Overall Phase III Grading

This policy applies to the following required clerkships/courses: Emergency Medicine, Family Medicine, Internal Medicine, Obstetrics & Gynecology, Pediatrics, Psychiatry, Radiology, and Surgery.

Successful completion of 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 generally 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 Core Clinical Subcommittee and Curriculum Committee 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 (The Clerkship AY will run from January through December. The clinical curriculum spans more than one year; therefore, students will follow the syllabus in the AY year in which the clerkship is taken.)


Clinical Evaluation Grading Scale
Honors Indicates outstanding or distinguished performance. This grade may be awarded by a clerkship as determined by the clerkship's honors criteria described in the course syllabus. (Honors criteria are reviewed and adjusted annually. Honors criteria is intended to be no more than approximately 20 percent of the class annually. The honors system is a criteria-based system. All students that meet the criteria will receive honors.)
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 may result in failure of the clerkship, regardless of the overall clerkship grade calculation. The course director has the authority to determine if a student passes the clerkship, regardless of the final grade calculation.

A failure of a single component 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.

Failure of two or more grade components (i.e. clinical grade, OSCE/Oral Exam, NBME, etc.) within the clerkship will result in failure of 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 0
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 Core Clinical Subcommittee and Curriculum Committee 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 weigh each individual clinical evaluation based on time spent with that faculty.  Once the clinical grade is determined, it is used uniformly for grade calculations.).

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 a 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

The NBME provides both a percentage correct score and a percentile score for each exam. The percentage correct score is utilized for overall grade calculations. The percentile score is used to determine if the student passed. 

Clerkships require the students score meet a minimum percentile score for passing. The percentile for passing is set by each clerkship and clearly published in the clerkship-specific syllabus

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 (6 or 8 week).

NBME

Determining Quarters for Percentile Scores

Class of ___

Clerkship Block

Months

Quarter

Notes

M2 Class

Short 1 & 2

Long 1

Jan/Feb/March

1

 

 

Short 3 & 4  

Long 2

April/May/June

Decided on a case by case basis. (Q1 or Q2)

Students on USMLE study and test time

 

Short 5 & 6

Long 3

July/Aug/Sept

2

 

 

Short 7 & 8

Long 4

Oct/Nov/Dec

3

 

 

Class of ___

Clerkship Block

Months

Quarter

Notes

M3 Class

Short 1 & 2 

Long 1

Jan/Feb/March

3

Career Exploration

(Student off cycle)

 

Short 3 & 4   

Long 2

April/May/June

4

 

 

Short 5 & 6  

Long 3

July/Aug/Sept

4

(Student off Cycle)

Eligibility for Retake

Any student whose subject examination NBME score is below the percentile passing rate as set by the clerkship will be given the opportunity to retake the NBME.

Students will only be allowed to retake one NBME exam at scheduled break/exam retake time.

Notification for Retake

The clerkship director will inform the student that she/he is eligible for the retake exam. In addition, if the student does not retake the exam, an F will be recorded on the student’s transcript for the clerkship.

Format for Retake

The format of the retake exam will be a different version of the exam than the original exam.

Timing for Retake

The retake exam will be scheduled during the next available curricular break or elective block. A Student request for alternative or delayed exam must be made in writing to the Student Promotions Committee. (Due to holiday schedules some curricular breaks may not allow for retake exams.)
The retake exam cannot be scheduled during a current clerkship without approval. Students will be informed of the date of the retake exam by the respective clinical campus clerkship coordinator.

M4 students who need to retake an exam should be scheduled as soon as possible. The student will arrange the retake with the respective clinical campus clerkship coordinator based on room and proctor availability.

Location for Retake

Students will retake the exam on the clinical campus they are assigned. Legitimate requests for retaking the exam on a different clinical campus will be considered on a case-by-case basis by the Office of Academic Affairs. If approved, a minimum of one week lead time is required. Retake exams may be offered at limited locations due to holiday and staffing schedules. Students are expected to travel to the clinical campus where the retake NBME is being held. Travel arrangements to the clinical campus site for the retake are the sole responsibility of the student.

Grade on Retake

1. Students must achieve at or above the percentile passing rate as set by the clerkship. The percentile will be determined based on the original date of exam (The student must meet the original passing score, the percentile mark from the block of the clerkship when the original NBME was taken.)

2. Passing the repeat examination, the overall clerkship grade will result in a P for passing. Honors cannot be achieved after retaking the NBME exam. ^Numerical grade will be determined using the chart below.

3. A failing grade on the retake exam will result in a failure of the clerkship and a student must then retake the entire clerkship. Failing a course will require the student to follow SPC guidelines for failures.

4. If the student fails the retake, they will be notified of their retake score by the clerkship director.

^The numerical grade will be used in class ranks.

Clerkship Grade Calculation after an NBME retake

Grade Prior to NBME Failure

(grade is calculated without the failing NBME score)

Grade After Passing NBME Retake

90 or higher

A grade of 78 will be submitted as your final clerkship grade.

80-89

A grade of 75 will be submitted as your final clerkship grade.

70-79

A grade of 72 will be submitted as your final clerkship grade.



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 from Block 1 through Block 8 (January-December). This must be approved by the Core Clinical Subcommittee and Curriculum Committee 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 case/component cannot be challenged.

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, smartwatches or PDAs are permitted. Notebooks, text books and writing utensils are also not permitted.

Any challenge to the OSCE grade must be submitted in writing within five business days of the student receiving the OSCE grade. 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.

OSCE

Eligibility for Retake

Any student whose OSCE score does not fall within the individual clerkships guidelines for successful completion will be given the opportunity for OSCE retake.


Students will only be allowed to retake one OSCE exam at scheduled break/exam retake time.

Notification for Retake

The clerkship director will inform the student that she/he is eligible for the retake exam. In addition, if the student does not retake exam, an F will be recorded on the student’s transcript for the clerkship.

Format for Retake

The format for the retake exam will be determined by the clerkship/course director(s).

Timing for Retake

The retake exam will be scheduled during the next available curricular break or elective block. In most cases, the retake will align with an already scheduled OSCE.  A Student request for alternative or delayed exam must be made in writing to the Student Promotions Committee. (Due to holiday schedules some curricular breaks may not allow for retake exams.)
The retake exam cannot be scheduled during a current clerkship without approval. Students will be informed of the date of the retake exam by the respective clinical campus clerkship coordinator.

Location for Retake

The retake OSCE exam may be offered at limited campuses in order to be cost effective. The location will be determined no less than two weeks prior to the retake exam. Students are expected to travel to the clinical campus where the retake OSCE is being held. Travel arrangements to the clinical campus site for the retake are the sole responsibility of the student.

Grade on Retake

1. Passing the repeat OSCE, the overall clerkship grade will result in a P for passing. Honors cannot be achieved after retaking the OSCE exam. ^Numerical grade will be determined using the chart below.

2. A failing grade on the retake exam will result in a failure of the clerkship and a student must then retake the entire clerkship.  Failing a course will require the student to follow SPC guidelines for failures.

3. If the student fails the retake, they will be notified of their retake score by the clerkship director.

^The numerical grade will be used in class ranks.

Clerkship Grade Calculation after an OSCE retake

Grade Prior to OSCE Failure

Grade After Passing OSCE Retake

90 or higher

A grade of 78 will be submitted as your final clerkship grade.

80-89

A grade of 75 will be submitted as your final clerkship grade.

70-79

A grade of 72 will be submitted as your final clerkship grade.

 

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 fourth year.

A complete discussion of the Attendance Policy can be found in the Student Handbook.


Clerkship Failures and Remediation

  • If a student fails any clerkship, the clerkship must be remediated successfully. 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 shelf-exam, the student will be referred to the Academic Success Committee for discussion.
  • If a student fails more than one OSCE, the student will be referred to the Academic Success Committee for discussion.
  • If issues with professionalism, administrative work/duties or attendance arise on more than one clerkship, without correction, the student may be referred to Academic Success Committee and/or the SPC for professionalism issues.

NOTE: For purposes of student probation or advancement, remediating a failed 6 week or 8 week clerkship does not change the fact that it was failed. For example, if one student failed a clerkship and successfully remediates that clerkship, it is still considered that the student failed 6 or 8 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 the overall clerkship grade calculation. The course director has the authority to determine if a student passes the clerkship, regardless of the final grade calculation.


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:

  1. Any failure in professionalism
  2. Failure of NBME Shelf Exam
  3. Failure of the OSCE
  4. Failure in overall clinical performance
  5. Any significant concern on a clinical evaluation
  6. Failure on an individual clinical evaluation
  7. Significant failure to complete administrative tasks
  8. Tardiness
  9. Significant concerns from patients, faculty, residents or staff