Implications for Academic Progress

The final grade for the core clerkship is determined by grades earned for each of the 3 components. To facilitate student success, remediation of deficiencies is integral to the grading system.

• Students must successfully complete all core clerkship/FM/GP requirements, pass all 3 components, and resolve any “I” grades of the core clerkship in order 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 and will earn a failing grade for the clerkship. An approved medical excuse is required for students to delay the end of clerkship NBME exam. Note: only one medical excuse is permitted per year.
• Failure of any of the 3 core clerkship/FM/GP components will result in an “I” grade and required 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 repercussions of additional failures. Time taken to remediate the knowledge component will consist of either bridge time or students will have to take a Leave of Absence.
• Failure of 2 or 3 core clerkship components will result in a failing grade for the core clerkship/FM/GP required rotation. Students will be required to repeat the clerkship/rotation in order to remediate academic deficiencies and earn a second grade for the clerkship.
• Students are permitted only one failure during the clinical studies phase of the curriculum.  Students with a second failing grade in the clinical terms will be recommended for dismissal. Any student recommended for dismissal will be given the opportunity to appeal to the CAPPS.
• Students must be making progress toward completing the MD Program within the 6-year maximum allowable timeline. Students not likely to complete requirements within the maximum allowable timeline will be recommended for dismissal.

Failure of the Knowledge Component

First Failure

• Students who fail the Knowledge component of a clerkship based on the NBME subject exam, will be issued an “I” and be required to take a make-up exam in the same discipline in order to rectify the “I” grade in the clerkship.
• Students are required to meet with their academic advisor to discuss remediation and the repercussions of additional failures, and to develop an Individualized Learning Plan (ILP).
• Make up exams will be taken once students have completed all core clerkships. Each failed exam will require a remediation study period of 3 weeks per failed Knowledge Component followed by a make-up exam in the failed discipline. Remediation periods must be done sequentially, not concurrently. Remediation periods will be bridge time or a Leave of Absence.
• Students must earn at least a passing score on the make-up exam.
• The score for the makeup exam will be used to determine the final grade for the clerkship that will replace the “I”.
• The maximum score for the Knowledge Component following this remediation is a “High Pass”.

Second Failure

• A second failure of the Knowledge Component of the same clerkship, despite a remediation period, will require an additional remediation study period of 3 weeks followed by a make-up exam in the failed discipline. 
• Students are required to meet with their academic advisor to discuss remediation and the repercussions 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”.
• If the student fails the second attempt at remediation, this will be treated as a second failed component and result 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 will be issued an “I” and be required to remediate non-discipline specific clinical skills deficiencies during the subsequent clerkship in order to rectify the “I” grade.
• Students are required to meet with their academic advisor to discuss remediation and the repercussions 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” will be used to resolve the “I” and determine the final grade.
• In order to remediate unresolved discipline-specific clinical skill deficiencies, students will be 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 will take place during the subsequent clerkship under the guidance of clinical preceptors in order to rectify the “I” grade in the clerkship.
• Students are required to meet with their academic advisor to discuss remediation and the repercussions 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” will be 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.
• If the student fails the second attempt at remediation, this will be treated as a second failed component and result 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 will be issued an “I” and be required to remediate deficiencies in professional behavior during the subsequent clerkship in order to rectify the “I” grade.
• Students are required to meet with their academic advisor to discuss remediation and the repercussions 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” will be 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 will take 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 repercussions 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 in order 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” will be used to resolve the “I” and determine the final grade.
• If the student fails the second attempt at remediation, this will be treated as a second failed component and result in an F grade replacing the “I” given for the clerkship.

Remediation of Failed Components: Highlights

Components Failed	First Failure	Second Failure	Third Failure
Knowledge Competency	- “I” grade for clerkship - mandatory advising meeting to develop an ILP - a required 3-week guided remediation period (as per Individualized Learning Plan) is required followed by a Make-up NBME Subject Exam once other core clerkships are completed - Student may earn up to a High Pass” for the clerkship once a pass is earned on the NBME -May not progress to Year 4 until NBME make-up exam is taken and passed	- “I” grade for clerkship - mandatory advising meeting to develop an ILP - a required 3-week guided remediation period (as per ILP) is required followed by a Make-up NBME Subject Exam once other core clerkships are completed - multiple remediation periods must be done sequentially -Student earns a “Pass” for clerkship once a pass is earned on NBME - May not progress to Year 4 until NBME make-up exam is taken and passed	- “F” grade for clerkship
Clinical Skills Competency	- “I” grade for clerkship - mandatory advising meeting to develop an ILP - remediation of deficient element(s) as per ILP with mentoring during subsequent clerkship - May not progress to Year 4 until remediation complete - Must “Pass” the Clinical Skills Component of the subsequent clerkship - “Pass” will be used to resolve the “I” - required to register for an elective in the same discipline as the failed clinical skills component to address discipline-specific deficiencies.	- “I” grade for clerkship - mandatory advising meeting to develop an ILP - remediation of deficient element(s) as per ILP with mentoring during subsequent clerkship - preceptor comments on deficient element - May not progress to Year 4 until remediation complete - Must “Pass” the Clinical Skills Component of the subsequent clerkship - “Pass” will be used to resolve the “I” - required to register for an elective in the same discipline as the failed clinical skills component to address discipline-specific deficiencies.	- “F” grade for clerkship
Professional Behavior Competency	- “I” grade for clerkship - mandatory advising meeting to develop an ILP - remediation of deficient component during subsequent clerkship - Must “Pass” the Professional Behavior Component of the subsequent clerkship - “Pass” will be used to resolve the “I” - once remediation is complete, the “F” will be replaced with a “Pass” to determine the grade to replace the “I” - May not progress to Year 4 until remediation complete	- “I” grade for clerkship - mandatory advising meeting to develop an ILP - remediation of deficient element(s) as per ILP with mentoring during subsequent clerkship - Must “Pass” the Professional Behavior Component of the subsequent clerkship - preceptor must comment on deficient component - “Pass” will be used to resolve the “I” - May not progress to Year 4 until remediation complete	- “F” grade for clerkship

Grading scale for NBME clinical subject exams

An exam-specific performance grading scale will be applied to all NBME exam raw scores.

Based on NBME published percentiles and SGU percentiles determined annually, percentile-based cut-points (10th/50th/75th) will be used to assign grades (Pass/High Pass/Honors) for core clerkship NBME clinical subject exams.

The following grading scale will be used to assign a score for the clinical knowledge component of a core clerkship

	<10th %ile	10th-49th %ile	50th-74th %ile	>74th %ile
NBME Raw Score Cut-Points	Fail	Pass	High Pass	Honors
Medicine	<63	63 - 73	74 - 78	>78
Pediatrics	<66	66 - 76	77 - 81	>81
Ob/Gyn	<65	65 - 75	76 - 81	>81
Surgery	<62	62 - 73	74 - 78	>78
Psychiatry	<75	75- 82	83 - 85	>85

The following grading scale will be used to assign a score for the clinical knowledge component of a Family Medicine/General Practice required rotation:

NBME Raw Score Cut-Points	<10th%ile Fail	10th %ile or greater  Pass
Family Medicine*	<65 Fail	65 and up

The average of the NBME national percentile data and the SGU SOM NBME percentile data for each of the six NBME clinical subject exams shall be used to determine whether a student obtained a grade of fail, pass, high pass, or honors for each of the core clerkship clinical subject exams or a pass/fail for the FM/GP clinical subject exams. This average of the NBME and SOM percentile data used to determine the grade of an individual student for each clerkship NBME shall be calculated using the percentile data of the previous academic cycle.

For core clerkships, obtaining an NBME clinical subject exam that ranks at the 10th percentile or above means the student earned a pass for the NBME clinical subject exam. Obtaining an NBME clinical subject exam score that ranks at the 50th to the 74th percentile means the student earned a High Pass. Obtaining an NBME grade that ranks at the 75th percentile or above means the student earned Honors.

For core the FM/GP required rotation, obtaining an NBME clinical subject exam that ranks at the 10th percentile or above means the student earned a pass for the NBME clinical subject exam.

Students must pass all required NBME Clinical Subject Exams in order to meet graduation requirements. The NBME Clinical Subject Exam (CSE) is the primary measure of a student’s clinical knowledge in a core clerkship/required rotation and a required component of a student’s clerkship/required rotation grade. 

Remediation of Clinical Knowledge/NBME Failures

Performance on the NBME Clinical Subject Exams is the best predictor of student performance on the Step 2 CK examination required for US residency placement. Below is the new remediation plan for students who fail one or more NBME clinical subject exams:

Students who Fail the NBME Clinical Subject Examination

The NBME Clinical Subject Exam is a challenging exam for which students must prepare during their core clerkship. Unfortunately, some students do fail this required examination and will require remediation prior to taking the Step 2 CK exam and progressing to the 4^th year of the MD Program.

First Failure

• Students who fail their core NBME clinical subject exam, will be required to remediate knowledge deficiencies, and take a make-up exam in the same discipline and earn a passing score. Upon failure of any core NBME clinical subject exam, students are required to contact their academic advisor to discuss remediation and the repercussions of additional failures on the MD program and Step examination timelines.
• Any failed NBME core clinical subject exam will require a 4-week mandatory remediation period: 3 weeks during which knowledge deficiencies are remedied   and one week during which the  NBME Clinical Subject Exam in the failed discipline is re-taken (make-up exam). The 4-week mandatory  remediation period will follow the completion of all core clerkships (at the end of the third year).
• The remediation period will be considered as either a bridge or a leave of absence. Students should discuss this with their clinical student coordinator, academic advisor and financial aid counselor.
• The  NBME Clinical Subject 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).
• At the start of the  4-week mandatory remediation study period students will receive an NBME permit to schedule the NBME Clinical Subject Make-up Exam  during the 4^th week. 
• The NBME Clinical Subject Make-up Exam must be taken within this  1-week window.
• It is the student’s responsibility to contact a Prometric center as soon as they are sent the NBME permit to ensure they schedule the NBME Clinical Subject Make-up Exam for a date that falls within the required 1-week window.
• Unless a Medical Excuse has been submitted (maximum 1 per calendar year), failure to schedule and take the  NBME Clinical Subject Make-up Exam within the required 1-week window means students have not met all clerkship requirements and will, therefore, be issued a failing grade for the clerkship.
• Should students have multiple failed NBME Clinical Subject Exams (different disciplines), each 4-week mandatory remediation period and make-up examination must be undertaken sequentially, not concurrently.
• Due to the time and effort required for adequate clinical subject knowledge remediation, students with multiple failed NBME Clinical Subject Exams will not be permitted to start  fourth year electives until remediation is complete and all NBME Clinical Subject Make-up exams have been passed.
• Students may schedule their fourth year electives; however, will not be permitted to start until they fulfill all requirements for third year.
• Students who have failed the NBME Clinical Subject Exam for their final year 3 core clerkship and whose scheduled first elective is set to begin immediately following the last core clerkship will be permitted to complete the elective but will be required to cancel any other scheduled electives to accommodate all 4-week mandatory remediation periods.
• Students who fail NBME examinations are particularly at-risk of either failing or performing sub-optimally on the Step 2 CK and, as a result, negatively affecting their prospects for a residency match.
• Students will not be certified to take Step 2 CK until all year 3 requirements have been met. Therefore, students should note that if they fail one or more NBME Clinical Subject Exams and require remediation and make-up exams, they may be required to postpone their scheduled Step 2 CK to ensure remediation has been completed and all year 3 requirements are met prior to taking the Step 2 CK.
• Students should note that if they fail multiple NBME Clinical Subject Exams and require remediation and make-up exams, they will need to postpone their scheduled Step 2 CK to ensure remediation has been completed and all year 3 requirements are met prior to taking the Step 2 CK.

Second Failure

• Students who fail the make-up of a failed core NBME clinical subject exam, despite a remediation period, will require an additional remediation study period of 4 weeks followed by a second make-up exam in the failed discipline. 
• The same details related to the first NBME Clinical Subject Exam failure apply to the remediation and make-up of the second exam failure.

Family Medicine/General Practice NBME

• The NBME Clinical Subject Exam in Family Medicine taken at the end of the required Family Medicine/General Practice clerkship is a graduation requirement. This clerkship is taken in either the 3 year with the other core clerkships or in the 4^th year with the other elective clerkships. Students who fail this NBME subject exam are expected to undertake a 4-week remediation of 3 weeks intensive study followed by an NBME clinical subject exam make-up in Family Medicine during the 4^th week. Additional remediation periods will be required for all subsequent failures of the FM NBME examination. Students who fail the NBME clinical subject exam in Family Medicine must complete the remediation requirement and pass the make-up examination by the end of the 4^th year in order to qualify for graduation.