1. Introduction

“Academic difficulty” is a comprehensive term used to refer to all students who are identified as demonstrating performance below expectations in the MD Program. These Guidelines are intended to support and ensure student achievement of course objectives and program competencies, with the ultimate goal being promotion through and graduation from the MD Program.

2. Mechanisms for identifying performance below expectations

There are two formal mechanisms for identifying performance below expectations in Years 3 and 4 of the MD Program, as follows:

1. Based on marked assessments, final clinical evaluations, and/or non-marked learning activities: In order to achieve credit in a Clerkship course, rotation or OSCE, a student must achieve the minimum grade and other performance requirements, as defined by the course or Program and in accordance with in the MD Program’s Standards for grading and promotion. A student who does not achieve the grade and/or performance requirements for an assessment or the course as a whole will be identified as being in academic difficulty. Procedures to address unsatisfactory progress provided in Section 3.
2. Based on professionalism assessments and critical incident reports: Satisfactory professionalism competency is a requirement to achieve credit in every course, and assessment of professionalism competency is included in every course. Satisfactory professionalism competency is required to graduate from the program. Assessment of professionalism takes place through competency-based professionalism assessments. Professionalism incidents that require immediate action are addressed through critical incident reports. The MD Program’s professionalism standards of achievement and procedures to address unsatisfactory progress with respect to professionalism are described in the Student professionalism guidelines.

3. Procedures to address performance below expectations in clerkship

(excluding professionalism assessments and critical incident reports)

Unsatisfactory performance based on marked assessments, final clinical evaluations, non-marked learning activities,  or on a program of formal remediation (Remediation and Probation procedures)

Following the identification of unsatisfactory performance based on marked assessments, final clinical evaluations, non-marked learning activities, and/ or on a program of formal remediation:

1. The student will be required to meet with the Year 3 or Year 4 Clerkship Director or delegate, as determined by the program.
2. The student will be informed both orally and in writing by the Year 3 or Year 4 Clerkship Director that their performance is below expectations, that the Board of Examiners will be informed of this fact, and that their performance will be discussed at a meeting of the Board of Examiners. Students will also be informed of the consequences of not successfully completing the required remediation or probation requirements, as set out in the MD Program’s Standards for grading and promotion. The student must be fully informed of their rights, including their right to provide a written submission to the Board of Examiners in the event that their performance is being reviewed by the Board.
3. The student may be required to meet with the Associate Dean, Learner Affairs or delegate for the purpose of exploring health-related or personal reasons for their unsatisfactory progress and potential supports needed.
4. Subject to the approval of the Board of Examiners, the course director is responsible, in consultation with the appropriate curriculum leaders, for the design and content of the remedial work or probation requirements, including the level of performance expected of the student to demonstrate that they have met the standard for successful completion of the course. Specific performance criteria that may differ from those normally used in a course may be required for successful completion of remedial work or probation requirements. The timing and duration of the remediation or probation will be dependent on the specific course in question and will be determined by the course director in consultation with the student, course committee, and Year 3 or Year 4 Clerkship Director. A program of formal remediation or probation may include the repetition of one or more courses when they are next offered the following year, which may require a delay in promotion to the next year or level of medical training or graduation from the program.
5. Following the specified time period for completion, the course director will review the student’s progress and decide, in consultation with the Year 3 or Year 4 Clerkship Director, if the student has successfully completed the formal program of remediation or probation requirements.
   1. If the course director decides that the student has successfully completed the formal program of remediation or probation requirements, a recommendation will be made to the Board of Examiners, in accordance with the MD Program’s Standards for grading and promotion. If remediation is successfully completed, the student will be assigned credit for the courses requiring remediation, subject to the approval of the Board. If probation is successfully completed, a grade of No Credit (NC) will be assigned to the course attempts requiring probation, regardless of the outcome of the probation on the subsequent attempts; the student will be assigned credit for the subsequent course attempts, subject to the approval of the Board.
   2. If the course director decides that the student has not successfully completed the formal program of remediation or probation requirements, the recommendation to the Board of Examiners will be governed by the MD Program’s Standards for grading and promotion. In such cases, the student should be provided with timely notice of the recommendation, disclosure of the evidence on which the recommendation is based (i.e. the reasons for the recommendation), and an opportunity to provide a response to the Board of Examiners.
6. The Board of Examiners will make the final determination regarding successful completion of the remediation or probation requirements. Students may appeal decisions made by the Board of Examiners to the Appeals Committee, which is a standing committee of the Council of the Faculty of Medicine.

4.  Procedures to address performance below expectations based on professionalism assessments and critical incident reports

The MD Program’s professionalism standards of achievement and procedures to address unsatisfactory progress with respect to professionalism are described in the Student professionalism guideline.