COM105 Progress, Promotion and Graduation with a Doctorate of Medicine (M.D.) - COM Medical Education

No./Title: COM105/Progress, Promotion and Graduation with a Doctorate of Medicine (M.D.)	Resp. Office: Medical Education Approval Body: CUME	Effective Date: 11/19/18
Category: COM/UME	Last Review: 07/20/26	Next Review: 07/20/29
Contact: Assoc. Dean of Medical Education	 901-448-4634	 meded@uthsc.edu
Related Policy: COM107 – Grading for the MD Curriculum COM121 – Professionalism EM104 – Withdrawal Policy EM118 – Satisfactory Academic Progress EM120 – Academic Standing AA110 – Grading Policy

POLICY

It is the policy of the University of Tennessee Health Science Center ( UTHealth Science Center) College of Medicine (COM) to apply uniform standards to assess student academic progress and determine qualification for promotion and graduation from the M.D. program. These will differ somewhat between the traditional 4-year program and the accelerated 3-year program (detailed in the Addendum).

RATIONALE AND PROCEDURE

Satisfactory academic progress is necessary to ensure the development of professional competence, and its documentation is required for a student to continue receiving financial aid from federal and other sources.
Students in good standing are those who have passed all courses, have passed the USMLE Step 1 and/or Step 2CK exams depending on whether they are rising clerkship (Step 1) or rising post-clerkship (Step 2CK) students, and who are not on probation or who have not been suspended for any reason (e.g. academic, conduct or professionalism). Students who have received an adverse action, including citations for professionalism, placement on probation for either conduct, professionalism, or academic reasons may have this information included on the student’s Medical Student Performance Evaluation (MSPE) letter based on a written recommendation from the Progress and Promotions (P&P) Committee.
Student progress will be monitored by the P&Pcommittee, appointed for each matriculating class, and remaining with that class through graduation. The Executive Dean of the COM appoints all regular members, including a voting chair.
1. Clinicians or other faculty who are health care providers to, family members of, or have a
  personal relationship with a student may not serve on any P&P committee meeting, or portion of any meeting, involving that student, but can participate in meetings for other students.
2. Members of the P&P Committee who have a conflict of interest [conflicts include but are not limited to serving as a course or clerkship director in which actions were taken that have an adverse academic effect of the student such as awarding a failing grade, friend or relative, or serving as a regular mentor to the student] must recuse themselves from committee deliberations for that student.
3. Additional ex-officio, non-voting members are appointed by the Associate Dean of Medical Education (ADME) and the Associate Dean of Student Affairs (ADSA). The latter officials will provide the committee with pertinent information from the Registrar’s Office and COM student records.
4. P&P meetings are called as needed by the ADME, their designee, or by the committee Chair. Deliberations are confidential. Recommendations are made to the Executive Dean by majority vote of members present. The committee maintains written records of all recommendations, summaries of which are on file in the Office of Medical Education.
Minimum standards for promotion to the next year of the curriculum and graduation are as follows:
1. Preclinical Curriculum
  1. Must pass each course.
  2. Must meet the professionalism standards as outlined in the Student Code of Conduct and Professionalism (COM 121) policies.
  3. Must pass the United States Medical Licensing Examination (USMLE) Step 1. There are three options by which the Step 1 exam may be taken.
    1. Option 1 (Traditional pathway) – For students matriculating prior to the Fall 2026, Step 1 is typically taken in April of the M2 year prior to Prep to Clerkships week. This allows students to begin clerkships as scheduled in May. For students matriculating in Fall 2026 and beyond, Step 1 will be taken in January or February of the M2 year.
    2. Option 2 (Short Delay) – This option will consist of an additional two months of study time. Reasons for this delay include, but are not limited to: need for remediation of any preclinical course, students who receive a below threshold score (to be determined annually and communicated to students at Step 1 orientation) on their first comprehensive basic science exam (CBSE) or comprehensive basic science self assessment (CBSSA), students who do not achieve the recommended equated percent correct (EPC) score on their CBSSA at the conclusion of the traditional study period, or students who failed their first attempt on Step 1. These students will delay entry into clerkships and will continue studying for 2 months/8 weeks and must achieve the minimum required EPC score prior to taking Step 1. The testing deadline for Option 2 will be the end of June with students entering clerkships in July (Block 7) for students matriculating before Fall 2026. For students matriculating in Fall 2026 or later, the deadline will be April to take the exam with proposed entry into clerkships by May.
    3. Option 3 (Extended Delay) – For students who matriculated prior to Fall 2026 and who are not ready to take Step 1 by the end of June (e.g. have not achieved the minimum EPC score on the final NBME practice exam taken one week prior to the exam, those who have failed Step 1 on their first attempt and need additional time, or those who have delayed studying for other reasons [e.g. physical or mental health, family issues, etc.] will delay clerkships until the following Spring semester (January). These students wil participate in Prep to Clerkships week then return to studying. The testing deadline for students in Option 3 will be 4 weeks before the start of the Spring semester. This option will result in a delayed graduation until December of the original grad year. For students who matriculated in Fall 2026 or later, this option will result in students starting clerkships in the Fall semester (July or later). Depending on when the student starts rotations, they may still be able to graduate within the traditional 4-year pathway. However, delaying clerkships beyond July of the third year may result in delayed graduation.
    4. Students who have failed Step 1 on the first attempt are not permitted to enter clerkships until attaining a passing score for Step 1, unless approved by an academic dean.
2. Clinical Curriculum
  1. Must pass each clerkship;
  2. Must meet the professionalism standards required in the COM as outlined in the Student Code of Conduct and Professionalism (COM 121) policies; and
  3. Must get a passing score on the USMLE Step 2CK (Clinical Knowledge) exam.
Failure to meet minimum standards will be addressed by the P&P Committee. After consideration of performance to date, the Committee will make one of the following recommendations:
1. During the Preclinical Curriculum:
  1. If the criteria in Section 7 below are met, the student may be allowed to repeat all or part of a preclinical year (recycle) to remediate a failed course. Students can repeat a preclinical year only once.
  2. The student is recommended for academic dismissal if any of the following criteria are met:
    1. Fails more than one course;
    2. Fails to pass USMLE Step 1 after two attempts; or
    3. Has a serious professionalism violation.
2. During the Clinical Curriculum:
  1. If the criteria in Section 7 below are met, the student is allowed to repeat a failed clerkship once (for a total of 2 attempts).
  2. The student is recommended for academic dismissal if any of the following criteria are met:
    1. Fails more than one clerkship;
    2. Fails a single clerkship twice;
    3. Fails to pass USMLE Step 2CK after three attempts; or
    4. Has a serious professionalism violation.
Course and exam remediations are subject to the following guidelines:
1. Only one course per academic year may be remediated. Students who fall into the remediation range for two courses will receive a failing grade (F) for each course. A student needing remediation of more than one course in an academic year must meet with the P&P Committee who will recommend either dismissal, or withdrawal with the opportunity to request reinstatement to join the next class (recycle) to repeat the failed courses.
2. Remediation of a first-year course will occur during the summer break between the first and second years. Remediation of a second-year course will occur after the end of the preclinical curriculum but prior to Step 1. Students will not be allowed to take Step 1 until all courses are successfully remediated.
3. Any student failing USMLE Step 1 on the first attempt will be given the option to remain in the current clinical clerkship or drop the clerkship to immediately restart Step 1 studying. Students will not be allowed to start any additional required clerkships until a passing score is received, unless approved by an academic dean. The Senior Assistant Dean of Preclinical (Basic Sciences) Curriculum, in consultation with the ADME, will review the student’s academic record and recommend a program of study for the student to follow while preparing to retake the examination.
4. During the clinical years, a student who otherwise passes a clerkship but fails a National Board of Medical Examiners (NBME) subject exam (shelf exam) will be allowed to retake the exam, but not while on another clerkship. A student who fails an examination in more than one clerkship may be asked to meet with the P&P Committee and is not permitted to begin additional clerkships until at least one of the failed exams has been remediated.
5. A student failing to pass Step 2CK examinations on the first or second attempt will be allowed to retake the exam. However, after the first failed attempt on Step 2CK, the student must meet with the Senior Assistant Dean of the Clinical Curriculum. After the second failed attempt, the student must meetwith their P&P Committee for consultation prior to scheduling the final retake exam.
6. Students who take a leave of absence after completing all required clinical courses and request reinstatement to the COM for graduation may be required to audit a previously passed clerkship and one or more Junior Internships to ensure the student has the requisite clinical skills and medical knowledge to enter a residency program. Auditing clinical courses will be at the discretion of the ADME in consultation with the Senior Assistant Dean of the Clinical Curriculum and the Associate Dean of Student Affairs. Successful completion, defined as passing the audited courses, will be a requirement for graduation.
Exceptions to the minimum standards described in Section 4 are made only under extenuating circumstances, and only upon the written recommendation of the P&P Committee and accepted, in writing, by the Executive Dean. A recommendation by the Committee to repeat all or part of the curriculum or year will only be made when all of the following criteria are met:
1. Identification of specific circumstances judged to have had a probable adverse impact on the student’s academic performance;
2. Judgment that the identified circumstances have a high probability of timely resolution or appropriate treatment;
3. Expectation that resolution and/or treatment of the identified circumstances will permit subsequent satisfactory performance in the curriculum; and
4. The student has demonstrated some evidence of the ability to succeed academically in the curriculum based on prior performance. If there has been insufficient opportunity to evaluate the student’s academic performance, this requirement may be waived at the discretion of the P&P Committee.
Dismissal from another college at UT Health Science Center or another institution may be grounds for dismissal from the COM.
Students who are withdrawn from the COM for personal or medical reasons with the intention of returning must submit a formal request to the ADME to be reinstated to the COM to complete the curriculum. Reinstatement is not automatic. Dismissal from another college at UT Health Science Center or another institution may be grounds for not allowing reinstatement.
Issues surrounding professional behavior may be forwarded to the P&P by the Professionalism Committee according to policy COM 121 (Professionalism Policy). Repeated complaints with no evidence of improvement, or even a single sufficiently serious complaint of unprofessional behavior, may result in referral to the COM P&P Committee, which may result in further actions including course failure, academic warning, probation or dismissal.
Students who are on probation or who have been suspended are not considered to be in good standing. Depending on the circumstances surrounding the probation, such a designation may require referral to the COM P&P Committee, which could result in a recommendation for dismissal. Non-academic probationary status could result in not meeting expectations as described in the Student Code of Conduct. All student conduct issues are investigated by the campus conduct office. Professionalism issues are investigated by the COM Professionalism Committee according to policy COM 121 and could also result in referral to the COM P&P Committee.
Deliberations and actions of the P&P committee, and provisions for due process, proceed as follows:
1. A student has the opportunity to meet with the P&P Committee to discuss their academic record and to present a plan for improvement to the Committee. It is the responsibility of the student to obtain and submit information or documentation to support a favorable recommendation prior to the P&P Committee decision. This includes any academic, medical, personal, financial or physical information the student wishes to release. The ADME and/or the ADSA are responsible for assisting the student in obtaining this information. The student may bring a support person or advocate, excluding legal counsel, to the P&P Committee meeting whom the student feels can contribute to his/her presentation. The support person may address the Committee at a designated time decided by the Committee with the following stipulations: 1) their comments to the Committee should be restricted to no more than 2-3 minutes unless additional time is granted by the Committee, and 2) the support person may not otherwise actively participate in the proceedings; the P&P Committee will expect that the student actively participates and provides answers to all questions that the Committee asks.
2. The Committee will make recommendations to the ADME. The ADME or a designee wil review the recommendations and submit them to the Executive Dean, either concurring or making alternative recommendations. The ADME or a designee will also convey these collective recommendations in writing to the student.
3. Only the Executive Dean makes decisions concerning the consequences of individual student academic performance. The Executive Dean will review all documentation supplied by the P&P Committee, the ADME, the student and other sources, and may choose to meet with the student. The decision of the Executive Dean will be reported to the P&P Committee by the ADME. Upon a negative decision by the Executive Dean a student is considered dismissed from the COM.
4. In case of an adverse recommendation by the P&P Committee, the student has a right to appeal the decision. To do so, the student must make a request to the ADME within five (5) working days of receipt of written notification of the P&P Committee recommendation. If the ADME has concurred in the adverse recommendation, the student may appeal to the Executive Dean of the COM. Upon dismissal by the Executive Dean, any appeal to a higher level is an appeal for reinstatement. A student dismissed for academic reasons may apply for readmission, but must follow all procedures required of new applicants. If readmitted, exceptions to state or federal licensing regulations may be needed to allow successful completion of the program.
The traditional M.D. program is designed to be completed in four years, with provision for alternative schedules.
1. In the event that a student cannot continue in the regular curriculum, they may choose to withdraw or take a leave of absence, if applicable. Also, since passing the USMLE Step 1 exam is required to enter the clinical curriculum and a passing score on Step 2CK is required for graduation, students may need to delay entry into the clerkships or residency while completing USMLE requirements. Students who have completed all required clinical courses (clerkships, electives and JIs), and then take a leave of absence before completing other graduation requirements may be required to audit a clerkship and/or JIs to ensure the student has the requisite clinical skills to enter a residency program.
2. Students will have six (6) consecutive years to complete the COM curriculum, including time spent withdrawn, on a leave of absence, or outside the curriculum to complete USMLE requirements. Failure to meet graduation requirements by the end of the sixth year (twelfth semester) following matriculation will result in dismissal. This limit does not apply to time spent in other curricula for students pursuing dual degrees or in other approved educational programs.
3. If normal progression through the curriculum is delayed for any reason, students must meet with the ADME and/or the ADSA and acknowledge in writing the understanding that the delay may impact completion of the course of study within the required time limit. Any appeal to extend completion of the curriculum beyond six years must be approved by the P&P Committee and by the ADME or designee.
4. Students who complete requirements on time can participate in commencement activities in May or December. Those who do not complete requirements in time for commencement will not receive their degree, and are therefore ineligible to begin post-graduate training. Degrees are also conferred in August without a ceremony, for students who complete degree requirements after the May graduation date and prior to September 1. For other students completing requirements out of phase, the transcript will be posted with the date of completion.

ADDENDUM — 3-YEAR ACCELERATED PROGRAM

The 3-year Accelerated MD Program Curriculum Committee will review student progress on a quarterly basis to ensure maintenance of good academic standing and that no professionalism or other issues may warrant deceleration into the traditional 4-year pathway, from the perspective of either the program or the student. A student may choose to decelerate at any time and for any reason. Students requesting to decelerate should do so in writing to the Director of the 3-year Program who will then notify the ADME.
Minimum standards for promotion to the next year of the curriculum and graduation are:
1. Preclinical Curriculum
  1. Must pass each course.
  2. Must meet the professionalism standards required of all students in the COM as outlined in the Student Code of Conduct and Professionalism (COM 121) policies.
2. Clinical Curriculum
  1. Must pass the USMLE Step 1 exam on the first attempt, which must be taken by June 30th of the second year.
  2. Must receive a passing grade in each clerkship.
  3. Must get a passing score on the first attempt for the USMLE Step 2 CK (Clinical Knowledge) exam, which must be taken by January of the third year.
  4. Must meet the professionalism standards required of all students in the COM as outlined in the Student Code of Conduct and Professionalism (COM 121) policies.
Failure to meet minimum standards will first be identified by the 3-year Accelerated MD Curriculum Committee, which will make a recommendation regarding the student’s ability to continue in the 3-year program. The Assistant Dean of the 3-year Curriculum Committee will then notify the appropriate Senior Assistant Dean ( Preclinical or Clinical Curriculum) to call a P&P Committee meeting. A representative from the 3-year Curriculum Committee will attend the P&P Committee meeting to provide the recommendation from the 3-year Curriculum Committee.
After consideration of performance to date, the P&P Committee will make one of the following recommendations:
1. During preclinical curriculum
  1. The student may be recommended for academic dismissal per the 4-year P&P policy, if the following occurs:
    1. Failure of more than one course.
2. During clinical curriculum
  1. The student is placed on academic probation, typically for one semester, if they do not pass any single clerkship.
    1. The student can repeat a failed clerkship, or potentially all core clerkships, but would need to decelerate into the 4-year MD program.
  2. The student may be recommended for academic dismissal based on the 4-year P&P policy if one of the following occurs:
    1. Failure to pass all required clinical courses.
    2. Failure to pass USMLE Step 1 after two attempts.
    3. Failure to pass USMLE Step 2CK after three attempts.
Course and exam remediations are subject to the guidelines outlined in the 4-year P&P policy, with the exception that students who need to remediate an entire course or clerkship will need to decelerate into the 4-year curriculum.
During the clinical years, a student who otherwise passes a clerkship but fails a National Board of Medical Examiners (NBME) subject (shelf) exam will receive an “R” for the rotation and will be allowed to retake the exam, but not while on another clerkship. A student who fails the NBME examination in more than one clerkship, and thus receiving 2 “R”s, will be required to meet with the 3-year committee. The student will not be allowed to continue in clinical clerkships until at least one of the “R”s has been remediated, and will likely need to decelerate into the 4-year curriculum.