SOM Grading Policy for Phase Two and Phase Three

I. PURPOSE

The purpose of this policy is to provide consistent guidelines for grading clerkships and electives in Phase 2 and Phase 3.

II. POLICY

A. It is the policy of the New York Medical College, School of Medicine (“NYMC SOM”) that at the end of each course, each student's performance is evaluated and recorded. The faculty determines a student’s final course/clerkship grade after evaluation of the student's performance in all aspects of the coursework, including achievement of course and college objectives/competencies in all domains (i.e., knowledge, skills, attitudes, and behaviors).

B. Grades for clerkships (Phase Two) must be posted to the learning management system within six (6) weeks of the end of the clerkship and/or elective.

C. Students may view their course or clerkship/elective grades in the student program reports and/or official transcript through the Registrar’s Office.

D. Criteria for assigning grades are established by the faculty responsible for the course according to parameters determined by the Education and Curriculum Committee (“ECC”). Guidelines for grading are reviewed periodically by the ECC and, as for all academic policies, are subject to change without prior notice.

E. During all phases of study, health professionals who provide health services, including psychiatric/psychological counseling, to a medical student have no involvement in the academic assessment or promotion of the medical student receiving those services, excluding exceptional circumstances (LCME Element 12.5).

F. For students who fail to satisfactorily complete coursework, please see the NYMC SOM Policy on Student Promotions V.I.1.a-c

G. For students with academic deficiencies, please see the NYMC SOM Policy for Management of Academic Deficiencies.

III. SCOPE

This policy applies to all faculty and students in the NYMC SOM.

IV. DEFINITIONS

ECC: Education and Curriculum Committee
SAPRC: Student Advancement, Promotions, and Review Committee
MEPO: Medical Education Program Objective
NBME: National Board of Medical Examiners
WBA: Workplace-Based Assessments
PET Log: Patient Encounter Tracker Log
Competency-based grading: assessment of student achievement using pre-defined standards
Grade abbreviations:

“F” = Fail
“P” = Pass
“CP” = Conditional Pass
“WP” = Withdraw Passing
“WF” = Withdraw Failing

V. PROCEDURES

A. The distribution of grades for clerkships and electives will be reviewed annually by the ECC using cumulative data each academic year.

B. Grading Format

1. Required Phase 2 clerkships are assessed using a competency-based system (described in detail below) and students are graded as Honors, High Pass, Pass, Fail.
2. The Physical Medicine and Rehab 2-week clerkship is graded as Credit / No Credit
3. Elective courses in Phase 2 are graded as Credit/ No Credit.
4. Required Phase 3 track rotations (e.g., Sub-Internship, Emergency Medicine, Intensive Care Unit, and Radiology and Diagnostic Medicine) and elective courses that involve direct patient care are graded as Honors, High Pass, Pass, Fail.
5. Electives in Phase 3 that are in-person but not direct patient care can be graded as Honors, High Pass, Pass, Fail or as Credit/No Credit.
6. Elective courses in Phase 3 that are not in-person are graded as Credit/ No Credit.
7. Failure in any component of any Phase 2 or Phase 3 course will result in failure of the course.

C. Phase 2 Clerkships

1. Competency-based grading in clerkships assesses students’ achievement using pre-defined standards, including a clinical performance grade and score on the NBME Subject examination, as well as overall professional behavior.
2. Recurrent lapses in professional behavior or one egregious lapse in behavior will result in failure of the clerkship.
3. Determinant of Clinical Performance Grade.

a. A student’s clinical grade is determined by a student’s performance across twelve domains corresponding to the twelve common clerkship objectives, which are rooted in the MEPOs (Medical Education Program Objectives), which are informed by the NYMC SOM’s graduation competencies. Four descriptions are listed as options for each domain, corresponding to Honors/High Pass/Pass/Fail level performance.
b. Honors threshold is defined as demonstrating honors level performance in at least 8 domains; no more than one domain below high pass level performance and 0 failed domains.
c. High Pass threshold is defined as demonstrating high pass or honors level performance in at least 10 domains and 0 failed domains without meeting criteria for Honors.
d. Pass threshold is defined as achieving pass, high pass, or honors level performance in all domains without meeting criteria for High Pass or Honors.
e. Fail threshold is defined as failing any domain.

4. The passing standard for NBME subject examinations will be determined by the Phase 2 and 3 Subcommittee of the ECC based on the NBME Standard Setting Panel’s recommended passing score. These standards will be reviewed on an annual basis.

a. The NBME exam grade category for High Pass and Honors is determined by the percentiles listed in Table 1. Percentiles are converted to raw score by the Assistant Dean for Clinical Sciences, based on the most recent NBME score tables available for a given academic year. If the target percentile does not exist in the NBME conversion table for a clerkship, the nearest percentile to the target percentile is used. If the nearest percentiles above and below the target threshold are equidistant to the target threshold, the lower percentile is used. See Table 2 below.
b. Students taking the assessment during the first quarter of the year (“Quarter 1”) will use Quarter 1 percentile data for the determination of grade benchmark standards; “total year” percentile data will be used for the remainder of the year.
c. “Quarter 1” is defined as the first two graded clerkships (excluding Physical Medicine & Rehabilitation) in the academic year for a given student.

5. Assignments will be mapped to domains and will impact the score in that domain:

a. Observed History and Physical:

i. Evaluation Question 1: Gather an accurate and comprehensive history while demonstrating respect and compassion to the patient.
ii. Evaluation Question 2: Perform both comprehensive and focused physical exams with proper technique and sensitivity to patient comfort

b. Written History and Physical:

i. Evaluation Question 3: Interpret clinical, epidemiological, and diagnostic information to generate a prioritized differential diagnosis and problem list
ii. Evaluation Question 7: Record accurate, well-organized, and timely written medical documentation.

c. Mid-Clerkship Feedback

i. Evaluation Question 10: Demonstrate self-reflection, response to feedback, initiative, and self-direction in learning
ii. Evaluation Question 12: Demonstrate professionalism in all interactions, including cultural sensitivity and commitment to ethical principles

d. PET Log

i. Evaluation Question 10: Demonstrate self-reflection, response to feedback, initiative, and self-direction in learning
ii. Evaluation Question 12: Demonstrate professionalism in all interactions, including cultural sensitivity and commitment to ethical principles

e. Student to request 3 WBAs

i. Evaluation Question 10: Demonstrate self-reflection, response to feedback, initiative, and self-direction in learning
ii. Evaluation Question 12: Demonstrate professionalism in all interactions, including cultural sensitivity and commitment to ethical principles

f. For other assignments, mapping to domains will be determined by the clerkship director. Each assignment maps to a minimum of 2 domains.
g. If assignments are not submitted by the assignment deadline, the student is only eligible for a pass in the domains mapped to that assignment as well as in the professionalism domain. If the assignment is not submitted by the end of the clerkship, the student will fail the clerkship.

6. For the core clinical clerkships, an overall clerkship grade is assigned. This is composed of a Clinical Performance Grade and the NBME Exam Grade. Table 3 below describes how the final grade is determined, accounting for the ratio of weighted clinical performance/NBME exam grades. Of note, a failure in professionalism will result in failure of the clerkship.

7. Incomplete

a. A grade of Incomplete will be assigned to a medical student who, for approved reasons, could not complete all clerkship components within the confines of the clerkship schedule and is granted a temporary extension by the Clerkship Director to complete the components within a specified time frame. When the student does complete the components of the clerkship, the student is entitled to any grade they achieve: Honors, High Pass, Pass, or Fail.
b. The student must complete the clerkship prior to advancing to Phase 3 of the curriculum.

8. Conditional Pass

a. A grade of CP in Phase 2 is applied to Phase 2 clerkships under the following circumstances:

i. A student who passes all elements of a clinical clerkship the NBME Subject Examination will be issued a CP grade for the clerkship.
ii. In this circumstance the student will coordinate a retake examination with the assistance of the Office of Student Affairs.

b. Once a CP has been received, the maximum grade for that clerkship is a Pass. If on the second attempt, the student does not meet the minimum benchmark on the NBME, the CP grade is converted to an F (failure). Further course of action will be determined by the SAPRC as described in the NYMC SOM Policy for Management of Academic Deficiencies. Students may retake up to two (2) NBME exams per year.
c. All CP grades in Phase 2 clerkships must be converted to another grade (P or F) within twelve (12) months. If the student is unable to achieve the minimum benchmark on the NBME within twelve (12) months of the issuance of the CP grade, the clerkship grade will be automatically converted into an F.
d. With approval from the Office of Student Affairs, a student may be conditionally enrolled in Phase 3 pending the results of retake examinations. However, such enrollment shall not be constituted as a promotion to Phase 3.
e. All CP grades, even after required remediation is addressed, will be recorded and tracked on the student’s internal records and considered as an “academic deficiency” for purposes of the SAPRC.
f. Students who must repeat an NBME, regardless of when the retake is scheduled, will be held to cutoffs that applied during the quarter and academic year they completed their clerkship.
g. Any repeated clerkship is graded according to the rubric that applies at the time of the repeated clerkship.

9. Guidelines for Repeating Clerkships

a. If a student is required to repeat a clerkship in its entirety because of academic deficiency, the student is eligible to earn any grade in that clerkship for the repeated coursework. Recognition of the prior unsatisfactory performance will be noted on the official school transcript and in the Medical Student Performance Evaluation (“MSPE”) and the student will be reviewed by the SAPRC, as per the NYMC SOM Policy for Management of Academic Deficiencies.
b. If a student does not successfully pass a clerkship remediation, including performance on the NBME Subject Examination upon repeat attempt, the student will be subject to additional actions by the SAPRC, with options, including but not limited to, repeat of a portion of the academic year, repeat of an entire academic year of dismissal from the NYMC-SOM as per the NYMC SOM Policy for Management of Academic Deficiencies.

D. Phase 2 Electives

1. Electives in Phase 2 are graded as Credit / No Credit.
2. If a student receives a grade of No Credit, the student may need to make up an elective prior to graduation.

E. Phase 3 Required Track Rotations and Electives

1. Required track rotations in Phase 3 are graded as Honors/High Pass/Pass/Fail. Grading is based on the 7 NYMC SOM graduation competencies, including professionalism. The final grading rubric can be found on the Phase 3 Final Evaluation form.
2. Electives in Phase 3 that are in-person but not direct patient care can be graded as Honors, High Pass, Pass, or Fail. Grading is based on the 7 NYMC SOM graduation competencies, including professionalism. The final grading rubric can be found on the Phase 3 Final Evaluation form.
3. Elective courses in Phase 3 that are not in person are graded as Credit/ No Credit. If a student receives a grade of No Credit, the student may need to make up an elective prior to graduation.
4. Repeated absences within a single course could result in a failing grade.
5. Incomplete

a. A grade of Incomplete will be assigned to a medical student who, for approved reasons, could not complete all course components within the confines of the course schedule and is granted a temporary extension by the Course Director to complete the components within a specified time frame. When the student does complete the components of the course, the student is entitled to any grade they achieve.
b. The student must complete the course prior to graduation.

F. Transition Courses (Transition to Clerkship, Transition to Phase 3, Transition to Residency)

1. Transition courses are graded as Credit/No Credit/Incomplete. To receive a grade of “Credit”, students must attend all mandatory sessions and complete all assignments by the end of the course.
2. Incomplete

a. A grade of Incomplete will be assigned to a student who, for approved reasons, could not complete all course components within the confines of the course schedule and is granted a temporary extension. Any required make-up due to unforeseen circumstances must be completed in a timely fashion as determined by the course directors.
b. The student must complete the course within 12 months as per theSOM Policy on the Management of Academic Deficiencies or, in the case of Transition to Residency, prior to graduation.
c. A failure in professionalism will result in a No Credit for the course. Remediation will be required as described in the Policy on Professionalism.

VI. EFFECTIVE DATE

This policy is effective immediately.

VII. POLICY MANAGEMENT

Executive Stakeholder: Dean, School of Medicine
Oversight Office: Undergraduate Medical Education

 

Table 1: NBME Percentiles

Table 2: Phase 2 NBME Score Chart Academic Year 2025-2026
(Updated 3/3/25)

Table 3: Clerkship Grade Determination