School of Medicine: Application Phase Summative Assessment and Grading Standards Procedure

Unit Procedure

Title

School of Medicine Offices of Medical Student Education: Application Phase Summative Assessment and Grading Standards Procedure

Introduction

Purpose

This Procedure establishes the University of North Carolina at Chapel Hill ("University") School of Medicine (SOM) Medical Doctorate (MD) degree program's assessment and grading standards for the Application Phase.

Scope

This Procedure applies to MD degree program students ("Students") in the Application Phase and evaluators, course/site directors and coordinators, and Offices of Medical Student Education (OMSE) staff involved in the Application Phase activities described in this Procedure.

Procedure

All courses at every campus and site must adhere to the assessment standards in this Procedure.

Assessment Categories, Minimum Passing Criteria, and Weights

Final Course Grades for all courses at each campus must be determined in accordance with the table below:

Course Grading Committees

Each clinical course has a Course Grading Committee composed of site directors and course directors. The committees meet once per course (every eight [8] weeks) to assess Student performance deficits, build consensus on final course grades, and work to ensure educational comparability across campuses. A representative from each campus (i.e., a campus director, a campus course coordinator for the respective course, or a campus director of the respective course) must be present at all Course Grading Committee meetings.

Final Grade Assignment and Summative Narrative Comments

The scale for final course grades must be assigned using the following guidelines:

Final Grades

• Final Course Grade Cut-Off Scores
  • 90% or Greater = Honors
  • 85% - 89.9% = High Pass
  • 72% - 84.9% = Pass
  • 71.9% or less = Fail
• Final Course Grades will be rounded to the nearest tenth.
• To receive a grade of Pass in a course, a Student must meet the passing criterion set for each assessment in the categories listed above and complete all clinical and written assignments by the last day of the course.
• To support professional growth, Students must consistently demonstrate professional behavior throughout a course. Repeated or serious lapses in professionalism may lead to a failing grade after holistic review by the Grading Committee.
• If a Student has an Incomplete Course Grade or a non-Remediated failure for any course, they cannot take any Individualization Phase Selectives.
• During a course, Students must bring any concerns about grading on assessments to the attention of the course director(s) via email within fifteen (15) business days of receiving their score. After the course, scores on individual assessments cannot be appealed.
• Course Committees will review the performance of all Students and decide by consensus if a Student requires Remediation or is not meeting course competencies. Students who fail will be required to retake the full course.
• Students not meeting competency in two (2) areas of the same course or the same area for two (2) consecutive courses will be referred to the Student Progress Committee (SPC) (e.g., if a Student does not meet competency for the OSCE and professionalism during the same course, they will be referred to the SPC).
• Course directors are responsible for notifying Students of any failure to meet a competency in any assessment. Course directors are also responsible for tracking failures and Incomplete Course Grades and ensuring Students complete all course requirements.

Summative Narrative Comments

Summative Narrative Comments should include general comments on Student performance as well as specialty-specific comments to include in the Medical Student Performance Evaluation (MSPE).

Competency Assessment Forms are due within twenty-one (21) calendar days of the last day of a course. Incomplete forms will be deleted by course coordinators. Final Course Grades are to be submitted within thirty-five (35) calendar days of course completion.

NBME Shelf Exam ("Shelf Exam")

• Failure on the Shelf Exam is defined as not achieving the minimum criteria.
• A failure of a Shelf Exam attempt is noted in the MSPE "For Deans Letter" comments in the SOM's evaluation system, One45, and on the front page of the MPSE under "remediations" and will result in referral to the SPC if the Student has failed previously failed other exams.
• A Student's first Shelf Exam score is used to calculate their Final Course Grade.
• Plans for making up missed Shelf Exams or Remediating failed Shelf Exams are developed for Students on an individual basis. All makeup Shelf Exams will be scheduled on pre-determined makeup days.
• Course directors are responsible for tracking exam failures and Incomplete Course Grades and ensuring Students complete all course requirements.
• If a Student's Final Course Grade is a Fail (F), inclusive of a Shelf Exam failure, the Course Grade will be submitted as a Fail (F) immediately. As Remediation will not alter a Final Course Grade calculation, Shelf Exam Remediation is not required to finalize Final Course Grades. Shelf Exam Remediation will occur with the course Remediation.
• If a Student fails or delays two (2) Shelf Exams or fails one (1) and delays one (1), the Student should strongly consider discontinuing the Application Phase until remediation can occur. However, once a Student has initiated a course, they will not be withdrawn for Shelf Exam failures unless the Student decides to withdraw voluntarily.
• For Students who fail a Shelf Exam twice, clinical Remediation is recommended for the course material covered on the Shelf Exam (content at the discretion of the course director/s). If a Student takes a Shelf Exam for a third time and does not achieve a passing score, they will receive a grade of Fail (F) for the course, and the Course Grading Committee will recommend that the Student retake the entire course. Decisions of the SPC may override Course Grading Committee recommendations. If a Course Grading Committee recommendation is overridden by an SPC decision: (i) the Associate Dean for Student Affairs will inform committee members of the decision verbally; and (ii) a formal notice is created by the Registrar in partnership with the chair of the SPC and sent to the appropriate parties via email.

OSCE

• Any Student who does not achieve competency on an OSCE case will need to work with course leadership and their advisor to schedule a time to retake the same OSCE case. This will need to be done when the OSCE is already being given but need not be at the same campus.
• Students will receive an Incomplete Course Grade for a grade until they retake the case and achieve competency
• Students who do not achieve competency after taking a case twice will be reviewed by the Course Grading Committee and clinical remediation may be recommended prior to taking the case for the third time. If a Student takes an OSCE case for the third time and does not achieve competency, they will receive a grade of Fail (F) for the course, and the Course Grading Committee will recommend that the Student retake the entire course.
• The original OSCE score will be used to calculate the final course grade.

Competency Assessment Form

• Any Student who does not achieve competency on each element of the Competency Assessment Form will be reviewed by the Course Grading Committee. Students who do not achieve competency for each element are at risk for failing the course or needing Remediation.
• Remediation will likely consist of an additional two (2) to four (4)-week clinical experience scheduled at the end of Application Phase.
• A Student's original Competency Assessment Form score will be used to calculate their Final Course Grade.

Professionalism Assessment Form

• Any Student who does not achieve competency on each element of the Professionalism Assessment Form as determined by the Course Committee will be assigned a grade of Incomplete and will not be eligible for Honors. The Incomplete grade will remain until the Student successfully completes the necessary remediation and achieves competency. This will be noted in the course comments on the MSPE.
• The Application Phase Leadership team (Director of the Application Phase, the Assistant Dean for Clinical Curriculum, and the Assistant Director of Curricular Affairs for Application Phase) will provide Students who do not achieve competency on each element of the Professionalism Assessment Form with professionalism materials and arrange a meeting to reflect on the areas needing improvement. During this meeting, a detailed Remediation Plan, including a timeline, will be established.
• If the Student achieves competency by fulfilling the Remediation Plan, their grade will be updated and released. Conversely, if the Student does not attain competency after Remediation, they will be referred to the Student Progress Committee. Furthermore, their performance will be reviewed in the subsequent Course Grading Committee meeting, placing them at risk of failing the course.
• A Student's original score on the Professionalism Assessment Form will be used to calculate their Final Course Grade.

Definitions

Application Phase: The twelve (12)-month clinical phase of the medical school curriculum dedicated to core clinical experiences, beginning in March and ending in February of the following, year consisting of:

• Six (6) clinical courses:
  • Community Based Primary Care
  • Pediatrics
  • Medicine
  • Surgery
  • Psychiatry
  • Obstetrics and Gynecology
• One (1) longitudinal course
  • Social and Health Systems 4

Individualization Phase: The final fourteen (14) months of the medical school curriculum dedicated to the completion of graduation requirements and electives tailored to a Student's career interest, beginning in March and ending in May of the following year consisting of:

• Two (2) Acting Internships
• One (1) Critical Care Selective
• One (1) Advanced Clinical Selective
• Four (4) Electives
• Two (2) Longitudinal Courses:
  • Science of Medicine
  • Social and Health Systems 5
• Transition to Residency (to be completed at the end of the phase)

Remediation: The process of providing additional instruction, support, and interventions to Students who Fail (F) a course.

Individualization Phase Selective: A required course offered in the fourth (4th) year (Individualization Phase). It is an MD program graduation requirement.

Incomplete Course Grade: A grade of incomplete reflects that a Student has yet to demonstrate all requirements to pass a given course at the conclusion of said course but still has the potential to do so. This may be due to a number of factors, including absences or required retakes of exams in the case of a Student achieving a passing score in the course but not achieving a passing score in a specific examination as defined by course syllabi.

Summative Narrative Comments: Written feedback provided at the end of a course, rotation, or period of training that summarizes a Student's overall performance.

Competency: An observable, measurable ability of a medical professional or trainee.

Competency Assessment Form: A structured tool used to evaluate an individual's knowledge, skills, and behaviors against defined performance standards or expectations.

Professionalism Assessment Form: A structured tool used to evaluate a student's adherence to defined professional standards.

National Board of Medical Examiners (NBME) Shelf Exams: Standardized tests from the NMBE given to Students at the end of their third (3rd)-year clinical rotations to measure mastery of the clinical knowledge required in specific medical disciplines.

Remediation Plan: A document outlining the process by which SOM will provide additional instruction, support, and interventions to Students who Fail (F) a course.

Related Requirements

External Regulations

• Liaison Committee on Medical Education (LCME) Functions and Standards of a Medical School
  • LCME 9.6: Setting Standards of Achievement
  • LCME 9.9: Student Advancement and Appeal Process

Unit Policies, Standards, and Procedures

• Student Assessment Policy
• TEC 2.0 Competencies and Milestones Policy

Contact Information

Primary Contact

Title: Assistant Director of Curricular Affairs, Application Phase

Name: Alice Stone

Email: Alice_Stone@med.unc.edu

Publication Details

Issuing Officer: Heather Tarantino, Associate Dean for Curricular Affairs, heather_tarantino@med.unc.edu

Effective Date: February 1, 2026

Review Cycle: The Application Phase Committee reviews this Policy annually and as needed and it is approved by the Education Committee.

Next Review Date: January 31, 2027