No./Title: COM107/Grading for the MD Curriculum	Resp. Office: Office of Medical Education (OME) Approval Body: Committee on Undergraduate Medical Education (CUME)	Effective Date: 05/20/19
Category: COM/UME	Last Review: 04/15/24	Next Review: 04/15/27
Contact: Michael Whitt, Ph.D. Associate Dean, Medical Education	 901-448-4634	 mwhitt@uthsc.edu
Related Policy: AA110 – Grading Policy COM105 – Progress Promotion and Graduation COM-G04 – M3 Examination Procedures	Program: MD

POLICY

It is the policy of the University of Tennessee Health Science Center (UTHSC) College of Medicine (COM) to apply uniform standards to the assignment of grades in courses and clinical clerkships.

RATIONALE AND PROCEDURE

1. Documentation of academic progress is essential to assessing student qualifications for promotion and graduation.
2. For students matriculating in the Fall 2021 or before, performance is graded with letters A, B, C and F, associated with numerical values 4, 3, 2 and 0 that are used to calculate a grade point average. Some courses may be graded as pass/fail (P/F). Students matriculating in the Fall 2022 and after, or returning to the curriculum after a leave of absence and who are scheduled to graduate in May 2026 or after, performance in all courses will be graded as P/F in the preclinical curriculum (M1/M2 years) and by Honors/High Pass/Pass/Fail (H/HP/P/F) in the clinical curriculum (M3/M4 years). Other letter grades are used to designate student status under specific circumstances as detailed below.
3. Clinicians or other faculty who provide health services, including psychiatric/psychological counseling, to a medical student, or who have a familial, personal or financial relationship with a student, may not participate in the academic assessment or promotion of the medical student receiving those services.
4. Procedures and responsibilities for student evaluation are as follows:
   1. Preclinical course directors are responsible for assignment of grades in years 1 and 2. Periodic examinations are given, generally with multiple-choice questions that are computer graded. Scores are recorded in the learning management system for student access. Laboratory performance, participation in small group activities, special projects, etc., may also influence the final grade. Grades for the pre-clinical years based on percentage scores are listed in Table 1. It is the responsibility of the course director to establish the criteria for awarding grades, and to communicate this information on the first day of class. Changes in total points available for use in grade calculations may be made at the discretion of the course director but changes must be communicated to students in writing at the time the adjustment is made. Concerns regarding examination questions, criteria for course evaluation, or final grades should be directed to the course director.
   2. Students are expected to take examinations as scheduled. Those unable to take a scheduled examination because of illness or other emergency must notify the Senior Assistant Dean for Basic Science Curriculum and the course director prior to the examination.
   3. Course directors will notify the Senior Assistant Dean for Basic Science Curriculum in the Office of Medical Education of students who do not receive a passing grade, providing all information pertinent to the assessment, and will also report the method, if any, by which a grade can be changed.
      1. The designation of “I” (Incomplete) is not a permanent grade but will be used when a student is unable to complete a course at the regular time. In such cases, arrangements will be made by the course director for the student to complete the requirements, and the “I” will be replaced by whatever grade the student earns. It is the responsibility of the student to work with the course director to arrive at a mechanism by which this can occur. The student must complete the remaining course requirements by the end of the term following that in which the ‘incomplete’ was received. Otherwise the “I” will be changed to a failing grade (“F”) in the permanent record.
      2. Students matriculating in Fall 2021 or before who earn a final score below 63% for a course will receive an “F”; those with a final score of 63 – <67.5% will receive a remediation grade (“R”), which can be converted to a letter grade of “C” upon successful remediation. Students matriculating in Fall 2022 and after who earn a final score below 66% will receive and “F”; those with a final score of 66 – <70% will receive an “R” grade. Like an “I” (Incomplete), an “R” is not a permanent grade. Failure to pass remediation will result in an “F”.
      3. In the preclinical phase only one course per semester may be remediated. Students with an R in more than one course, or an F grade in any single course cannot progress in the curriculum. A student needing remediation of more than one course must meet with their P&P committee who will evaluate whether the student has achieved Satisfactory Academic Progress (SAP) to remain enrolled in the COM.
      4. A student withdrawing from courses prior to completion in the first or second year will receive a “W” if withdrawal occurs before the course midpoint. Withdrawal after the midpoint but prior to 70% completion will result in a grade of “WP” (withdrawn passing) or “WF” (withdrawn failing) based on performance to that point. Thereafter, failure to complete a course will result in a score of zero for any remaining assignment or test, which will be factored into the grade calculation. Deadline dates will be posted in the academic calendar for each term. After withdrawal, a course must be repeated at UTHSC.
      5. For students matriculating in Fall 2021 or before, the cumulative GPA is calculated to two decimal places from the final grades attained in all programs in which a student has been enrolled for academic credit. For students who must retake courses this includes those repeated at UTHSC and taken in approved summer programs. Students matriculating in Fall 2022 and after will not receive a GPA; however class rank will be determined by the formula (overall percent course average X credit hours) for the preclinical years.
   4. Student evaluations in the clerkship and elective portion of the curriculum (years 3 and 4) include written examinations as well as an increased emphasis on other forms of assessment. Clerkship examinations are normally in multiple -choice format and most are obtained from the National Board of Medical Examiners (NBME). Oral examinations administered by faculty and house staff are also utilized in some clerkships. In addition, clinical performance is evaluated in such areas as: history taking and physical exam, progress notes and oral presentations, fund of knowledge and understanding of disease mechanisms, clinical application, problem solving, professional attributes and responsibilities, self-improvement and adaptability, information management, relationship to patients, interpersonal relationship. Clerkships may also use other components for assessment including case or clinical presentations, writing assignments, or other written exams. Each component of the grade will be discussed at the appropriate clerkship orientation. For students matriculating in Fall 2021 or before, grades for the clinical years based on percentage scores are listed in Table 2. Students matriculating in Fall 2022 or after will receive Honors/High Pass/Pass/Fail grades. Students may achieve a mix of grades for the various components. The final grade will be determined from the lowest rating of any single grading component as illustrated in Table 4. To receive an overall grade of Honors in a clerkship, students must achieve a score of Honors for each component of clerkship grading. To receive an overall grade of High Pass in a clerkship, students much achieve a score of High Pass or better on each component of clerkship grading. To receive an overall grade of Pass in a clerkship, students much achieve a score of Pass or better on each component of clerkship grading. If a student receives Pass for the clinical component, a High Pass on the NBME/Shelf exam and a Honors on the clerkship defined third component, they will receive an overall Pass as their final grade.
      1. Students must receive formative written feedback at the midway point of that portion of a rotation used as a basis for final clinical evaluation. The form must be signed by both the attending/resident and the student, and must then be submitted to the clerkship coordinator to be placed in the student record.
      2. All required clinical experiences and work hour logs are due the last day of the rotation. If a student fails to complete required clinical experiences and work hour logs (all requirements) by the end of the clerkship, the student will be made aware of the delinquency no later than 1 week after the clerkship ends and an email will be sent to the Associate Dean of Student Affairs who will contact the student to discuss the reason the logs were not completed on time, and emphasize the importance of completing the logs. The student must then submit the completed logs no later than 2 weeks post-rotation.
      3. If a student fails to complete all requirements by 4 weeks after the rotation ends the student will fail the rotation and will receive an “F” on their transcript. Failure will require the student to repeat the rotation.
      4. As in the preclinical years, a grade of “I” will be used when a student is unable to complete a clerkship for reasons other than failure to complete required clinical experiences and work hour logs at the regular time, with comparable provision for subsequently completing the work and receiving a grade (Table 2). As indicated in 4.c.i., an “I” (Incomplete) is not a permanent grade.
      5. Students who fail the clerkship subject (shelf) exam but have passed the remaining portions of a core clerkship will be assigned a temporary letter grade of “R” (Retake) and can schedule this retake through the Office of Medical Education. Like an “I”, an “R” is not a permanent grade.
      6. On rare occasion, it may be appropriate to request to retake a clerkship subject (shelf) exam if there was significant disruption during the examination day even with a passing score. Test day issues and disruptions must be reported at the time of test administration per the M3 Exam Procedures document in order to be considered for future retake eligibility. An appeal to retake the shelf exam due to disruption must be made in writing (email will suffice) to the clerkship director within 4 weeks of testing date, and the opportunity to retake the exam will be at the discretion of the clerkship director and the Senior Assistant Dean/Assistant Dean of Clinical Curriculum on an individual basis. If an examination retake is allowed, the better of the two test scores will be used in calculation of the final grade.
      7. The retake of exams in clerkships taken in Blocks 5 through 10 must be completed by the first week of class in January. For clerkships taken after Block 11 of the M3 year, the retake must be completed no later than the end of Block 8 prior to the year of graduation. Students should not retake the exam during a subsequent clerkship, since this often results in another failure. Instead, they should use time off during holidays, CEs, or option block time to study and retake any failed exams.
      8. Students with two R’s will need to step out of the clerkships and use option blocks until they are able to remediate one or both of the R’s. The best grade that can be obtained after retaking and passing the examination is a “B” for students matriculating Fall 2021 or before, or a “P” for students matriculating in Fall 2022 or after. For students who fail the first attempt at a shelf exam, their final grade will be calculated using the average of the two shelf exam attempts. A second failing score, or failure to retake the exam on time, will result in the permanent assignment of a failing grade for the clerkship, and require that a student retake the entire course.
      9. It is recommended that grades (including “I”) be submitted no later than 4 weeks after completion of the required rotation. Except in extenuating circumstances al grades must be submitted within 6 weeks after completion of the rotation.
      10. Any “I” not converted to a final grade by the end of the next academic term will automatically revert to an “F”.
5. A student may appeal a final grade if they feel that it was assigned inappropriately and not in accordance with the course syllabus or clerkship statement of policy distributed at the beginning of the program. For courses during the pre-clinical years and for longitudinal courses (Longitudinal Scholar’s Program and Principles of Clinical Medicine), students have until 30 days after the start of the next semester to appeal a final grade. For clerkships and other clinical rotations, students have until 4 weeks after submission of the final grade to request additional clinical evaluations that may affect the final grade. The decision to allow additional evaluations will be at the discretion of the clerkship/course director. Appeals are to be directed initially to the course/clerkship director within 4 weeks of submission of the grade, and if not resolved, then an appeal may be made in writing within 5 business days to the Memphis course/clerkship director. Further appeal may be made to the campus-specific department chair, within 5 business days of the decision by the Memphis course/clerkship director. If unresolved at the department level, and for pre-clinical and longitudinal courses, additional sequential appeals may be made in writing to the appropriate Senior Assistant Dean/Assistant Dean, then to the Associate Dean of Medical Education, and finally to the Executive Dean of the COM. Appeals to the each of the Deans must be made in writing within five (5) business days of receipt of written notification of the prior recommendation. The decision of the Executive Dean is final.

APPROVAL HISTORY

Effective: 05/20/19 Revised: 10/17/22 Revised: 02/20/23 Revised: 12/27/23 Revised: 04/15/24

Table 1. UTHSC COM Pre-Clinical (M1/M2) Grading System (For Students Matriculating Fall 2021 or Before)

Grade	Percentage Score	Performance descriptor	Quality Points
A	89.5 – 100	Exceeds expectations	4
B	78.5 – < 89.5	Meets expectations	3
C	67.5 – < 78.5	Needs improvement	2
R	63 – < 67.5	Remediate	0
F	< 63	Fail	0
P	N/A	Pass	0
W	N/A	Withdrew before evaluation	0
WP	N/A	Withdrew passing	0
WF	N/A	Withdrew failing	0
I	N/A	Incomplete	0

Table 2. UTHSC COM Pre-Clinical (M1/M2) Grading System (For Students Matriculating Fall 2022 or After)

Grade	Percentage Score	Performance descriptor	Quality Points
P	70 – 100	Pass	0
F	< 66	Fail	0
R	66 – < 70	Remediate	0
W	N/A	Withdrew before evaluation	0
WP	N/A	Withdrew passing	0
WF	N/A	Withdrew failing	0
I	N/A	Incomplete	0

Table 3 UTHSC COM Clinical (M3/M4) Grading System (For Students Matriculating Fall 2021 or Before)

Grade	Percentage Score	Performance descriptor	Quality Points
A	89.5 – 100	Exceeds expectations	4
B	78.5 – < 89.5	Meets expectations	3
C	67.5 – < 78.5	Needs improvement	2
R	†	Retake	0
F	< 67.5	Fail	0
P	N/A	Pass	0
I	N/A	Incomplete	0

Table 4 UTHSC COM Clinical (M3/M4) Grading System (For Students Matriculating Fall 2022 or After)

Grade* Individual Component

Scores

Performance descriptor Grade Points

Honors Honors in all graded components

High Pass High Pass or better in all

graded components

Consistently exceeds expectations

Meets and occasionally exceeds expectations

100

90

Pass Pass or better in all graded

components

Meets expectations 80

R † Retake 0

Failure of any graded

F component††

Fail 0

I N/A Incomplete 0

*Final grades are determined by the lowest rating of any single grading component in a clerkship.

† In years 3 and 4, the “R” grade is used when a student has failed to pass the NBME clerkship subject exam, but has otherwise satisfactorily completed a clerkship. The “R” indicates the student is required to retake the exam, which must be passed on the next attempt to receive a grade. Details are described in section 4.d.

†† Failure of any graded component of the clerkship will result in an overall grade of Fail for the course. For clerkship subject exams, students are allowed one retake. If a student fails the retake exam, they will receive a grade of Fail for the course and must repeat the clerkship.