Grading: Clerkship Level


Policy 540.40


Policy Statement  


All Larner College of Medicine clerkships use the same grading criteria as described below. Bridge courses within the Clerkship curriculum are graded Pass/Fail.

  1. All students must successfully fulfill all University of Vermont Larner College of Medicine Competencies and Medical Education Programmatic Objectives and 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 tool.
    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.
    2. For clerkship rotations using other cognitive assessment tools, such as a locally produced or other national examination, a passing score is determined annually by the Clerkship Director using a criterion-based system.
  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. 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.
    2. Domain scores are calculated across cases.
      1. Professionalism: Passing score is 80 or one standard deviation below the mean, whichever is lower.
      2. Communication: Passing score is 80 or one standard deviation below the mean, whichever is lower.
      3. History: Passing score is 70 or one standard deviation below the mean, whichever is lower.
      4. Physical Exam: Passing score is 70 or one standard deviation below the mean, whichever is lower.
  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 35 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 two in all domains on the Universal Clerkship Assessment form, and
  2. Pass the medical knowledge exam (refer to passing cut offs above) on first or second attempt, and
  3. Pass the Clinical Skills Examination (refer to CSE passing cut offs above) on first or second attempt, if the clerkship is using a summative, graded CSE, and
  4. Pass all other graded components of the clerkship (i.e., Evidence-based medicine activity, reflection, note, etc.) on the first or second attempt, and
  5. Complete all clerkship activities by 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. Fail to complete all clerkship assignments by end of business day on 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 assignments, within one year of completing the course.

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 and the Level Director.
  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 may not take the retake exam while enrolled in a subsequent elective or required clinical course.
    3. 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.
    4. The student cannot schedule the retake exam during other course activities.
    5. 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).
    6. 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

  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, all required work of the Clerkship Level must be completed successfully.
  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]

Policy Oversight


Level Director of Clinical Clerkship

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