Grading: Clerkship Level

Policy 540.40

Policy Statement  

All Larner College of Medicine clerkships are graded Pass/Fail and use the grading criteria below.  The four bridge courses in the Clerkship Level are graded Pass/Fail.

  1. All students must successfully fulfill all University of Vermont Larner College of Medicine Competencies and Medical Education Programmatic Objectives, as well as clerkship specific competencies to pass a clerkship.
  2. Each clerkship will assess the medical knowledge competency by a standardized written or oral examination and/or other assessment tools.
    1. For clerkship rotations using a National Board of Medical Examiners (NBME) subject exam to assess medical knowledge, a passing score is defined as a score equal to or greater than the fifth percentile nationally based on the NBME first quartile, as measured from the previous year.
    2. For clerkship rotations using other cognitive assessment tools, such as a locally produced or other national examinations, a passing score is determined annually by the Clerkship Director using a criterion-based system and presented to the Medical Curriculum Committee (MCC) in the annual Quality Assurance Report (QAR).
  3. Each clerkship will assess student clinical performance. Clinical performance can be assessed by preceptor observation, written notes, oral presentations, simulation exercises, and other means. All clerkship rotations will use the Universal Clerkship Assessment form to assess clinical performance.
  4. Clerkships may use a Clinical Skills Examination (CSE) as part of the student’s assessment within the clerkship.  These may be formative or summative CSEs that will be graded pass/fail.
    1. Generally, there are four domains (Professionalism, Communication, History and Physical Exam) in a CSE.  Domain scores are calculated across cases. If the CSE is summative and graded, each domain must be passed to pass the CSE. Some CSEs also assess patient education and telemedicine skills.
  5. At the conclusion of a clerkship, Clerkship Directors assign a grade of Pass, Incomplete, or Fail for each individual student’s performance.
  6. Clerkship grades are posted to the grade portal of the Office of Medical Education (OME) within 42 days of the end of the clerkship.

Policy Elaboration  

Assignment of Grades

Pass Criteria: A grade of Pass will be assigned to students who meet all of the following criteria.

  1. Receive an average score of greater than or equal to 2.0 (two) in all domains on the Universal Clerkship Assessment form,
  2. Pass the medical knowledge exam (refer to passing cut offs above) on first or second attempt,
  3. Pass the CSE (refer to CSE passing cut offs above) on first or second attempt, if the clerkship is using a summative, graded CSE. See below for domain calculations:
    1. Professionalism:  Passing score is 80 or 1.5 standard deviations below the mean, whichever is lower.
    2. Communication: Passing score is 80 or 1.5 standard deviations below the mean, whichever is lower.
    3. History: Passing score is 70 or 1.5 standard deviations below the mean, whichever is lower.
    4. Physical Exam: Passing score is 70 or 1.5 standard deviations below the mean, whichever is lower. 
  4. Pass all other graded components of the clerkship (i.e., Evidence-based medicine activity, reflection, note, etc.) on the first or second attempt as outlined in the syllabus,
  5. Complete all clerkship activities by the end of business day within 14 days after the last day of the course.

Incomplete Criteria: A grade of Incomplete will be assigned to students who meet any one of the following criteria.

  1. Unable to meet the goals and objectives of the clerkship, as determined by the Clerkship Director due to missed clinical time, or an excused absence, or
  2. Fail the medical knowledge test first attempt, or have an approved exam delay, or
  3. Fail the summative, graded CSE (if the clerkship has one) first attempt or have an approved CSE delay, or
  4. Fail any “other” graded component, first attempt, or
  5. Failure to complete all clerkship activities by the end of business day 14 days after the last day of the course

Fail Criteria: A grade of Fail will be assigned to students who meet any one of the following criteria:

  1. An average score of less than two in any domain on the Universal Clerkship Assessment form, or
  2. Fail the medical knowledge exam, second attempt, or
  3. Fail the summative, graded CSE exam (if the clerkship has one), second attempt, or
  4. Fail any “other” graded component, second attempt, or
  5. Fail to complete all clerkship activities within one year of completing the course.
  6. A student who does not attend a scheduled Clerkship without formal approval will be assigned a grade of Fail.

Remediation

Incomplete Grades: A grade of Incomplete can be converted to a grade of Pass by successful remediation of all eligible clerkship components.

  1. Clinical Performance Remediation policy and procedure:
    1. Students who were unable to meet the goals and objectives of the clerkship due to missed clinical time, will perform remedial activities at the discretion of the Clerkship Director in consultation with the Level Director as needed.
  2. Medical Knowledge Exam Remediation/Retake policy and procedure:
    1. The student is responsible for contacting the specific Clerkship Coordinator and the Office of Medical Education Clerkship Level Coordinator to initiate the process for scheduling a retake exam.
    2. The student is responsible for meeting with the Director of Academic Achievement to identify any resources, tutoring or accommodations that will maximize student success.
    3. The student may not retake an exam while enrolled in another clinical course (required or elective). This includes the Winter Holiday and Rotation 6 of the clerkship year. If a student has not taken the rotation 6 Medical Knowledge Exam, a student may not schedule a retake during the Winter Holiday.
    4. The student may not retake an exam during any other course/clerkship activities.
    5. Students may sit for retake exams during non-clinical courses such as a reading, scholarly project, or teaching assistant electives during Advanced Integration, or during a Clerkship Bridge Week, or a vacation week that is between clerkships as long as it does not interfere with course activities.
    6. The student must schedule the retake exam during designated days/times, within the normal workday (8:00 a.m.- 4:30 p.m., Monday-Friday), when the University is open (UVM Administrative Closures), as determined by the Clerkship Level Team.
    7. The Clerkship Level Coordinator will help finalize the date, time and location of the retake exam, help arrange a proctor and any necessary technology assistance from College of Medicine Technology Services (COMTS).
    8. The Clerkship Coordinator will communicate the retake results to the student, the course director, and the OME Clerkship Level team. The Clerkship Coordinator will upload the retake grade into the grading portal.
  3. Clinical Skills Exam Remediation/Retake policy and procedure:
    1. Students failing a clinical skills examination, either formative or summative/graded, will perform remedial activities at the discretion of the Clerkship Director and the Director of Simulation Education of the Clinical Simulation Laboratory.
    2. Following completion of these activities (if any), students must schedule a remedial clinical skills examination during the times designated by the Director of Simulation Education of the Clinical Simulation Laboratory.
  4. Other Graded Components Remediation policy and procedure:
    1. Students failing other graded components will perform remedial activities at the discretion of the Clerkship Director.
  5. Clerkship Assignments/Requirements Remediation policy and procedure:
    1. Students failing to complete clerkship assignments will perform remedial activities at the discretion of the Clerkship Director.

Failing grades: A grade of Fail will be recorded on the student’s permanent transcript, unless the student appeals the grade in accordance with Policy 540.60 - Grade Appeals and Narrative Assessment Appeals.

End of Clerkship Clinical Skills Examination

Students transitioning into the Advanced Integration Level will sit for the twelve-station, End of Clerkship (EOC) Clinical Skills Exam (CSE), which is a graduation requirement.

  1. Students must pass the End of Clerkship (EOC) Clinical Skills Examination (CSE) in order to graduate.
  2. To be eligible to take the EOC CSE, students must meet one of the following criteria below:
    1. Have a grade of Pass in all eight clerkships, or
    2. Have completed all of the clinical time in all eight clerkships, but carry a grade of Incomplete due to a missing medical knowledge exam score, or
    3. Have only one week of clinical work remaining in a six- or seven-week clerkship or two days remaining in a three and a half week clerkship and carry a grade of Incomplete.
  3. A student failing the EOC CSE after one attempt will receive a grade of Incomplete and must retake the exam.
  4. Upon successful retake of the EOC CSE, the grade will be changed to Pass.
  5. Students failing the EOC CSE a second time will receive a transcript grade of Fail and will meet with the Associate/Assistant Dean for Students for the opportunity to discuss further remediation to be approved by the Advancement Committee.

Applicability of the Policy

Clerkship Level Students

Related Larner College of Medicine Policies

Related University of Vermont Policies

Related Liaison Committee on Medical Education (LCME) Standard(s)

9.6 Setting Standards of Achievement

History

  • 7/25/2012 Policy Adopted/Affirmed [Medical Curriculum Committee]
  • 5/23/2016 Policy Revised [Medical Curriculum Committee]
  • 8/16/2016 Policy Revised [Medical Curriculum Committee]
  • 3/21/2017 Policy Revised [Medical Curriculum Committee]
  • 12/17/2019 Policy Revised [Medical Curriculum Committee]
  • 2/16/2021 Policy Edited [Medical Curriculum Committee]
  • 7/19/2022 Policy Revised [Medical Curriculum Committee]
  • 1/17/2023 Policy Revised [Medical Curriculum Committee]
  • 6/20/2023 Policy Revised [Medical Curriculum Committee]
  • 12/19/2023 Policy Edit [Medical Curriculum Committee]

Policy Oversight

Assistant Dean of Clerkship Curriculum

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