All academic deficiencies, patterns of unprofessional behavior and egregious violations of professionalism will be presented to the Academic Standards and Achievement Committee (ASAC) that acts on behalf of the faculty of the School of Medicine. This policy specifies how ASAC will deal with student academic deficiencies in courses, clerkships, electives, the Clinical Practice Examination (CPX) and with failures on the United States Medical Licensing Examination (USMLE) Step 1 and Step 2 examinations, including compliance with the Standards for Academic Standing (see end of this document).
The courses and electives in the pre-clerkship and post-clerkship phases of the Next Generation Curriculum, the Family Medicine, Perioperative Medicine and Surgical Subspecialties clerkships are graded as pass/fail (P/F); any F constitutes a failure. The other clerkships are graded with letter grades (A, B, C or F). With the exception of the Patient-Student Partnership Course, a score of 70% or higher is required for successful completion of each course and clerkship. A score lower than 70% constitutes an F; each F constitutes a failure and is documented on the official transcript and the Medical Student Performance Evaluation (MSPE). The Patient-Student Partnership Course requires a score of 80% or higher to pass. Failure to achieve an 80% in this course constitutes a failure and would likewise be documented on the official transcript and the MSPE.
Professional attitudes and behaviors are components of the 12 Competencies Required of the Contemporary Physician that enable the independent performance of the responsibilities of a physician and therefore are a requirement for the successful award of the degree of Doctor of Medicine. The School of Medicine’s Professionalism Objectives establish general standards applicable to all students in the School of Medicine. However, it is the responsibility of the faculty and the ASAC, as appropriate, to interpret and apply the general Professionalism Objectives to specific situations when concerns are raised about student performance or behaviors.
Evaluation of professional attitudes and behaviors is an integral part of a student’s assessment and generally is accomplished through observation and narrative recording. Praise/Concern Cards and written narratives are assessment tools used to describe behaviors in areas of altruism; honesty and integrity; caring, compassion and communication; respect for others; respect for differences; responsibility and accountability; excellence and scholarship; leadership and knowledge and other skills related to professionalism. These professional attitudes and behaviors are monitored and recorded throughout undergraduate medical education.
Any breach of professionalism resulting in a recorded observation, e.g., Professionalism Concern Card, letter, written report, etc., must be addressed with the student by their college dean and documentation of the discussion must be recorded. If a student receives three or more written observations of concern or is reported for two breaches of the Health Insurance Portability and Accountability Act (HIPAA), or is cited for a single egregious breach of professionalism, notice will be sent to ASAC for review. A student identified as having a pattern of unprofessional behavior may be directed to further counseling and /or to supportive remediation and/or placed on academic warning or academic probation (as defined below), or if the professional violations are severe, a student may be dismissed from school even if they have passing grades in all courses. ASAC will assess the severity of the problem, the management and the consequences, including possibly reporting the behaviors in the student’s Medical Student Performance Evaluation (MSPE). Egregious behaviors, such as but not limited to assault on or threat to a patient, patient’s family member, student, GME trainee or faculty member, conduct that may constitute a felony, etc., regardless of whether criminal prosecutions are initiated or pursued, will be referred immediately to ASAC, irrespective of whether previous observations of concern exist, with the recommendation for dismissal from school.
Decisions regarding academic deficiencies of MSTP students during their MD coursework are governed by the ASAC. Final decisions regarding academic deficiencies of MSTP students during their doctoral coursework are determined by the ASAC, but the decision is weighted heavily upon the recommendation of the BIMS Academic Progress and Achievement Committee (BAPAC), which acts as a subcommittee to the ASAC with respect to MSTP students. The BAPAC serves as an institutional oversight committee with representation from all Biomedical Sciences (BIMS)-affiliated degree-granting programs to ensure that individual programs have followed their processes regarding remediation and dismissal for academic deficiencies, ensuring due process for students. The BAPAC assesses whether the policies have been followed and assures fairness and consistency across the interdisciplinary programs comprising BIMS. See individual BIMS-affiliated PhD program standards and “BAPAC Operating Procedures” at http://bims.virginia.edu/bims-committee-membership/bims-academic-progress-and-achievement-committee/.
Reports of an MSTP student’s unprofessional, unethical, or illegal activities or behaviors are reviewed and acted upon by the ASAC.
Decisions regarding academic deficiencies of PHS graduate students during their MD coursework are governed by the ASAC. Final decisions regarding academic deficiencies of PHS graduate students during their PHS coursework are determined by the ASAC, but the decision is weighted heavily upon the recommendation of the PHS Academic Promotion and Achievement Committee (PHS APAC), which acts as a subcommittee to the ASAC with respect to PHS graduate students. See SOM Bylaws, Section 8, Standing Committees, PHS Academic Promotion and Achievement Committee, https://med.virginia.edu/school-administration/wp-content/uploads/sites/304/2018/02/BYLAWS-February-21-2018.pdf.
Reports of a PHS graduate student’s unprofessional, unethical, or illegal activities or behaviors are reviewed and acted upon by the ASAC.
The pre-clerkship phase of the Next Generation Curriculum comprises the first three semesters of the educational program. This phase consists of ten graded courses, each assigned a pass/fail grade at the end of the course:
- Integrated Systems I (first semester)
- Integrated Systems II (second semester)
- Integrated Systems III (third semester)
- Foundations of Clinical Medicine 1-A (FCM 1-A)
- Foundations of Clinical Medicine 1-B (FCM 1-B)
- Foundations of Clinical Medicine 1-C (FCM 1-C)
- Patient Student Partnership 1-A (PSP 1-A)
- Patient Student Partnership 1-B (PSP 1-B)
- Patient Student Partnership 1-C (PSP 1-C)
- Social Issues in Medicine (SIM) (either semester one or two during the first year).
Integrated Systems I consists of the following course components or “systems”: Cells to Society, Foundations of Medicine (FoM), Cells, Blood and Cancer (CBC) and Microbes, Immunity, Transfusion and Transplantation (MITT). Integrated Systems II consists of the following course components: Musculoskeletal Integument System (MSI), Gastrointestinal System (GI) and Mind, Brain and Behavior (MBB). Integrated Systems III consists of the following course components: Cardiovascular System (CV), Pulmonary System (Pulm), Renal System, Endocrine-Reproductive System (Endo-Repro) and Hematology (Heme). In order to receive a passing grade for an integrated system course, a student must have an average score for all systems of 70% or above.
Patient Student Partnership 1 (three courses) runs in tandem with Foundations of Clinical Medicine 1 and introduces students to a longitudinal patient experience. Performance is assessed in at each semester by a P/F grade. Students must achieve an 80% or greater on the requirements for this course in order to pass.
In order to progress to the third semester of the curriculum, a student must have achieved an average score of 70% or higher on Integrated Systems I and Integrated Systems II and have received a P for FCM-1A and 1B, PSP-1A and 1B, as well as Social Issues in Medicine. Failure to meet any one of these criteria will result in a referral to ASAC for review and action. Any requirement for remediation must be completed prior to the beginning of the third semester.
Successful completion of the third semester requires an average score of 70% or higher in the Integrated Systems III course, and a grade of P in FCM-1C and PSP-1C. Failure to meet any one of these criteria will result in a referral to the ASAC for review and action.
A passing score on a summative examination within a course is 70%. Students achieving less than 70% on a summative assessment will be referred to ASAC with the recommendation from the respective system leader for remediation. If the student is in good standing professionally, has done well formatively, and has no other academic deficiencies, ASAC generally will allow the student to take a reexamination. The reexamination score, if passing, will be an additional score factored into the cumulative total. If the summative examination is failed the second time with a score lower than 70%, ASAC will review the student’s performance again and decide either to allow the student to make a third attempt at a reexamination or repeat the course. The final decision regarding reexamination rests with ASAC. Failure to pass a summative on the third attempt constitutes a failure of the system and therefore failure of the course. Any approved summative reexaminations must be taken according to the approved make-up schedule for the current academic year at the next available examination time as determined by ASAC. A student failing 5 total summative examinations in the pre-clerkship phase of the curriculum will be referred to ASAC and will be considered for dismissal. A student who does not take an examination and who does not have an excused absence, will receive a professionalism concern card and a referral to ASAC.
With regard to anatomy practical examinations, a score of 70% or higher is passing. Individual anatomy practical exam scores factor into the respective organ system grades, e.g., an anatomy practical examination score in MSI factors into the MSI grade and an MBB anatomy practical exam score factors into the MBB grade. Anatomy practical examinations also are graded as a thread across the Integrated System in which they occur, i.e., Integrated Systems II or III. A cumulative score of 70% or higher across the anatomy thread is required to progress to the clerkship phase of the curriculum. Students achieving a cumulative anatomy score of less than 70% for Integrated Systems II (consisting of anatomy practical examinations from MSI, GI and MBB) or Integrated System III (consisting of anatomy practical examinations from CV, Pulmonary, Renal and Endo-Repro) will be referred to ASAC and require remediation. Any remediation required by ASAC will include all anatomy from the semester failed, and the format for reexamination will be at the discretion of the anatomy director. Reexamination must occur by the end of the semester break immediately following the course in which the failure occurred. With approval of the Anatomy Director, remediation may occur during spring break, early summer break or fall break.
One component of assessment in FCM-1 is OSCEs. Students must achieve a passing grade on the OSCEs in FCM to pass the FCM course. A passing graded on the FCM-1B OSCE is required to pass FCM-1B and to progress to the third semester. A passing grade on the FCM-1C OSCE is required to pass FCM-1C and begin clerkships. A failure on the FCM 1 B or 1C OSCE is referred to ASAC for review and action. Typically, ASAC allows a student in good standing to remediate and retest. A second failure of the FCM OSCEs results in an F in the corresponding course and the student will be referred to ASAC for review and action. The FCM-1B OSCE must be passed prior to starting the third semester and the FCM-1C OSCE must be passed prior to starting clerkships.
Completion of the National Board of Medical Examiners Comprehensive Basic Science Exam in the third semester is a requirement of the pre-clerkship curriculum.
Students who achieve a passing grade in Integrated Systems I, Integrated Systems II, Integrated Systems III, FCM-1A-B-C, PSP-1A-B-C, SIM, have taken USMLE Step 1 and have achieved a passing grade in the Transitions Course may progress to clerkships. If notification of a failing score on Step 1 is received after a student has begun a clerkship, they generally will be allowed to complete that clerkship. The student will be removed from subsequent clerkships until a retest is completed.
Students in the dual MD/PhD degree program must take USMLE Step 1 prior to entering the PhD portion of the program and must pass Step 1 in order to continue in the graduate program.
A passing cumulative numerical score of 70% must be achieved in order to pass a clerkship. The score achieved correlates to an assigned letter grade of A+, A, A-, B+, B, B-, C+, C or C-. Earning a cumulative score of less than 70% constitutes a failure and automatic referral to ASAC, and also requires repeating the clerkship and all its requirements. Even if a student numerically achieves a passing score of 70%, the Clerkship Director may decline to pass a student based upon poor clinical performance and/or concerning issues of professionalism. In this circumstance, the clerkship director will make a recommendation to ASAC regarding their concerns with appropriate documentation. If failure is upheld by ASAC, remediation likely will include repeating the clerkship. When a clerkship requires repeating it will be noted in the MSPE, and the student’s transcript will show two enrollments in the same course with two separately determined and reported grades.
A passing score on each subject (shelf) examination will be set by the annual recommended passing score determined by the National Board of Medical Examiners. Not achieving this score constitutes a failure of the examination and therefore a deficiency for the clerkship. The student will be assigned an Incomplete on their transcript until the deficiency is removed when the examination is passed. Students who do not achieve a passing score on a shelf examination will be referred to ASAC with the recommendation from the clerkship director for appropriate remediation. Generally, if the student performed well clinically and is in good standing professionally, the student would be able to take a reexamination unless the score on the subject examination is so low that removing the deficiency still will result in a failure. The reexamination grade, if passing, will remove the deficiency from the course; however, the initial score is the only one that will be factored into the final clerkship grade. The final grade then will replace the Incomplete on the transcript. A second failure of the shelf exam will be referred to ASAC for review and action. Should ASAC permit the student to take the shelf examination a third time and the student passes, the clerkship deficiency will be satisfied; however, the first score is still the only one calculated into the clerkship grade. Failure to pass a shelf examination on the third attempt constitutes a failure of the clerkship and will be referred to ASAC for review and action. If approved, shelf reexaminations will occur at the completion of the student’s third year. By special arrangement with the clerkship director, a shelf re-examination may be scheduled during summer break, Thanksgiving break, or during the winter holiday break. Depending upon the timing of the clerkship with the deficiency, a student with an outstanding deficiency in a single clerkship may be allowed to continue into the elective portion of the curriculum but will not be allowed to take an elective in the discipline of the clerkship deficiency until the deficiency has been remediated. If a student fails shelf examinations in three different clerkships, the student will be referred to ASAC for review and, unless there are mitigating circumstances, will be considered for dismissal from school.
A passing cumulative score of 70% must be achieved to pass the Geriatrics Clerkship in fourth year. Earning less than a 70% constitutes a failure and requires repeating the clerkship and all its requirements. The ACE is a required single 4-week clinical experience selected by the student and is graded Pass/Fail. Students must achieve a passing grade in this course to receive credit. Remediation of a deficiency in an ACE is required. A student must pass the Geriatrics clerkship as well as their selected ACE to meet graduation requirements. Remediation of a deficiency in an elective is not required, however the student will not receive credit toward the MD degree for that elective. A student must meet the elective credit requirements in order to fulfill graduation requirements.
An Incomplete may be assigned to a course or clerkship on a student’s transcript should an emergent situation, e.g., death of an immediate family member, illness or accident, etc., arise after the student successfully has completed the majority of the requirements. An Incomplete cannot be assigned as a grade when the student is failing the course or clerkship. When the requirements have been completed, the Incomplete will be removed and replaced by the course or clerkship grade. An Incomplete grade will become an F one year after it is issued if not remediated. Grades of F will not be changed after remediation.
Should a student need extended time off from medical school, interrupting a course or clerkship, the student must request a leave of absence or withdrawal per School of Medicine Leave of Absence, Withdrawal, Readmission Policy. Any course or clerkship in progress will be graded as W. If and when the student is readmitted from a withdrawal, ASAC will determine how much, if any, of the course or clerkship will need to be repeated. The grade of W will remain on the student’s transcript.
In order to receive the recommendation from ASAC for graduation and conferral of the MD degree, a student must satisfy all academic and professionalism graduation requirements with no outstanding deficiencies. In addition, passing scores on the CPX, USMLE Step 1, USMLE Step 2 Clinical Knowledge and the USMLE Step 2 Clinical Skills are required for graduation.
In order to advance to the clerkships, a student must successfully complete the pre-clerkship curriculum and must have taken USMLE Step 1 at least 10 days before the Transition course. A student may begin the clerkships pending notification of their Step 1 score. If notification of a failing score on Step 1 is received after a student has begun a clerkship, they generally will be allowed to complete that clerkship. The student then will discontinue clerkships in order to concentrate on retaking and passing Step 1. The Step 1 examination may be taken no more than three times. Three failures of Step 1 will result in the student’s dismissal from the School of Medicine, without recourse to the appeals process. The college deans in consultation with the Director of Academic Enhancement may determine, based on a student’s academic performance, that the student is at risk of failing USMLE Step 1 and may recommend that the student delay sitting for the examination in order to have more time for preparation. In this circumstance, the student will complete the Transitions Course so the student can return to the clerkships upon satisfactory completion of USMLE Step 1. After successful completion of the core clerkships, the student must take both parts of Step 2 of the USMLE (2 CK and 2 CS). Passing both Step 2 CK and Step 2 CS is required for graduation. Students are allowed a total of three attempts to pass each of the two Step 2 examinations; failure to pass either Step 2 examination for a third time will result in dismissal from medical school, without recourse to the appeals process. Students must pass all required clerkships and take USMLE Step 2 CS and 2 CK no later than November 1 of their last academic year in medical school to ensure an opportunity for remediation prior to residency match and graduation, should a failure occur.
Students are required to take and pass the Clinical Practice Examination (CPX) after the completion of the clerkships. This is a requirement for graduation. Students failing the CPX are referred to ASAC and should review their performance and address their deficiencies prior to retaking the examination.
All requirements for graduation, including passing Step 1, Step 2 CK and Step 2 CS of the USMLE, must be completed within six years from the date the student matriculated in the School of Medicine. For students in the MD/PhD dual degree program, graduation requirements must be completed within nine years; students in the MD/JD program must complete graduation requirements within eight years; for students in other dual degree programs graduation requirements must be completed within seven years. Exceptions to this policy are rare and must be approved by ASAC.
When testing accommodations have been granted to a student by the SOM, a student must share their desire to invoke that accommodation at least two weeks prior to a summative assessment and at the time of orientation for clerkships.
- The Course, System or Clerkship Director notifies both the student and the School of Medicine Registrar/college dean of deficiency or failure.
- The student is withdrawn from clinical responsibilities (if applicable).
- The student is required to meet with their college dean. At this meeting, the Policy on Academic and Professional Advancement is discussed and the student is notified of the next ASAC meeting. The ASAC meetings usually occur monthly. In the pre-clerkship phase of the curriculum, a student who scores less than 70% on a summative assessment shall meet with the system leader and/or the Director of Academic Enhancement to discuss learning strategies to improve performance.
- The student shall be reviewed by ASAC.
- Students may submit a written statement, results of a drug test, results of a Counseling and Psychological Services (CAPS) screening or any other relevant data to ASAC and/or request to meet in person with ASAC.
- All students subject to dismissal or who may be required to repeat an academic period will be offered the opportunity to meet with ASAC.
- ASAC reviews each student’s academic record, takes into account any other relevant information or data and recommendations from a Course or Clerkship Director, and determines remediation or other action based upon the Policy on Academic and Professional Advancement.
- The Chair of ASAC notifies the student in writing of the Committee’s decision.
- If applicable and approved, the Office of Student Affairs schedules the remediation required by ASAC in collaboration with Course or Clerkship Directors taking into account the make-up schedule for that academic year.
- In the cases where a student is asked to repeat an entire segment of the curriculum or is dismissed from the School of Medicine, they can appeal the decision of ASAC following the Appeals Process described below.
- ASAC decisions regarding promotion or graduation due to failure to pass Steps 1, 2 CK or 2 CS of the USMLE or dismissal resulting from three failures cannot be appealed.
- The SOM registrar shall communicate with student, college dean and ASAC to confirm when deficiencies or examination failures have been remediated.
- If ASAC requires a dismissal from the School of Medicine or repetition of an academic period, the notification to the student will provide the option of an appeal and a description of the appeals process. This option will not be granted to those students failing to pass Steps 1, 2 CK or 2 CS of the USMLE within three attempts. The student may formally request that the Associate Dean for Student Affairs appoint an ad hoc Appeals Committee to review the decision of ASAC. The student must file their appeal no later than 14 days from receipt of notification or lose the right to appeal.
- The three-person ad hoc Appeals Committee is drawn from a pool of 10 faculty members named by the Associate Dean for Student Affairs, none of whom are current members of ASAC. The student selects one member, the Senior Associate Dean for Education selects one member, and the Dean selects the third member (who chairs the ad hoc Appeals Committee). The Associate Dean for Student Affairs serves as staff liaison, ex officio, without vote.
- The student is permitted to inspect their entire medical school file, including any material upon which the decision of ASAC was based.
- The student is permitted to have counsel, to submit affidavits and exhibits and to summon witnesses at the Appeals Committee hearing. Legal counsel may be present to provide advice, but legal counsel will not be permitted to participate actively in the presentation of testimony, examination/cross examination of witnesses or oral arguments.
- The Appeals Committee is to conduct a hearing as soon as possible (ordinarily within 14 days) and will uphold, modify or reverse the decision(s) of ASAC.
- The Appeals Committee will provide the student with all the evidence against him or her, including the academic grades and written evaluations, and will base its recommendations upon the evidence presented at the hearing.
- The Appeals Committee will send its decision, along with a written record of its proceedings, to the Dean of the School of Medicine.
- The decision of the Appeals Committee will be final.
A student may be placed on academic warning by ASAC during a specified period in which the student’s academic and/or professional deficiencies must be remediated or they will risk progression to academic probation.
A student may be placed on academic probation by ASAC during a specified period in which the student’s academic progress and/or professional behaviors are monitored closely with periodic required reviews by ASAC. The student remains enrolled during this time. The committee may appoint specific faculty to implement remediation and evaluate the student’s progress. If deficiencies or failures are not rectified according to the remediation plan set by ASAC within the specified period of time, the student is subject to dismissal from the University. Academic probation is reflected on the MSPE.
A student is in good academic standing if the student makes satisfactory progress, defined as progressing at a pace of completion allowing the student to meet academic requirements to achieve the Doctor of Medicine degree within a six-year limit (150% of the program length) set from matriculation.
A student is not in good academic standing if making inadequate academic progress that threatens their ability to achieve the Doctor of Medicine degree within a six-year limit set from matriculation as determined by the Academic Standards and Achievement Committee.
The following are standards for each phase of the curriculum to determine whether or not students are maintaining Satisfactory Academic Progress (SAP).
- A student is declared not in good academic standing if they have failures or an unsatisfactory in any course or system that are not successfully remediated at the time of the first day of class, third semester.
- A student is declared not in good academic standing if they have >2 course Incompletes and/or Withdrawals and if the Incompletes or Withdrawals are not remedied at the time of the first day of class, third semester.
- A student is declared not in good academic standing if they have failures or an unsatisfactory in any course that are not successfully remediated at the time of the first day of period one of the clerkships.
- A student is declared not in good academic standing if they have >2 course Incompletes and/or Withdrawals and if the Incompletes or Withdrawals are not remedied at the time of the first day of period one of the clerkships.
- A student is declared not in good academic standing if they do not pass USMLE Step 1 on the second attempt.
- A student is declared not in good academic standing if they have >2 deficiencies (failing 2 or more clerkships with an F) and if the deficiencies are not remediated at the time of four months from the end of the 48-week clerkship period.
- A student is declared not in good academic standing if they have >2 Incompletes or Withdrawals and if the Incompletes and/or Withdrawals are not remedied at the time of four months from the end of the 48-week clerkship period.
- A student is declared not in good academic standing if they fail to pass either part of USMLE Step 2 on the second attempt.
The Post- Clerkship (Elective) Phase
- A student is declared not in good academic standing if not making adequate progress to achieve the Doctor of Medicine degree within the time limit set from matriculation.
- A student is declared not in good academic standing if they receive two or more unsatisfactory elective evaluations.