Implications for Academic Progress

The final grade for each core clerkship is determined by grades earned for each of the 3 components.

Students must successfully complete all core clerkship/Family Medicine/General Practice (FM/GP) requirements, pass all 3 components, and resolve any “I” grades of the core clerkship to earn at least a “Pass” for the clerkship and progress to Year 4 of the MD program.

• Students who do not complete required clerkship components by the scheduled end of a clerkship (and are not on an approved LOA) earn a failing grade for the clerkship. An approved Clinical/Medical excuse is required to delay the NBME Clinical Subject Examination at the end of a clerkship. Note: only one Clinical/Medical excuse is permitted per 12-month period.
• Failure of any of the 3 components results in an “I” grade and requires remediation of the failed component. Students who earn an “I” grade for a failed component must attend an academic advising meeting to discuss remediation of the academic deficiency and the consequences of additional failures. Remediation of the Knowledge Component is completed during bridge time or, if bridge time is unavailable, during a leave of absence.
• Failure of 2 or 3 core clerkship components results in a failing grade for the core clerkship/FM/GP required rotation. Students must repeat the clerkship/rotation to remediate academic deficiencies and earn a second grade for the clerkship. Repeat grades do not replace the previous grades. Grades from all core rotation attempts contribute to a student’s cumulative WMPG.
• Students are permitted only one failure during the clinical studies phase of the curriculum.
• Students with a second failing grade during the clinical phase are recommended for dismissal with the opportunity to appeal to the CAPPS.
• Students must make progress toward completing the MD Program within the 6-year maximum timeline. Students unlikely to complete requirements within this timeline are recommended for dismissal.

Failed Components and Remediation
Overview

Opportunities for remediation are built into the clinical phase grading system. Students who fail only one component of a rotation earn an “I” grade and are offered an opportunity to remediate deficiencies to earn a passing grade. 

Remediation of a failed Knowledge Component requires participation in the Clinical Examination Study Program. Students who fail a second component and earn a failing grade for a course are not eligible to participate in this remediation program. Further criteria for remediating failed components are detailed below. 

Students who fail 2 or 3 components earn a failing grade for the rotation. Students who earn an F grade are required by the APRC to repeat a course (timeline permitting) to remediate deficiencies or are recommended for dismissal with an opportunity to appeal to the CAPPS.

Failure of the Knowledge Component

First Failure

• Students who fail the Knowledge Component of a clerkship based on the NBME Clinical Subject Examination are issued an “I” grade and are required to participate in the Clinical Examination Study Program and take a Make-up Exam in the same discipline to rectify the “I” grade in the clerkship.
• Students are required to meet with their academic advisor to discuss remediation and the consequences of additional failures, and to develop an Individualized Learning Plan (ILP).
• Make-up Exams are taken once students have completed all core clerkships. Each failed exam requires a 3-week remediation study period per failed Knowledge Component followed by a Make-up Exam in the failed discipline. Remediation periods must be completed sequentially, not concurrently. Remediation periods utilize bridge time or require a leave of absence.
• Students must earn at least a passing score on the Make-up Exam.
• The score on the Make-up Exam is used to determine the final clerkship grade, replacing the “I” grade.
• The maximum score for the Knowledge Component following this remediation is a “High Pass”. Students who additionally fail either the Clinical Skills or Professional Behavior Component are issued a failing course grade and are not eligible to participate in the Clinical Examination Study Program. 

Second Failure

• A second failure of the Knowledge Component of the same clerkship, despite a remediation period, requires an additional 3-week remediation study period followed by a Make-up Exam in the failed discipline.
• Students are required to meet with their academic advisor to discuss remediation and the consequences of additional failures, and to develop an Individualized Learning Plan (ILP).
• The maximum score for the Knowledge Component following a second remediation is a “Pass”.
• Failure of the second attempt at remediation is treated as a second failed component and results in an F grade, replacing the “I” given for the clerkship.

Failure of the Clinical Skills Component

First Failure

• Students who fail the Clinical Skills Component of a clerkship are issued an “I” grade and are required to remediate non-discipline specific clinical skills deficiencies during the subsequent clerkship to rectify the “I” grade.
• Students are required to meet with their academic advisor to discuss remediation and the consequences of additional failures, and to develop an Individualized Learning Plan (ILP).
• Students must earn at least a “Pass" for the failed component during the remediation clerkship.
• Additionally, comments provided by preceptors of this clerkship should specifically appraise performance in the deficient component to demonstrate that remediation has occurred.
• Regardless of performance on the Clinical Skills Component during the remediation clerkship, a “Pass” is used to resolve the “I” and determine the final grade.
• To remediate unresolved discipline-specific clinical skill deficiencies, students are required to register for an elective in the same discipline as the failed clinical skills component.

Second Failure

• A second failure of the Clinical Skills Component of a clerkship, despite an opportunity to remediate, demonstrates the student is unable to remediate deficiencies independently.  Focused remediation of clinical skills deficiencies takes place during the subsequent clerkship under the guidance of clinical preceptors to rectify the “I” grade in the clerkship.
• Students are required to meet with their academic advisor to discuss remediation and the consequences of additional failures, and to develop an Individualized Learning Plan (ILP).
• Students must earn at least a “Pass” on the Clinical Skills Component of the subsequent clerkship.
• Additionally, comments provided by preceptors should specifically appraise performance in the deficient aspects of the clinical skills component to demonstrate that remediation has occurred.
• Regardless of performance on the Clinical Skills Component during the remediation term, a “Pass” is used to resolve the “I” and determine the final grade.
• The second remediation attempt does not replace the discipline-specific elective requirement issued upon initial failure of the clinical skills component.
• Failure of the second attempt at remediation is treated as a second failed component and results in an F grade, replacing the “I” given for the clerkship.

Failure of the Professional Behavior Component

First Failure

• Students who fail the Professional Behavior Component of a clerkship are issued an “I” grade and are required to remediate deficiencies in professional behavior during the subsequent clerkship to rectify the “I” grade.
• Students are required to meet with their academic advisor to discuss remediation and the consequences of additional failures, and to develop an Individualized Learning Plan (ILP).
• Students must earn at least a “Pass" for the failed component during this clerkship to demonstrate remediation has been achieved.
• Regardless of performance on the Professional Behavior Component during the remediation clerkship, a “Pass” is used to resolve the “I” and determine the final grade.

Second Failure

• A second failure of the Professional Behavior Component, despite an opportunity to remediate, demonstrates the student is unable to remediate deficiencies independently.  Focused remediation of professional behavior deficiencies takes place during the subsequent clerkship under the guidance of clinical preceptors.
• Students are required to meet with their academic advisor to discuss remediation and the consequences of additional failures, and to develop an Individualized Learning Plan (ILP).
• Students must earn at least a “Pass" on the Professional Behavior Component of the subsequent clerkship to rectify the “I” grade.
• Additionally, comments provided by preceptors should specifically appraise professional behavior to demonstrate that remediation has occurred.
• Regardless of performance on the Professional Behavior Component during the remediation clerkship, a “Pass” is used to resolve the “I” and determine the final grade.
• Failure of the second attempt at remediation is treated as a second failed component and results in an F grade that replaces the “I” given for the clerkship.

Remediation of Failed Components: Summary

Grading Scale for the NBME Clinical Subject Examinations

An exam-specific performance grading scale is applied to all total equated percent correct scores reported by the NBME.

For each NBME Clinical Subject Examination, percentile-based cut-points are established annually using the average of NBME national percentile data and SGUSOM percentile data from the previous academic cycle. These cut-points are used to determine whether a student receives a Fail, Pass, High Pass, or Honors grade for each core clerkship NBME Clinical Subject Examination, or a Pass/Fail grade for the NBME Clinical Subject Examination in Family Medicine/General Practice.

For core clerkships, the 10th, 50th, and 75th percentile cut-points are used to assign grades of Pass, High Pass, and Honors for the Clinical Knowledge component of the clerkship.

The following grading scale is used to assign a score for the Clinical Knowledge Component of a core clerkship:

Interpretation of the Grading Scale for Core Clerkships:

• Below the 10^th percentile: Fail
• 10^th–49^th percentile: Pass
• 50^th–74^th percentile: High Pass
• Above the 74^th percentile and above: Honors

The following grading scale is used to assign a score for the Clinical Knowledge Component of a Family Medicine/General Practice required rotation:

Interpretation of the Grading Scale for the Family Medicine/General Practice required rotation:

• Below the 10^th percentile: Fail
• 10^th percentile and above: Pass

Students must pass all required NBME Clinical Subject Examinations to meet graduation requirements. The NBME Clinical Subject Examination is the primary measure of a student’s clinical knowledge within a core clerkship/required rotation and is a required component of a student’s clerkship/required rotation grade. 

Remediation of Clinical Knowledge

Performance on the NBME Clinical Subject Examinations is a strong predictor of performance on USMLE Step 2, which is required for US residency placement. Students who fail one or more NBME Clinical Subject Examination must complete the required remediation plan before progressing to the fourth year of the MD Program. The remediation plan is outlined below.

First Failure of an NBME Clinical Subject Examination (no other failed course components)

• Students who fail a core NBME Clinical Subject Examination must remediate their knowledge deficiencies and pass a Make-up Exam in the same discipline. Upon failing a core NBME Clinical Subject Examination, students are required to contact their academic advisor to discuss the remediation process and the consequences of additional failures on progression through the MD program and USMLE Step examination timelines.
• A failed core NBME Clinical Subject Examination requires completion of a mandatory 4-week remediation period following completion of all core clerkships (at the end of the third year). 
• The remediation period consists of 3 weeks of mandatory participation in the Clinical Examination Study Program followed by one week during which the NBME Clinical Subject Examination in the failed discipline is re-taken (Make-up Exam). 
• The remediation period utilizes either bridge time or a leave of absence. Students should discuss this with their clinical student administrator, academic advisor, and financial aid counselor.
• At the beginning of the 4-week mandatory remediation period, students receive an NBME permit and are responsible for scheduling the Make-up Exam for the NBME Clinical Subject Examination at a Prometric testing center during the fourth week of the remediation period.
• The Make-up Exam must be taken within the week following the end of the required 3-week remediation period (an 8-day period between the Saturday at the end of week 3 and the Sunday of the following week).
• Unless an approved Clinical/Medical Excuse has been granted (maximum 1 per 12-month period), failure to schedule and take the Make-up Exam within the required 1-week testing window means the student has not met all clerkship requirements. The student is therefore issued a failing grade for the clerkship.
• Students with failures in more than one NBME Clinical Subject Examination (different disciplines) must complete each mandatory 4-week remediation period and Make-up Examination sequentially, not concurrently.
• Because adequate remediation requires dedicated study time, students with multiple failed NBME Clinical Subject Examinations are not permitted to begin fourth-year electives until all remediation is completed and all Make-up Exams for the NBME Clinical Subject Examinations have been passed. Students may schedule fourth-year electives in advance but are not permitted to begin them until all third-year requirements have been fulfilled.
• Students who fail the NBME Clinical Subject Examination in their final Year 3 core clerkship and are scheduled to begin an elective immediately afterward are permitted to complete the first elective. However, any subsequently scheduled electives must be cancelled to accommodate the required remediation periods. 
• Students who fail one or more NBME Clinical Subject Examinations are at increased risk of failing or performing suboptimally on USMLE Step 2, which may adversely affect residency match prospects. 
• Students will not be certified to take USMLE Step 2 until all Year 3 requirements have been met. Students requiring remediation of one or more NBME Clinical Subject Examinations may therefore need to postpone their scheduled USMLE Step 2 examination date.

Second Failure of an NBME Clinical Subject Examination

• Students who fail the Make-up Exam for a failed core NBME Clinical Subject Examination must complete an additional remediation 4-week remediation period followed by a second Make-up Exam in the same discipline.
• The same details related to the first NBME Clinical Subject Examination failure apply to the remediation and Make-up Exam of the second exam failure.

NBME Clinical Subject Examination for the Family Medicine/General Practice Required Rotation

• The Family Medicine/General Practice (FM/GP) required rotation is taken in either the 3rd year with the other core clerkships or in the 4th year with the other elective clerkships.
• The NBME Clinical Subject Examination in Family Medicine is a graduation requirement and is taken at the end of the FM/GP required rotation.  
• Students who fail this NBME Clinical Subject Examination are expected to undertake a 4-week remediation of 3 weeks intensive study followed by a Make-up Exam for the NBME Clinical Subject Examination in Family Medicine during the 4th week. Additional remediation periods are required for all subsequent failures of the NBME Clinical Subject Examination in Family Medicine. Students who fail the NBME Clinical Subject Examination in Family Medicine must complete the remediation requirement and pass the Make-up Exam before the end of the 4th year to qualify for graduation.
• A failing score on the NBME Clinical Subject Examination in Family Medicine does not prevent advancement to the fourth year. However, students must successfully complete all required remediation and pass the Make-up Exam prior to the end of the fourth year to qualify for graduation.
• The clinical schedule may require modification to accommodate FM/GP remediation. Remediation may not be the final activity of the fourth year; therefore, remediation should be undertaken as soon as possible after completion of the FM/GP required rotation. Delaying remediation may adversely affect graduation timelines and residency eligibility.