Grades Other Than Passing Policy

Effective Date: 1999
Responsible Party: University of Alabama Marnix E. Heersink School of Medicine’s Associate Dean for Undergraduate Medical Education
Contacts: Kevin Leon, MD, Associate Dean for Undergraduate Medical Education

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Policy Abstract

Students at the University of Alabama at Birmingham Marnix E. Heersink School of Medicine must pass all required courses and curriculum components to graduate. Additionally, students must pass the minimum number of weeks credit for each curriculum component required for graduation. The Student Academic Standing Committee (SASC) determines all statuses and actions related to grades other than passing in one or multiple courses.

Reason for Policy

This policy establishes that students at the UAB Heersink School of Medicine must pass all required courses and curriculum components to graduate. It also specifies the available options in the case that a required course or curriculum component is not passed. This policy meets the requirements set forth by the Liaison Committee for Medical Education (LCME) as follows:

Element 10.3: Policies Regarding Student Selection/Progress and Their Dissemination
“The faculty of a medical school…develop and implement effective policies and procedures regarding, and make decisions about, medical student…assessment, promotion, graduation, and any disciplinary action. The medical school makes available to all interested parties its criteria, standards, policies, and procedures regarding these matters.”

Scope

This policy applies to all Heersink School of Medicine students.

Policy

Students must pass all courses and curriculum components used to fulfil graduation requirements.

Students receiving a grade other than passing in a required course or program must successfully complete that course or program to graduate. If the course is an elective, acting internship, or special topics course, the student must either successfully complete the same course or successfully complete a different course that meets the same graduation requirement.

The Student Academic Standing Committee (SASC) reviews all instances of grades other than passing and determines progression, statuses, and actions related to such grades. All decisions regarding student status, course remediation, course completion, course repetition, recycling, dismissal, completion of required program components, and academic progression are approved by the SASC.

Procedure

1. Definitions

The following course grades are considered grades other than passing. Detailed definitions can be found in the Medical Student Grading Policy.

Table 1.1

F	Failure
I	Incomplete
N	Remediation required on National Board of Medical Examiners (NBME) subject examination
WP	Withdrawn passing
WF	Withdrawn failing
W	Withdrawn
F/P or F/F	Preclerkship, learning community, and scholarly activity courses which are remediated appear on the academic record as F/P or F/F as appropriate
N/P, N/HP* or N/F	Clerkship courses remediated by repetition of the NBME subject examination appear on the academic record as N/P, N/HP, or N/F as appropriate. The N/HP designation will take effect 4/28/2024.

Coursework is categorized into the following graduation requirements*

Table 1.2

Pre-clerkship Courses	Required
Clerkships	Required
Acting Internships (AI)	Students may select from multiple course options to fulfill this requirement
Electives	Students may select from multiple course options to fulfill this requirement
Learning Communities (LC)	Required
Preparation for Residency	Required
Scholarly Activity (SA)	Required
Special Topics (ST)	Students may select from multiple course options to fulfill this requirement
Observed Structured Clinical Examinations (OSCEs)	Required

*Graduation requirements may vary by program or track. Please refer to the Graduation Requirements for details.

2. Notification

Upon recognition that a student will receive a grade other than passing, the Course Director and/or Director of Assessment, will send notification of the final grade to the student. A copy of the written correspondence will also be sent to the Associate Dean for Undergraduate Medical Education, the Associate Dean for Students, and the Associate Dean for Admissions and Enrollment Management. Students have the right to appeal a grade up to 2 weeks following notification (See Medical Student Grading Policy, Appeal Process).

3. Academic Standing

Academic status for students receiving a grade of F or WF in a preclinical course will be Active with Deficiency, provided no other academic issues need resolution. Upon course remediation, academic status will return to Good Standing. Students who fail more than one (1) course in a given preclinical year are subject to academic probation status as designated by the SASC. Students receiving a grade of I or N will be placed on a status of Active with Deficiency, provided no other academic issues need resolution. Grades of WP or W do not affect academic standing. Students receiving a grade of F or WF in a clinical course are subject to academic probation status as designated by the SASC.

The return to a status of Active in Good Standing after placement on Active with Deficiency or Academic Probation is dependent upon course type and number of non-passing grades. In general, students whose status is Active with Deficiency return to Good Standing upon successful remediation of failed preclinical coursework provided no other academic issues need resolution. In general, students whose status is Academic Probation return to Active in Good Standing upon receipt of a passing score on USMLE Step 1 provided no other academic issues need resolution. Timing of return to Active in Good Standing after clinical course failures is described in the tables that follow.

4. Grades of F

Students receiving a grade of F in a required course must remediate or repeat that course to graduate. If the course is an elective, acting internship, or special topics course, the student must either successfully complete the same course or successfully complete a different course that meets the same graduation requirement.

4.1. Remediation of Grades of F in required preclinical courses

The following table summarizes general actions related to grades of F in first and second year required courses. Variations in circumstances and situations unique to individual students may alter these general guidelines. All decisions are subject to review and approval by the SASC.

Note: When an entire module must be remediated, the remediation process and timeline is specified by the module director in collaboration with the Office of Undergraduate Medical Education. In rare cases when satisfactory remediation cannot be accomplished within the required timeframe without the student stopping academic progression, the student will be required to recycle.

Table 4.1

Course or Required Curriculum	Action	Details
Patient, Doctor, Society	Remediation	• Must remediate to the satisfaction of the module director.
Patient, Doctor, Society	Timeline for remediation	• Must remediate prior to the start of MS2 year.
Fundamentals of Medicine All five blocks of this course must be passed to proceed to the MS1 organ system modules.	Remediation	• Students who fail ONE block may remediate the failed block. Students must successfully pass the remediation examination for the failed block before proceeding to the organ system modules. • Students who fail ONE block and successfully remediate the block will receive a grade of P for the course. • The block remediation examination must be passed for a student (a) to pass the failed block, (b) to pass the module as a whole (provided no other block failures), and (c) to proceed to the organ system modules. • Students who fail TWO blocks will receive a grade of F for the course. • Students are typically required to recycle (repeat) the first year of medical school in its entirety, provided no other issues need resolution. • Failure of a block remediation examination will result in failure of the block and failure of the Fundamentals of Medicine Module. • Students who fail a block remediation are required to recycle (repeat) the first year of medical school.
	Timeline for remediation	• Required BEFORE the start of the organ system modules. Specific dates will be designated yearly. • Students unable to remediate prior to the start of organ system modules for reasons other than those considered excused under the absence policy, are required to recycle (repeat) the MS1 year.
ICM 2: Clinical Skills Integration (academic year 2023-24 and earlier)	Remediation	• Must remediate to the satisfaction of the course director. • Students who fail the remediation will recycle the MS2 year.
	Timeline for remediation	• Prior to the start of the next MS2 year. • Students unable to remediate prior to the start of the next MS2 year for reasons other than those considered excused under the absence policy, are required to recycle (repeat) the MS2 year.
Organ Modules: Cardiovascular, Pulmonary, Gastrointestinal, Renal, Neurosciences, Musculoskeletal & Skin, Endocrine, Reproductive, Hematology-Oncology Both the Summative Performance (K) component and the Application (P) component must be passed to pass the course.	Remediation	• Failure of either the Summative Performance (K) component or the Application (P) component results in a grade of F for the course. • Beginning with 2023-24 academic year, a combined raw score (Summative, Application, and Skills portions of the grade) that is below 70.0 will require a time-based remediation process. • Students must remediate the module to the satisfaction of the module director. • Failure to successfully remediate is grounds for recycling the first or second year of medical school.
	Timeline for remediation	• For MS1 courses: Prior to the start of the next MS1 year. • For MS2 courses: Prior to taking USMLE Step 1. • Students unable to remediate within the timeline for reasons other than those considered excused under the absence policy, are required to recycle the year.
Evidence-Based Medicine	Remediation	• Must remediate to the satisfaction of the module director.
Evidence-Based Medicine	Timeline for remediation	• Prior to taking USMLE Step 1. • Students unable to remediate within the timeline for reasons other than those considered excused under the absence policy, are required to recycle.
OSCEs	Remediation	• A combined OSCE average below 70.0 at the end of MS2 year will require remediation. • Must remediate to the satisfaction of the Directors of Clinical Skills program.
OSCEs	Timeline for remediation	• Prior to beginning first clerkship. • Initiation of first clerkship may be delayed until successful remediation of OSCEs.

4.2. Remediation of Grades of F in clerkships

Students receiving a grade of F in a clerkship must successfully remediate that course by repeating it. A grade of F is typically received when a student fails the clinical component of a clerkship or fails a repeated attempt on a clerkship shelf exam. Reasons for failure of the clinical component include, but are not limited to, clinical performance not meeting the standards for a passing grade as determined by the clerkship director(s), absence beyond those allowed to meet the attendance requirement, or professionalism breaches. For shelf exam failures, see section 7. Grades of N below.

The following table summarizes general actions related to grades of F in clerkships. Variations in circumstances and situations unique to individual students may alter these general guidelines. All decisions are subject to review and approval by the SASC.

Note that students receiving a grade of F in a clerkship may be allowed to repeat that clerkship on a different campus than the campus on which the grade of F was received.

Table 4.2

	Status	Continuation in Coursework	Remediation and Time Limit	Beginning New Coursework
1st Clerkship Failure	Academic Probation Usually returned to Active in Good Standing upon receipt of passing score on USMLE Step 2 CK provided no other academic issues need resolution	Student’s option to (a) complete any clerkship or course currently in progress or (b) withdraw immediately	Must repeat the entire clerkship within 12 weeks of notification of failure. Requests for an extension of this time limit must be approved by the Associate Dean for Undergraduate Medical Education prior to this deadline	Students may begin new coursework after completing the repeated clerkship
2nd Clerkship Failure	Academic Probation Subject to dismissal Usually returned to Active in Good Standing immediately prior to graduation if approved by SASC to continue	Required to withdraw from coursework immediately Placed on School-Initiated Leave of Absence	Must repeat the entire clerkship immediately upon return from leave of absence if approved to continue	Students may begin new coursework after completing the repeated clerkships provided no additional actions specified by the SASC
3rd Clerkship Failure	Academic Probation Subject to dismissal Usually returned to Active in Good Standing immediately prior to graduation if approved by SASC to continue	Required to withdraw from coursework immediately Placed on School-Initiated Leave of Absence	Must repeat the entire clerkship immediately upon return from leave of absence if approved to continue	Return to coursework dependent upon SASC decision

4.3. Remediation of Grades of F in other required courses or curriculum components.

The following table summarizes general actions related to grades of F in other required courses or curriculum components. Variations in circumstances and situations unique to individual students may alter these general guidelines. All decisions are subject to review and approval by the SASC.

Table 4.3

Preparation for Residency	Remediation	• Must remediate to the satisfaction of the course director. • Failure of remediation will require that the student repeat the full course at its next offering.
Preparation for Residency	Timeline for remediation	• Prior to graduation. • Students unable to remediate within the timeline are required to repeat the full course at its next offering.
Introduction to the Scholarly Activity	Remediation	• Must remediate to the satisfaction of the Director of Scholarly Activity.
Introduction to the Scholarly Activity	Timeline for remediation	• Prior to the beginning of the MS2 year. • Students unable to remediate prior to the start of the next MS2 year for reasons other than those considered excused under the absence policy, are required to recycle (repeat) the MS1 year.
Scholarly Activity Milestones Composed of 3 milestones. All 3 milestones must be passed to graduate	Remediation	• Failure of any milestone must be remediated to the satisfaction of the Director of Scholarly Activity. • Students who fail ONE milestone and successfully remediate the milestone will receive a grade of P for the course. Students who fail TWO milestones and successfully remediate the material will receive a grade of F/P for the course.
	Timeline for remediation	• Within 12 weeks of milestone deadline. • Students unable to remediate within 12 weeks of the deadline for reasons other than those considered excused under the absence policy, will not be able to start new coursework until the milestone is completed, may be removed from coursework, or placed on School-Initiated Leave of Absence to provide time for completion of milestone. • All milestones must be completed prior to graduation.
Learning Community 1, 2, 3, or 4	Remediation	• Must remediate to the satisfaction of the course director. • MS1-3: Failure of remediation will require that the student repeat the full course at its next offering. • MS4: May not graduate until successful remediation.
Learning Community 1, 2, 3, or 4	Timeline for remediation	• For LC 1, 2, or 3: Prior to the start of the next academic year. • For LC 4: Prior to graduation. • Students unable to remediate by the deadline for reasons other than those considered excused under the absence policy, are required to recycle (LC1-3) or may result in delay of graduation (LC4).
MS3 OSCEs	Remediation	• Must remediate to the satisfaction of the program directors. • Students will not be permitted to participate in acting internships until they pass the remediation.
MS3 OSCEs	Timeline for remediation	• Prior to beginning acting internships.

4.4 Remediation of Grades of F in other courses

Some components of the curriculum allow students to select from specified courses to fulfil that component to graduate (see graduation requirements list in Section 1). Students receiving a grade of F in such a course may opt to (a) repeat the same course or (b) select another course from the specified course list to count toward that requirement.

The following table summarizes general actions related to grades of F in courses used to fulfil graduation requirements in which a variety of courses may be used. Variations in circumstances and situations unique to individual students may alter these general guidelines. All decisions are subject to review and approval by the SASC.

Table 4.4

	Status	Continuation in Coursework	Remediation and Time Limit	Beginning New Coursework
1st Course Failure - Acting Internship or Teaching Associate Courses	Academic Probation Usually returned to Active in Good Standing immediately prior to graduation	May continue in coursework provided no other academic issues need resolution	Must successfully complete the requirement prior to graduation	N/A
1st Course Failure - Elective	Academic Probation If occurring in first or second year: Usually returned to Active in Good Standing with receipt of passing score on USMLE Step 1 provided no other academic issues need resolution If occurring in third year: Usually returned to Active in Good Standing with receipt of passing score on USMLE Step 2 CK provided no other academic issues need resolution If occurring in fourth year: Usually returned to Active in Good Standing immediately prior to graduation	May continue in coursework provided no other academic issues need resolution	Must successfully complete the requirement prior to graduation	N/A
2nd Course Failure - Any combination of Acting Internship, Electives, and/or Teaching Associate Courses	Academic Probation Subject to dismissal Usually returned to Active in Good Standing immediately prior to graduation if approved by SASC to continue	May be required to withdraw from coursework immediately dependent upon the time sequence of failures May be placed on School-Initiated Leave of Absence	If approved to continue, must successfully complete the requirement prior to graduation	Return to coursework dependent upon SASC decision
3rd Course Failure - Any combination of Acting Internship, Electives, and/or Teaching Associate Courses	Academic Probation Subject to dismissal Usually returned to Active in Good Standing immediately prior to graduation if approved by SASC to continue	Required to withdraw immediately if in coursework. Placed on School-Initiated Leave of Absence	If approved to continue, must successfully complete the requirement prior to graduation	Return to coursework dependent upon SASC decision
Special Topics (ST)	Active with Deficiency Usually returned to Active in Good Standing upon successful completion of the same or another Special Topics Course	May continue in coursework provided no other academic issues need resolution	Must successfully complete the requirement prior to graduation	N/A

5. Grades of WF

A student who withdraws from a course prior to its completion and receives a grade of WF is considered to have failed the course. Since a WF is a failing grade, it is treated in the same manner as a grade of F. All procedures related to notification and academic status are the same as those for grades of F (see above). The student will be reviewed by the SASC.

6. Grades of WP and W

A student who withdraws from a course prior to its completion and receives a grade of WP or W will not be given credit for the course or any part thereof.

7. Grades of N

A student who fails an NBME subject examination in a clerkship on the first attempt will receive a grade of N in the clerkship. Upon receipt of the score on the second attempt of the same NBME subject examination, the N grade will be amended to N/P or N/F as appropriate. After 4/29/23, a student may receive a grade of N/HP when they earn Honors for their clinical performance. A second failure of the same subject examination results in a failing grade for the course, and is treated in the same manner as a grade of F. In this case, all procedures related to notification, academic standing, and terms of remediation are the same as those for grades of F in a clerkship (see above).

Students requiring remediation on the first attempt on an NBME subject examination (N) in a clerkship will be required to successfully pass that examination within 12 weeks of notification of the examination failure. Requests for an extension of this time limit must be approved by the Associate Dean for Undergraduate Medical Education prior to this deadline. If the subject examination is not retaken within the approved period, the student may retake the course. The original course grade remains an N.

The following chart summarizes general actions related to grades of N. Variations in circumstances and situations unique to individual students may alter these general guidelines. All decisions are subject to review and approval by the SASC.

Table 7

	Status	Continuation in Coursework	Remediation and Time Limit
1st Clerkship Subject Exam Failure (N)	Active with Deficiency Usually returned to Active in Good Standing upon receipt of passing score on subject examination provided no other academic issues need resolution	Student’s option to (a) complete any clerkship or course currently in progress or (b) withdraw immediately provided no other academic issues need resolution	Must retake the examination within 12 weeks of notification of failure. Requests for an extension of this time limit must be approved by the Associate Dean for Undergraduate Medical Education prior to this deadline
2nd Clerkship Subject Exam Failure (Same Clerkship)	Grade of N/F in clerkship Academic Probation Usually returned to Active in Good Standing upon receipt of passing score on USMLE Step 2 CK provided no other academic issues need resolution	May be required to withdraw from coursework immediately. See table above regarding clerkship failure. May be placed on School-Initiated Leave of Absence. See table above regarding clerkship failure.	Must commence within 12 weeks of notification of failure by repeating the entire clerkship. In all cases, requests for an extension of this time limit must be approved by the Associate Dean for Undergraduate Medical Education prior to the deadline
2nd Clerkship Subject Exam Failure (Different Clerkships)	Academic Probation Subject to dismissal Usually returned to Active in Good Standing upon receipt of passing score on USMLE Step 2 CK provided no other academic issues need resolution	May be required to withdraw from coursework immediately if other academic issues need resolution, otherwise may remain in current course. May be placed on School-Initiated Leave of Absence	Must commence within 12 weeks of notification of failure by retaking the subject examination. In all cases, requests for an extension of this time limit must be approved by the Associate Dean for Undergraduate Medical Education prior to the deadline.
3rd Clerkship Subject Exam Failure	Academic Probation Subject to dismissal If allowed to continue, usually returned to Active in Good Standing upon receipt of passing score on USMLE Step 2 CK provided no other academic issues need resolution	Required to withdraw from coursework immediately Placed on School-Initiated Leave of Absence	Dependent upon SASC decision

8. Grades of I

Students receiving a grade of I must successfully complete any missing course requirements within the deadline stipulated by the course director to receive credit for the course. In general, a first or second year student may not commence a new academic year until any grade of I is resolved; a student in the third or fourth year has up to 1 year to resolve grades of I. Failure to successfully complete missing course requirements or failure to complete them within the specified timeframe may result in a grade of F for the course; in this case the grade of F will be treated as outlined above.

9. Multiple Grades Other Than Passing

Students receiving more than one grade other than passing, regardless of the type of each course (including Preparation for Residency, Scholarly Activity, and Learning Community), may be required to remediate courses, repeat courses, or recycle an academic year, or may be dismissed from the School of Medicine. Students receiving more than one grade other than passing, regardless of the type of each course, may also be required to stop coursework, be placed on School-Initiated leave of absence, and/or be required to remediate as outlined in tables above.

As in all cases of grades other than passing, the SASC will review each instance of failure and make determinations regarding the student’s academic progression.

9.1. In Preclinical Courses

The SASC typically takes the following actions for students receiving multiple grades of F or WF in preclinical courses:

- Receipt of two grades of F or WF during the MS 1 year: Typically required to recycle (repeat) the MS 1 year in its entirety.
- Receipt of two grades of F or WF during the MS 2 year: Typically required to recycle (repeat) the MS 2 year in its entirety.
- Receipt of two grades of F or WF in preclinical coursework during two different academic years: Typically required to remediate coursework to the satisfaction of the course directors.
- Receipt of three grades of F or WF in preclinical coursework: Subject to dismissal.

9.2. In Clerkships

Students receiving more than one grade other than passing in clerkships are subject to the actions detailed in Table 4.2 and Table 7 above.

9.3. In Other Course Types

Students receiving more than one grade other than passing in courses other than preclinical or clerkship courses are subject to the actions detailed in Table 4.4 above. The SASC will review each instance of grades other than passing for course types not addressed in the tables above and make determinations regarding the student’s academic progression.

10. Academic Dismissal

Academic dismissal will be considered for, but is not limited to, the following reasons:

Failure to successfully remediate coursework.
Failure to successfully remediate by the specified deadline.
Failure of two or more courses in a single academic year.
Failure of two or more clerkship courses.
Failure of two or more courses regardless of course type.
Grades other than passing in two or more courses, regardless of the type of grade or type of course.

As in all cases of grades other than passing, the SASC will review each instance of failure and make determinations regarding the student’s academic progression, including need for remediation, recycling, or dismissal.

11. Academic Record and Transcript

The academic transcript reflects a student’s total, unabridged academic history at the School of Medicine. All courses are recorded on the academic transcript whether attempted or completed. Grades are not removed or replaced on the transcript after a course has been remediated or repeated since doing so is inconsistent with the representation of an unabridged record (i.e., a complete, accurate, and unedited record of the student’s academic performance).

For this reason, preclinical courses remediated by examination and/or completion of assigned work appear on the academic record as F/P or F/F as appropriate. Clerkship courses remediated by repetition of the NBME subject examination appear on the academic record as N/P or N/F as appropriate. After 4/29/24 N/HP will designate when a student failed then successfully remediated the NBME subject examination and earned Honors for their clinical performance in a clerkship. In instances where a course is repeated, both course attempts will appear on the academic record with the appropriate grades.

Since the academic transcript is an unabridged academic history, a course title on the transcript reflects the name of the course at the time the course was taken. Course name changes are effective for a future term or academic year and are not retroactive.

12. SASC Authority

All decisions regarding academic status, course remediation, course completion, course repetition, recycling, dismissal, academic progression, and academic status are subject to approval by the SASC. Students can respond and appeal any adverse decision by the SASC related to status, recycling, promotion, graduation, or dismissal. See Medical Student Academic Progress Review Policy for details.

History

Policy Created: 1999
Approved: April 1, 2024, by UA System Office
Revised: March 2024

University of Alabama at Birmingham Marnix E. Heersink School of Medicine policies, statements, and guidance shall be reviewed periodically to determine whether revisions are appropriate to address the needs of the medical school community.

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