1 when that improvement fell off. (Bloodgood, et al.)A recent conversation on the Dr-ED list serve highlighted the conundrum currently facing students and medical educators. It seems that no matter how we change the learning environment to support our students’ well-being and their professional development, the threat posed by the score a student achieves on USMLE Step 1 is more harmful and powerful than anything we can do to mitigate its negative impact. Students now enter medical school believing that nothing in the pre-clerkship phase of medical education matters other than their performance on USMLE Step 1 as it will determine not only where they will obtain a residency but IF they will obtain a residency.We try to engage them in active learning but they prefer the efficiency of lectures on what they need to memorize. We try to help them learn about ethics, human development, interviewing skills, and they reject us saying those topics are “common sense” and “fluff” and not highly represented on USMLE Step 1 so we’re wasting their time. Carry this to the logical conclusion, and medical schools are producing students who are well-prepared for Step 1 but ill-prepared for the clinical learning environment of clerkships. All of the time, effort and money invested in improving medical education may be for naught. Why? Medical students focus their efforts on memorizing facts for Step 1—not because it’s necessary for licensure but in order to get a premier residency. But medical students are bright and insightful and display cognitive dissonance regarding their medical education. Students will say they know that active learning, problem solving and a focus on clinical reasoning will make them better doctors, but despite this cognition they behave in a way that focuses on memorizing for Step 1.The simple solution to this worsening problem is to score USMLE Step 1 as pass or fail or delay the release of numerical scores until after residency interviews are completed. Anxiety about the numerical scores compromises the education of our medical students.About the author:R. J. Canterbury, M.D., M.S., DLFAPA, is the Senior Associate Dean for Education and Wilford W. Spradlin Professor of Psychiatry and Neurobehavioral Sciences at the University of Virginia School of Medicine. His research interests include substance abuse, epidemiology of substance abuse and AIDS, and health services research.References:Bloodgood, Robert A, Short, Jerry G, Jackson, John M, Martindale, James R. A Change to Pass/Fail Grading in the First Two Years at One Medical School Results in Improved Psychological Well-Being, Academic Medicine, 84(5), May 2009, pp 655-662.Pass-fail is here to stay in medical schools. And that's a good thing.FRANCIS DENG, MD AND AUSTIN WESEVICH | EDUCATION | AUGUST 3, 2016Starting this fall, second-year students will no longer have the stress of grades at our medical school, Washington University in St. Louis (WashU). In extending the pass-fail system from the first year to the second preclinical year, WashU joins the other 18 of the top 20 research medical schools on U.S. News and World Report that grade the entire preclinical curriculum on a pass-fail basis. (The sole holdout is Penn, which maintains a graded system for two of three preclinical semesters.)Locally, the change caps an evolving, years-long conversation between students, instructors, and administrators. But we are just one of the many medical schools lately to catch onto a national movement that started long ago.Turbulent sixtiesSome schools such as Harvard, Stanford, and Yale have maintained preclinical pass-fail for decades. Many other schools dabbled in curricular reform in the 1960s. Opponents hoped the storm would pass. A provocative article published in the New England Journal of Medicine in 1978 blamed the “transient sociopolitical turmoil” of the preceding decade for causing a revolution in medical education with digressions such as “social medicine,” “primary care,” “elective scheduling,” and especially “the experiment in pass/fail grading.” The authors decried the subversion of traditions and erosion of standards, pleading for maintaining “elitism in education.”It’s important to note that these authors’ beliefs came from the perspective of resident selection rather than of medical education. They believed that “it is impossible to prevent a bright student in a good environment from becoming an excellent physician by manipulating such inconsequentials as the curriculum and the grading system,” but they saw evidence that inferior residents were selected in the absence of a class ranking based on grades.Preclinical pass-fail trendNow, the storm has settled somewhat. Though the politics have changed, pass-fail grading is no fad. Schools are now increasingly reaching a stable compromise: grades for clinical clerkships, pass-fail for preclinical courses. In fact, more than half of the aforementioned medical schools changed to all-pass-fail preclinical curricula in the past decade, and none have reverted back to multi-tier grading.The current trend for preclinical pass-fail is driven by two major factors: 1) decreased relative importance of preclinical grades in residency applications, and 2) increased focus on student wellness and mental health.Emory University Match DayLow importance in residency applicationsA dwindling minority of residency programs place value on performance in basic science courses. Practically speaking, the data are often uninterpretable. Grade distributions vary dramatically between schools or even within a single institution. These days, preclinical curricula differ in length, course naming, degree integration, and grading scales. In contrast, the USMLE Step 1 exam provides a commonly understood measure of basic science knowledge for all MD students. With the availability of standardized assessment, it is no wonder that surveys of program directors rank basic science honors among the least commonly considered factors for interviewing and ranking applicants. Step 1 scores rank among the most common.Given the importance of Step 1 scores to residency applications, some have worried about the effect of changing grading policies on Step 1 performance. We now know from the experience of several schools that changed to pass-fail that students perform just as well as before. Moreover, schools that switched did not find significant differences in residency match quality.Focus on student wellnessEven though preclinical grades do not greatly affect residency applications, they still appear on transcripts and factor into class rank and AOA medical honor society selection. Chronic pressure to get the best grades can lead to significant distress. In recent years, academic leaders have increasingly recognized the importance of mitigating unnecessary stress during medical training.We found that an overwhelming majority of students at all stages at our medical school thought they would be somewhat or much less stressed during the preclinical years if they were evaluated on a pass-fail basis. Multiple peer-reviewed studies verify these beliefs.In a multi-institutional study, students in 3+-interval graded schools had significantly higher stress, emotional exhaustion, and depersonalization and were more likely to have burnout or considered dropping out compared to students in schools with pass-fail grading. Grading scale was more strongly associated with student well-being than the number of contact days or tests.When the University of Virginia changed to pass-fail, preclinical students had higher well-being and vitality and reduced anxiety and depression. When Mayo Medical School switched part of its curriculum to pass-fail, students had less stress, improved mood, and even greater group cohesion. When Saint Louis University changed to pass-fail as part of a multifaceted preclinical curricular reform, students had lower levels of moderate or severe depression symptoms, anxiety symptoms, and stress. We believe a simple change in grading systems can lead to a clinically significant change in student wellness and mental health.National organization endorsementThe alarming levels of burnout among physicians, residents, and medical students demand greater national attention to wellness. The American Medical Student Association passed policy in 2012 stating that it “STRONGLY URGES all medical schools to adopt the use of a strictly pass/fail grading policy during the preclinical years of medical school” to reduce the risk of poor student health and wellness and to promote teamwork and collaboration rather than competition. In 2012, the American Medical Association (AMA) approved policy entitled “Supporting Two-Interval Grading Systems for Medical Education,” which acknowledged the benefits of a pass-fail system for the non-clinical curriculum. By 2013, as tabulated by the AMA and published in JAMA, pure pass-fail was the most common preclinical grading system across the country, found at 41 percent of allopathic schools.We believe the so-called “pass/fail experiment” has finally proven itself and will continue to propagate, not as a reaction to “transient sociopolitical turmoil,” but as an enduring curricular reform that prevents unnecessary mental turmoil during training.Francis Deng is a resident physician and can be reached on Twitter @francisdeng. Austin Wesevich is a medical student.AMA Journal of Ethics®Illuminating the art of medicineVirtual Mentor. November 2009, Volume 11, Number 11: 842-851.Can a Pass/Fail Grading System Adequately Reflect Student Progress?Commentary by Bonnie M. Miller, MD, Adina Kalet, MD, MPH, Ryan C. VanWoerkom, Nicholas Zorko and Julia HalseyAs David, a second-year medical student, made his way into the lecture hall, he was surprised to see how packed the room was. A group of 25 third-year students, or one-fifth of the class, had recently petitioned to switch from a traditional letter-grade system to one that was pass/fail at their school, and the medical student government organized a townhall meeting for students to discuss the matter. Unable to find a place to sit, David stood against the wall alongside his good friend Beth, a fellow second-year. In the room he saw students of all levels, from first-years to fourth-years, engaged in excited chatter.LEARNING OBJECTIVE: Identify the objectives of effective medical school grading systems and how medical schools can design them.The third-year class president, Sam, stood up. “Okay everyone, quiet down so that we can begin the discussion. We had not expected a turnout of this magnitude; it’s clear that this is an issue many of you feel quite passionately about. The administration has informed us that adopting a pass/fail system will require a majority vote from the student body.”The volume level in the room suddenly increased.He continued, “So, we hope that this meeting will serve as a lively debate where students on either side of this issue can share their arguments with the voting body.”“Pass/fail is such a great idea,” David whispered to Beth.To his surprise, she disagreed. “I don’t think so,” Beth replied. “I personally work harder and perform better when I am graded.”One of the third-year petitioners stood up to argue, “Our medical school is known for being one of the most intensely competitive programs in the country. We are already so stressed out—becoming pass/fail would remove an atmosphere of hypercompetition, and that will be a good change for our mental, emotional, and physical well-being.” His words were met with applause from some students in the hall.Another third-year petitioner presented a counterargument. “The majority of our graduating students match with residency programs each year, and most of those match at one of the programs they ranked in their top three. We’ve done very well with grades—would the same be true if we became pass/fail? Also, those of us interested in matching into very competitive specialties, such as dermatology, ophthalmology, and surgical specialties are put at a disadvantage since class rank and academic performance are highly regarded by residency directors in these specialties.”David, who himself had a particular interest in going into surgery, looked around the hall and saw a number of students nodding their heads in agreement. Beth nudged him playfully and whispered, “See what I mean?”Commentary 1by Bonnie M. Miller, MDThe primary purpose of any grading system is to measure student achievement of established learning objectives. Performance data let individual students know where they stand in the development of needed competencies. Aggregated performance data supply faculty and medical school administration with information about the effectiveness of teaching. A traditional grade stratifies students according to level of achievement and can motivate students, reward effort, and perhaps signify suitability for a potential area of study. A pass/fail grade indicates simply that a student has achieved an expected level of competence, information that is critically important if medical education is to fulfill its obligation to the public.The ideal grading system would also encourage the development of desirable professional behaviors. Does a traditional grading system encourage students to constantly strive for excellence, a habit that, theoretically, they would maintain when they no longer receive grades? Does a pass/fail system encourage collegiality, collaboration, and teamwork, since no one is disadvantaged by another’s success, and mutual benefit can result from sharing. In the case scenario we are commenting on, is Beth correct in fearing a lack of motivation in the absence of grades, or is David justified in his concern about grade-induced hyper-competitiveness?I believe that concerns about both consequences are justified, but my experience with grading systems suggests that neither is inevitable. Based on our grade-system change at Vanderbilt University earlier in the decade, I believe that elements such as faculty role modeling, selection of teaching strategies, careful and inclusive selection of the qualities that are being assessed, and use of criteria-based grading systems are more important contributors to student evaluation than whether or not letter grades are used.Faculty RoleGrading systems exist within the larger context of an educational environment that can powerfully mold the professional development of students. If students are hypercompetitive, it is unlikely that the grading system alone creates that behavior. Similarly, if students consistently aim their efforts at minimal passing performance, the environment might lack the ingredients needed to inspire excellence. Regardless of the grading system, medical school faculty and administration should be aware of the environments they create and monitor them with vigilance to assure that they support the attitudes and behaviors expected of the profession.In any grading system, faculty members should serve as role models who demonstrate a passion for excellence and a quest for improvement, both in their teaching efforts and their patient-care responsibilities. Role models who strive for excellence, not because of grades but for the good of those they serve, help students move beyond the external rewards that motivated them in their previous endeavors. Whether in teaching teams or in clinical teams, faculty members can also model the collaboration and collegiality that are important for effective, high-quality patient care. Finally, when faculty members care for the well-being and professional growth of their students, they model the compassionate and nurturing attitudes we hope those students will adopt.Teaching and Course-Management StrategiesTeaching strategies can also ameliorate the potentially negative side effects of a grading system. Many students study best in groups or learn most deeply when they are challenged to teach their peers, and schools with traditional grading systems can actively promote these approaches. Faculty can use course-management systems that allow all students to see the answers to all questions asked, and students can be encouraged to post helpful articles and learning tips. Team-based learning rewards group performance as opposed to individual effort, while creating pressure not to let one’s peers down, which discourages the slacking that a pass/fail system might encourage.Choosing What to MeasurePerhaps the grading system a school uses is less important than the qualities it chooses to grade. Assessment indeed drives learning, and if we feel that the professional development of our students is critical, we should demonstrate that by assessing it. In both science-based and clinical courses, students should be evaluated on their initiative, engagement with and concern for their own learning, interpersonal skills, teamwork skills and collegiality. Schools can devise grading policies, whether pass/fail or traditional, in which failure to demonstrate one of these key attributes can lead to failure in the course, regardless of cognitive achievement.Criteria-Based GradingFinally, the use of a normative versus a criteria-based grading system can influence student behaviors. In the former, the grade distribution is determined by comparative student performance, limiting the number of highest grades and creating an atmosphere in which one student’s performance can influence the grade of another. This is more likely to induce competition. In a criteria-based system, the requirements for each grade interval are predetermined, and any student who meets the designated requirements receives the designated grade, even if an entire class qualifies for an A. While this model could lead to grade inflation, it does recognize all students who achieve a certain level of excellence. And shouldn’t all medical teachers aspire to the goal of having all students excel?The Vanderbilt Grading ExperienceIn 2002, Vanderbilt University reexamined its traditional letter grading system. Like students at David and Beth’s school, our students performed very well in the residency match, and we were leery of changes that would make it more difficult for program directors to evaluate students. Unlike students at David and Beth’s school, ours did not complain of an overly competitive atmosphere. I’d like to think that this was because of our collegial educational environment, but a criteria-based system probably helped. Our greatest concern at that time was for the fairness of grades in the first year of medical school. Because of the wide variation in our students’ undergraduate preparation and the difficulties of adjusting to medical school, we felt that letter grades reflected not only effort and ability, but also the strength of the undergraduate program, the major a student had selected, and the ease of social transition. Most of our students who received marginal grades in the first year subsequently performed at very high levels, but were left with transcripts that marred their overall records.To balance our concern for first-year grades with our concern for the impact of a pure pass/fail system on the residency application process, we decided upon a hybrid system with pass/fail in the first year only; honors/pass/fail in the second year; and honors/high pass/pass/fail in the third and fourth years. We hoped that the noncompetitive culture of collaboration established in the first year would continue throughout the remaining 3 years, even as more grade intervals were introduced.Some faculty feared, like Beth, that first-year students would lack the motivation to put forth their strongest efforts. Fortunately, this fear never became a significant reality. Our curriculum remains rigorous and demands hard work, and the environment still encourages our students to reach for excellence. Occasionally a student’s performance slips on the last exam in a course if he or she is easily within the passing range, but this has not been a large enough effect to diminish overall class performance from year to year. Student performance in the subsequent years of medical school and on Step 1 of the United States Medical Licensing Examination (USMLE) has actually improved, relieving anxieties about the grading system’s long-term negative impacts on the learning habits.Paradoxically, in the first year of the transition, students and faculty sensed an increase in student competitiveness in the second-year class, even though this class entered with a traditionally graded system. We quickly realized that this resulted from a concurrent switch to a normative-based system that limited the number of honors grades to 25 percent of the class. In the following year, we reverted to a criteria-based system that set the honors bar extremely high to combat grade inflation but allowed all students who cleared that bar to receive an honors grade. Many students in that second-year class were also unhappy with the change and reported that they had selected Vanderbilt because of its traditional grading system. We learned from this experience that whenever possible, major policy and curriculum changes should be phased in with the entering classes. I have also become a strong believer in a criteria-based system that sets high standards but proudly recognizes all students who meet them.Because we maintained four grading intervals in the clinical years, we experienced no measurable change in the outcomes of our residency match. For schools that use a pass/fail only system throughout the 4-year curriculum, program directors rely more on qualitative measures, such as the comments recorded on clerkships assessment forms, letters of recommendation, and the nature of student leadership and scholarship accomplishments. With a sense that these subjective measures are less reliable than the objectivity of grades, program directors also tend to rely more heavily on Step 1 scores and the reputation of the medical school.No grading system is perfect in its ability to assess learners accurately, promote professional behaviors, and predict future accomplishments. Regardless of the system selected, a school must be aware of the potential for unintended consequences and should strive for an educational environment that counters these and encourages students to excel for the right reason, which is that their excellence will someday improve the lives of others.Bonnie M. Miller, MD, is the senior associate dean for health sciences education at Vanderbilt University School of Medicine in Nashville.Commentary 2by Adina Kalet, MD, MPHAs medical educators, our responsibility to society is to ensure that all physicians are competent to practice medicine. Ideally, both faculty and students should enthusiastically engage in an evaluation system that facilitates our fulfilling this responsibility. I am a strong believer in a grading system that is ultimately pass/fail—but is at the same time rich in confidential, formative feedback that helps students identify their strengths and weaknesses. To be meaningful, the “pass” thresholds must be competency- and criterion-based, not arbitrary or norm-referenced, i.e., predetermined percentages of students pass and fail.Competitive residency programs choose residents based on whatever evidence of their abilities exists. Residencies are looking for students who are a good fit for their program, well prepared, and capable of handling the work. The absence of letter grades on the formal transcript, without evidence of a rigorous, reliable assessment process is problematic for two reasons. First, it places enormous, undeserved pressure on students to do well on National Board Exams. Second, this approach overemphasizes the reputation of the medical school and its admissions policies.The debate presented in the case scenario focuses on the wrong outcomes. For example, students often defend pass/fail systems as more conducive to a relaxed learning environment because there is less interpersonal competition. I am not certain that this reflects reality. All medical students are highly achievement-oriented and many are competitive by nature. To be successful and competent physicians they must learn to manage the negative impact of these otherwise valuable personal traits in complex and competitive environments. On the other side of the argument, pass/fail systems disadvantage students who are consistently struggling because it allows them to squeak by without being identified for special attention early. In addition, even in schools like mine, NYU Medical Center, that operate with a pass/fail preclinical system, numeric grades are generated and followed for certain purposes (e.g., AOA determination), and students are well aware of this contradictory policy.In saying that the grades debate often focuses on the wrong outcome, I also mean that scores on exams are only useful if the exams themselves are reliable and valid measures of what they are meant to measure. Ideally, competency exams would provide students with detailed information to help determine whether they had the minimum competency to serve as physicians. We would overcome current weaknesses in measuring the remarkable capacities some students have in areas such as interdisciplinary teamwork and complex critical thinking. Once we have decided on fair, criterion-based measures that assess critical competencies, there is no way we could ethically, morally, or professionally argue against using such measures. Since most of our exams or grading systems do not reach this level of evidence, however, we use them as blunt instruments rather than sources of meaningful information.In sum, I don’t care as much as many students do about whether we use pass/fail or other systems. I care that we measure what is important and act on those measures to ensure excellence in our graduates.Adina Kalet, MD, MPH, is the Arnold P. Gold Professor of humanism and professionalism and an associate professor of medicine and surgery at New York University School of Medicine. She has a long-standing research interest in assessment of clinical competence and the relationship between medical education and patient outcomes. She has mentored three cohorts of NYU SOM Virtual Mentor student editors.Commentary 3by Ryan C. VanWoerkom, Nicholas Zorko, and Julia HalseyDuring the late 1960s and early 1970s, medical schools moved away from traditional grading systems and began adopting pass/fail or honors/pass/fail evaluation [1]. It is thought that the impetus for these changes originated with the concern that grade-based learning did not prepare for lifelong learning outside of the academic world and that it suppressed creativity and increased stress [1, 2]. On the other hand, it is well-known that residency directors hold the dean’s letter in high regard and favor the more discriminative letter-grade evaluation report [1, 3, 4].The ultimate quick test in medicine is applying the principle of primum non nocere (first do no harm). Is there a possibility that by changing the grading system to a less rigorous, more comfortable pass/fail system we may be harming patients? This would occur indirectly by allowing some students to slip through the cracks of a low-demand education and evaluation system. Gonnella et al. noted that students in need of remediation (not meeting basic standards set for competence in medical education) often went unidentified under a pass/fail system. “Failure to identify students who pass only narrowly results in the suppression of information that is critical to the future development of the students, and is important in the prevention of problems in professional practice” [5]. This does not bode well for patients, even if only a few sub-par students slip through the system without undergoing appropriate remediation.One example of a problem in professional practice could occur while a student or resident is caring for patients on a hospital team. The extra effort spent by one student studying for an “A” may trigger a memory for the correct tests needed to arrive at a diagnosis and implement an alleviating treatment, a connection that another student who only wanted to pass may not have made. The use of pass/fail grading has been correlated by some groups with poorer performance on exams [8, 9]. Additional information supporting this view was found in a study of surgery residents trained under different grading systems in medical school. Moss et al. found that residents who attended medical schools that assigned grades performed better than those who attended schools that used pass/fail systems [6]. Proponents of pass/fail grading argue that students working in such systems report a greater sense of satisfaction and well-being, but there is evidence refuting this reduction in anxiety upon implementation of a pass/fail grading system [7]. This perceived decrease in anxiety, regardless of validity, may not be worth the decrease in knowledge acquisition that may occur with less rigorous study habits.Students’ personal characteristics and attributes may influence their behavior and attitudes as strongly as a strictly graded traditional system with its intense pressure to perform well—the extrinsic factors—but the two are not easily separated. As one comes closer to measuring an extrinsic factor in medical education, he or she inadvertently affects the intrinsic. Consider, for example, the competitiveness that is said to infect medical students. A student who is willing to pull ahead at the risk of alienating classmates may be innately achievement-oriented, so the cause for his or her behavior is independent of the medical school environment and its pressure to compete.Kaitlyn died by suicide in medical schoolMany schools have opted for the honors/pass/fail grading system, which does not eliminate the pressure or incentive for students who wish to compete for honors grades. Honors/pass/fail may have the paradoxical effect of placing additional pressure on competitive students to perform even better simply because their grading system fails to discriminate adequately.A survey of surgery clerkship directors revealed consensus that a three-tiered system did not do enough to differentiate students appropriately. Pass/fail programs, this Ravelli et al. study concluded, “produced little reliable discrimination” between the quality of students and their peers [2]. With this in mind, it is more just to acknowledge a continuum of grades properly than to differentiate only between pass/fail. Consider a student who received the all-time top score for a medical school exam and was given the same grade as a student who passed by one question. This system results in general statements of evaluation for a majority of students without providing a means of recognition for outstanding efforts.Although many medical schools tout their pass/fail grading system as a means of attracting prospective medical students, these same schools, in truth, rank their students because they know that residency programs want them to distinguish among students. If students are not ranked in a traditional numerical order (e.g., 1/125), they are lumped in quartiles. In order for medical schools to maintain clout in placing their students in competitive residencies, the Medical Student Performance Evaluations (MSPEs) that they send to residency programs must rank students in some useful way. This may even lead to confusion among students regarding their own rank systems.Turning to the other side of the debate—the argument for pass/fail grading—students have more compelling motivators than grades. Having made it through the weeding process in high school and college classes and even the application process where grades were the most important criteria, medical students need to acquire the knowledge necessary to pass the national boards, obtain residencies and fellowship, and establish a satisfying career. At this point in their medical education, they have greater motivators to learn than simply to get an A on a test.The letter-grading system also suffers from grade-inflation, which has caused distress in admissions committees and employers of various disciplines. Grade inflation has placed a greater significance on standardized testing as the most objective way for schools to compare candidates from different programs. This in turn, may make the medical board exams a more stressful experience.While much of this discussion may not seem to be directly related to ethics, in the grand scheme of things, performing at a level which is anything less than one’s best has the potential to be detrimental to a patient’s well-being and is therefore unethical. The AMA Code of Medical Ethics states,Incompetence, corruption, or dishonest or unethical conduct on the part of members of the medical profession is reprehensible. In addition to posing a real or potential threat to patients, such conduct undermines the public’s confidence in the profession [10].Therefore, medical students’ ethical obligation encompasses the duty to prevent incompetence within their profession.Steve Prefontaine put it best: “To give anything less than your best is to sacrifice the gift.” As physicians or future physicians, we owe it to our patients and society to give our absolute best effort in exchange for the trust and responsibility for their lives they have given over to our care. We have been given a gift and privilege to study and practice medicine and should thus handle it appropriately regardless of the method used to evaluate us.ReferencesDietrick JA, Weaver MT, Merrick HW. Pass/fail grading: a disadvantage for students applying for residency. Am J Surg. 1991;162:(1)63-66.Ravelli C, Wolfson P. What is the “ideal” grading system for the junior surgery clerkship? Am J Surg. 1999;177(2):140-144.Lurie SJ, Lambert DR, Grady-Weliky TA. Relationship between dean’s letter rankings and later evaluations by residency program directors. Teach Learn Med. 2007:19(3):251-256.Provan JL, Cuttress L. Preferences of program directors for evaluation of candidates for postgraduate training. CMAJ. 1995;153(7):919-923.Gonnella JS, Erdmann JB, Hojat M. An empirical study of the predictive validity of number grades in medical school using 3 decades of longitudinal data: implications for a grading system. Med Educ. 2004;38(4):425-434.Moss TJ, Deland EC, Maloney JV Jr. Selection of medical students for graduate training: pass/fail versus grades. N Engl J Med. 1978;299(1):25-27.Yarbro RC. A comparison of anxiety levels of students taking pass/fail versus grade in student teaching. Tenn Educ. 1982;12(2):33-36.Weller LD. The grading nemesis: an historical overview and a current look at pass/fail grading. J Res Devel Educ. 1983;17:39-45.Suddick DE, Kelly RE. Effects of transition from pass/no credit to traditional letter grade system. J Exp Educ. 1981;50:88-90.American Medical Association. Opinion 9.04. Discipline and medicine. Code of Medical Ethics. Chicago, IL: American Medical Association. 1994. http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion904.shtml. Accessed October 12, 2009.Ryan C. VanWoerkomis a fourth-year medical student at the University of Utah in Salt Lake City, with plans to enter a career in internal medicine. He serves as the chair of the Committee on Bioethics and Humanities for the American Medical Association-Medical Student Section as well as being the Midwest representative to the American College of Physicians Council of Student Members.Nicholas Zorkois a fourth-year MD/PhD student at The Ohio State University in Columbus. He graduated from Ohio State with a bachelor’s degree in biology in 2006, and is currently the vice chair for the Committee on Bioethics and Humanities for the American Medical Association-Medical Student Section.Julia Halseyis a third-year medical student at the University of Missouri in Columbia. She graduated from Truman State University in Kirksville, Missouri, with a bachelor’s degree in biology and from Trinity International University in Deerfield, Illinois, with a master’s degree in bioethics. She currently serves as the student representative to the AMA’s Council on Ethical and Judicial Affairs.Related in VMNurturing Leaders for an Environment of Change, November 2009Is There More to Medical School than Grades? December 2003The people and events in this case are fictional. Resemblance to real events or to names of people, living or dead, is entirely coincidental. The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.© 2009 American Medical Association. All Rights Reserved.Grading Systems in Medical School: Pass/Fail or A-F Scale?Author: Veronica Reina Mar 25, 2014Up until medical school, the majority of your classes used the traditional A-F grading scale to rate your academic achievement. Everyone loves to get an A, and receiving an F is a sure sign that you blew it. When you begin your research for medical school, you’ll want to think about the importance of whether a school uses a traditional grading system or relies on Pass/Fail ratings. There are a number of factors to consider, and each medical school grading system has both advantages and disadvantages.In a more conventional A-F medical school grading system, future residency options are greatly increased based on that graded performance. The clear competitive benefit of a conventional grading system is that it can distinguish candidates based on how they performed as compared to their peers. Unfortunately, according to the National Institutes of Health (NIH), being ranked in an A-F medical school grading system raises anxiety levels and heightens depression as medical students compete for the most coveted residencies and other post medical career paths. Medical students must decide whether a coveted residency is worth the added stress inherent in a highly competitive A-F medical school grading system. These factors increasingly lead more medical schools to adapt the Pass/Fail system.The simplicity and non-competitive nature of the Pass/Fail medical school grading system depends on the intensity of the medical school curriculum and the degree of the Pass/Fail system. More schools are implementing a hybrid medical school grading system, wherecoursework completed during the first two years is evaluated as Pass/Fail and the final two years are graded using the conventional A-F scale. More widely used is the High Pass-Pass-Fail medical school grading system, which allows for students to distinguish themselves particularly by receiving a High Pass rating. The Pass/Fail medical school grading system places a critical amount of importance on letters of recommendation and national board testing as predictors of your future success in your residency.At a number of elite medical schools, including both the Yale School of Medicine and Stanford Medical School, the vetting process to gain acceptance to these institutions is so thorough that the grading system is secondary to the prestige of the medical school. Studies often show that attendance at elite medical schools leads to the most sought after residencies. A better predictor of student success during medical school and in applying to residency programs is your benchmark performance on the US Medical Licensing Examination. Ultimately, this exam is the most important gauge of a student’s success in medical school.Residency programs sets their own standards pertaining to acceptance and success. Acceptance in these programs is based on a number of factors. One of those is whether your medical school employs a conventional A-F grading system or Pass/Fail system. Medical school grades are not the only criteria for matching to your ideal residency program, but they are significant enough that you will want to do some research and be informed about the criteria by which you will eventually be evaluated. The road to becoming a medical professional is fraught with choices. Making well advised and thoroughly researched decisions, like the grading system used by your medical school, is critical to your success. — Post by Madeliane Kingsbury.A Medical School goes Pass/Fail only: Why this is an Excellent Change!september 17, 2016 by lifeofamedstudent, posted in med student adviceWell I’m officially THAT old, bitter resident. I had to walk uphill to medical school 10 miles there and back. “In my day” medical school was fail, pass, high pass, or honors. I just found out that the medical school I graduated from has changed the first 2 years of science courses to simply pass/fail (while retaining the honors/high pass grades in clinical rotations). I am so annoyed! Why does this bother me? Because that’s not how it was when I was there! Because having the extra high pass and honors adds a great deal of unnecessary stress to students as they are adjusting to the brutal workload of medical school. BUT BECAUSE I HAD TO GO THROUGH IT, SO SHOULD EVERYONE ELSE, DAMMIT!In all seriousness, I am in complete agreement and happy for the change.The first year of medical school was the absolute hardest of my life. The stress was monumental. The coursework is overwhelming. The absolute competition, while often among friends, is real. With the high pass/honors in place, it wasn’t good enough to just pass. It wasn’t good enough to even high pass! Everyone, admit it or not, felt the pressure of having those staggered “grades.”My first semester I had a hard time adjusting to the rigors of medical school. The study habits that had suited me so well in undergrad, were completely failing me. As a result, my grades that semester were also struggling. After one particularly bad exam result in anatomy, the idea of failing a class for the first time was unbelievably depressing. I had graduated high school and then even undergrad with a 4.0. I had never even had a “B” before. Yet, by November of that first semester, failing was a reality that I had to live with every day. The effect that had on my psyche was truly significant. Luckily, and with some serious hard work, I passed that anatomy class and all my classes that semester.By second semester, I began to find my study groove and was getting my confidence back. Even early in that semester, I no longer had to question whether I would pass or not. I was doing fine in all my courses. However, that did not take the pressure off. Once I realized, passing wasn’t the issue, it quickly became whether or not I would “high pass.” I’ve always been the type to push myself but in medical school the looming issue is always the competition. What residency you can realistically apply to is greatly affected by the scores you receive. So once I knew I could pass my classes, I felt I had to high pass them. Just like that first semester trying to pass, I was now only happy with a “high pass.” That second semester I ended up with a “high pass” in three of my courses, and I was honestly less happy about it than when I’d found out I’d barely “passed” that first semester.This trend would continue and by 3rd year, I wasn’t even happy with a high pass and downright disappointed when I only passed a rotation. Then my 4th year of medical school I managed to receive an honors grade in 6 of my 9 courses. Yet I still was probably not as emotionally satisfied or happy as the day I found out I passed that first anatomy class I was so worried about.My actual medical school transcript.While some might look at my story and feel I’m an example for why staggered grades HELPS students push to achieve more and more, I disagree. The added stress of always having the next higher grade to achieve is unnecessary and even harmful. Medical school IS stressful. It’s stressful no matter how you are graded. The goal IS to pass and be sufficiently trained to enter a residency, where only then are you actually trained to take care of patients. This isn’t 1960 and people are not practicing medicine unboarded straight from medical school. Medical school is now just a hoop to jump and likewise should simply be a course to pass.I consider myself a fairly emotionally robust person. I have entered a speciality (anesthesia) where the choices I make can have an instantaneous life or death consequence. I have always handled pressure well and may even enjoy it a little bit. Not everyone is like that. Fewer still enjoy or thrive under it. The staggered honors-high pass grades tends to adversely affect these people the most. It takes good passing students, who will become good doctors, and crushes them under the added pressure. Deflates them with the unstopping competition. Eventually, burning them out toward medicine. And horrifically, every year a few of them decide to commit suicide.Will a pass/fail only curriculum make medical school easy? Not even close. But it definitely could take unnecessary stress off students. That first two years of medical school were the hardest of my life. If had a pass/fail curriculum been in place maybe I wouldn’t be saying that today, at least after the second semester. And just maybe, there would be a lot of other great doctors out there that hadn’t been eventually burned out by the same system. If you are in a program that still uses a staggered honors grading system, I’ll give you the same advice that was given to me during those years: P = M.D, baby. Because you know what they call the person that graduates without a single honors grade? DOCTOR.What do you think? Is Pass/Fail a way to improve student wellness? Or is there benefit to having a staggered grading system? Add your thoughts in the comment section below!

The following is the blueprint for exactly what’s happened over the last four decades. It is very real. It presents all of us with precisely how the American working and middle classes have been screwed.Confidential Memorandum: Attack of American Free Enterprise SystemDATE: August 23, 1971TO: Mr. Eugene B. Sydnor, Jr., Chairman, Education Committee, U.S. Chamber of CommerceFROM: Lewis F. Powell, Jr.This memorandum is submitted at your request as a basis for the discussion on August 24 with Mr. Booth (executive vice president) and others at the U.S. Chamber of Commerce. The purpose is to identify the problem, and suggest possible avenues of action for further consideration.Dimensions of the AttackNo thoughtful person can question that the American economic system is under broad attack. This varies in scope, intensity, in the techniques employed, and in the level of visibility.There always have been some who opposed the American system, and preferred socialism or some form of statism (communism or fascism). Also, there always have been critics of the system, whose criticism has been wholesome and constructive so long as the objective was to improve rather than to subvert or destroy.But what now concerns us is quite new in the history of America. We are not dealing with sporadic or isolated attacks from a relatively few extremists or even from the minority socialist cadre. Rather, the assault on the enterprise system is broadly based and consistently pursued. It is gaining momentum and converts.Sources of the AttackThe sources are varied and diffused. They include, not unexpectedly, the Communists, New Leftists and other revolutionaries who would destroy the entire system, both political and economic. These extremists of the left are far more numerous, better financed, and increasingly are more welcomed and encouraged by other elements of society, than ever before in our history. But they remain a small minority, and are not yet the principal cause for concern.The most disquieting voices joining the chorus of criticism come from perfectly respectable elements of society: from the college campus, the pulpit, the media, the intellectual and literary journals, the arts and sciences, and from politicians. In most of these groups the movement against the system is participated in only by minorities. Yet, these often are the most articulate, the most vocal, the most prolific in their writing and speaking.Moreover, much of the media-for varying motives and in varying degrees-either voluntarily accords unique publicity to these “attackers,” or at least allows them to exploit the media for their purposes. This is especially true of television, which now plays such a predominant role in shaping the thinking, attitudes and emotions of our people.One of the bewildering paradoxes of our time is the extent to which the enterprise system tolerates, if not participates in, its own destruction.The campuses from which much of the criticism emanates are supported by (i) tax funds generated largely from American business, and (ii) contributions from capital funds controlled or generated by American business. The boards of trustees of our universities overwhelmingly are composed of men and women who are leaders in the system.Most of the media, including the national TV systems, are owned and theoretically controlled by corporations which depend upon profits, and the enterprise system to survive.Tone of the AttackThis memorandum is not the place to document in detail the tone, character, or intensity of the attack. The following quotations will suffice to give one a general idea:William Kunstler, warmly welcomed on campuses and listed in a recent student poll as the “American lawyer most admired,” incites audiences as follows:“You must learn to fight in the streets, to revolt, to shoot guns. We will learn to do all of the things that property owners fear.”2 The New Leftists who heed Kunstler’s advice increasingly are beginning to act — not just against military recruiting offices and manufacturers of munitions, but against a variety of businesses: “Since February, 1970, branches (of Bank of America) have been attacked 39 times, 22 times with explosive devices and 17 times with fire bombs or by arsonists.”3 Although New Leftist spokesmen are succeeding in radicalizing thousands of the young, the greater cause for concern is the hostility of respectable liberals and social reformers. It is the sum total of their views and influence which could indeed fatally weaken or destroy the system.A chilling description of what is being taught on many of our campuses was written by Stewart Alsop:“Yale, like every other major college, is graduating scores of bright young men who are practitioners of ‘the politics of despair.’ These young men despise the American political and economic system . . . (their) minds seem to be wholly closed. They live, not by rational discussion, but by mindless slogans.”4 A recent poll of students on 12 representative campuses reported that: “Almost half the students favored socialization of basic U.S. industries.”5A visiting professor from England at Rockford College gave a series of lectures entitled “The Ideological War Against Western Society,” in which he documents the extent to which members of the intellectual community are waging ideological warfare against the enterprise system and the values of western society. In a foreword to these lectures, famed Dr. Milton Friedman of Chicago warned: “It (is) crystal clear that the foundations of our free society are under wide-ranging and powerful attack — not by Communist or any other conspiracy but by misguided individuals parroting one another and unwittingly serving ends they would never intentionally promote.”6Perhaps the single most effective antagonist of American business is Ralph Nader, who — thanks largely to the media — has become a legend in his own time and an idol of millions of Americans. A recent article in Fortune speaks of Nader as follows:“The passion that rules in him — and he is a passionate man — is aimed at smashing utterly the target of his hatred, which is corporate power. He thinks, and says quite bluntly, that a great many corporate executives belong in prison — for defrauding the consumer with shoddy merchandise, poisoning the food supply with chemical additives, and willfully manufacturing unsafe products that will maim or kill the buyer. He emphasizes that he is not talking just about ‘fly-by-night hucksters’ but the top management of blue chip business.”7A frontal assault was made on our government, our system of justice, and the free enterprise system by Yale Professor Charles Reich in his widely publicized book: “The Greening of America,” published last winter.The foregoing references illustrate the broad, shotgun attack on the system itself. There are countless examples of rifle shots which undermine confidence and confuse the public. Favorite current targets are proposals for tax incentives through changes in depreciation rates and investment credits. These are usually described in the media as “tax breaks,” “loop holes” or “tax benefits” for the benefit of business. As viewed by a columnist in the Post, such tax measures would benefit “only the rich, the owners of big companies.”8It is dismaying that many politicians make the same argument that tax measures of this kind benefit only “business,” without benefit to “the poor.” The fact that this is either political demagoguery or economic illiteracy is of slight comfort. This setting of the “rich” against the “poor,” of business against the people, is the cheapest and most dangerous kind of politics.The Apathy and Default of BusinessWhat has been the response of business to this massive assault upon its fundamental economics, upon its philosophy, upon its right to continue to manage its own affairs, and indeed upon its integrity?The painfully sad truth is that business, including the boards of directors’ and the top executives of corporations great and small and business organizations at all levels, often have responded — if at all — by appeasement, ineptitude and ignoring the problem. There are, of course, many exceptions to this sweeping generalization. But the net effect of such response as has been made is scarcely visible.In all fairness, it must be recognized that businessmen have not been trained or equipped to conduct guerrilla warfare with those who propagandize against the system, seeking insidiously and constantly to sabotage it. The traditional role of business executives has been to manage, to produce, to sell, to create jobs, to make profits, to improve the standard of living, to be community leaders, to serve on charitable and educational boards, and generally to be good citizens. They have performed these tasks very well indeed.But they have shown little stomach for hard-nose contest with their critics, and little skill in effective intellectual and philosophical debate.A column recently carried by the Wall Street Journal was entitled: “Memo to GM: Why Not Fight Back?”9 Although addressed to GM by name, the article was a warning to all American business. Columnist St. John said:“General Motors, like American business in general, is ‘plainly in trouble’ because intellectual bromides have been substituted for a sound intellectual exposition of its point of view.” Mr. St. John then commented on the tendency of business leaders to compromise with and appease critics. He cited the concessions which Nader wins from management, and spoke of “the fallacious view many businessmen take toward their critics.” He drew a parallel to the mistaken tactics of many college administrators: “College administrators learned too late that such appeasement serves to destroy free speech, academic freedom and genuine scholarship. One campus radical demand was conceded by university heads only to be followed by a fresh crop which soon escalated to what amounted to a demand for outright surrender.”One need not agree entirely with Mr. St. John’s analysis. But most observers of the American scene will agree that the essence of his message is sound. American business “plainly in trouble”; the response to the wide range of critics has been ineffective, and has included appeasement; the time has come — indeed, it is long overdue — for the wisdom, ingenuity and resources of American business to be marshalled against those who would destroy it.Responsibility of Business ExecutivesWhat specifically should be done? The first essential — a prerequisite to any effective action — is for businessmen to confront this problem as a primary responsibility of corporate management.The overriding first need is for businessmen to recognize that the ultimate issue may be survival — survival of what we call the free enterprise system, and all that this means for the strength and prosperity of America and the freedom of our people.The day is long past when the chief executive officer of a major corporation discharges his responsibility by maintaining a satisfactory growth of profits, with due regard to the corporation’s public and social responsibilities. If our system is to survive, top management must be equally concerned with protecting and preserving the system itself. This involves far more than an increased emphasis on “public relations” or “governmental affairs” — two areas in which corporations long have invested substantial sums.A significant first step by individual corporations could well be the designation of an executive vice president (ranking with other executive VP’s) whose responsibility is to counter-on the broadest front-the attack on the enterprise system. The public relations department could be one of the foundations assigned to this executive, but his responsibilities should encompass some of the types of activities referred to subsequently in this memorandum. His budget and staff should be adequate to the task.Possible Role of the Chamber of CommerceBut independent and uncoordinated activity by individual corporations, as important as this is, will not be sufficient. Strength lies in organization, in careful long-range planning and implementation, in consistency of action over an indefinite period of years, in the scale of financing available only through joint effort, and in the political power available only through united action and national organizations.Moreover, there is the quite understandable reluctance on the part of any one corporation to get too far out in front and to make itself too visible a target.The role of the National Chamber of Commerce is therefore vital. Other national organizations (especially those of various industrial and commercial groups) should join in the effort, but no other organizations appear to be as well situated as the Chamber. It enjoys a strategic position, with a fine reputation and a broad base of support. Also — and this is of immeasurable merit — there are hundreds of local Chambers of Commerce which can play a vital supportive role.It hardly need be said that before embarking upon any program, the Chamber should study and analyze possible courses of action and activities, weighing risks against probable effectiveness and feasibility of each. Considerations of cost, the assurance of financial and other support from members, adequacy of staffing and similar problems will all require the most thoughtful consideration.The CampusThe assault on the enterprise system was not mounted in a few months. It has gradually evolved over the past two decades, barely perceptible in its origins and benefiting (sic) from a gradualism that provoked little awareness much less any real reaction.Although origins, sources and causes are complex and interrelated, and obviously difficult to identify without careful qualification, there is reason to believe that the campus is the single most dynamic source. The social science faculties usually include members who are unsympathetic to the enterprise system. They may range from a Herbert Marcuse, Marxist faculty member at the University of California at San Diego, and convinced socialists, to the ambivalent liberal critic who finds more to condemn than to commend. Such faculty members need not be in a majority. They are often personally attractive and magnetic; they are stimulating teachers, and their controversy attracts student following; they are prolific writers and lecturers; they author many of the textbooks, and they exert enormous influence — far out of proportion to their numbers — on their colleagues and in the academic world.Social science faculties (the political scientist, economist, sociologist and many of the historians) tend to be liberally oriented, even when leftists are not present. This is not a criticism per se, as the need for liberal thought is essential to a balanced viewpoint. The difficulty is that “balance” is conspicuous by its absence on many campuses, with relatively few members being of conservatives or moderate persuasion and even the relatively few often being less articulate and aggressive than their crusading colleagues.This situation extending back many years and with the imbalance gradually worsening, has had an enormous impact on millions of young American students. In an article in Barron’s Weekly, seeking an answer to why so many young people are disaffected even to the point of being revolutionaries, it was said: “Because they were taught that way.”10 Or, as noted by columnist Stewart Alsop, writing about his alma mater: “Yale, like every other major college, is graduating scores’ of bright young men … who despise the American political and economic system.”As these “bright young men,” from campuses across the country, seek opportunities to change a system which they have been taught to distrust — if not, indeed “despise” — they seek employment in the centers of the real power and influence in our country, namely: (i) with the news media, especially television; (ii) in government, as “staffers” and consultants at various levels; (iii) in elective politics; (iv) as lecturers and writers, and (v) on the faculties at various levels of education.Many do enter the enterprise system — in business and the professions — and for the most part they quickly discover the fallacies of what they have been taught. But those who eschew the mainstream of the system often remain in key positions of influence where they mold public opinion and often shape governmental action. In many instances, these “intellectuals” end up in regulatory agencies or governmental departments with large authority over the business system they do not believe in.If the foregoing analysis is approximately sound, a priority task of business — and organizations such as the Chamber — is to address the campus origin of this hostility. Few things are more sanctified in American life than academic freedom. It would be fatal to attack this as a principle. But if academic freedom is to retain the qualities of “openness,” “fairness” and “balance” — which are essential to its intellectual significance — there is a great opportunity for constructive action. The thrust of such action must be to restore the qualities just mentioned to the academic communities.What Can Be Done About the CampusThe ultimate responsibility for intellectual integrity on the campus must remain on the administrations and faculties of our colleges and universities. But organizations such as the Chamber can assist and activate constructive change in many ways, including the following:Staff of ScholarsThe Chamber should consider establishing a staff of highly qualified scholars in the social sciences who do believe in the system. It should include several of national reputation whose authorship would be widely respected — even when disagreed with.Staff of SpeakersThere also should be a staff of speakers of the highest competency. These might include the scholars, and certainly those who speak for the Chamber would have to articulate the product of the scholars.Speaker’s BureauIn addition to full-time staff personnel, the Chamber should have a Speaker’s Bureau which should include the ablest and most effective advocates from the top echelons of American business.Evaluation of TextbooksThe staff of scholars (or preferably a panel of independent scholars) should evaluate social science textbooks, especially in economics, political science and sociology. This should be a continuing program.The objective of such evaluation should be oriented toward restoring the balance essential to genuine academic freedom. This would include assurance of fair and factual treatment of our system of government and our enterprise system, its accomplishments, its basic relationship to individual rights and freedoms, and comparisons with the systems of socialism, fascism and communism. Most of the existing textbooks have some sort of comparisons, but many are superficial, biased and unfair.We have seen the civil rights movement insist on re-writing many of the textbooks in our universities and schools. The labor unions likewise insist that textbooks be fair to the viewpoints of organized labor. Other interested citizens groups have not hesitated to review, analyze and criticize textbooks and teaching materials. In a democratic society, this can be a constructive process and should be regarded as an aid to genuine academic freedom and not as an intrusion upon it.If the authors, publishers and users of textbooks know that they will be subjected — honestly, fairly and thoroughly — to review and critique by eminent scholars who believe in the American system, a return to a more rational balance can be expected.Equal Time on the CampusThe Chamber should insist upon equal time on the college speaking circuit. The FBI publishes each year a list of speeches made on college campuses by avowed Communists. The number in 1970 exceeded 100. There were, of course, many hundreds of appearances by leftists and ultra liberals who urge the types of viewpoints indicated earlier in this memorandum. There was no corresponding representation of American business, or indeed by individuals or organizations who appeared in support of the American system of government and business.Every campus has its formal and informal groups which invite speakers. Each law school does the same thing. Many universities and colleges officially sponsor lecture and speaking programs. We all know the inadequacy of the representation of business in the programs.It will be said that few invitations would be extended to Chamber speakers.11 This undoubtedly would be true unless the Chamber aggressively insisted upon the right to be heard — in effect, insisted upon “equal time.” University administrators and the great majority of student groups and committees would not welcome being put in the position publicly of refusing a forum to diverse views, indeed, this is the classic excuse for allowing Communists to speak.The two essential ingredients are (i) to have attractive, articulate and well-informed speakers; and (ii) to exert whatever degree of pressure — publicly and privately — may be necessary to assure opportunities to speak. The objective always must be to inform and enlighten, and not merely to propagandize.Balancing of FacultiesPerhaps the most fundamental problem is the imbalance of many faculties. Correcting this is indeed a long-range and difficult project. Yet, it should be undertaken as a part of an overall program. This would mean the urging of the need for faculty balance upon university administrators and boards of trustees.The methods to be employed require careful thought, and the obvious pitfalls must be avoided. Improper pressure would be counterproductive. But the basic concepts of balance, fairness and truth are difficult to resist, if properly presented to boards of trustees, by writing and speaking, and by appeals to alumni associations and groups.This is a long road and not one for the fainthearted. But if pursued with integrity and conviction it could lead to a strengthening of both academic freedom on the campus and of the values which have made America the most productive of all societies.Graduate Schools of BusinessThe Chamber should enjoy a particular rapport with the increasingly influential graduate schools of business. Much that has been suggested above applies to such schools.Should not the Chamber also request specific courses in such schools dealing with the entire scope of the problem addressed by this memorandum? This is now essential training for the executives of the future.Secondary EducationWhile the first priority should be at the college level, the trends mentioned above are increasingly evidenced in the high schools. Action programs, tailored to the high schools and similar to those mentioned, should be considered. The implementation thereof could become a major program for local chambers of commerce, although the control and direction — especially the quality control — should be retained by the National Chamber.What Can Be Done About the Public?Reaching the campus and the secondary schools is vital for the long-term. Reaching the public generally may be more important for the shorter term. The first essential is to establish the staffs of eminent scholars, writers and speakers, who will do the thinking, the analysis, the writing and the speaking. It will also be essential to have staff personnel who are thoroughly familiar with the media, and how most effectively to communicate with the public. Among the more obvious means are the following:TelevisionThe national television networks should be monitored in the same way that textbooks should be kept under constant surveillance. This applies not merely to so-called educational programs (such as “Selling of the Pentagon”), but to the daily “news analysis” which so often includes the most insidious type of criticism of the enterprise system.12 Whether this criticism results from hostility or economic ignorance, the result is the gradual erosion of confidence in “business” and free enterprise.This monitoring, to be effective, would require constant examination of the texts of adequate samples of programs. Complaints — to the media and to the Federal Communications Commission — should be made promptly and strongly when programs are unfair or inaccurate.Equal time should be demanded when appropriate. Effort should be made to see that the forum-type programs (the Today Show, Meet the Press, etc.) afford at least as much opportunity for supporters of the American system to participate as these programs do for those who attack it.Other MediaRadio and the press are also important, and every available means should be employed to challenge and refute unfair attacks, as well as to present the affirmative case through these media.The Scholarly JournalsIt is especially important for the Chamber’s “faculty of scholars” to publish. One of the keys to the success of the liberal and leftist faculty members has been their passion for “publication” and “lecturing.” A similar passion must exist among the Chamber’s scholars.Incentives might be devised to induce more “publishing” by independent scholars who do believe in the system.There should be a fairly steady flow of scholarly articles presented to a broad spectrum of magazines and periodicals — ranging from the popular magazines (Life, Look, Reader’s Digest, etc.) to the more intellectual ones (Atlantic, Harper’s, Saturday Review, New York, etc.)13 and to the various professional journals.Books, Paperbacks and PamphletsThe news stands — at airports, drugstores, and elsewhere — are filled with paperbacks and pamphlets advocating everything from revolution to erotic free love. One finds almost no attractive, well-written paperbacks or pamphlets on “our side.” It will be difficult to compete with an Eldridge Cleaver or even a Charles Reich for reader attention, but unless the effort is made — on a large enough scale and with appropriate imagination to assure some success — this opportunity for educating the public will be irretrievably lost.Paid AdvertisementsBusiness pays hundreds of millions of dollars to the media for advertisements. Most of this supports specific products; much of it supports institutional image making; and some fraction of it does support the system. But the latter has been more or less tangential, and rarely part of a sustained, major effort to inform and enlighten the American people.If American business devoted only 10% of its total annual advertising budget to this overall purpose, it would be a statesman-like expenditure.The Neglected Political ArenaIn the final analysis, the payoff — short-of revolution — is what government does. Business has been the favorite whipping-boy of many politicians for many years. But the measure of how far this has gone is perhaps best found in the anti-business views now being expressed by several leading candidates for President of the United States.It is still Marxist doctrine that the “capitalist” countries are controlled by big business. This doctrine, consistently a part of leftist propaganda all over the world, has a wide public following among Americans.Yet, as every business executive knows, few elements of American society today have as little influence in government as the American businessman, the corporation, or even the millions of corporate stockholders. If one doubts this, let him undertake the role of “lobbyist” for the business point of view before Congressional committees. The same situation obtains in the legislative halls of most states and major cities. One does not exaggerate to say that, in terms of political influence with respect to the course of legislation and government action, the American business executive is truly the “forgotten man.”Current examples of the impotency of business, and of the near-contempt with which businessmen’s views are held, are the stampedes by politicians to support almost any legislation related to “consumerism” or to the “environment.”Politicians reflect what they believe to be majority views of their constituents. It is thus evident that most politicians are making the judgment that the public has little sympathy for the businessman or his viewpoint.The educational programs suggested above would be designed to enlighten public thinking — not so much about the businessman and his individual role as about the system which he administers, and which provides the goods, services and jobs on which our country depends.But one should not postpone more direct political action, while awaiting the gradual change in public opinion to be effected through education and information. Business must learn the lesson, long ago learned by labor and other self-interest groups. This is the lesson that political power is necessary; that such power must be assidously (sic) cultivated; and that when necessary, it must be used aggressively and with determination — without embarrassment and without the reluctance which has been so characteristic of American business.As unwelcome as it may be to the Chamber, it should consider assuming a broader and more vigorous role in the political arena.Neglected Opportunity in the CourtsAmerican business and the enterprise system have been affected as much by the courts as by the executive and legislative branches of government. Under our constitutional system, especially with an activist-minded Supreme Court, the judiciary may be the most important instrument for social, economic and political change.Other organizations and groups, recognizing this, have been far more astute in exploiting judicial action than American business. Perhaps the most active exploiters of the judicial system have been groups ranging in political orientation from “liberal” to the far left.The American Civil Liberties Union is one example. It initiates or intervenes in scores of cases each year, and it files briefs amicus curiae in the Supreme Court in a number of cases during each term of that court. Labor unions, civil rights groups and now the public interest law firms are extremely active in the judicial arena. Their success, often at business’ expense, has not been inconsequential.This is a vast area of opportunity for the Chamber, if it is willing to undertake the role of spokesman for American business and if, in turn, business is willing to provide the funds.As with respect to scholars and speakers, the Chamber would need a highly competent staff of lawyers. In special situations it should be authorized to engage, to appear as counsel amicus in the Supreme Court, lawyers of national standing and reputation. The greatest care should be exercised in selecting the cases in which to participate, or the suits to institute. But the opportunity merits the necessary effort.Neglected Stockholder PowerThe average member of the public thinks of “business” as an impersonal corporate entity, owned by the very rich and managed by over-paid executives. There is an almost total failure to appreciate that “business” actually embraces — in one way or another — most Americans. Those for whom business provides jobs, constitute a fairly obvious class. But the 20 million stockholders — most of whom are of modest means — are the real owners, the real entrepreneurs, the real capitalists under our system. They provide the capital which fuels the economic system which has produced the highest standard of living in all history. Yet, stockholders have been as ineffectual as business executives in promoting a genuine understanding of our system or in exercising political influence.The question which merits the most thorough examination is how can the weight and influence of stockholders — 20 million voters — be mobilized to support (i) an educational program and (ii) a political action program.Individual corporations are now required to make numerous reports to shareholders. Many corporations also have expensive “news” magazines which go to employees and stockholders. These opportunities to communicate can be used far more effectively as educational media.The corporation itself must exercise restraint in undertaking political action and must, of course, comply with applicable laws. But is it not feasible — through an affiliate of the Chamber or otherwise — to establish a national organization of American stockholders and give it enough muscle to be influential?A More Aggressive AttitudeBusiness interests — especially big business and their national trade organizations — have tried to maintain low profiles, especially with respect to political action.As suggested in the Wall Street Journal article, it has been fairly characteristic of the average business executive to be tolerant — at least in public — of those who attack his corporation and the system. Very few businessmen or business organizations respond in kind. There has been a disposition to appease; to regard the opposition as willing to compromise, or as likely to fade away in due time.Business has shunted confrontation politics. Business, quite understandably, has been repelled by the multiplicity of non-negotiable “demands” made constantly by self-interest groups of all kinds.While neither responsible business interests, nor the United States Chamber of Commerce, would engage in the irresponsible tactics of some pressure groups, it is essential that spokesmen for the enterprise system — at all levels and at every opportunity — be far more aggressive than in the past.There should be no hesitation to attack the Naders, the Marcuses and others who openly seek destruction of the system. There should not be the slightest hesitation to press vigorously in all political arenas for support of the enterprise system. Nor should there be reluctance to penalize politically those who oppose it.Lessons can be learned from organized labor in this respect. The head of the AFL-CIO may not appeal to businessmen as the most endearing or public-minded of citizens. Yet, over many years the heads of national labor organizations have done what they were paid to do very effectively. They may not have been beloved, but they have been respected — where it counts the most — by politicians, on the campus, and among the media.It is time for American business — which has demonstrated the greatest capacity in all history to produce and to influence consumer decisions — to apply their great talents vigorously to the preservation of the system itself.The CostThe type of program described above (which includes a broadly based combination of education and political action), if undertaken long term and adequately staffed, would require far more generous financial support from American corporations than the Chamber has ever received in the past. High level management participation in Chamber affairs also would be required.The staff of the Chamber would have to be significantly increased, with the highest quality established and maintained. Salaries would have to be at levels fully comparable to those paid key business executives and the most prestigious faculty members. Professionals of the great skill in advertising and in working with the media, speakers, lawyers and other specialists would have to be recruited.It is possible that the organization of the Chamber itself would benefit from restructuring. For example, as suggested by union experience, the office of President of the Chamber might well be a full-time career position. To assure maximum effectiveness and continuity, the chief executive officer of the Chamber should not be changed each year. The functions now largely performed by the President could be transferred to a Chairman of the Board, annually elected by the membership. The Board, of course, would continue to exercise policy control.Quality Control is EssentialEssential ingredients of the entire program must be responsibility and “quality control.” The publications, the articles, the speeches, the media programs, the advertising, the briefs filed in courts, and the appearances before legislative committees — all must meet the most exacting standards of accuracy and professional excellence. They must merit respect for their level of public responsibility and scholarship, whether one agrees with the viewpoints expressed or not.Relationship to FreedomThe threat to the enterprise system is not merely a matter of economics. It also is a threat to individual freedom.It is this great truth — now so submerged by the rhetoric of the New Left and of many liberals — that must be re-affirmed if this program is to be meaningful.There seems to be little awareness that the only alternatives to free enterprise are varying degrees of bureaucratic regulation of individual freedom — ranging from that under moderate socialism to the iron heel of the leftist or rightist dictatorship.We in America already have moved very far indeed toward some aspects of state socialism, as the needs and complexities of a vast urban society require types of regulation and control that were quite unnecessary in earlier times. In some areas, such regulation and control already have seriously impaired the freedom of both business and labor, and indeed of the public generally. But most of the essential freedoms remain: private ownership, private profit, labor unions, collective bargaining, consumer choice, and a market economy in which competition largely determines price, quality and variety of the goods and services provided the consumer.In addition to the ideological attack on the system itself (discussed in this memorandum), its essentials also are threatened by inequitable taxation, and — more recently — by an inflation which has seemed uncontrollable.14 But whatever the causes of diminishing economic freedom may be, the truth is that freedom as a concept is indivisible. As the experience of the socialist and totalitarian states demonstrates, the contraction and denial of economic freedom is followed inevitably by governmental restrictions on other cherished rights. It is this message, above all others, that must be carried home to the American people.ConclusionIt hardly need be said that the views expressed above are tentative and suggestive. The first step should be a thorough study. But this would be an exercise in futility unless the Board of Directors of the Chamber accepts the fundamental premise of this paper, namely, that business and the enterprise system are in deep trouble, and the hour is late.Footnotes (Powell’s)Variously called: the “free enterprise system,” “capitalism,” and the “profit system.” The American political system of democracy under the rule of law is also under attack, often by the same individuals and organizations who seek to undermine the enterprise system.Richmond News Leader, June 8, 1970. Column of William F. Buckley, Jr.N.Y. Times Service article, reprinted Richmond Times-Dispatch, May 17, 1971.Stewart Alsop, Yale and the Deadly Danger, Newsweek, May 18. 1970.Editorial, Richmond Times-Dispatch, July 7, 1971.Dr. Milton Friedman, Prof. of Economics, U. of Chicago, writing a foreword to Dr. Arthur A. Shenfield’s Rockford College lectures entitled “The Ideological War Against Western Society,” copyrighted 1970 by Rockford College.Fortune. May, 1971, p. 145. This Fortune analysis of the Nader influence includes a reference to Nader’s visit to a college where he was paid a lecture fee of $2,500 for “denouncing America’s big corporations in venomous language . . . bringing (rousing and spontaneous) bursts of applause” when he was asked when he planned to run for President.The Washington Post, Column of William Raspberry, June 28, 1971.Jeffrey St. John, The Wall Street Journal, May 21, 1971.Barron’s National Business and Financial Weekly, “The Total Break with America, The Fifth Annual Conference of Socialist Scholars,” Sept. 15, 1969.On many campuses freedom of speech has been denied to all who express moderate or conservative viewpoints.It has been estimated that the evening half-hour news programs of the networks reach daily some 50,000,000 Americans.One illustration of the type of article which should not go unanswered appeared in the popular “The New York” of July 19, 1971. This was entitled “A Populist Manifesto” by ultra liberal Jack Newfield — who argued that “the root need in our country is ‘to redistribute wealth’.”The recent “freeze” of prices and wages may well be justified by the current inflationary crisis. But if imposed as a permanent measure the enterprise system will have sustained a near fatal blow.This is the infamous “Powell Memo”. It could hardly be clearer. The sad part here is that millions of American voters are complicit in this attack upon themselves. They’ve been storming the gates of their own little castles for almost forty years now. Wake the hell up!

What has happened to the United States since the end of the 1960’s is complicated but there is a Rosetta Stone called the Powell Memorandum and it is a must read for every U.S. citizen.Maybe you are wondering about the origins of institutions like The Cato Institute, The Heritage Foundation, The Manhattan Institute, etc etc . You might be wondering where NPR news and other news media find their experts from such places. Maybe you are wondering how selection of textbooks takes place that provide such a narrow view of America and the world. Look no further than the Powell memorandum.Supreme Court Justice Powell wrote a memorandum, a call to arms just before he was appointed by President Nixon to SCOTUS. The public was not allowed to see a copy of this memo until after Powell’s confirmation. It is important to read the whole thing because whether or not one agrees with some of Powell’s reasons for writing the memo that he puts forth in the beginning, it is clear the plan that he articulates was operationalized and what we have now, Donald Trump as president is the unintended outcome of this plan.Powell wrote this memo in response to the first Earth Day in 1970 and Ralph Nader. In it he tells the business community that they must control information coming out of the media especially the news media, control textbooks both in college and high school, control who are considered “the scholars”. control who speaks with authority in this country, control the faculty, control scholarly articles, control government, control the court's, control of corporations through stockholders, etc.So here it is in full or you can read The original Powell Memorandum Scanned In The following text is copied from here.Confidential Memorandum: Attack of American Free Enterprise SystemDATE: August 23, 1971TO: Mr. Eugene B. Sydnor, Jr., Chairman, Education Committee, U.S. Chamber of CommerceFROM: Lewis F. Powell, Jr.This memorandum is submitted at your request as a basis for the discussion on August 24 with Mr. Booth (executive vice president) and others at the U.S. Chamber of Commerce. The purpose is to identify the problem, and suggest possible avenues of action for further consideration.Dimensions of the AttackNo thoughtful person can question that the American economic system is under broad attack. This varies in scope, intensity, in the techniques employed, and in the level of visibility.There always have been some who opposed the American system, and preferred socialism or some form of statism (communism or fascism). Also, there always have been critics of the system, whose criticism has been wholesome and constructive so long as the objective was to improve rather than to subvert or destroy.But what now concerns us is quite new in the history of America. We are not dealing with sporadic or isolated attacks from a relatively few extremists or even from the minority socialist cadre. Rather, the assault on the enterprise system is broadly based and consistently pursued. It is gaining momentum and converts.Sources of the AttackThe sources are varied and diffused. They include, not unexpectedly, the Communists, New Leftists and other revolutionaries who would destroy the entire system, both political and economic. These extremists of the left are far more numerous, better financed, and increasingly are more welcomed and encouraged by other elements of society, than ever before in our history. But they remain a small minority, and are not yet the principal cause for concern.The most disquieting voices joining the chorus of criticism come from perfectly respectable elements of society: from the college campus, the pulpit, the media, the intellectual and literary journals, the arts and sciences, and from politicians. In most of these groups the movement against the system is participated in only by minorities. Yet, these often are the most articulate, the most vocal, the most prolific in their writing and speaking.Moreover, much of the media-for varying motives and in varying degrees-either voluntarily accords unique publicity to these “attackers,” or at least allows them to exploit the media for their purposes. This is especially true of television, which now plays such a predominant role in shaping the thinking, attitudes and emotions of our people.One of the bewildering paradoxes of our time is the extent to which the enterprise system tolerates, if not participates in, its own destruction.The campuses from which much of the criticism emanates are supported by (i) tax funds generated largely from American business, and (ii) contributions from capital funds controlled or generated by American business. The boards of trustees of our universities overwhelmingly are composed of men and women who are leaders in the system.Most of the media, including the national TV systems, are owned and theoretically controlled by corporations which depend upon profits, and the enterprise system to survive.Tone of the AttackThis memorandum is not the place to document in detail the tone, character, or intensity of the attack. The following quotations will suffice to give one a general idea:William Kunstler, warmly welcomed on campuses and listed in a recent student poll as the “American lawyer most admired,” incites audiences as follows:“You must learn to fight in the streets, to revolt, to shoot guns. We will learn to do all of the things that property owners fear.”2 The New Leftists who heed Kunstler’s advice increasingly are beginning to act — not just against military recruiting offices and manufacturers of munitions, but against a variety of businesses: “Since February, 1970, branches (of Bank of America) have been attacked 39 times, 22 times with explosive devices and 17 times with fire bombs or by arsonists.”3 Although New Leftist spokesmen are succeeding in radicalizing thousands of the young, the greater cause for concern is the hostility of respectable liberals and social reformers. It is the sum total of their views and influence which could indeed fatally weaken or destroy the system.A chilling description of what is being taught on many of our campuses was written by Stewart Alsop:“Yale, like every other major college, is graduating scores of bright young men who are practitioners of ‘the politics of despair.’ These young men despise the American political and economic system . . . (their) minds seem to be wholly closed. They live, not by rational discussion, but by mindless slogans.”4 A recent poll of students on 12 representative campuses reported that: “Almost half the students favored socialization of basic U.S. industries.”5A visiting professor from England at Rockford College gave a series of lectures entitled “The Ideological War Against Western Society,” in which he documents the extent to which members of the intellectual community are waging ideological warfare against the enterprise system and the values of western society. In a foreword to these lectures, famed Dr. Milton Friedman of Chicago warned: “It (is) crystal clear that the foundations of our free society are under wide-ranging and powerful attack — not by Communist or any other conspiracy but by misguided individuals parroting one another and unwittingly serving ends they would never intentionally promote.”6Perhaps the single most effective antagonist of American business is Ralph Nader, who — thanks largely to the media — has become a legend in his own time and an idol of millions of Americans. A recent article in Fortune speaks of Nader as follows:“The passion that rules in him — and he is a passionate man — is aimed at smashing utterly the target of his hatred, which is corporate power. He thinks, and says quite bluntly, that a great many corporate executives belong in prison — for defrauding the consumer with shoddy merchandise, poisoning the food supply with chemical additives, and willfully manufacturing unsafe products that will maim or kill the buyer. He emphasizes that he is not talking just about ‘fly-by-night hucksters’ but the top management of blue chip business.”7A frontal assault was made on our government, our system of justice, and the free enterprise system by Yale Professor Charles Reich in his widely publicized book: “The Greening of America,” published last winter.The foregoing references illustrate the broad, shotgun attack on the system itself. There are countless examples of rifle shots which undermine confidence and confuse the public. Favorite current targets are proposals for tax incentives through changes in depreciation rates and investment credits. These are usually described in the media as “tax breaks,” “loop holes” or “tax benefits” for the benefit of business. As viewed by a columnist in the Post, such tax measures would benefit “only the rich, the owners of big companies.”8It is dismaying that many politicians make the same argument that tax measures of this kind benefit only “business,” without benefit to “the poor.” The fact that this is either political demagoguery or economic illiteracy is of slight comfort. This setting of the “rich” against the “poor,” of business against the people, is the cheapest and most dangerous kind of politics.The Apathy and Default of BusinessWhat has been the response of business to this massive assault upon its fundamental economics, upon its philosophy, upon its right to continue to manage its own affairs, and indeed upon its integrity?The painfully sad truth is that business, including the boards of directors’ and the top executives of corporations great and small and business organizations at all levels, often have responded — if at all — by appeasement, ineptitude and ignoring the problem. There are, of course, many exceptions to this sweeping generalization. But the net effect of such response as has been made is scarcely visible.In all fairness, it must be recognized that businessmen have not been trained or equipped to conduct guerrilla warfare with those who propagandize against the system, seeking insidiously and constantly to sabotage it. The traditional role of business executives has been to manage, to produce, to sell, to create jobs, to make profits, to improve the standard of living, to be community leaders, to serve on charitable and educational boards, and generally to be good citizens. They have performed these tasks very well indeed.But they have shown little stomach for hard-nose contest with their critics, and little skill in effective intellectual and philosophical debate.A column recently carried by the Wall Street Journal was entitled: “Memo to GM: Why Not Fight Back?”9 Although addressed to GM by name, the article was a warning to all American business. Columnist St. John said:“General Motors, like American business in general, is ‘plainly in trouble’ because intellectual bromides have been substituted for a sound intellectual exposition of its point of view.” Mr. St. John then commented on the tendency of business leaders to compromise with and appease critics. He cited the concessions which Nader wins from management, and spoke of “the fallacious view many businessmen take toward their critics.” He drew a parallel to the mistaken tactics of many college administrators: “College administrators learned too late that such appeasement serves to destroy free speech, academic freedom and genuine scholarship. One campus radical demand was conceded by university heads only to be followed by a fresh crop which soon escalated to what amounted to a demand for outright surrender.”One need not agree entirely with Mr. St. John’s analysis. But most observers of the American scene will agree that the essence of his message is sound. American business “plainly in trouble”; the response to the wide range of critics has been ineffective, and has included appeasement; the time has come — indeed, it is long overdue — for the wisdom, ingenuity and resources of American business to be marshalled against those who would destroy it.Responsibility of Business ExecutivesWhat specifically should be done? The first essential — a prerequisite to any effective action — is for businessmen to confront this problem as a primary responsibility of corporate management.The overriding first need is for businessmen to recognize that the ultimate issue may be survival — survival of what we call the free enterprise system, and all that this means for the strength and prosperity of America and the freedom of our people.The day is long past when the chief executive officer of a major corporation discharges his responsibility by maintaining a satisfactory growth of profits, with due regard to the corporation’s public and social responsibilities. If our system is to survive, top management must be equally concerned with protecting and preserving the system itself. This involves far more than an increased emphasis on “public relations” or “governmental affairs” — two areas in which corporations long have invested substantial sums.A significant first step by individual corporations could well be the designation of an executive vice president (ranking with other executive VP’s) whose responsibility is to counter-on the broadest front-the attack on the enterprise system. The public relations department could be one of the foundations assigned to this executive, but his responsibilities should encompass some of the types of activities referred to subsequently in this memorandum. His budget and staff should be adequate to the task.Possible Role of the Chamber of CommerceBut independent and uncoordinated activity by individual corporations, as important as this is, will not be sufficient. Strength lies in organization, in careful long-range planning and implementation, in consistency of action over an indefinite period of years, in the scale of financing available only through joint effort, and in the political power available only through united action and national organizations.Moreover, there is the quite understandable reluctance on the part of any one corporation to get too far out in front and to make itself too visible a target.The role of the National Chamber of Commerce is therefore vital. Other national organizations (especially those of various industrial and commercial groups) should join in the effort, but no other organizations appear to be as well situated as the Chamber. It enjoys a strategic position, with a fine reputation and a broad base of support. Also — and this is of immeasurable merit — there are hundreds of local Chambers of Commerce which can play a vital supportive role.It hardly need be said that before embarking upon any program, the Chamber should study and analyze possible courses of action and activities, weighing risks against probable effectiveness and feasibility of each. Considerations of cost, the assurance of financial and other support from members, adequacy of staffing and similar problems will all require the most thoughtful consideration.The CampusThe assault on the enterprise system was not mounted in a few months. It has gradually evolved over the past two decades, barely perceptible in its origins and benefiting (sic) from a gradualism that provoked little awareness much less any real reaction.Although origins, sources and causes are complex and interrelated, and obviously difficult to identify without careful qualification, there is reason to believe that the campus is the single most dynamic source. The social science faculties usually include members who are unsympathetic to the enterprise system. They may range from a Herbert Marcuse, Marxist faculty member at the University of California at San Diego, and convinced socialists, to the ambivalent liberal critic who finds more to condemn than to commend. Such faculty members need not be in a majority. They are often personally attractive and magnetic; they are stimulating teachers, and their controversy attracts student following; they are prolific writers and lecturers; they author many of the textbooks, and they exert enormous influence — far out of proportion to their numbers — on their colleagues and in the academic world.Social science faculties (the political scientist, economist, sociologist and many of the historians) tend to be liberally oriented, even when leftists are not present. This is not a criticism per se, as the need for liberal thought is essential to a balanced viewpoint. The difficulty is that “balance” is conspicuous by its absence on many campuses, with relatively few members being of conservatives or moderate persuasion and even the relatively few often being less articulate and aggressive than their crusading colleagues.This situation extending back many years and with the imbalance gradually worsening, has had an enormous impact on millions of young American students. In an article in Barron’s Weekly, seeking an answer to why so many young people are disaffected even to the point of being revolutionaries, it was said: “Because they were taught that way.”10 Or, as noted by columnist Stewart Alsop, writing about his alma mater: “Yale, like every other major college, is graduating scores’ of bright young men … who despise the American political and economic system.”As these “bright young men,” from campuses across the country, seek opportunities to change a system which they have been taught to distrust — if not, indeed “despise” — they seek employment in the centers of the real power and influence in our country, namely: (i) with the news media, especially television; (ii) in government, as “staffers” and consultants at various levels; (iii) in elective politics; (iv) as lecturers and writers, and (v) on the faculties at various levels of education.Many do enter the enterprise system — in business and the professions — and for the most part they quickly discover the fallacies of what they have been taught. But those who eschew the mainstream of the system often remain in key positions of influence where they mold public opinion and often shape governmental action. In many instances, these “intellectuals” end up in regulatory agencies or governmental departments with large authority over the business system they do not believe in.If the foregoing analysis is approximately sound, a priority task of business — and organizations such as the Chamber — is to address the campus origin of this hostility. Few things are more sanctified in American life than academic freedom. It would be fatal to attack this as a principle. But if academic freedom is to retain the qualities of “openness,” “fairness” and “balance” — which are essential to its intellectual significance — there is a great opportunity for constructive action. The thrust of such action must be to restore the qualities just mentioned to the academic communities.What Can Be Done About the CampusThe ultimate responsibility for intellectual integrity on the campus must remain on the administrations and faculties of our colleges and universities. But organizations such as the Chamber can assist and activate constructive change in many ways, including the following:Staff of ScholarsThe Chamber should consider establishing a staff of highly qualified scholars in the social sciences who do believe in the system. It should include several of national reputation whose authorship would be widely respected — even when disagreed with.Staff of SpeakersThere also should be a staff of speakers of the highest competency. These might include the scholars, and certainly those who speak for the Chamber would have to articulate the product of the scholars.Speaker’s BureauIn addition to full-time staff personnel, the Chamber should have a Speaker’s Bureau which should include the ablest and most effective advocates from the top echelons of American business.Evaluation of TextbooksThe staff of scholars (or preferably a panel of independent scholars) should evaluate social science textbooks, especially in economics, political science and sociology. This should be a continuing program.The objective of such evaluation should be oriented toward restoring the balance essential to genuine academic freedom. This would include assurance of fair and factual treatment of our system of government and our enterprise system, its accomplishments, its basic relationship to individual rights and freedoms, and comparisons with the systems of socialism, fascism and communism. Most of the existing textbooks have some sort of comparisons, but many are superficial, biased and unfair.We have seen the civil rights movement insist on re-writing many of the textbooks in our universities and schools. The labor unions likewise insist that textbooks be fair to the viewpoints of organized labor. Other interested citizens groups have not hesitated to review, analyze and criticize textbooks and teaching materials. In a democratic society, this can be a constructive process and should be regarded as an aid to genuine academic freedom and not as an intrusion upon it.If the authors, publishers and users of textbooks know that they will be subjected — honestly, fairly and thoroughly — to review and critique by eminent scholars who believe in the American system, a return to a more rational balance can be expected.Equal Time on the CampusThe Chamber should insist upon equal time on the college speaking circuit. The FBI publishes each year a list of speeches made on college campuses by avowed Communists. The number in 1970 exceeded 100. There were, of course, many hundreds of appearances by leftists and ultra liberals who urge the types of viewpoints indicated earlier in this memorandum. There was no corresponding representation of American business, or indeed by individuals or organizations who appeared in support of the American system of government and business.Every campus has its formal and informal groups which invite speakers. Each law school does the same thing. Many universities and colleges officially sponsor lecture and speaking programs. We all know the inadequacy of the representation of business in the programs.It will be said that few invitations would be extended to Chamber speakers.11 This undoubtedly would be true unless the Chamber aggressively insisted upon the right to be heard — in effect, insisted upon “equal time.” University administrators and the great majority of student groups and committees would not welcome being put in the position publicly of refusing a forum to diverse views, indeed, this is the classic excuse for allowing Communists to speak.The two essential ingredients are (i) to have attractive, articulate and well-informed speakers; and (ii) to exert whatever degree of pressure — publicly and privately — may be necessary to assure opportunities to speak. The objective always must be to inform and enlighten, and not merely to propagandize.Balancing of FacultiesPerhaps the most fundamental problem is the imbalance of many faculties. Correcting this is indeed a long-range and difficult project. Yet, it should be undertaken as a part of an overall program. This would mean the urging of the need for faculty balance upon university administrators and boards of trustees.The methods to be employed require careful thought, and the obvious pitfalls must be avoided. Improper pressure would be counterproductive. But the basic concepts of balance, fairness and truth are difficult to resist, if properly presented to boards of trustees, by writing and speaking, and by appeals to alumni associations and groups.This is a long road and not one for the fainthearted. But if pursued with integrity and conviction it could lead to a strengthening of both academic freedom on the campus and of the values which have made America the most productive of all societies.Graduate Schools of BusinessThe Chamber should enjoy a particular rapport with the increasingly influential graduate schools of business. Much that has been suggested above applies to such schools.Should not the Chamber also request specific courses in such schools dealing with the entire scope of the problem addressed by this memorandum? This is now essential training for the executives of the future.Secondary EducationWhile the first priority should be at the college level, the trends mentioned above are increasingly evidenced in the high schools. Action programs, tailored to the high schools and similar to those mentioned, should be considered. The implementation thereof could become a major program for local chambers of commerce, although the control and direction — especially the quality control — should be retained by the National Chamber.What Can Be Done About the Public?Reaching the campus and the secondary schools is vital for the long-term. Reaching the public generally may be more important for the shorter term. The first essential is to establish the staffs of eminent scholars, writers and speakers, who will do the thinking, the analysis, the writing and the speaking. It will also be essential to have staff personnel who are thoroughly familiar with the media, and how most effectively to communicate with the public. Among the more obvious means are the following:TelevisionThe national television networks should be monitored in the same way that textbooks should be kept under constant surveillance. This applies not merely to so-called educational programs (such as “Selling of the Pentagon”), but to the daily “news analysis” which so often includes the most insidious type of criticism of the enterprise system.12 Whether this criticism results from hostility or economic ignorance, the result is the gradual erosion of confidence in “business” and free enterprise.This monitoring, to be effective, would require constant examination of the texts of adequate samples of programs. Complaints — to the media and to the Federal Communications Commission — should be made promptly and strongly when programs are unfair or inaccurate.Equal time should be demanded when appropriate. Effort should be made to see that the forum-type programs (the Today Show, Meet the Press, etc.) afford at least as much opportunity for supporters of the American system to participate as these programs do for those who attack it.Other MediaRadio and the press are also important, and every available means should be employed to challenge and refute unfair attacks, as well as to present the affirmative case through these media.The Scholarly JournalsIt is especially important for the Chamber’s “faculty of scholars” to publish. One of the keys to the success of the liberal and leftist faculty members has been their passion for “publication” and “lecturing.” A similar passion must exist among the Chamber’s scholars.Incentives might be devised to induce more “publishing” by independent scholars who do believe in the system.There should be a fairly steady flow of scholarly articles presented to a broad spectrum of magazines and periodicals — ranging from the popular magazines (Life, Look, Reader’s Digest, etc.) to the more intellectual ones (Atlantic, Harper’s, Saturday Review, New York, etc.)13 and to the various professional journals.Books, Paperbacks and PamphletsThe news stands — at airports, drugstores, and elsewhere — are filled with paperbacks and pamphlets advocating everything from revolution to erotic free love. One finds almost no attractive, well-written paperbacks or pamphlets on “our side.” It will be difficult to compete with an Eldridge Cleaver or even a Charles Reich for reader attention, but unless the effort is made — on a large enough scale and with appropriate imagination to assure some success — this opportunity for educating the public will be irretrievably lost.Paid AdvertisementsBusiness pays hundreds of millions of dollars to the media for advertisements. Most of this supports specific products; much of it supports institutional image making; and some fraction of it does support the system. But the latter has been more or less tangential, and rarely part of a sustained, major effort to inform and enlighten the American people.If American business devoted only 10% of its total annual advertising budget to this overall purpose, it would be a statesman-like expenditure.The Neglected Political ArenaIn the final analysis, the payoff — short-of revolution — is what government does. Business has been the favorite whipping-boy of many politicians for many years. But the measure of how far this has gone is perhaps best found in the anti-business views now being expressed by several leading candidates for President of the United States.It is still Marxist doctrine that the “capitalist” countries are controlled by big business. This doctrine, consistently a part of leftist propaganda all over the world, has a wide public following among Americans.Yet, as every business executive knows, few elements of American society today have as little influence in government as the American businessman, the corporation, or even the millions of corporate stockholders. If one doubts this, let him undertake the role of “lobbyist” for the business point of view before Congressional committees. The same situation obtains in the legislative halls of most states and major cities. One does not exaggerate to say that, in terms of political influence with respect to the course of legislation and government action, the American business executive is truly the “forgotten man.”Current examples of the impotency of business, and of the near-contempt with which businessmen’s views are held, are the stampedes by politicians to support almost any legislation related to “consumerism” or to the “environment.”Politicians reflect what they believe to be majority views of their constituents. It is thus evident that most politicians are making the judgment that the public has little sympathy for the businessman or his viewpoint.The educational programs suggested above would be designed to enlighten public thinking — not so much about the businessman and his individual role as about the system which he administers, and which provides the goods, services and jobs on which our country depends.But one should not postpone more direct political action, while awaiting the gradual change in public opinion to be effected through education and information. Business must learn the lesson, long ago learned by labor and other self-interest groups. This is the lesson that political power is necessary; that such power must be assidously (sic) cultivated; and that when necessary, it must be used aggressively and with determination — without embarrassment and without the reluctance which has been so characteristic of American business.As unwelcome as it may be to the Chamber, it should consider assuming a broader and more vigorous role in the political arena.Neglected Opportunity in the CourtsAmerican business and the enterprise system have been affected as much by the courts as by the executive and legislative branches of government. Under our constitutional system, especially with an activist-minded Supreme Court, the judiciary may be the most important instrument for social, economic and political change.Other organizations and groups, recognizing this, have been far more astute in exploiting judicial action than American business. Perhaps the most active exploiters of the judicial system have been groups ranging in political orientation from “liberal” to the far left.The American Civil Liberties Union is one example. It initiates or intervenes in scores of cases each year, and it files briefs amicus curiae in the Supreme Court in a number of cases during each term of that court. Labor unions, civil rights groups and now the public interest law firms are extremely active in the judicial arena. Their success, often at business’ expense, has not been inconsequential.This is a vast area of opportunity for the Chamber, if it is willing to undertake the role of spokesman for American business and if, in turn, business is willing to provide the funds.As with respect to scholars and speakers, the Chamber would need a highly competent staff of lawyers. In special situations it should be authorized to engage, to appear as counsel amicus in the Supreme Court, lawyers of national standing and reputation. The greatest care should be exercised in selecting the cases in which to participate, or the suits to institute. But the opportunity merits the necessary effort.Neglected Stockholder PowerThe average member of the public thinks of “business” as an impersonal corporate entity, owned by the very rich and managed by over-paid executives. There is an almost total failure to appreciate that “business” actually embraces — in one way or another — most Americans. Those for whom business provides jobs, constitute a fairly obvious class. But the 20 million stockholders — most of whom are of modest means — are the real owners, the real entrepreneurs, the real capitalists under our system. They provide the capital which fuels the economic system which has produced the highest standard of living in all history. Yet, stockholders have been as ineffectual as business executives in promoting a genuine understanding of our system or in exercising political influence.The question which merits the most thorough examination is how can the weight and influence of stockholders — 20 million voters — be mobilized to support (i) an educational program and (ii) a political action program.Individual corporations are now required to make numerous reports to shareholders. Many corporations also have expensive “news” magazines which go to employees and stockholders. These opportunities to communicate can be used far more effectively as educational media.The corporation itself must exercise restraint in undertaking political action and must, of course, comply with applicable laws. But is it not feasible — through an affiliate of the Chamber or otherwise — to establish a national organization of American stockholders and give it enough muscle to be influential?A More Aggressive AttitudeBusiness interests — especially big business and their national trade organizations — have tried to maintain low profiles, especially with respect to political action.As suggested in the Wall Street Journal article, it has been fairly characteristic of the average business executive to be tolerant — at least in public — of those who attack his corporation and the system. Very few businessmen or business organizations respond in kind. There has been a disposition to appease; to regard the opposition as willing to compromise, or as likely to fade away in due time.Business has shunted confrontation politics. Business, quite understandably, has been repelled by the multiplicity of non-negotiable “demands” made constantly by self-interest groups of all kinds.While neither responsible business interests, nor the United States Chamber of Commerce, would engage in the irresponsible tactics of some pressure groups, it is essential that spokesmen for the enterprise system — at all levels and at every opportunity — be far more aggressive than in the past.There should be no hesitation to attack the Naders, the Marcuses and others who openly seek destruction of the system. There should not be the slightest hesitation to press vigorously in all political arenas for support of the enterprise system. Nor should there be reluctance to penalize politically those who oppose it.Lessons can be learned from organized labor in this respect. The head of the AFL-CIO may not appeal to businessmen as the most endearing or public-minded of citizens. Yet, over many years the heads of national labor organizations have done what they were paid to do very effectively. They may not have been beloved, but they have been respected — where it counts the most — by politicians, on the campus, and among the media.It is time for American business — which has demonstrated the greatest capacity in all history to produce and to influence consumer decisions — to apply their great talents vigorously to the preservation of the system itself.The CostThe type of program described above (which includes a broadly based combination of education and political action), if undertaken long term and adequately staffed, would require far more generous financial support from American corporations than the Chamber has ever received in the past. High level management participation in Chamber affairs also would be required.The staff of the Chamber would have to be significantly increased, with the highest quality established and maintained. Salaries would have to be at levels fully comparable to those paid key business executives and the most prestigious faculty members. Professionals of the great skill in advertising and in working with the media, speakers, lawyers and other specialists would have to be recruited.It is possible that the organization of the Chamber itself would benefit from restructuring. For example, as suggested by union experience, the office of President of the Chamber might well be a full-time career position. To assure maximum effectiveness and continuity, the chief executive officer of the Chamber should not be changed each year. The functions now largely performed by the President could be transferred to a Chairman of the Board, annually elected by the membership. The Board, of course, would continue to exercise policy control.Quality Control is EssentialEssential ingredients of the entire program must be responsibility and “quality control.” The publications, the articles, the speeches, the media programs, the advertising, the briefs filed in courts, and the appearances before legislative committees — all must meet the most exacting standards of accuracy and professional excellence. They must merit respect for their level of public responsibility and scholarship, whether one agrees with the viewpoints expressed or not.Relationship to FreedomThe threat to the enterprise system is not merely a matter of economics. It also is a threat to individual freedom.It is this great truth — now so submerged by the rhetoric of the New Left and of many liberals — that must be re-affirmed if this program is to be meaningful.There seems to be little awareness that the only alternatives to free enterprise are varying degrees of bureaucratic regulation of individual freedom — ranging from that under moderate socialism to the iron heel of the leftist or rightist dictatorship.We in America already have moved very far indeed toward some aspects of state socialism, as the needs and complexities of a vast urban society require types of regulation and control that were quite unnecessary in earlier times. In some areas, such regulation and control already have seriously impaired the freedom of both business and labor, and indeed of the public generally. But most of the essential freedoms remain: private ownership, private profit, labor unions, collective bargaining, consumer choice, and a market economy in which competition largely determines price, quality and variety of the goods and services provided the consumer.In addition to the ideological attack on the system itself (discussed in this memorandum), its essentials also are threatened by inequitable taxation, and — more recently — by an inflation which has seemed uncontrollable.14 But whatever the causes of diminishing economic freedom may be, the truth is that freedom as a concept is indivisible. As the experience of the socialist and totalitarian states demonstrates, the contraction and denial of economic freedom is followed inevitably by governmental restrictions on other cherished rights. It is this message, above all others, that must be carried home to the American people.ConclusionIt hardly need be said that the views expressed above are tentative and suggestive. The first step should be a thorough study. But this would be an exercise in futility unless the Board of Directors of the Chamber accepts the fundamental premise of this paper, namely, that business and the enterprise system are in deep trouble, and the hour is late.Footnotes (Powell’s)Variously called: the “free enterprise system,” “capitalism,” and the “profit system.” The American political system of democracy under the rule of law is also under attack, often by the same individuals and organizations who seek to undermine the enterprise system.Richmond News Leader, June 8, 1970. Column of William F. Buckley, Jr.N.Y. Times Service article, reprinted Richmond Times-Dispatch, May 17, 1971.Stewart Alsop, Yale and the Deadly Danger, Newsweek, May 18. 1970.Editorial, Richmond Times-Dispatch, July 7, 1971.Dr. Milton Friedman, Prof. of Economics, U. of Chicago, writing a foreword to Dr. Arthur A. Shenfield’s Rockford College lectures entitled “The Ideological War Against Western Society,” copyrighted 1970 by Rockford College.Fortune. May, 1971, p. 145. This Fortune analysis of the Nader influence includes a reference to Nader’s visit to a college where he was paid a lecture fee of $2,500 for “denouncing America’s big corporations in venomous language . . . bringing (rousing and spontaneous) bursts of applause” when he was asked when he planned to run for President.The Washington Post, Column of William Raspberry, June 28, 1971.Jeffrey St. John, The Wall Street Journal, May 21, 1971.Barron’s National Business and Financial Weekly, “The Total Break with America, The Fifth Annual Conference of Socialist Scholars,” Sept. 15, 1969.On many campuses freedom of speech has been denied to all who express moderate or conservative viewpoints.It has been estimated that the evening half-hour news programs of the networks reach daily some 50,000,000 Americans.One illustration of the type of article which should not go unanswered appeared in the popular “The New York” of July 19, 1971. This was entitled “A Populist Manifesto” by ultra liberal Jack Newfield — who argued that “the root need in our country is ‘to redistribute wealth’.”The recent “freeze” of prices and wages may well be justified by the current inflationary crisis. But if imposed as a permanent measure the enterprise system will have sustained a near fatal blow.*One of our great frustrations is that foundations and funders who prefer a democratic republic to corporate domination have failed to learn from the success of these corporate institutions. They decline to invest in long-term education and culture-shifting that we and a small number of allied organizations work to achieve. Instead, they overwhelmingly focus on damage control and short-term goals. This approach stands no chance of yielding the systemic change needed to reverse the trend of growing corporate dominance.Patient nurturing of movement-building work remains the exception to the rule among foundations that purport to strengthen democracy and citizen engagement. The growing movement to revoke corporate personhood is supported almost entirely from contributions by individual (real) people like you. Please consider supporting the work of groups like Move to Amend, Free Speech for People and Reclaim Democracy! that devote themselves to this essential movement-building work, rather than short-term projects and results demanded by most foundations.Addenda:Washington and Lee University has created this archive (pdf) of significant follow-up communications to the Powell Memo.On the occasion of the memo’s 40th anniversary, Bill Moyers’ website posted useful background and commentary.