2.03 Grading and Examination

Office of the Registrar

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2.03 Grading and Examination

General Principles

The director of each course/clerkship determines the nature, frequency, content, and scoring of student examinations. All formally designated examinations, including quizzes, are required of all students registered in the course or clerkship. Mid-course evaluations or interim examinations should take place no later than approximately halfway through a course or clerkship to provide timely feedback to students about their academic performance.

In the unusual event that a student is excused from an interim examination or final examination, the course or clerkship director will provide a single make-up opportunity for all students. The make-up examination will be equivalent to but not the same examination given on the scheduled day of the original exam.

In the extraordinary circumstance that a student has examinations in two courses simultaneously, the student will bear the responsibility of notifying both course directors in writing. If the courses are both required, the course directors will consult with each other and the student to set the times at which their respective examinations are to be taken. If one course is required and the other elective, the student will take the exam in the required course at the scheduled time and work with the elective course director to arrange an alternative time for the elective course exam.

Students who fail a course or clerkship are required to take a re-examination and/or do remedial work. If a student fails re-examination or the student performs unsatisfactorily in the remedial work, a final grade of unsatisfactory is reported to the Registrar, and the student is referred immediately to the Promotion and Review Board (PRB; see Section 4.02). The PRB may require the student to retake the same or equivalent course/clerkship as approved by the course/clerkship director, Society Master and PRB. All unsatisfactory grades must be resolved before a student may progress to the next phase of the curriculum and/or graduate (see below and Section 2.19, Satisfactory Academic Progress).

Only one opportunity will be allowed to remediate an unsatisfactory grade by repetition of a course or clerkship. If a student fails to attain a satisfactory (or better) grade upon repetition of the course or clerkship, the final grade will be unsatisfactory, and the student will be referred to the PRB for consideration of the student’s future status in the MD program.

All unsatisfactory grades from one academic year must be remediated before a student may begin the next academic year. Any student with an unsatisfactory grade in any course or clerkship, or a substantiated concern about professional conduct or responsibility, must complete remedial work at HMS prior to undertaking any extramural educational experience.

All disciplinary cases involving a student must be resolved, and the student’s status in the School must be restored to “good standing,” before the student may receive a degree. Only students who are in good standing will be permitted to participate in commencement or related activities or exercises.

Grading System – Years I and II

  1. All courses taken by first- and second-year Harvard medical students are graded satisfactory/unsatisfactory.
  2. For students of exceptional merit, a Letter of Excellence may be written and forwarded to the Registrar, to be added to the student’s permanent file.
  3. Marginal performance by a student is to be noted by the course director on the grade sheet in the appropriate column. The marginal grade will be noted in the PRB’s review of student performance but will not be part of the student's official record.
  4. A grade of incomplete signifies failure to complete course requirements because of personal illness, death in the family, or a similar compelling, serious reason, and must be resolved within a specified time or a grade of unsatisfactory will be recorded. A grade of incomplete may be given by a course or clerkship director only for those reasons and must be given before the end of a course or clerkship. A grade of incomplete must be accompanied by a written explanation to the Registrar and to the student's Society Master.
  5. When incomplete and/or unsatisfactory grades have been remediated, the course/clerkship director should notify the Registrar, in writing, as soon as possible in order for the grade to be updated in the student's permanent academic record.
  6. Narratives on the performance of each student are to be prepared by the faculty of all courses having regular small group teaching sessions and in core and elective clerkships. This routinely applies to tutorials but may also include labs and conferences. Course directors are responsible for forwarding narratives within four weeks of the end of the course to the Registrar for inclusion in the student's official record. Copies of narratives are provided to the Academic Societies for each student's file and to the PRB for review.
  7. Each Society regularly reviews grades and narratives of all students in the Society and may refer students to the PRB if indicated.

Final Examination Policy

The policy on taking final examinations is designed to be fair, uniform, and transparent across courses and clerkships and across academic societies. Maintaining a standard of professional behavior applies to a student’s responsibility for taking examinations.

  1. All students are required to take final exams on the dates published in the Academic Calendars posted to MyCourses, including Shelf Exams in core clerkships.
  2. Students may be permitted to take a final exam on a date later than the one published in the Academic Calendar for the following reasons only:

a.   Failure to pass the exam.

b.   Extraordinary circumstances outside a student’s control that prevent him/her from physically taking the final exam on the date published in the Academic Calendar. Examples include:

i.    Illness or accident

ii.   Death in the immediate family

  1. Conflicts with religious obligations.
  2. Conflicts with other scheduled MIT or Harvard course exams in required courses.
  1. In the event of 2b, 2c, or 2d above, the student is required to notify immediately his/her course/clerkship director(s), who will determine whether the student may be permitted to take the final exam on a date later than the one published in the Academic Calendar, and his/her Academic Society Master.
  2. In no case will a student be allowed to take a final exam before the date published in the Academic Calendar.
  3. Students who are unable to take a final exam for the reasons cited in 2b, 2c or 2d above will be given a grade of incomplete for the course until the exam has been taken and passed, at which time the grade will be changed on the transcript.
  4. Students who fail to take a final exam for other, non-sanctioned reasons will receive a grade of unsatisfactory, which will be recorded on the transcript.
  5. No examinations shall be administered to an individual student via e-mail or any other remote arrangement unless this was the mechanism by which the original exam was administered to the entire class. Absent this arrangement, to ensure a ‘level playing field’ for every member of the class, students must be physically present for all examinations and make-up examinations.
  6. In the event of 2a above, the student must sit for the exam on the designated make-up exam date. In the event of 2b, 2c, or 2d above, the student must sit for the exam immediately following the circumstance that prevented him/her for sitting for the exam, per arrangement with the course/clerkship director.

Reporting Bottom-Quartile Performance Patterns on Final Exams to the Academic Societies

Currently, a student who passes but has difficulty in mastery of material during preclerkship courses may not come to the attention of faculty and academic advisors. As a result, the academic problems such students encounter may not be identified until the PCE year; by that time, multiple opportunities for remediation have been missed. After thoughtful discussion, and with input from an ad hoc student/faculty committee, the Curriculum Committee voted that notification be sent to the student’s Society Master if, on at least three major exams, a student’s scores fall in the lowest quartile. This policy was adopted not to be punitive or to detract from the collaborative learning environment students and faculty have worked so hard to foster; instead, the policy is designed to fulfill an important responsibility of the faculty to identify students who would benefit from attention and academic help.

When such consistent marginal performance is recognized, the student’s Society Master will be notified and will request a meeting with the student to determine whether he/she is in need of academic assistance, a formal remediation plan, or personal support. The objective of the policy is to help students perform at their highest level and progress toward achieving their academic goals long before marginal preclinical performance translates into inadequate preparation for, and performance during, the clinical years. Our goal is to help students be more insightful about their strengths and weaknesses, to arm them with the appropriate tools for self-improvement, and to make them aware of resources for seeking help when necessary.

Grading System – Years III and IV

  1. Most courses (see exceptions in paragraphs 3 and 4) taken during Years III and IV, including clinical clerkships and clinical electives, effective May 2013, are graded honors with distinction/honors/pass/unsatisfactory. Although grades are determined based on demonstrated competency, in order to assure fairness and consistency of grading across sites and disciplines, guidelines exist for the directors of all core clerkships regarding the distribution of the above grades.
  • Honors with Distinction: up to 30%
  • Honors: 50-60%
  • Pass: 10-15%
  • Unsatisfactory: as needed (rarely assigned)

The summative narrative component of grading in clinical clerkships and electives becomes part of the official record. Beginning in AY13 (October 2012), summative comments from all core clerkships will be quoted in chronologic order in the Medical Student Performance Evaluation (MSPE or “Dean’s Letter”). Formative comments regarding performance in clinical clerkships and electives are to assist students' self-directed learning. Formative and summative comments will be available online following submission to the Registrar for review by the student and the student’s Master and Associate Masters. Formative and summative comments will also be available to the Promotion and Review Board in its review of a student’s performance and/or compliance with the HMS standards of professional conduct and responsibility. Clerkship/course directors are expected to submit grades and evaluation narratives within four weeks and no later than six weeks of the end of the clerkship/course.

  1. A grade of incomplete signifies failure to complete course requirements because of personal illness, death in the family, or a similar compelling, serious reason, and must be resolved within a specified time or a grade of unsatisfactory will be recorded. A grade of incomplete may be given by a clerkship or course director only for those reasons and must be given before the end of a clerkship/course. A grade of incomplete must be accompanied by a written explanation to the Registrar and to the student's Society Master.
  2. Patient-Doctor III is graded satisfactory/unsatisfactory, and a narrative description of each student's performance is forwarded to the Registrar for inclusion in the student's official record.
  3. The PCE is graded satisfactory/unsatisfactory.

Academic Difficulty during the PCE

If a student is having academic difficulty during the PCE, the PCE Director and the student’s Society Master, in consultation with the HMS Registrar, will determine whether the student should continue the PCE or withdraw or discontinue. In either case a remediation plan will be formulated. If the decision is to require the student to discontinue the PCE, the student should be presented at the Promotion and Review Board and placed on Monitored Academic Status (MAS) or, if the student has failed one or more clerkships, the student will be placed on Academic Probation.

Failure of Shelf Exams during the PCE

  1. If a student fails a single Shelf Exam, the Registrar will report this failure to the PCE Director. The PCE Director and/or the clerkship director will discuss the failure with the student’s Academic Society and design a plan for remediation.
  2. The student ordinarily will be required to take the make-up Shelf Exam during the next vacation period (vacation periods occur at the end of the first quarter, over the December holidays, and at the end of the PCE year).
  3. If a student fails two Shelf Exams, he/she may be required to withdraw from the PCE and re-enter the PCE the following May. This decision will be made by the PCE Director, in consultation with the student’s Academic Society and HMS Registrar.

Honors in a Special Field

The MD degree with Honors in a Special Field (cum laude, magna cum laude, summa cum laude) is awarded to graduating MD degree candidates who have performed original and meritorious investigation in a subject and have demonstrated ability, scholarship, and special knowledge of the field in which the chosen subject is a part. An original thesis, describing basic or clinical research or other scholarly investigation (e.g., social sciences, ethics, history of medicine) involving a minimum of four to six consecutive months (often more, in the experimental biological sciences) must be submitted for consideration and will form the basis for an oral examination.

The MD Honors Thesis must be distinct from any prior or concurrent graduate-level thesis (e.g., MPH, PhD).

Candidates for Honors in a Special Field should speak with one of their Society Fellows, complete a Statement of Intent no later than the first week of October in the expected year of graduation and submit their full proposal to the coordinator of Honors in a Special Field (located in the mezzanine of Cannon Society). The thesis submission deadline is during the first week of February. Oral examinations are held from February through April.

HST/London Society students are required to submit their completed theses to the HST Program for evaluation and submission to the Honors process.

A student must be in good academic standing in the MD program to be considered for a degree with honors.

Also in Section 1.07, MD Degree with Honors in a Special Field.

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