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: 02/21/22	Next Review: 02/20/25
Contact: Michael Whitt, Ph.D. Assoc. Dean of Medical Education	🕿 901-448-4634	🖂 mwhitt@uthsc.edu
Related Policy: COM107 – Grading for the MD Curriculum COM121 – Professionalism SA104 – Withdrawal Policy SA118 – Satisfactory Academic Progress SA120 – Academic Standing AA110 – Grading Policy

POLICY

It is the policy of the University of Tennessee Health Science Center (UTHSC) 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

1. 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.
2. Student progress will be monitored by a Progress and Promotions Committee (P&P), 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. 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. Members of the P&P 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] must recuse themselves from committee deliberations for that student. 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. 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.
3. Minimum standards for promotion to the next year of the curriculum and graduation are as follows:
   1. Preclinical courses (years 1 and 2)
      1. Passing grade in each course.
      2. Grade point average (GPA) of 2.25 or better on a 4.00 scale.
      3. Passing score at or above the national standard on the United States Medical Licensing Examination (USMLE) Step 1.
   2. Clinical rotations (years 3 and 4)
      1. Passing grade in each clerkship.
      2. GPA of 2.25 or better on a 4.00 scale.
      3. Passing score at or above the national standard on the USMLE Step 2CK (Clinical Knowledge).
4. Failure to meet minimum standards will be addressed by the P&P. After consideration of performance to date, the committee will make one of the following recommendations:
   1. During preclinical courses (years 1 and 2)
      1. The student is placed on academic probation, typically for one semester, so that a minimum required GPA can be achieved.
      2. The student is allowed to repeat all or part of a preclinical year to remediate a failed course or achieve a minimum required GPA.
      3. The student is recommended for academic dismissal. Criteria include:
         
         1. Failure of more than one course.
         2. Failure to pass USMLE Step 1 after two attempts.
   2. During clinical rotations (years 3 and 4)
      1. The student is placed on academic probation, typically for one semester, so that a minimum required GPA can be achieved.
      2. The student is allowed to repeat a failed clerkship once (for a total of 2 attempts) or potentially all core clerkships in year 3.
      3. The student is recommended for academic dismissal. Criteria include:
         
         1. Failure to pass all required clinical courses.
         2. Failure to pass USMLE Step 2CK after three attempts.
5. Course and exam remediations are subject to the following guidelines:
   1. Only one course per semester may be remediated. A student needing remediation of more than one course must meet with his/her P&P committee who will evaluate whether the student has achieved Satisfactory Academic Progress (SAP) to remain enrolled in the COM. If the P&P allows the student to remain in the COM, only one course can be remediated. The student will receive a failing grade (F) in the other course, which must be repeated. The choice of which course grade to remediate will be made by the student after consultation with the P&P.
   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 second-year curriculum but prior to sitting for Step 1. Students will not be allowed to sit for Step 1 until all courses are successfully completed.
   3. The P&P has the option of recommending that a student who completes but fails first- or second-year courses, or has a cumulative GPA less than 2.25 at the end of these academic years, may correct the academic deficiency by successfully completing courses taken at other institutions, repeating courses at UTHSC, or both.
   4. Any student failing USMLE Step 1 on the first attempt will be given the option to leave or remain in the current clinical clerkship and will not be allowed to start any additional clerkships until a passing score is received. The Sr. Asst. Dean of Basic Sciences 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.
   5. During the clinical years, a student who otherwise passes a clerkship but fails a National Board of Medical Examiners (NBME) post-clerkship exam will be allowed to retake the exam, but not while on another clerkship. A student who fails the examination in more than one clerkship may be asked to meet with the P&P, and is not allowed to begin additional clerkships until at least one of the repeat exams has been passed.
   6. 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 Sr. Assistant Dean of the Clinical Curriculum. After the second failed attempt, the student must meet with his/her P&P committee for consultation prior to scheduling the retake exam.
   7. 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 Sr. Assistant Dean of the Clinical Curriculum and the Associate Dean of Student Affairs. Successful completion, defined as earning the equivalent of a “B” or higher in the audited courses, will be a requirement for graduation.
6. Exceptions to the minimum standard is made only under extenuating circumstances, and only upon the written recommendation of the P&P and accepted, in writing, by the Executive Dean. A recommendation by the committee to repeat the curriculum 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, generally in less than 6 months.
   3. Expectation that resolution of the identified circumstances will permit subsequent satisfactory performance in the curriculum.
7. 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 UTHSC or another institution may be grounds for dismissal from the COM.
8. Issues surrounding professional behavior may be forwarded to the P&P by the Professionalism Committee according to policy COM 121 (Professionalism). Repeated complaints with no evidence of improvement, or even a single sufficiently serious complaint of unprofessional behavior, could trigger referral to the COM P&P committee, which may result in further actions including course failure, academic warning, probation or dismissal.
9. Deliberations and actions of the P&P, and provisions for due process, proceed as follows:
   1. A student has the opportunity to meet with the P&P 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 any person, excluding legal counsel, whom the student feels can contribute to his/her presentation.
   2. The committee will make recommendations to the ADME. The ADME or a designee will review the recommendations and submit them to the Executive Dean, either concurring or making alternative recommendations. The ADME or a designee will also covey 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, 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 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, 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 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.
10. 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 (e.g. take a leave of absence). Also, since a passing score on USMLE Step 1 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 leave, or outside the curriculum to complete USMLE requirements. Failure to meet graduation requirements by the end of the sixth year 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 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

1. 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.
2. Minimum standards for promotion to the next year of the curriculum and graduation are:
   1. Preclinical courses (year 1 and first half of year 2)
      1. Passing grades in each course.
      2. Minimum GPA of 2.6 on a 4.0 scale or consistent with the mean of the 4-year class cohort, whichever is lower.
      3. Professionalism standards required of all students in the COM as outlined in the Student Code of Conduct and P&P policies.
   2. Clinical rotations (second half of year 2 and year 3)
      1. Passing score on first attempt for the USMLE Step 1, which must be taken by June 30^th of the second year.
      2. Passing grades in each clerkship.
      3. Minimum GPA of 3.0 on a 4.0 scale or the average of the 4-year class cohort, whichever is lower.
      4. Passing score on first attempt for the USMLE Step 2 CK (Clinical Knowledge) exam, which must be taken by January of the third year.
      5. Professionalism standards required of all students in the COM as outlined in the Student Code of Conduct and P&P policies.
3. 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 Director of the 3-year Curriculum Committee will then notify the appropriate Senior Assistant Dean (Basic Sciences 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.
4. After consideration of performance to date, the P&P committee will make one of the following recommendations:
   1. During preclinical courses (year 1 and first half of year 2)
      1. The student is placed on academic probation, typically for one semester, so that a minimum required GPA can be achieved.
         
         1. If the student is unable to achieve the minimum required GPA after one semester, then the student will be required to decelerate into the traditional 4-year MD program.
      2. 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. Failure to maintain a GPA of 2.25 on a 4.0 scale.
   2. During clinical rotations (second half of year 2 and year 3)
      1. The student is placed on academic probation, typically for one semester, so that a minimum required GPA in the 3 year Accelerated program can be achieved.
         
         1. If the student is unable to achieve the minimum required GPA after one semester, then the student will be required to decelerate into the traditional 4-year MD program.
         2. 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.
5. 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.
6. During the clinical years, a student who otherwise passes a clerkship but fails a National Board of Medical Examiners (NBME) post-clerkship 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 P&P 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.

APPROVAL HISTORY

Effective: 11/19/18

Revised: 09/20/21

Revised: 02/21/22