Overall Phase III Grading

Successful completion of Phase III clinical clerkships represents a significant competency milestone and indicates that the student is progressing appropriately in their formation as a student physician. The clinical clerkships are the best opportunity to evaluate the entire development of the medical student including the competency areas of medical knowledge, clinical care, communication, professionalism, systems-based practice, practice-based learning, and cultural competence. ALL of these domains contribute to the overall clerkship evaluation, and ALL are important to a successful clinical practice.

Clerkship Grades

Clerkship course grades are comprised of clinical evaluation scores, OSCE/Oral exam scores, NBME shelf exam scores, and other assignments and assessments from the clerkship. Each clerkship discipline determines its overall course grading schema, which is approved by the Phase III Curriculum Subcommittee prior to the start of each academic year and will remain standard for the entire academic year from blocks 1 through 8. All clerkship grading methods will be clearly published in the clerkship-specific syllabus.

Clerkship course grades are comprised of clinical evaluation scores, OSCE/Oral exam scores, NBME shelf exam scores, and other assignments and assessments from the clerkship. Each clerkship discipline determines its overall course grading schema, which is approved by the Phase III Curriculum Subcommittee prior to the start of each academic year and will remain standard for the entire academic year from blocks 1 through 8. All clerkship grading methods will be clearly published in the clerkship-specific syllabus.

Clinical Evaluation Grading Scale
Honors Indicates outstanding or distinguished performance. This grade may be awarded by a clerkship to up to 20 percent of students per academic year as determined by the clerkship's honors criteria described in the course syllabus.
Pass Indicates satisfactory mastery of clerkship requirements. Most students will fall into this category.
Fail Indicates student performance does not meet the passing standard established for the clerkship

A failing grade in any single component (domain or sub-domain of the clinical evaluation, NBME shelf exam, OSCE, oral exam, etc.) may result in failure of the clerkship, regardless of the overall clerkship grade. A failure of a single or of multiple sub-components will be discussed by the clerkship director and course director to determine whether the failure should be remediated with a grade of incomplete (IP) until the student has successfully completed the remediation requirements, or result in a failure (F) for the clerkship.

Clinical Evaluation

The same competency based evaluation form is utilized for all clerkships. Scored competency domains include History Taking Skills, Physical Examination & Mental Status, Written Communication, Verbal Communication, Patient Communication, Medical Knowledge, Professionalism, and Practice Based Learning & Improvement. Health Care System Based Practice is assessed but does not currently count in point totals.

Scoring of the evaluation is completed as follows:

Competency Domain Scoring
Competency Domain Point Value
Does not meet expectations 0
Not applicable or did not observe 1
Meets expectations 1
Exceeds Expectations 2
Clinical Evaluation Grading Scale
Points Grade
0-6pts 65%
7pts 70%
8pts 80%
9pts 85%
10pts 87%
11pts 90%
12-13pts 93%
14pts 95%
15pts 97%
16pts 100%

Compilation of the clinical evaluation component of the clerkship course grade may be based on the available individual campus resources but must be approved by the Phase III Curriculum Subcommittee as part of the overall clerkship course grading schema and must be clearly communicated in writing to students at the beginning of the course in the campus-specific course materials. (For example, campus A may bring faculty together for a grading conference at the end of the clerkship and determine one clinical grade based upon feedback from all relevant faculty. Campus B may have each faculty submit a separate clinical evaluation form; the final clinical grade is based upon an average of all evaluation scores. Campus C may weight each individual clinical evaluation based on time spent with that faculty). Individual grades provided by faculty may not be appealed although students are welcome to discuss all evaluations with their course leadership.

A failure on a single evaluation or evaluation domain or subdomain on any clinical evaluation will be reviewed by the clerkship director and course director to determine whether the area may be remediated or result in a failure (F) for the clerkship.

NBME Shelf Exams

On the NBME Shelf exams, all clerkships require the students score at least at the fifth percentile (minimum). 

Failure to pass the NBME exam will require a retake of the examination. If the student fails to pass the retake examination then the student fails the clerkship and must remediate the entire clerkship (six or 12 weeks).


OSCE/Oral Interviews

Although OSCE/Oral Interview formatting and logistics will be similar across clerkships, each clerkship will determine the OSCE grading system that will remain standard for the entire academic year. This must be approved by the Phase III Curriculum Subcommittee as part of the overall clerkship course grading scheme.

No challenges to an OSCE grade will be reviewed unless the student has received an overall failing grade on the OSCE. Failure on a single OSCE component cannot be challenged. The clerkship director, course director and appropriate representatives from the College of Medicine will determine whether the failure should be remediated with a grade of incomplete (IP) until the student has completed the remediation, or result in a failure (F) for the clerkship.

OSCE exam materials will be available for review for up to five business days after the student receives the OSCE grade, by scheduling an appointment with the campus clerkship staff representative. When reviewing the exam no cell phones, laptops, or PDAs are permitted. Notebooks, text books and writing utensils are also not permitted.

Any challenge to the grade must be submitted in writing with appropriate documentation/references within two business days of individual OSCE review. Any challenges submitted after this time period will not be accepted. A challenge to the OSCE grade allows for a total re-grading of the student’s OSCE, which means the student(s) could lose points in other areas. Three faculty members designated by the clerkship director will determine the results of challenges for failing grades. Two out of three faculty members must be in agreement for a ruling.


Other Assignments & Assessments and Administrative Work

One of the competencies students must develop during their clinical training is the ability to accurately and appropriately document in a timely manner. Documentation is an essential and important feature of patient care and the professional workplace. Completing administrative work and keeping logs becomes a student training exercise in documentation. The seriousness and accuracy with which students maintain and update their log and complete other administrative work will be a part of their evaluation during the rotations. All of these features of documentation — seriousness, accuracy, conscientiousness, timeliness and honesty — are aspects of professionalism.

Failure to complete any component of the clerkship grade, including completing required patient logs and other assessments or administrative work/duties, will require remediation of that component.  Failure to complete the required remediation will be considered an issue of professionalism and could result in failure of the clerkship.


Attendance Policy

Attendance is an integral part of the learning process and students must be present to engage in the education experience. Continued issues or concerns with attendance will be monitored by the clerkships and reported to Student Promotions Committee (SPC) and could negatively affect student’s grades and ability to progress to Phase IV.

A complete discussion of the Attendance Policy can be found in the Student Handbook. The following general rules must be observed.

  • Four to six absences (any reason) for a six-week clerkship must be remediated
  • More than six absences (any reason) may result in repeating a six-week clerkship
  • Seven to 12 absences (any reason) on a 12-week clerkship must be remediated
  • More than 12 absences (any reason) on a 12-week clerkship may result in repeating the clerkship

Phase III Policy on Clerkship Failures and Remediation 

  • Each clerkship in Phase III must be passed to advance to Phase IV.  If a student fails any clerkship, the clerkship must be remediated successfully. All clerkships in the Phase III curriculum can be remediated.
  • Every component listed in the Clerkship Grading Schema must be passed in order to successfully pass the clerkship. This is to ensure students have demonstrated competency in all aspects of the curriculum. 
  • To pass a clerkship, all individual components and assessments within the clerkship must be successfully completed (initially or upon remediation).
  • If a student fails more than one NBME self exam during Phase III, the student will be referred to the SPC for discussion.
  • If a student fails more than one OSCE during Phase III, the student will be referred to the SPC for discussion. If issues with professionalism, administrative work/duties or attendance arise on more than one clerkship during Phase III, without correction, the student may be referred to the SPC for professionalism issues.

NOTE: For purposes of student probation or advancement, remediating a failed six-week or 12-week clerkship does not change the fact that it was failed. Thus, for example, if one student failed a clerkship and successfully remediates that clerkship, it is still considered that the student failed six or 12 weeks of coursework.

It is the responsibility of the course director and clerkship director to develop mechanisms for remediation for all non-examination failures and to administer the remediation of these components to students.

  • Students will be notified by the clerkship director if there is a need to remediate any component of a clerkship.
  • Failure to remediate a clerkship component will result in a recommendation to the SPC that the student repeat the entire clerkship course, regardless of performance in other graded components and final clerkship grade (even if the clerkship was passed).

Student Promotions Committee

The progress of all students is closely monitored by the Student Promotions Committee (SPC). Students’ final clerkship grades are reported to the SPC at the end of each clerkship for review. A complete outline of SPC policy can be found in the Student Handbook.

The following issues should be reported separately to Academic Affairs, even if the student successfully remediates the concern and passes the clerkship:

  • Any failure in professionalism
  • Failure of NBME Shelf Exam
  • Failure of the OSCE
  • Failure in overall clinical performance
  • Any significant concern on a clinical evaluation
  • Failure on an individual clinical evaluation
  • Significant failure to complete administrative tasks
  • Tardiness
  • Significant concerns from patients, faculty, residents or staff