Grading System for Students Who Started Their Core Clerkships (Year 3) Before January 3rd, 2022

The final grade in the clerkship represents a semi-quantitative average of five components:

  1. Clinical Reasoning 20%
  2. Clinical Skills 20%
  3. Professional Behavior 20%
  4. Communication Skills 10%
  5. NBME Clinical Subject Exam grade 30%

Items one through four reflect subjective faculty assessments at the hospital.

The students take the NBME Clinical Subject Exam during the final  2 weeks of their clerkship. The Office of Clinical Education Operations receives the scores from the NBME  and scores are automatically uploaded to the SGU Clinical Evaluation System.

The NBME Clinical Subject Exams will be graded as follows:



75 or greater

A+ (Honors)

70 – 74


65 – 69


60 – 64


59 or below


The electronic evaluation automatically determines the final grade based on the Clerkship Director’s grades of the individual components plus the NBME grade. Depending on the grades on other evaluation components, it is possible for students who fail the NBME exam but pass the other components of the clerkship to earn a passing grade for the clerkship. This grade is final. Even after repeating and passing the NBME exams, the grade will not be changed. In such cases repeating the clerkship is not necessary; the school will give students credit for the clerkship. However, the Graduation Assessment Board will not approve this student for graduation until the student demonstrates competency in the relevant subject area by passing the make-up of the failed NBME examination after additional study time to improve medical knowledge and test-taking skills.

Since performance on the NBME clinical Subject Exams correlates with performance on Step 2 CK, students who perform poorly on the NBME exams (failing or persistent low scores) should consider a structured program during their fourth year to improve their medical knowledge and test-taking skills. In another example, a student may pass the NBME but fail another individual component of the clerkship such as communication skills or professional behavior.  In such a case, if the final grade is passing, the school will give the student credit for the clerkship, but the student should work to remediate these deficiencies during subsequent rotations to achieve the desired level of competency in the particular component(s).

1.  Definition of Grades



A+ (Honors)

requires all As and an A+ on the NBME exam. A+ (honors) must be given to students with these grades.


is given to students who proficiently develop the competencies listed in the Clinical Training Manual and whose overall performance is good.


is given to those students who only adequately develop the required competencies and whose overall performance is acceptable.


is given to those students who barely meet minimum requirements. This grade is, in fact,  A “warning“ grade and identifies  a student who is struggling in medical school and Requires additional mandated training and/or counseling.


is given to those students whose continuation in medical school is problematic.  An ‘F’ in any component of the assessment precludes a student from meeting graduation requirements until the GAB determines that the student has reached the required level of competency in that component(s). A final grade of F leads to a recommendation for dismissal from medical school.


A Clerkship Director may report a “No Grade” for a student who is registered in a course. Students must fulfill all course requirements as defined by the Clerkship. Once all requirements have been completed, the NG will convert to a final grade. Failure to complete remaining requirements within the required timeframe as outlined in the CTM will result in an “F” grade for the clerkship.


is given when additional clinical work/remediation is required to complete the course. The “I” designation remains on the transcript until a final course grade is given upon completion of remaining course requirements.

Clerkship Directors have the option of adding + or – to the above grades based on their opinion. Only A+ requires objective criteria.

 In summary, grading of student performance should use the following:

       A+ = exceptional

       A  =  good

       B  =  adequate

       C  =  minimal

       F  =  failing

Components of the Assessment

Clinical Performance

The teaching physicians  who work with the  student during  the rotation  assess the  student’s   clinical  performance in  four areas clinical reasoning, clinical skills, communication, and professional behavior (Appendix X). . The more feedback the Clerkship Director gets from different members of the medical staff that instructed the student, the more objective grades can be. The faculty assesses the extent to which the student has developed the competencies required for that rotation. These specific competencies appear in Section II of this manual in the curriculum for each of the core clerkships.   

NBME End of Clerkship Exam Policies and Procedures

     The NBME Clinical Subject (Shelf) Exam must be taken by all students  during the final 2 weeks of  the  clerkship.  Scheduling for  this  exam is done  by  the Office of Clinical Education Operations – NBME Team. Students who test at Prometric Centers receive permits at least three weeks prior to each exam. Hospitals must excuse students one day before the pediatrics, family medicine, ob/gyn and psychiatry exams for study time and two days before the medicine and  surgery exam for study time. Students are excused for the entire day of the exam.              

Clinical experience during the  rotation does not  provide adequate preparation for the NBME  exam. Students must use UWorld and Firecracker as well as other recommended resources for each clerkship to prepare for these exams. Students can find the content outline of these exams on the NBME website.  Students must sit the NBME exam before  starting their next rotation.

  • All students must attend the NBME exam as scheduled.
  • Students who are too  ill to take  the exam as  scheduled should refer to the “Medical Excuse” policy in the Student Manual.
  • Failure to take the NBME End  of Clerkship  Exam on  time constitutes a failure to complete required clerkship components and will result in a failing grade for the clerkship.
  • Students who earn a failing grade in a clerkship must repeat and pass the clerkship to meet graduation requirements.
  • Any student who has failed an NBME clinical subject exam must remediate knowledge deficiencies and retake the failed subject exam.
  • Passing all 6 NBME clinical subject exams (IM, Surgery, Pediatrics, Ob/Gyn, Psychiatry, and Family Medicine) is a graduation requirement.
  • Any student who fails a required NBME clinical subject exam is required to retake and pass the failed exam.
  • For students who have not yet completed all required core clerkships (year 3), failed NBMEs must be retaken and passed prior to starting year 4 electives.
  • For students who have completed all required core clerkships (currently in their 4th year), all failed NBME exams must be re-taken and passed by the end of the 4th year.
  • Students intending to schedule re-takes must contact for instructions on how to schedule this exam. Retakes must be scheduled at least 4 weeks prior to the intended exam date.
  • Students should plan their schedules accordingly and consult their Academic Advisor for guidance on planned remediation and scheduling retakes.
  • A 3-week remediation period for each failed NBME clinical subject exam is strongly recommended followed by the required retake of the failed exam. This may be taken in the form of bridge time or an LOA.
  • A GAB elective in the failed subject is no longer a requirement for remediation of failed NBME clinical subject exams. Students who have already scheduled these electives may take the elective as planned or arrange for an alternate elective. Contact your clinical student coordinator for any changes to scheduled electives.