MD: Evaluation and Grades

More information about assessing student performance and integrity can be found in the Assessing Academic Achievement and Professionalism section of this Bulletin.

Following are general guidelines for exams administered in the undergraduate medical curriculum. Additional requirements may be posed by the individual course director.

Washington University School of Medicine Formative Assessment and Feedback for Medical Students Policy

Background

Formative assessment and feedback are critical to high-quality medical education, and, as such, they are central to the educational mission of Washington University School of Medicine (WUSM). In keeping with LCME Standard 9.7, WUSM is committed to ensuring that each medical student is assessed and provided with formal formative feedback early enough during each required course or clerkship to allow sufficient time for improvement. For the purposes of this policy, formative assessment is defined as any no/low stakes assessment performed during the learning experience for the purposes of providing formative feedback. Formative feedback is defined as information communicated to a medical student in a timely manner that is intended to modify the student’s thinking or behavior to improve subsequent learning and performance in the medical curriculum.

Policies

All students must receive meaningful formal formative assessment of and feedback on their performance during each of the required courses and clerkships of all phases of the Gateway Curriculum at WUSM. At minimum, this feedback should occur at the midpoint of the course or clerkship, although formative assessment and feedback occurring before and after this point are also encouraged.

Required courses or clerkships that are less than four weeks in length must provide an alternate means by which each student can measure their progress in learning at a point that still allows sufficient time for improvement.

Directors of required courses and clerkships are responsible for documenting that each student has received formative assessment and feedback. The Committee for Oversight of Medical Education (COMSE) will conduct oversight of student responses on both internal and external surveys for all required modules and clerkships. In the event that a given module, course, or clerkship fails to demonstrate that each student has received formative assessment and feedback, additional inquiry will be conducted by the Associate Dean for Medical Student Education. In the event that a consistent pattern of noncompliance is identified, the COMSE will make specific recommendations for remediation.

Guidelines

Quality feedback ought to include reinforcement of things done well, identification of room for improvement or omissions, and specific strategies for improvement. Evidence for this feedback in the form of specific examples and observations should also be included.

The Washington University School of Medicine Formative Assessment and Feedback for Medical Students Policy was last approved by the Oversight Committee on Medical Education on Oct. 5, 2020. All substantive edits to this policy require approval by the Oversight Committee on Medical Education governing body.


Washington University School of Medicine Narrative Assessment Policy

Background

Washington University School of Medicine (WUSM) is committed to providing the highest quality medical education to our students who are preparing to lead the future of health and medicine. Narrative assessment provides students with the critical guidance needed to improve performance. Acknowledging the importance of narrative assessment, the LCME element 9.5 requires that students receive narrative feedback on competency development, including non-cognitive achievement. The purpose of narrative assessment is to ensure that students are provided feedback on their development and progress, with sufficient time to receive support in bringing their performance onto a better trajectory, when necessary.

Policies

Narrative assessment is a required component of the assessment of each student in the Gateway Curriculum at WUSM across all competency domains.

Narrative assessments of a medical student's performance will be provided when all of the following curricular conditions are met:

  • Students work in small groups of less than or equal to 12 members.
  • Students in small groups work together as a team toward a shared goal.
  • Small groups of the same composition are observed longitudinally by the same faculty member for at least three sessions, with a ratio of one faculty member to one student team.

Narrative assessment can be provided in courses that do not meet these criteria, provided there is documentation that the nature of the interaction allows for meaningful feedback regarding the indicated competencies.

The Washington University School of Medicine Narrative Assessment Policy was last approved by the Committee on the Oversight of Medical Education governing body on Oct. 4, 2021. All substantive edits to this policy require approval by the Committee on the Oversight of Medical Education governing body.


Washington University School of Medicine High-Stakes Exam Expectations for Medical Students in All Phases of the Curriculum

The term high-stakes exams is used to denote all summative assessments, which are those assessments that evaluate student learning against intended course outcomes at the conclusion of instruction. Within the preclinical curriculum, the term includes all events for which the activity type is listed as “Exam.” Within the clinical curriculum, the term includes NBME Shelf Exams.

  • Students are required to take all examinations at the originally specified time. A student may be excused from this rule for extenuating circumstances at the discretion of the associate dean for student affairs (ADSA). Examples of extenuating circumstances include personal illness and personal or family emergency. Doctor appointments of a routine nature or personal obligations such as weddings, birthday celebrations, or other planned personal or family commitments are generally not considered to be extenuating circumstances for which students can be exempted from the regularly scheduled exam date.
  • All makeup exam requests go through the ADSA. The ADSA then submits the approved request to the Office of Medical Student Education (OMSE), and the OMSE will then transfer and track the requests granted. Course directors should refer all makeup exam requests to the ADSA.
  • Students who are unable to attend a scheduled examination should promptly contact the ADSA. Students should also notify the course director(s); in cases related to personal illness, students should also contact Student Health Services. The OMSE handles all exam rescheduling, and examinations will only be rescheduled after approval by the ADSA. The timing of the rescheduled examination will be determined by the OMSE in collaboration with the course director(s).
  • Students are expected to be punctual and should be assembled in the designated exam area before the official start time of the exam. Tardiness will not be excused except in extenuating circumstances. For purposes of the exam, "tardiness" will be defined by the course director or exam proctor. The course director will set expectations and determine consequences for exam tardiness. 
  • Students are expected to place all personal items, including muted cell phones, in designated areas.
  • Students are expected to follow all proctor instructions.
  • Students must not share study materials, exchange information, or collaborate or communicate with others during the exam.
  • After taking the exam, students must not share information about the exam with anyone who has not yet taken it.

Exam Expectations for Faculty

  • Exams should be proctored by the course director or a designee appointed by the course director comfortable with proctoring and exam administration guidelines. NBME subject exams are proctored by or coordinated by the Office of Student Affairs.
  • Administration should be fair to all students.
  • If the faculty member answers a substantive question or clarifies an issue, the same should be communicated to all students, including those in separate rooms or at different times.
  • Reasonable adjustments should be offered to students who require special accommodations, including a separate testing room or additional time. Course directors are notified of these students through the associate dean for student affairs.
  • If a student behaves inappropriately, the course director should notify the associate dean for student affairs immediately (refer to examples in the Cheating section below regarding inappropriate behaviors).
  • All requirements of students should be communicated to all students prior to the start of the exam.

Special Accommodations

Any student needing accommodations for exams should review the school's Students with Disabilities Policy in advance of exams. Students needing accommodations should meet with the associate dean for student affairs in advance of exams to discuss their request. The associate dean for student affairs will inform course directors of approved exam accommodations.


Cheating

The following examples are intended to be representative of behaviors that constitute cheating in the context of an exam. This is not intended to be an all-inclusive list.

  • Looking at or copying from another student's test
  • Collaborating with another student during the test without authorization
  • Using lecture notes or textbooks during an exam without authorization
  • Possessing crib notes during an exam
  • Using signals/signs to obtain answers from others
  • Using a calculator, cell/smart phone, smart watch, computer, or any other device or learning aid without authorization (This includes storing, receiving, and/or accessing course matter stored on such devices.)
  • Obtaining assistance in answering questions on a take-home exam without authorization
  • Obtaining advance copies of exams or quizzes by any means
  • Having someone else take an exam in your place
  • Feigning illness or submitting misleading statements to avoid taking an exam at the scheduled time
  • Changing an answer on a graded test and claiming the question response was incorrectly marked wrong

United States Medical Licensing Exam (USMLE)

Students who matriculated prior to 2014 and who anticipate practicing clinical medicine are required to take the USMLE Step 1 and 2 examinations. Beginning with the class matriculating in 2014, all students are required to take the USMLE Step 1 and Step 2 prior to graduation.

The USMLE is designed to "assess a physician's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care."* The USMLE represents a single uniform examination for medical licensure in the United States, and, as such, is a minimum requirement for obtaining a medical license.

The USMLE consists of three separate examinations:

"Step 1 assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Step 1 ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning." Step 1 is taken after completing the second year at Washington University School of Medicine.

"Step 2 assesses whether you can apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision and includes emphasis on health promotion and disease prevention. Step 2 ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills that provide the foundation for the safe and competent practice of medicine." Step 2 exams are taken after completing the third year but prior to graduation from Washington University School of Medicine.

"Step 3 assesses whether you can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care." Step 3 is taken following graduation and during internship/residency training.

Further information can be obtained from the USMLE Bulletin of Information published by the National Board of Medical Examiners. This is available, along with application forms and additional information, on the USMLE website.

*

The quoted material throughout this section is from the USMLE website.


Grading System

I. First and Second Year

Courses in the first-year and second-year curriculum are evaluated on a Pass (P) or Fail (F) basis. For purposes of the final official grade records of the School of Medicine, grades used for the first year and second year are as follows:

  • P = Pass, indicating satisfactory performance
  • F = Fail; any grade of F remains on the student's academic record. When the course is repeated or remediated the new grade will appear as a separate entry in addition to the failing grade.
  • L = Successful audit
  • NG = Course credit earned, students not graded
  • W = Withdrawal from a course
  • Z = Unsuccessful audit

Valid temporary grades include the following:

  • E = Temporary grade, makeup of failed exam pending
  • I = Incomplete, temporary grade pending completion of course requirements, replaced with an F if not removed within one year (In rare instances, the Committee on the Academic and Professional Evaluation of Students [CAPES] may grant an extension. Incomplete indicates that, because of a delay excused by the course director, the student has not completed the requirements to pass a course.)

II. Subsequent Years

For purposes of the final official grade records of the School of Medicine, the following grades are used for subsequent years:

  • H = Honors, reflecting a truly outstanding performance
  • HP = High Pass, awarded for excellent/very good work
  • P = Pass, indicating satisfactory performance
  • F = Fail (Any grade of F remains on the student's academic record. In clinical clerkships that have a subject examination, students must score at or above the 10th percentile of the national pool of students taking the examination to pass the clerkship. If a student fails a shelf examination for the second time in a third-year clerkship, an F is recorded on the permanent record.)

When the course is repeated or remediated, the new grade will appear as a separate entry in addition to the failing grade.

  • Cr/NCr = Credit/No Credit for select second- and fourth-year courses
  • L = Successful audit
  • NG = Course credit earned, students not graded
  • W = Withdrawal from a course
  • Z = Unsuccessful audit

Valid temporary grades include the following:

  • E = Temporary grade, makeup of failed exam pending (In clinical clerkships that have a subject examination, students must score at or above the 10th percentile of the national pool of students taking the examination to pass the clerkship. If a student fails the subject examination once, the grade of E will be recorded. Upon successfully retaking the subject examination, the new grade will replace the grade of E on the permanent academic record. If the shelf examination is failed a second time, the grade of F is recorded on the permanent academic record.)
  • I = Incomplete, temporary grade pending completion of course requirements, replaced with an F if not removed within one year (In rare instances, the CAPES may grant an extension. Incomplete indicates that, because of a delay excused by the course director, the student has not completed the requirements to pass a course.)

Grade Notification Policy for Washington University School of Medicine MD Program

Background

The Liaison Committee on Medical Education (LCME) element 9.8 requires that all final grades be recorded and available to students within six weeks of the end of a course or clerkship. The Gateway Curriculum of Washington University School of Medicine is a competency-based curriculum in which students do not receive tiered grades. Summative decisions regarding competency are made at the level of each phase and, in Phase 2, each clerkship for patient care only. Decisions regarding course credit, which are based on the completion of the required elements of a course, are made at the completion of each course during Phase 1. The purpose of this policy is to ensure that no summative assessment or course credit decision is delayed beyond six weeks from the end of or final requirement due date for any course or clerkship, as mandated by our accrediting body. 

Policies

  • The Medical School Registrar is responsible for monitoring and reporting that all competency or credit decisions for courses, clerkships, and phases are submitted in the learning management system (LMS) within six weeks of the end of the course or clerkship or final requirement due date.
  • The failure of course or clerkship directors to submit 100% of decisions within this time frame will result in corrective action(s) as appropriate.

Guidelines

  • Communication: The expectations for the return of competency and credit decisions should be shared with course and clerkship directors at least annually. All course and clerkship directors should be encouraged to create a streamlined process for the completion and integration of student evaluations in order to meet grade submission deadlines.

The Grade Notification Policy for the Washington University School of Medicine MD Program was last approved by the Committee on the Oversight of Medical Student Education (COMSE) governing body on Jan. 10, 2022. All substantive edits to this policy require approval by COMSE.


Grade Point Average, Class Ranking, and Grade Distributions

For more information about grade-point average, class ranking, and grade distributions, please visit the Assessing Academic Achievement & Professionalism section of this Bulletin.


Pre-Clerkship Grade Appeals

For more information about grade appeals, please visit the Assessing Academic Achievement & Professionalism section of this Bulletin.


Clerkship Grade Appeals

Background

Washington University School of Medicine (WUSM) is committed to rigorous, equitable, and credible processes for the assessment and grading of our students. Students who do not feel their grade accurately reflects their performance because of (1) a failure to follow a course’s stated processes for gathering and judging assessment evidence or (2) unfair bias have the right to appeal the grade.

The Grade Appeal Policy at WUSM is in place to allow for the identification and — if confirmed — remediation of a systematic error in the assessment and/or grading process outlined in the relevant course syllabus and/or policies. In keeping with LCME standards 9.9, 10.3, and 11.6, we adhere to the following policy for the appeal of all clerkship grades at WUSM.

Policy

If a student believes there was a systematic error in the assessment and/or grading process or the presence of bias as stated above, they may file a formal appeal. Students wishing to appeal their grade must do so by filing a Grade Appeal Form within 10 business days after final grades are due for a given course per WUSM’s Grade Notification Policy. Grade appeals received after this deadline will not be accepted unless approved by the Assistant Dean of Assessment and the Registrar in the case of unusual circumstances outside the student’s control (e.g., a clerkship posts a final grade after WUSM’s deadline).

The student must provide a detailed explanation of the basis for the appeal and pertinent documentation. Any factors not directly relevant to the assessment of performance within the specific course/clerkship (e.g., a student’s stated career goals) cannot be taken into consideration when processing a grade appeal.

The Clerkship Director, Associate/Assistant Clerkship Director, and/or their designee will investigate the basis of the student’s appeal. They will meet with the student (either in person or via virtual meeting) and any other stakeholders as needed to investigate the appeal, following which they will render a decision.

If the student still perceives systematic flaws in the process or bias impacted the final outcome of the grading and/or appeals process, they can submit a second appeal to the Associate Dean for Medical Student Education. They must do so within 10 business days of the decision of the Clerkship Director/Associate/Assistant Clerkship Director during the original appeal. The Associate Dean for Medical Student Education will convene an ad hoc appeals committee to adjudicate the appeal based on adherence to the stated processes of the clerkship for assessment and grading. In the event that this ad hoc committee finds systematic flaws or bias in the grading process, they will render a new review of the assessment evidence and a new judgment. The appeals committee will reach a decision by majority vote ordinarily within 21 days of receipt of the second appeal. The Associate Dean for Medical Student Education retains discretion to make reasonable adjustments to this timeline as necessary. If identified, patterns of failure to adhere to procedures by a grading committee will be addressed by the Assistant Dean of Assessment.

In the event that evidence of bias in the grading process is found, this will be considered a failure of the original grading decision to adequately adhere to the predetermined processes, and the appeals committee will issue a new grade. The appeals committee must also provide a summary of the evidence to the course director, the Associate Dean of Student Affairs, and the Assistant Dean of Assessment. Further handling of the matter will take place according to WUSM’s Policy Against Medical Student Mistreatment and other applicable policies.

Guidelines

Students are advised that feedback from any one individual front-line assessor does not guarantee a specific grade. Front-line assessors are not in a position to grade students.

The perceived absence of formative/constructive feedback from any individual front-line assessor similarly does not guarantee a specific grade. Receiving insufficient feedback cannot be the sole basis for a grade appeal. If a student feels that they are getting insufficient feedback, even after asking, they are encouraged to discuss this with the course director before the end of the course.

When relevant, mid-course/clerkship feedback is not a guarantee of any specific final clinical grade.

Students actively participating in the residency match process should also notify the office of career counseling whenever a grade appeal is in process.

The Washington University School of Medicine Clerkship Grade Appeals Policy was last approved by the Academic Affairs Committee on July 8, 2021.  All substantive edits to this policy require approval by the Academic Affairs Committee.


Remediation

For more information about remediation, please visit the Assessing Academic Achievement & Professionalism section of this Bulletin.