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Academic Performance and Progression

I. ACADEMIC PROGRESSION

There are many curriculum paths, which a student can take during his/her medical education. The three major ones are:

The standard four-year plan for the M.D. degree includes the following:

Students, who have satisfactorily completed all course work, may request a non-standard schedule when exceptional, educational opportunities are available. Modifications can only be approved by the Associate Dean for Student Affairs who has the right to refer a request to the Student Standards Committee. The student must submit a written request to the Associate Dean outlining the reason for the modification, the timeline, and a plan for re-entering the MD curriculum. He/she must also meet with the Associate Dean to discuss the details and to obtain a decision on the proposal. The Associate Dean will review the customized schedule with the following parameters in mind:

Module 1 Progression

Module 1 is graded on a pass/fail basis with one grade being awarded for the entire module, which consists of the traditional basic science disciplines. Each discipline coordinator awards a grade of pass/unsatisfactory/fail for his/her component of the curriculum and informs the students of their grades. A student cannot remediate more than two Unsatisfactory grades in Module 1. Three or more Unsatisfactory grades (excluding embryo) will result in a Failure for Module 1 and the student will have to repeat the entire Module. If halfway through Module 1, a student has accumulated 3 Failures or more, the student will receive a Withdraw/Failing for the Module and have to repeat the entire Module. Makeup exams are not given during Module 1 in order to allow students to concentrate on each discipline. Make-up exams are offered according to the following schedule:

Modules 2, 3, and 6 Progression

"Unsatisfactory" grades in the Spring of Year 1 must be remediated by August 10th in order for the student to progress into the Fall of Year 2.

Fall of Year 2 "Unsatisfactory" grades which are issued by December 15th must be remediated by January 1 in order for the student to progress into the Spring of Year 2 (Module 4.)

“Unsatisfactories” which are reported to the student by the course director in early January must be remediated by February 1st.

Module 4 Progression

Module 4 is a 48-week curriculum, composed of core clerkships which are required of all students. All students, except those in the MD/PhD track, must complete Module 4 in its entirety in one calendar year. MD/PhD students must successfully complete 6 months of Module 4 before beginning graduate coursework with the remainder, scheduled on an individualized basis.
MD/PhD students who receive an “Unsatisfactory” in any course must complete all required makeup work during the first six months of the clerkships or remediate the clerkship no later than September 1 in order to begin graduate course work in the fall of their third year.
Non-MD/PhD students who receive an “Unsatisfactory” in any core clerkship must successfully complete the makeup work in order to progress into Module 5. Makeup exams are given according to the following schedule:

One exam failure/clerkship

If a student passes the clinical portion of the course but fails a clerkship exam, he/she will be given the opportunity to take the test again. The initial course grade will be recorded as an "Unsatisfactory". High pass is the maximum grade, which can be given after one re-test is taken and passed.

Two exam failures/clerkship

If a student receives a High Pass or Honors in the clinical portion of the course but fails the initial exam and the re-take exam, he/she will have to pass the Step 2 Clinical Knowledge exam to receive a passing grade for the clerkship. Step 2 must be taken by August 1st. Pass is the maximum grade, which can be given under these circumstances. The student will be able to enroll in Module 5 courses even with the remaining Unsatisfactory grade in a Module 4 clerkship.

If a student receives a Low Pass or Pass in the clinical portion of the course but fails the initial exam and the re-take exam, he/she will be given a Fail for the clerkship and need to repeat it in its entirety. This situation will be reported to the Student Standards Committee and noted in the student's Medical Student Performance Evaluation letter. When a student needs to repeat the course, after a failure on the first attempt, he/she is given one opportunity to earn a passing grade by the course end date. If this is not accomplished, the student's record will be re-reviewed by the Student Standards Committee, who may initiate dismissal proceedings.

The Student Standards Committee will review all records of students, who have multiple exam failures. If extenuating circumstances prevent a non MD/PhD student from completing Module 4 in one calendar year, he/she may move into Module 5 as long as the student is in good academic and disciplinary standing and has the approval of the Associate Dean for Student Affairs.

Clinical Remediation

If clinical remediation time is required, the first course registration will be permanently marked on the transcript with the designation of No Grade (NG.) If the student is able to remediate the grade to a passing level, then the passing grade (maximum grade is Pass ) is noted as a separate entry on the transcript. If remediation is not successful, a grade of Fail will be recorded and the student will repeat the course in its entirety.

Module 5 Progression

A student who receives an “Unsatisfactory” in any component of Module 5 will be required to do remedial work. If clinical remediation time is required, the first course registration will be permanently marked on the transcript with the designation of No Grade (NG.) If the student is able to remediate the grade to a passing level, then the passing grade (maximum grade is Pass) is noted as a separate entry on the transcript. If remediation is not successful, a grade of Fail will be recorded and the student will repeat the course in its entirety.

A student who receives a grade of Fail will be required to re-take the same course or a course identified by the Student Standards Committee. The student must complete the remedial work, preferably within two months after the grade has been received by the Registrar's Office, and no later than by March 15th before graduation.

II. LEAVES OF ABSENCE and GAPS

Leave of Absence

Students may request a leave of absence for up to one year. A leave is a period of non-enrollment marked by loss of student status. Students on leave may work in the School as long as student status is not required and with the understanding that the activity will not fulfill any M.D. degree requirements. However, students on leave may not participate in any School sponsored patient care activities in the inpatient setting, outpatient setting, or in the community. A leave of absence will be noted in the Medical Student Performance Evaluation without giving specific reasons.

Notification/Financial Obligations

Insurance

Gaps

When a student's schedule has to be adjusted for a time period of 2 to 8 weeks then the time missed is considered to be a "gap”. The amount of time can range from 2 to 8 weeks; schedule adjustments, which exceed 8 weeks, must be considered as leaves of absence. Requests for a gap must be approved by the Associate Dean for Student Affairs. The student must communicate with the Associate Dean for Student Affairs at the beginning of the gap and, again, when he/she would like to resume course work. In the case of illness, a student must provide documentation from a treating physician at the beginning of the gap and, again, at the time when he/she would like to resume coursework. A gap will be noted in the Medical Student Performance Evaluation without giving specifics about the nature of the illness or crisis.

Involuntary Leave of Absence

When a student exhibits behavior resulting from a psychological, psychiatric, or other medical condition that:

III. ACHIEVING ACADEMIC PERFORMANCE

To earn the M.D. degree, each student must:

Patient Care
Students must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Medical Knowledge
Students must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

Practice-Based Learning and Improvement
Students must be able to investigate the practice of medicine by appraising and assimilating scientific evidence.

Interpersonal and Communication Skills
Students must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients’ families and professional associates.

Professionalism
Students must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

Systems-Based Practice
Students must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

The granting of an MD degree requires more than the passing of all requirements. The student must complete all course work and also demonstrate a level of competence across all professionalism domains. Because the Doctor of Medicine degree assumes a level of competence across all disciplines, the Student Standards Committee assumes responsibility for determining the overall competence of the students. A student is awarded the M.D. degree after approval by a consensus vote of the Student Standards Committee and a confirmation vote by the Standing Committee of Department Chairs and the Dean.

Students may not graduate with an "unsatisfactory" or unremediated failing grade in any required or elective course taken for credit. Permanent transcript grades include the following:

Temporary transcript grades include:

Internal grade for advising purposes only

HONORS (H) designates exceptional performance and may be issued in Modules 2, 4, and the clinical components of Module 5.

HIGH PASS (HP) designates above average performance and may be issued in Module 4 and the clinical components of Modules 5. Final grades are a composite of several components, with cut-off points and weighting determined individually by each department and for each course.

PASS (P) designates a fully satisfactory performance and may be issued in all Modules.

CREDIT (CR) designates fully satisfactory performance and is issued for away rotations supervised by non-medical school faculty.

NO CREDIT (NC) designates academic performance that does not meet the minimum passing standards at an away rotation supervised by non-medical school faculty.

FAIL (F) designates academic performance, which does not meet the minimum passing standards and requires repetition of the entire course. A student may fail a course due to inadequate knowledge, lack of clinical skills or unprofessional behavior. A Fail may be awarded when:

A student who receives a "Fail" in Module 1 or in any individual course must repeat the course or Module 1 and is given one additional opportunity to earn a passing grade by the course end date. The academic record of any student receiving a Failure in any course will be reviewed by the Student Standards Committee.

UNSATISFACTORY (U) designates academic performance, which does not meet the minimum competency requirements by the end of the course. A student may receive this grade due to inadequate knowledge, lack of clinical skills or unprofessional behavior. This grade is given at the discretion of the course director, when the student’s performance warrants only one remedial opportunity to complete the course requirements. Remediation can include retaking an exam or completing additional assignments (rather than repeating the entire course) in order to raise the grade to a passing level. Except in the case of continually recurring clerkships, the remedial work must be completed no later than before the course is offered again and in accordance with the deadlines set in the “Progression” policies.

The “U” appears on the student’s transcript until the remedial work is completed. The "U" is replaced by the student's final grade once the remedial work has been satisfactorily completed; a grade of Honors cannot be earned and therefore High Pass is the highest grade that can be achieved in a clinical course and Pass in a pre-clinical course. If the remedial attempt is not satisfactory, the grade is changed to a “Fail” and the student must repeat the course in its entirety.

NO GRADE (NG)
If clinical remediation time is required, the first course registration will be permanently marked on the transcript with the designation of No Grade (NG.) If the student is able to remediate the grade to a passing level, then the passing grade is noted as a separate entry on the transcript. If remediation is not successful, a grade of Fail will be recorded and the student will repeat the course in its entirety.

INCOMPLETE (I) is issued when the student is unable to complete the course by the course end date due to non-academic extenuating circumstances. The course director will issue the grade of “I” if he/she believes that the student can finish the course requirements in a reasonable amount of time, no longer than one year following the date of the course’s end. The “I” is replaced by the student's final grade, which is awarded when all course requirements have been satisfactorily completed; a grade of Honors is permissible. In the event that requirements cannot be completed in the stated time allotted, the grade will be changed to “Withdraw/Passing” or to “Withdraw/Failing”. If the course is required or if the grade is Withdraw/Failing, the student will have to repeat it in its entirety.

WITHDRAW A grade of withdraw is issued when a student cannot successfully complete a course and the course has not ended. The students’ academic status at the time of withdrawal is noted; therefore, withdrawals are recorded as Withdraw/Passing (W/P) or Withdraw/Failure (W/F). If a student withdraws before he/she has taken any assessments, the course director will review the available evaluation data to determine whether the status upon withdrawal is passing or failing. If a student withdraws with a current grade of Unsatisfactory (i.e. it has already been determined that remedial work will be needed) the grade will be recorded as W/F. If a student is issued a Withdraw/Failing in Module 1 or in any individual course, he or she must repeat the course and is given one additional opportunity to earn a passing grade by the course end date. A withdrawal will be issued if these circumstances occur on or after the third day of the course.

LOW PASS (LP) designates minimally satisfactory (borderline) performance. Its main use is to track a student’s performance over time to enable the School to offer additional assistance to the student at the earliest reasonable opportunity. This grade is reported on the student's transcript as a "Pass".

GRADE APPEALS
If a student is dissatisfied with a grade assigned by a course director, he or she may contact the course director to discuss the grade within four months of receipt of the grade in the Registrar’s Office. The course director will review once again, the student’s performance in the course and will decide if a grade revision is warranted. If the grade is not changed and the student wishes to pursue the issue further, he or she may follow the chart below. The Associate Dean for Student Affairs is available for consultation during this process. Details can be found at: http://www.med.upenn.edu/student/GradeAppealProcess.html

IV. MONITORING ACADEMIC PROGRESS

Students’ records are reviewed bi-weekly at meetings conducted by the Associate Dean for Student Affairs and attended by the Advisory Deans, the Associate Dean for Curriculum, the Vice Dean for Education, the Registrar and the Director of Student Affairs.   Students are contacted whenever non-passing grades or professionalism issues are reported. Records that generally contain multiple non-passing/low pass/withdraw grades are referred to the Student Standards Committee by the Associate Dean for Student Affairs.  A student will be informed when his or her academic progress is scheduled to be presented to the Student Standards Committee.  The student will be notified by the Office of Student Affairs prior to his or her record being presented before the Student Standards Committee and given the option to appear at the meeting If the student accepts the opportunity to make a presentation to the Committee, he/she is encouraged to be accompanied by a faculty advisor who is a member of the School of Medicine Standing Faculty. A student will be informed of recommendations and decisions which the Student Standards Committee makes about his or her academic progress or professional conduct.  Following a meeting at which a student’s record is discussed, the student will receive a letter reporting the outcome of the Committee’s deliberations. 

When a student’s record is presented, the Committee has several options which include, but are not limited to:

Academic notification is defined as a non- “adverse” action; therefore, it will not be mentioned in the student’s Medical Student Performance Evaluation or in outside requests for documentation (e.g.—visiting student elective applications, other degree program applications, license requests)

Probation is defined as an “adverse” action; therefore, it will be mentioned in the student’s Medical Student Performance Evaluation and in outside requests for documentation (e.g. ­visiting student elective applications, other degree program applications, license requests).   Students, who are on probation, are not eligible to participate in rotations outside of Penn or in extra educational activities, such as a year of research.   This status also may preclude a student from enrolling in a graduate program (i.e.--a second degree at Penn or at another institution.)  In addition the students’ course directors may be notified of this status and interim evaluations are sought.   Clinical course directors have the right to limit the students’ choice of site assignments.

The Student Standards Committee will be given monthly updates on all students who are on Probation.

If a student fails to remediate the performance deficiencies which led to Academic or Professionalism Notification or Academic or Professionalism Probation, dismissal may be considered by the Student Standards Committee as outlined in the procedures below. 

The Student Standards Committee may also

If the student refuses to accept the recommendation, the Vice Dean for Education may initiate the University Involuntary Leave of Absence Policy.  For more information on Involuntary Leave of Absence, please refer to Part Two, Section II of this document.

V. PROCEDURES FOR DISMISSAL

When the Committee is scheduled to review a student’s record for consideration of dismissal for academic or professionalism issues, the student will be notified in writing by the Associate Dean for Student Affairs.  Notification will include:

The student is encouraged to be accompanied by an advisor who is a School of Medicine standing faculty member.  The student should give the advisor’s name to the Associate Dean for Student Affairs two weeks before the meeting date.  The Associate Dean will brief the advisor so he/she understands his/her role in the process.

Other guests or advisors may be permitted to attend the committee meeting only if a request has been made in writing to the Associate Dean for Student Affairs at least one week in advance and subsequently approved by the Chair of the Committee prior to the meeting.

Following the presentation of student information and the student’s presentation, the Committee meets in session to deliberate on the case and to make a decision on the course of action, based on the established guidelines contained in this document.  If the Committee votes to dismiss the student based on academic deficiencies or professionalism issues, the Chair of the Student Standards Committee will submit the decision to the Dean within 48 hours.   T he Dean informs the student of the dismissal in writing within ten (10) working days of notification of the dismissal.  The student has ten (10) working days from the receipt of the letter from the Dean to submit a request for appeal of the dismissal or withdraw from the School of Medicine. 

VI. APPEALS PROCESS

The only action taken by the Committee that can be appealed is dismissal.  If a student receives a dismissal letter from the Dean, he/she may submit a written request for appeal to the School of Medicine Appellate Officer, stating the specific ground on which the appeal is based.   Appellate review is limited to new material and prejudicial procedural error, error in the interpretation or application of a relevant regulation and new information sufficient to alter the Student Standards Committee determination. The request for an appeal must be submitted within ten (10) working days after the student's receipt of the letter indicating the Committee’s dismissal decision. The Appellate Officer will review the case and determine whether to accept the appeal or uphold the dismissal decision.  The decision of the Appellate Officer is final. The Appellate Officer will notify the student in writing if the appeal is accepted or if the dismissal decision is upheld.  If the appeal is accepted, the case is referred back to the Student Standards Committee to develop a plan of remediation.

The Appellate Officer is a member of the School of Medicine standing faculty who is not on the Student Standards Committee, and is appointed by the Vice Dean for Education for a three-year term.

 

diagram of dismissal proces


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