Introduction

These Standards serve as an adjunct to the University Assessment and Grading Practices Policy and describe the practices of the MD program with regard to determining student grading and promotion in Clerkship (Years 3 and 4) and also apply to students registered in the MD Extended Clerkship. They are complemented by the MD Program’s Academic difficulty procedural guidelines and Student professionalism guidelines.

Standards

1. Authority of the Board of Examiners: All decisions related to a MD student’s grading and promotion are ultimately made by the Board of Examiners, a standing committee of the Council of the Temerty Faculty of Medicine. To inform these decisions, the Board of Examiners receives recommendations from the Clerkship Director (or designate) and/or and Faculty Lead, Ethics & Professionalism.
2. Individual assessment marks and course grades:
   1. Individual assessment marks: Marks for individual assessments are not subject to any formal approval, but rather serve as the basis for decisions about overall course standing. Individual assessment marks do not appear on transcripts or other documentation provided by the MD Program to external individuals or organizations.
   2. Provisional (unofficial) course grades: Course grades communicated through MedSIS or other means constitute an unofficial record; they are reserved exclusively for internal use and do not appear on transcripts or other documentation provided to external individuals or organizations. Provisional course grades are subsequently recommended to the Board of Examiners (see Sections 7 and 8).
   3. Official course grades: Upon approval of the Board of Examiners, course grades are made available to students in the Accessible Campus Online Resource Network (ACORN), which is the official record and is used by the University to generate official transcripts. MD program course grades are transcripted as “Credit (CR)”, “No Credit (NC)”, “In Progress” (IPR) or “Incomplete” (INC).
3. Standards of achievement on each type of assessment, other than professionalism: It is the responsibility of each Clerkship course committee, in consultation with the relevant theme leads as well as the Student Assessment and Standards Committee (SASC), to define satisfactory completion of each type of assessment required during their course, in accordance with guidelines articulated below. (This section does not apply to the assessment of professionalism, which is addressed in the MD Program’s Student professionalism guidelines.) Specifically:
   1. Assessment methods: Course committees are responsible for establishing the assessment methods to be used in the course. These assessment methods are subject to periodic review by the Student Assessment and Standards Committee (SASC) and/or Program Evaluation Committee. Changes to assessment methods must be brought to the attention of the Clerkship Director, in accordance with the MD Program’s Guidelines for making curricular changes.
   2. Standards of achievement on assessments - Definition of satisfactory performance or “pass”: For mastery exercises and oral exams in all Clerkship courses, this threshold is 60%. For other marked assessments (excluding final clinical evaluations), this threshold is normally 60%, as determined by the course committee. For the clerkship OSCE, the numeric threshold is set according to the borderline regression method. Assessments on which a “pass” is achieved will be recorded as “CR” (“Credit”). Assessments on which unsatisfactory performance, or a “fail” is achieved will be recorded as “NC” (“No Credit”).
   3. Definition of “satisfactory completion” for final clinical evaluations: An overall assessment of “meets expectations” or above on each final clinical evaluation in a course is required to achieve “satisfactory completion” of the clinical evaluation for that course. An overall assessment below “meets expectations” on any final clinical evaluation in a course is considered unsatisfactory performance or a “fail”. The overall assessment of final clinical evaluations requires a holistic judgement and does not represent an average of individual assessments.
   4. Definition of an “incomplete” mandatory non-marked learning activity: Course committees are also responsible for identifying any mandatory non-marked learning activities (e.g. required encounters and procedures in the core clinical clerkship courses) that are required for successful completion of the course. Incomplete non-marked learning activities will be recorded as “INC” (“Incomplete”).
   5. Definition of successful completion of the Clerkship OSCE: The standard for successful completion of the  Clerkship OSCE is determined by the MD Program using a borderline regression method. The Clerkship OSCE is sequential in nature. A student who does not achieve standard on the first Clerkship OSCE attempt will be required to successfully complete a supplementary OSCE prior to promotion to Year 4 (see section 7.e). The supplementary OSCE expectations will be communicated to the student. If the supplementary OSCE is satisfactory, according to the standard set by the borderline regression method, the student will be assigned credit (CR) for the Clerkship OSCE. If the supplementary OSCE attempt is unsuccessful, a recommendation to the Board of Examiners will normally be made for NC in the course.
   6. Communication to students: Course committees are responsible for articulating the assessment methods and standards of achievement for their course in a course outline provided to students no later than the first day of the course. Any changes to the assessment methods after they have been made known to students must take place in accordance with the University Assessment and Grading Practices Policy.
4. Professionalism: 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.
5. Standards of achievement in a course as a whole:
   1. Determination of achievement: It is the responsibility of each course committee to define satisfactory completion of their course as a whole. Specifically:
      1. Additional expectations for marked assessments: For each Clerkship rotation, there is a requirement to achieve 60% on each mastery exercise and oral exam, as applicable to the specific rotation.
      2. Clinical evaluations: An overall assessment of “meets expectations” or above on each final clinical evaluation in a course is required to achieve “satisfactory completion” of the clinical evaluation for that course.
      3. Mandatory non-marked learning activities: By their nature, mandatory non-marked learning activities are required in order to complete the course.
      4. Professionalism: See Section 4 above.
6. Definition of provisional course grades in MedSIS: Provisional course grades differ in some respects from the final grades awarded by the Board of Examiners. Specifically:
   1. CR (Credit) is used to denote that all requirements in the course have been met. This is the grade that will be recommended to the Board of Examiners, barring the availability of new information that calls into question the student’s successful performance in the course, as described in Section 8.
   2. NC (No Credit) is used to denote that a student has not been successful in completing the course due to any of the reasons in Section 6a. The recommendation to the Board of Examiners will depend on the student’s history of academic difficulty, as described in Section 8. If formal remediation is assigned by the Board of Examiners, an interim notation of NGA will be assigned to the course (see below). 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.
   3. NGA (No Grade Available) is used to denote that a student has been assigned formal remediation that is pending completion. If remediation is successfully completed, the student will be assigned credit for the courses requiring remediation, subject to the approval of the Board.
7. Principles governing recommendations to the Board of Examiners: The Clerkship Directors (or designate) and Faculty Lead, Ethics & Professionalism will be guided by the following principles in making their recommendations to the Board of Examiners:
   1. Successful completion of a course: A grade of “Credit (CR)” in a course will be recommended to the Board of Examiners if a student:
      1. has achieved 60% on each written mastery exercise and oral exam required for the course, AND
      2. has achieved an overall assessment of “meets expectations” or above on each final clinical evaluation required for the course, AND
      3. has satisfactorily completed, as determined by the course, any marked assessments required for the course in addition to mastery exercises and oral exams, AND
      4. has performed satisfactorily on any non-marked learning activities in that course, including but not limited to professionalism, logging of clinical experiences and completion of required number of Entrustable Professional Activities (EPAs), in courses where this is relevant.

   2. Remediation: A program of formal remediation will normally be recommended to the Board of Examiners if a student:

      1. has not achieved at least 60% on each written mastery exercise and oral exam required for the course, OR
      2. has not achieved an overall assessment of “meets expectations” or above on each final clinical evaluation required for the course, OR
      3. has not performed satisfactorily on any non-marked learning activities of the course, including but not limited to logging of clinical experiences or completion of required number of Entrustable Professional Activities (EPAs), in courses where this is relevant, by the time of the Board’s meeting.

      In cases where a program of formal remediation is approved by the Board of Examiners, the student will receive an interim grade of No Grade Available (NGA) and be required to repeat failed course components within the same academic year (or immediately after).
      
      If the remedial program is successfully completed, the student will be assigned credit for the subsequent course attempt(s), subject to the approval of the Board.

      If the remedial program is not successfully completed, failure in the course and probation will normally be recommended to the Board of Examiners.
      
      In cases where a program of formal remediation is recommended to the Board of Examiners, 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. 

   3. Probation: Probation will normally be recommended to the Board of Examiners if a student has:

      1. not successfully completed remediation previously imposed by the Board of Examiners, OR
      2. not achieved credit on the first attempt in two or more courses (totaling at least 12 weeks in curriculum, or equivalent) in the same level of the program, as confirmed by the Board of Examiners.

      In cases where probation is approved by the Board of Examiners, the student will receive a final grade of No Credit (NCR) in relevant course(s) with unsuccessful remediation, regardless of the outcome of the probation on the subsequent attempts. The student’s promotion to the next year or level of medical training will be delayed.
      
      To clear probation, the student must re-register in the same level of the program and successfully repeat relevant courses when they are next offered the following term or academic year. At the discretion of the Clerkship Directors and/or course director(s), a recommendation may be made for a student to repeat all of the courses in the academic year in question or only the course(s) in which they experienced academic difficulty.
      
      When the student clears probation, the student will be assigned credit for the repeat course attempt(s), subject to the approval of the Board, and be placed in Good Standing.
      
      If probation is not successfully completed, failure in the repeated course(s) and dismissal from the program will normally be recommended to the Board of Examiners.
      
      Probation may also be recommended to the BOE if a student fails 2 attempts at the Clerkship OSCE.
      
      In cases where probation is approved by the Board of Examiners, the student will receive an interim grade of No Grade Available (NGA) to denote that the course is pending completion. To clear probation, the student must successfully re-assess in Clerkship OSCEs.
      
      When the student clears probation, the student will be assigned credit for the Clerkship OSCEs course, subject to the approval of the Board, and be placed in Good Standing.
      
      If probation is not successfully completed, failure in the Clerkship OSCE course and dismissal from the program may be recommended to the Board of Examiners.
      
      In cases where probation is recommended to the Board of Examiners, 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.

   4. Dismissal: Dismissal from the program will normally be recommended to the Board of Examiners if a student has not successfully completed probation.

      In cases where dismissal from the program is recommended to the Board of Examiners, 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.

   5. Promotion: Promotion from Year 3 to Year 4 will be recommended to the Board of Examiners if a student has achieved “Credit” in all Year 3 courses. Recommendations regarding promotion from Year 3 to Year 4 will be made no later than 60 days after the end of the Year 3 academic year. The timing of recommendations for promotion will be informed by applicant timelines for the first iteration of the residency match process. Students who have not been promoted from Year 3 to Year 4 may not be allowed to enrol in or complete Year 4 course or program requirements.
   6. Graduation: Graduation at the next Convocation of the MD program will be recommended to the Board of Examiners if a student has been deemed to have successfully achieved credit for every program course and requirement, including the specified amount of approved and assessed elective time. Graduation from the MD Program also requires successful completion of the Clerkship OSCE, in accordance with the standard for successful completion determined by the Program.
8. Deviations from normal practice: Where the word “normally” is used in relation to recommendations to the Board of Examiners, the Clerkship Director, individual course directors, and Faculty Lead, Ethics & Professionalism may choose to deviate from the recommendation that is indicated in these Standards. In such cases, a rationale must be provided to the Board of Examiners for the deviation, and the Board of Examiners will take both the recommendation and the rationale under consideration.
9. Appeals: Students may appeal to decisions made by the Board of Examiners to the Appeals Committee, which is a standing committee of the Council of the Temerty Faculty of Medicine.

Date of original adoption: 10 February 2012 

Date of last amendment: 25 October 2024