In This Section

Grading and Promotional Policies, Candidates for MD Degree

Preamble

The faculty and academic administrators of the Lewis Katz School of Medicine (LKSOM), recognize their responsibility to assure that graduates of the School are intellectually, clinically and ethically qualified and have the maturity and emotional stability to assume the professional responsibilities implicit in the receipt of the degree of Doctor of Medicine. Therefore, they have established these policies to guide themselves and the students in pursuing a level of academic and professional excellence required for the conferral of that degree. Specific procedures have been established to provide uniformity and equity of process in all situations requiring administrative action.

The School administers three academic programs: a Doctor of Medicine (MD) degree; a graduate degree, such as the Master of Science, Master of Arts or Doctor of Philosophy; and Post-baccalaureate program. This document provides information for those students who are candidates for the MD degree. This document is also relevant for MD/PhD, MD/MBA, MD/MA in Urban Bioethics and MD/MPH students during the periods when they are engaged in course work for the Doctor of Medicine degree.

For purposes of this policy, the term “course” shall include educational experiences identified as “courses”, “blocks” and “clerkships”. 

Responsibility

A. ESTABLISHMENT
The Dean of the School of Medicine approves all grading and promotional policies, as established and recommended by the curriculum committee.

B. IMPLEMENTATION

1. Faculty

Faculty are responsible for implementing grading policies, regulations and procedures. They may do so as members of a department that administers courses or as members of an integrated course. For the courses for which they are responsible, faculty members:

a) establish standards to be met for attaining course credit and criteria for assigning specific grades
b) assign final grades for course work

2. The Senior Associate Dean for Education

The Senior Associate Dean for Education administers the promotional policies, regulations and procedures, as recommended by the curriculum committee and approved by the Dean.

3. Student Academic Standards and Promotions Committee

The Student Academic Standards and Promotions Committee is a standing committee of the School, with faculty in part appointed by the Dean and in part elected by the Medical Faculty Senate, and with students nominated by the Student Government Association then appointed by the Senior Associate Dean for Education. The Committee makes recommendations to the Senior Associate Dean for Education about student promotions and disciplinary actions, based on academic (course grades) and non-academic (professionalism) issues. If the Committee must meet at a time when it is impossible to convene a quorum, the Dean may appoint alternate members on an ad hoc basis.

4. Student Learning Environment and Appeals Committee

The Student Learning Environment and Appeals Committee is a standing committee of the School, with faculty in part appointed by the Dean and in part elected by the Medical Faculty Senate, and with students nominated by Student Government Association then appointed by the Associate Dean for Student Affairs. The Committee works to improve the learning environment by addressing student concerns about mistreatment; it also hears student appeals of grades and promotional and disciplinary decisions. The committee makes recommendations to the Dean, whose rulings are final. If the Committee must meet at a time when it is impossible to convene a quorum, the Dean may appoint alternate members on an ad hoc basis.

Course Requirements and Sequencing

The curriculum of the School is divided into four distinct curricular years that must be satisfied in the prescribed sequence. All required courses of all four years, including the required number of approved elective and selective courses in the third and fourth years, must be completed satisfactorily before a student can be recommended for graduation. A student may not repeat a course more than once, and no more than three distinct academic years may be utilized to fulfill the requirements of either the first and second years or the third and fourth years of the curriculum. With the exception of combined degree programs, a student must complete the MD degree program in no more than six years (including independent study and leaves of absence). For the purposes of this regulation, repetition of a curricular semester shall be interpreted as utilization of one full academic year.

All courses of a particular year must be completed satisfactorily before a student may begin any course of the ensuing curricular year. Students must successfully complete the second year curriculum prior to taking the USMLE Step 1 examination, and must take USMLE Step 1 prior to beginning third year clerkships. All re-examinations for courses in any given academic year must be passed prior to beginning the next academic year.

Evaluation and Standing of Students 

No faculty member or resident who has provided care for a student may participate in the student’s direct supervision or evaluation. It is the responsibility of both the faculty/resident and the student to request a change of assignment as soon as such a situation arises by contacting the Clerkship Director or the Associate Dean for Clinical Education. This policy may not be waived even if both parties agree. 

GRADING 

All courses, whether required or elective, and all research experiences specifically approved as part of an individual student's curriculum, must be graded according to the stated grading system. Final grades must be submitted in writing to the Office of Student Records and made available to the students within four weeks of the completion of a course. If the final grade for a course is an F (Fail), a special effort must be made to inform the Senior Associate Dean for Education promptly by phone or email and to submit that information in writing as soon as possible, preferably earlier than the standard four-week deadline. For clerkships in the spring semester of the fourth curricular year, all grades must be submitted no later than one week before the date of graduation.

The Pre-clerkship Curriculum:

1. The Standard Grading System: The standard grading system for the pre-clerkship curriculum provides one level of credit (Pass) and three levels of non-credit (Fail, Incomplete, and Withdrawn)

The standard grading system for the pre-clerkship curriculum provides one level of credit (Pass) and three levels of non-credit (Fail, Incomplete, and Withdrawn). 

a. Pass (P): a satisfactory performance that meets or exceeds basic course requirements. To receive a passing grade, students must meet all of the following requirements:

  • a final course average (including all graded components of the course) of 70% or greater;
  • a cumulative average on all written/multiple choice examinations of 70% or greater, using the examination weights established for the course; and
  • meeting all interpersonal and professional standards expected of a medical student including professionalism, ability to work as part of a team, and presentation skills.

b. Fail (F): a performance below acceptable minimum standards. 

  • When a failing performance (F) has been remedied through some method other than a repeat curricular semester or curricular year, a grade of “P” will be awarded. Both the original “F” and the subsequent “P” earned by course remediation will appear on the transcript. 
  • When a student repeats a course as part of the requirement to repeat a curricular semester or a curricular year, the final grade recorded on the transcript for the repeated course shall be the actual grade earned (P or F). Both the original “F” and the subsequent (P or F) grade earned by repeating the course will appear on the transcript.

c. Incomplete (I): Grades of “I” are assigned in accordance with Temple University Policy on Incomplete Course Work and are applied at the School as described below: 

  • A Course Director, following consultation with the Senior Associate Dean for Education, may assign the grade of “I” to indicate that a student has been unable to complete all the course requirements for reasons beyond his/her control (e.g., death in the family, significant illness or injury, etc.). 
  • When the grade of “I” is assigned to a course, the student must complete the course requirement before the beginning of the next academic year unless the Course Director, with the concurrence of the Senior Associate Dean for Education, has provided a specific alternative time period, not to exceed one year from the original end date of the course. The student will be informed in writing of the requirements for completion of the course and timeline for completion.
  • If a student obtains a final course average (including all graded components of the course) of 70% or greater, but does not achieve a cumulative average on written examinations of at least 70%, he or she will receive an “Incomplete” grade for the block. In this case, the student will be offered a cumulative re-examination. The re-examination must be taken before the end of the semester in which the course was completed (for 1st year students, December 31 or June 30; for 2nd year students, December 31 or April 30).

If the student achieves a score of 70% or greater on the re-examination, the final course grade will be converted to “Pass”. The final course score will be the final course weighted average (including all graded components of the course) achieved before the re-examination was taken.

If a student does not achieve a score of 70% on the cumulative re-examination, the student will fail the course. He or she will be required to remediate the course before progressing to the next academic year.

If a student obtains a final course average (including all graded components of the course) of 70% or greater, but does not meet interpersonal or professional expectations, he or she will receive an “Incomplete” or “Fail” grade, at the discretion of the course director. Requirements for converting the final score to “Pass” will be determined by the Education and Student Affairs Deans, based on the specific behaviors demonstrated.

A student who has two Incomplete grades because of failed examinations must stop coursework until the examinations have been passed. 

  • Once all course requirements have been attempted, the course director must assign a final grade of “P” or “F” in place of the “I” grade. If the requirements for the incomplete course have not been met within the specified time limit, no agreement has been made to extend the time limit and the student has not withdrawn from school, a final grade of “F” will be assigned.

d. Withdrawn (W): If the student has withdrawn from school, the Senior Associate Dean for Education will assign a “W” grade to the student's record

2. Assignment of Final Course Grades

The final course grade includes written examinations and scores received in workshops, conferences, and any other mandatory activities. The syllabus for each course defines the weighting of components used in determining the final grade.

Some activities, including Clinical Reasoning Conferences, require mandatory preparation such as pre-tests. As part of the “Professionalism” component of each course, students are required to complete the preparatory activity by the specified deadline.

A student who does not complete a mandatory preparatory activity should email the Course Coordinator, with a copy to the Course Director, stating the reason the activity was not completed. If the Course Director determines, after discussion with the Office of Medical Education, that the failure to complete an assignment was not excused, one percentage point will be deducted from the final course average. The student will be notified accordingly.

The Doctoring Course has additional mandatory activities that are described in the course syllabus. The syllabus describes the point values of these activities and their weight in the final course grade

2. The Standard Grading System: Clerkship and Advanced Clerkship Curriculum:

The standard grading system for the third and fourth (Clerkship and Advanced Clerkship) years provides three levels of credit (Honors, High Pass and Pass) and three levels of non-credit (Fail, Incomplete and Withdrawn).

  1. Honors (H): a clearly superior performance that reflects comprehensive achievement of course objectives. 
  2. High Pass (HP): a performance well beyond minimum course requirements. 
  3. Pass (P): a satisfactory performance that meets basic course requirements. 
  4. Fail (F): a performance below acceptable minimum standards.
    • When a failing performance (F) has been remedied through some method other than a repeat curricular semester or curricular year, the only possible grade of credit shall be P. In this case, both the original F and the subsequent P grade earned by course remediation will appear on the transcript.
    • When a student repeats a course as part of the requirement to repeat a curricular semester or a curricular year, the final grade recorded on the transcript for the repeated course shall be the actual grade earned (H, HP, P or F). Both the original F and the subsequent (H, HP, P or F) grade earned in the repeat course will appear on the transcript. 
  5. Incomplete (I): Grades of Incomplete are assigned in accordance with Temple University Policy on Incomplete Course Work and are applied at the school as described below:
    • A clerkship director, following consultation with the Senior Associate Dean for Education, may assign the grade of I to indicate that a student has been unable to complete all of the course requirements for reason(s) beyond his/her control (e.g., death in the family, significant illness or injury, etc.).
    • A grade of Incomplete will also be assigned when a student does not pass the clinical subject exam on a required clerkship.
    • When a grade of Incomplete is assigned because of a failed shelf exam, the student must take and pass a re-examination no later than December, for a failure in the fall semester, and no later than July, for a failure in the spring semester.  A student who has two Incompletes in clerkships because of failed shelf exams must stop clinical rotations until both shelf exams have been passed.
    • When the grade of Incomplete is assigned to a clerkship, for a reason other than the shelf exam, the student must complete the course requirement before the beginning of the next academic year unless the clerkship director, with the concurrence of the Senior Associate Dean for Education, has provided a specific alternative time period, not to exceed one year from the completion date of the course.
    • Once all course requirements have been attempted, the Clerkship Director must assign a final grade of H, HP, P or F in place of the Incomplete grade. If the requirements for the incomplete course have not been met within the specified time limits, no agreement has been made to extend the time limit and the student has not withdrawn from school, a final grade of F will be assigned.
  6. Withdrawn (W): If the student has withdrawn from school, the Senior Associate Dean for Education will assign a W (Withdrawn) grade to the student's record.

When written confirmation of a final grade for a fourth year course is not received by one week prior to graduation from the school, the Senior Associate Dean for Education, acting at his/her own discretion, may assign and have duly recorded on the student’s academic transcript a final grade of P.

3. The Credit (CR)/Fail (F) Grading System: First and Second Year Electives

The Credit/Fail grading system is applicable to all elective courses during the first and second years of the curriculum and to Independent Study courses.

EVALUATION OTHER THAN GRADES

1. Pre-clerkship courses

At the conclusion of pre-clerkship courses and Doctoring, a formal written narrative evaluation of each student’s performance should be submitted, when appropriate, by the course director to the Office of Medical Education.

2. Clinical Comprehension and Competence

At the conclusion of each clinical clerkship and research course, whether required or elective, a formal written narrative evaluation of each student's performance must be submitted to the Office of Medical Education.

a. Mid-course Feedback: The clerkship director, site director, or designated faculty member must provide mid-clerkship formative feedback. Interim evaluative comments from the faculty directly to the student are required during all clerkships. Such interim formative feedback must be given at the mid-point of each clerkship when faculty are required to communicate to each student information concerning the student's performance to date and, as appropriate, recommendations for improvement. If there are any concerns regarding a student’s performance, this feedback should also be given to the clerkship director or site director, and the Associate Dean for Clinical Education.

b. Final Evaluation and Grade: Within four weeks of the conclusion of a clerkship, the clerkship director must submit to the Office of Medical Education a final evaluation and grade for each student assigned to that clerkship. The evaluation and grade should address the student's attributes, including his/her fund of knowledge, level of comprehension, clinical skills, interpersonal and communication skills and professional behavior. The Associate Dean for Clinical Education and/or Senior Associate Dean for Education will review all evaluations  and should the report warrant additional action, the education deans shall, following consultation with the Student Academic Standards and Promotions Committee, take  appropriate action.

3. Statement on Fitness for Professional Responsibility

Professionalism is a core value of medicine, a major element forming the essence of a physician. Its importance is equal to that of knowledge and technical skills, with all three elements essential to providing the expected quality of health care. Key professionalism competencies include character, integrity, honesty, personal motivation, responsibility, accountability, compassion, continued professional development, ability to work in teams, and respect for patients, teachers and colleagues. Medical students are expected to meet standards of professionalism, as described in the Medical School Competencies and Honor Code, both of which are accessible on the medical school’s website and in this handbook. 

Meeting the standards of professionalism is an essential component in the assessment of medical student performance in all four years of the curriculum. Failure to meet standards of professionalism may result in a Fail grade in a course or clerkship, formal written report to the Senior Associate Dean for Education or the Associate Dean for Student Affairs, counseling, referral to the Honor Board or Student Academic Standards and Promotions Committee, or dismissal.

Accordingly, course and clerkship directors must evaluate each student’s professional attitudes and behaviors, and submit to the Senior Associate Dean for Education a written report describing a student’s professionalism. In addition, any faculty member may submit a written report describing any incident that might reflect either an unprofessional attitude or behavior or exceptional professionalism (see Appendix A). All such reports are placed in the student's official school file and may be reflected in the student’s Medical Student Performance Evaluation. If the Senior Associate Dean for Education or the Associate Dean for Student Affairs receives a second report of unprofessional attitude or behavior for any student and concludes that some action is appropriate, the receipt of that second report will be reflected in the student’s Medical Student Performance Evaluation.

Upon receipt of a report reflecting an unprofessional attitude or behavior, the Senior Associate Dean for Education or Associate Dean for Student Affairs will meet with the student to discuss the concern, and following consultation with members of the Academic Standards and Promotions Committee, take appropriate action(s). 
    
If the student disagrees with any decision reached by the Senior Associate Dean for Education or Associate Dean for Student Affairs, (s)he may within seven days of such notification, appeal in writing to the Dean through the Student Learning Environment and Appeals Committee. The process for the appeal and the standards upon which decisions are to be made are explained below.

Students who receive a commendation for exceptional professionalism are informed by the Senior Associate Dean for Education or Associate Dean for Student Affairs. Exemplary professionalism is identified in the student’s Medical Student Performance Evaluation.

Any student who is suspected of having a physical or mental health concern that could prevent him/her from fulfilling professional responsibilities can be required by either the Senior Associate Dean for Education or the Associate Dean for Student Affairs to undergo an administrative interview to determine fitness for duty. Based upon the recommendation of the health professional completing the administrative interview, the student could be required to undergo testing that could include drug testing. 

STANDING OF STUDENTS

A student is considered to be in good academic standing, as long as (s)he meets the following criteria: 

  1. Has completed satisfactorily the requirements of all courses to date
  2. Is passing all courses in which (s)he is enrolled 
  3. Has passed USMLE examinations required to be taken by him/her
     

THE PROMOTIONAL SYSTEM

  1. Students must pass all required and elective courses/clerkships to be promoted to the next academic year or graduate.
  2. A student who fails one course/clerkship will be permitted to remediate the failing grade. 
  3. A student who fails two courses/clerkships in the same year is placed on academic probation and must repeat the year.
  4. A student who fails more than two courses/clerkships in the same year is dismissed.
  5. A student who fails two courses/clerkships across more than one year will be placed on academic probation.
  6. A student who goes on a leave of absence or on independent study with failing grades in more than one course/clerkship will be placed on academic probation.
  7. At any point in the curriculum, a student on academic probation who fails a course/clerkship will be dismissed.
     

REMEDIATING A FAILING PERFORMANCE 

  1. First and Second Year (Pre-clerkship) grade remediation will not be permitted until the end of the academic year; a failed clerkship must be repeated in the block after notification of the failure is given to the student.
  2. Only one attempt is permitted to remedy an F grade in any course by re-examination, a repeat clerkship, or other method as determined by the course or clerkship director in consultation with the Senior Associate Dean for Education.
  3. A student who fails the remediation must repeat the entire academic year and is placed on academic probation.
  4. A student who is eligible to take a re-examination or other requirement must do so during the officially designated period.

GRADUATION 

To be eligible for graduation, students must pass the required courses and clerkships, demonstrate proficiency in all seven competency domains, and pass USMLE Steps 1, 2CK and 2CS. Final decisions regarding graduation are made by the Senior Associate Dean for Education upon the recommendation of the Academic Standards and Promotions Committee. Recommendations are based upon a comprehensive evaluation of each student’s academic and professional performance and fitness for professional responsibility.

Probation

ACADEMIC 

A student shall be placed on academic probation when s/he:

  1. is required to repeat all or part of an academic year, due to unsatisfactory academic performance
  2. takes a leave of absence or independent study leave with a failing performance in more than one course or clerkship
  3. fails two courses in a single or multiple years 

Once placed on academic probation, the student remains in that status as long as s/he remains matriculated at the school.

A student on academic probation will be dismissed if s/he receives a final grade of F for any course/clerkship in a repeat year or subsequent year, while matriculated at the school.

NON-ACADEMIC

When, in narrative comments evaluating a student, faculty members express concern about a student’s fitness to assume professional responsibilities, the Senior Associate Dean for Education, based upon recommendation of the Academic Standards and Promotions Committee or Honor Board, may place a student on non-academic probation. In such instances, the Senior Associate Dean states in writing the specific conditions of the probation. The Associate Dean for Student Affairs is responsible for monitoring the student’s adherence to the conditions of the probation. Should the student violate those conditions, the Senior Associate Dean for Education may take further action(s).

At the discretion of the Senior Associate Dean for Education, students on probation may be restricted from scheduling academic, clinical or research courses. 

Conditions for which a Student may be Dismissed

  1. Failure of three courses (Blocks or Doctoring) in the first two years
  2. Failure of three clerkships, or two clerkships and Doctoring, in M3/M4 years
  3. Failure of USMLE Step 1 three times or failure to pass USMLE Step 1 within a year of completing the Year 2 curriculum
  4. Failure of USMLE Step 2 CK three times or failure to pass USMLE Step 2 CK within two years of beginning the Year 4 curriculum
  5. Failure of USMLE Step 2 CS three times or failure to pass USMLE Step 2 CS within two years of beginning the Year 4 curriculum
  6. Failure to develop and maintain the professionalism standards essential to the practice of medicine. 
  7. Failure to complete all requirements of the MD degree within six calendar years, excluding time for combined-degree work, but including other leaves of absence.

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