M3 and M4 Clerkship Grading

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Rationale:

To provide a standard method of grading for all clerkships.

Scope and Applicability:

All students enrolled in the Doctor of Medicine (MD) program.

Standard Practice Guideline:

Grading in clerkships is based on assessment in three separate areas; medical knowledge, clinical performance, and clinical skills.  Grades for clerkships are generally posted by four weeks after the last day of the clerkship and must be posted within six weeks.

Assessment of medical knowledge is measured by performance on the National Board of Medical Examiners (NBME) subject examination when such an examination is available and suitable for the content contained in that clerkship. In the instance when a NBME subject examination is not available, another internally- or externally-produced high stakes comprehensive examination may be substituted with the approval of the Associate Dean for Clinical Education.

The summary Clinical Performance Evaluation (CPE) is a narrative evaluation completed by the clerkship director characterizing a student's clinical performance. The clerkship director assigns the ratings and completes this narrative evaluation of clinical performance based on summative feedback from faculty and residents that have supervised the student during the clerkship. Direct observations by supervising physicians and clinical faculty are collected via clinical performance assessments that are used to inform the summary CPE. The decision whether a student receives an “exceeds expectations”, "meets expectations" or "below expectations" on their CPE is at the discretion of the clerkship director determined by clinical performance metrics.

The Objective Structured Clinical Examination (OSCE) is a performance-based measure of a student's clinical skills competence. During an OSCE, trainees are observed and evaluated as they rotate through stations with standardized patients or simulators to evaluate clinical skills. The decision whether a student "passes" or "fails" their OSCE is at the discretion of the clerkship director, based on evaluation of live or recorded data of the OSCE by the OUWB Clinical Skills and Training Center instructors, standardized patients and clerkship faculty.

The final grades for the clerkships are Honors, High Pass, P1, P2, and Fail. These grades are awarded based on the following criteria:

HN (Honors) is a permanent grade, assigned by the faculty member(s) responsible for the clerkship, which denotes student performance exceeds expectations.

To earn a grade of Honors in a clerkship, a student must score above or equal to the 80th percentile on the NBME subject exam, earn a grade of “exceeds expectations” on the CPE, earn a grade of “pass” on the OSCE and complete all components of the clerkship. The above performance criteria must be achieved on all assessments on the first attempt in order to qualify for Honors.

HP (High Pass) is a permanent grade, assigned by the faculty member(s) responsible for the clerkship, which denotes student performance which qualifies for passing with distinction.

To earn a grade of High Pass in a clerkship, a student must “pass” the OSCE on the first attempt, score between the 40th and 79th percentile on the NBME subject exam and earn a grade of “exceeds expectations” on the CPE; or “pass” the OSCE, score above or equal to the 80th percentile on the NBME subject examination and earn a grade of “meets expectations” on the CPE. The above performance criteria must be achieved on all assessments on the first attempt in order to qualify for High Pass.

P1 (Pass on First Attempt) is a permanent grade, assigned by the faculty member(s) responsible for the course, which denotes that the student demonstrates the expected level of performance/competency in clerkship requirements on first attempt. 

Students who meet the minimum criteria for passing the clerkship, and have not scored at or above the 40th percentile on the NBME subject exam, will receive the grade of P1. Therefore, the minimum criteria for passing the clerkship are an NBME subject exam score ranging from the 8th percentile to the 39th percentile, a grade of “pass” on the OSCE, and “meets expectations” on the CPE, on first attempt.

P2 (Pass on Second Attempt) is a permanent grade assigned by the faculty member(s) responsible for the course, which denotes that the student demonstrates the expected level of performance/competency in clerkship requirements after successfully retaking assessment(s).

FL (Fail) is a permanent grade, assigned by the faculty member(s) responsible for the clerkship, which denotes student performance does not meet expectations.

Students who require major remediation on 2 of the 3 clerkship assessment components (NBME subject exam, OSCE, or CPE) on the first attempt, or who have failed a single assessment component on the second attempt (failing to successfully retest a major remediation), will receive a final grade of Fail in the clerkship and will be required to repeat the entire clerkship to progress. Students who are assigned a grade of “Fail” for a required clerkship will need to either retake the clerkship in its entirety or will be dismissed from the medical school.

W (Withdraw) is a permanent grade, assigned by the faculty member(s) responsible for the clerkship, in any clerkship in which the student withdraws prior to completion of the clerkship.

The grade of Withdraw can be assigned at any time prior to the completion of a clerkship, and after the 100% refund period for the semester has expired (please see the tuition refund schedule). Students who are assigned a grade of “Withdraw” will be required to retake the clerkship.

Temporary Grades

I (Incomplete) is a temporary grade, assigned by the faculty member(s) responsible for the clerkship, which indicates work in the clerkship is incomplete.

Students may receive a grade of incomplete for one of two reasons: 1) excused absences resulting in incomplete assignments or assessments or 2) failure to meet the minimum criteria for any one of the clerkship assessment components (NBME subject exam, OSCE or CPE). Students will receive a grade of Incomplete until all clerkship requirements and assessments are satisfied.

Upon receipt of an Incomplete grade, the student must meet with the Clerkship Director or delegate to develop a timeline plan to complete the required coursework and pass any required assessments. Whether the Incomplete is due to excused absences or need for additional coursework, assessments or remediation, the clerkship director, with consultation with the Associate Dean for Clinical Education and Clinical Optimization Specialist(s), will propose a list of remediation requirements with timeline plan, that are required in order for the student to receive a passing grade. The remediation plan and timeline should be made in writing and forwarded to the Clinical Optimization Specialist and the student. For students who receive a grade of Incomplete due to need for additional coursework, assessments or remediation, the clerkship director will determine the core competency domains in which the student needs additional work, for example, knowledge, patient care, communication skills, or professionalism. The clerkship director will also designate whether the remediation need is major or minor.

Examples of need for major remediation:

• NBME subject exam failure
• Additional clinical time needed to demonstrate minimum standards in patient care
• Combination of deficiencies, for example, failure of more than one assessment component
• Major deficiencies identified on OSCE

Examples of minor remediation:

• Focused area of deficiency identified by OSCE failure
• Focused areas of deficiency from CPE that does not require additional clinical assignment

Successful remediation of deficiencies that resulted in an Incomplete grade with major remediation requirements will result in the grade of Incomplete being replaced by a grade of P2.

Successful remediation of deficiencies that resulted in an Incomplete grade with minor remediation requirements will result in the grade of Incomplete being replaces by a grade of P1.

If the requirements are not satisfied or the assessment is not remediated, the grade of Incomplete will convert to a grade of Fail. Removal of an Incomplete as a result of excused absences may be replaced by the earned grade assignments of Honors, High Pass, P1, P2, or Fail following timeline plan completion. Students are also subject to any additional guidance provided in clerkship syllabi pertaining to Incomplete grades following absences.

Related Policies and Forms:

Appendix