Unit Policy
Title
Department of Health Sciences, Physician Assistant Program: Policy on Clinical Rotation Grading
Introduction
Purpose
This Policy defines how Physician Assistant (PA) Program (Program) students (Students) are graded in Rotations during the Clinical Phase of the Program.
Scope
This Policy applies to Program faculty and Students who have matriculated into the Program.
Policy
Policy Statement
The Clinical Phase of the Program is an important phase where Students are evaluated on an ongoing basis for preparedness to practice, and where grading is used to determine progress or remediation in the Program. Students must complete a total of ten (10) Rotations during the Clinical Phase: (i) eight (8) Required Rotations; and (ii) two (2) Elective Rotations.
Clinical Rotation Grading
Each of the Program’s Rotations is its own discrete course for which Students receive a final course grade. A Student’s final Rotation grade reflects the comprehensive evaluation of the Student’s performance during their Rotation, and includes, but is not limited to, consideration of the following:
- The Preceptor’s evaluation of the Student for the Rotation;
- The Student’s performance on Objective Structured Clinical Examinations (OSCEs);
- The Student’s performance on Rotation assignments; and
- The Student’s performance in completing Patient Logs & Time Sheets during the Rotation.
All assignments and required course components of a Rotation are published in the Rotation’s syllabus, along with the Rotation’s Learning Outcomes; Instructional Objectives; and Grading weighting and breakdown.
All of the Program’s Rotations are Pass/Fail courses. This means that, for all Rotations, Students must achieve a minimum final weighted grade of seventy percent (70%) in order to receive a grade of ‘pass’. For Required Rotations, Students must receive a Passing Threshold grade on the Rotation’s End of Rotation (EOR) Examination in order to pass the Rotations. Elective Rotations do not have EOR Examinations.
End of Rotation Examinations
Schedule and Attendance
EOR Examinations are administered on the final day of each Required Rotation on campus with in-person proctoring unless otherwise specified in writing via email by the Director of Clinical Education (DCE). Students are required to attend all EOR Examinations. Students who fail to take an examination due to Unapproved Absence or Excessive Tardiness may be referred to the Student Progress Committee by the DCE for further consideration.
Make-up Examinations
Make-up examinations for Excused Absences are scheduled by the DCE. Make-up examinations for Unapproved Absences or Excessive Tardiness, if determined appropriate by the Student Progress Committee, will also be scheduled by the DCE.
Details and Grading
The Program utilizes EOR Examinations provided by the Physician Assistant Education Association (PAEA). PAEA EOR Examinations each consist of one hundred and twenty (120) questions. Students are allotted two (2) hours (120 minutes total), split into two (2) one (1) hour sessions, for each examination and are provided with a ten (10)-minute break following the one (1) hour session. Students’ Academic accommodations must be approved by the University Office of Equal Opportunity and Compliance (EOC) and cannot be applied retroactively.
Scores for EOR Examinations are reported on a scale of 300-500 (i.e., lowest possible score = 300, highest possible score = 500), as determined by PAEA. The passing threshold is specific to each Required Rotation’s EOR Examination and has been determined by calculating one standard deviation from the national mean, as published by PAEA.
Students must achieve the minimum passing threshold for each EOR Examination prior to receiving a final grade for that Required Rotation. The minimum passing thresholds for each EOR Examination are as follows:
| Required Rotation |
Passing Threshold |
| Family Medicine |
≥384 |
| Internal Medicine |
≥389 |
| Surgery |
≥392 |
| Pediatrics |
≥391 |
| Obstetrics/Gynecology |
≥386 |
| Behavioral Medicine |
≥390 |
| Emergency Medicine |
≥390 |
| Primary Care |
≥384 |
Student Requirements
In order to maintain EOR Examination integrity, Students must adhere to the following:
- Arrive promptly at least fifteen (15) minutes before the designated examination start time.
- Have only the following resources in an examination room: laptop or tablet device; pen/pencil; and one (1) blank scratch sheet of paper. All resources must be verified by the examination’s proctor for use during the examination. Students must leave all other belongings, including beverages, tissue boxes, etc. outside an examination room.
- Students are permitted one ten (10)-minute break between sixty (60)-question sections. Students are not permitted to talk or access study materials, electronic devices, or any other resources during this break.
- Not look at other Students’ screens or take screenshots of examination questions at any point during an examination.
- Not talk or ask questions during an examination.
- Not permitted to wear any kind of electronic devices, including, but not limited to, wrist devices such as smart watches, virtual glasses, and/or headphones during an examination. Students are permitted to use ear plugs.
- If a Student experiences technical difficulty during an examination, the Student must raise their hand, and the proctor will assist them.
- Follow all policies associated with PAEA EOR Examinations. Students who violate these policies will be referred to the Student Progress Committee for possible disciplinary action, which may result in a Student’s referral to the University Honor System, failure of the Rotation, etc.
Failure of First EOR Examination
If a Student fails an EOR Examination for the first time:
- The Student must meet with the DCE within five (5) business days of the original examination date.
- The Student will receive an “Incomplete (IN)” as a final course grade for that Required Rotation pending Remediation and retesting.
- The Student will be required to complete a Remediation assignment as determined by the DCE prior to the Student being eligible to retest with a Remediation EOR Examination. If the Student fails to complete the Remediation assignment by the assigned date and time, the Student will receive a “zero” for the retest.
- Upon their successful completion of the Remediation assignment, the Student will be required to take a Remediation EOR Examination on the second Monday of the following Rotation (approximately ten (10) days after the failed EOR Examination, subject to the Policy on Leave of Absence).
- The Student must achieve the minimum passing score for the Required Rotation’s EOR Examination on the Remediation EOR Examination.
- The Student will be excused from their then-current Rotation only to take the remediation EOR Examination. The Student’s absence for their Rotation will not count toward their total absences in the Clinical Phase.
Failure of Remediation EOR Examination
If a Student fails a Remediation EOR Examination or receives a zero for failure to complete a Remediation assignment:
- The Student will fail the Required Rotation and receive a final course grade of Fail (F).
- The Student will be referred to the Student Progress Committee for academic performance concerns.
- The Student Progress Committee will determine an appropriate action.
- If the Student Progress Committee recommends further Remediation, the Student will be required to repeat the entire Required Rotation and will be held to all requirements outlined in the course’s syllabus, including taking the EOR Examination. The Student’s final course grade of Fail (F) for their first attempt of the course will remain on the Student’s transcript, regardless of the Student’s final course grade for the repeated Required Rotation.
- If another EOR Examination is not available for the Student’s repeated Required Rotation, the Program will require the Student to take a comparable multiple-choice examination containing the same breadth and depth of content.
- The Student may be delayed in their Program completion and graduation.
Failure of Two EOR Examinations (from different required rotations)
If, after already having failed an EOR Examination for a Required Rotation, a Student fails an EOR Examination for a different Required Rotation, the Student will:
- Perform the Remediation process outlined above under “Failure of First EOR Examination”.
- Be referred to the Student Progress Committee for ongoing academic performance concerns.
Failure of Second Remediation EOR Examination
If a Student fails a second Remediation EOR Examination, the Student will receive a final course grade of Fail (F) for that Required Rotation and be referred to the Student Progress Committee for dismissal.
Failure of Third EOR Examination
If a Student fails a third EOR Examination, and the third failure is not a second Remediation EOR Examination, the Student will be referred to the Student Progress Committee for academic performance concerns.
Definitions
Elective Rotation: Supervised clinical practice experiences that may differ by Student and which allow Students to gain exposure to, or a deeper understanding of medical specialties related to their clinical areas of interest.
End of Rotation (EOR) Examination: This is a multiple-choice examination all Students must take at the end of each Required Rotation. This examination is specific to each Required Rotation and is intended to objectively assess medical knowledge related to the specialty.
Excessive Tardiness: Occurrence of a Student being more than fifteen (15) minutes late for an examination. A Student who is excessively tardy for an EOR Examination will not be permitted to sit for that examination and, as a result, will receive a score of “zero” on the examination and fail the Required Rotation.
Instructional Objectives: Statements that describe observable actions or behaviors that a Student will be able to demonstrate after completing a unit of instruction. Instructional Objectives serve as a guide for Students in achieving Learning Outcomes.
Learning Outcomes: The medical knowledge, interpersonal, Clinical and Technical skills, professional behaviors, and clinical reasoning and problem-solving abilities that a Student has attained after completing a curricular component of the Program. All learning outcomes are assessed.
Objective Structured Clinical Examination: A standardized assessment tool used to evaluate a Student’s clinical and/or technical skills in a simulated environment.
Pass/Fail Course:
Preceptor: Any instructional faculty member who provides Student supervision during supervised clinical practice experiences. Also referred to as the preceptor of record. Trainees may not be preceptors.
Required Rotation: Rotations that the Program requires all Students to complete. While an elective rotation may be required, it is not included in this definition because the definition of the elective rotation varies.
Remediation: The Program-defined process for addressing deficiencies in a Student’s knowledge and skills, such that the correction of these deficiencies is measurable and can be documented.
Rotation: A Supervised Clinical Practice Experience for which there are published expected learning outcomes and Student evaluation mechanisms.
Supervised Clinical Practice Experiences (SCPEs): Supervised Student encounters with patients, either in-person or by telemedicine, that include comprehensive patient assessment, involvement in patient care decision-making, and result in a detailed plan for patient management. The Program also refers to SCPEs as “Rotations”.
Unapproved Absence: A Student’s absence from an examination for which the Student did not receive prior approval from the Program’s Director of Clinical Education (DCE). A Student with an Unapproved Absence for an EOR Examination will receive a score of “zero” on that examination, resulting in the Student’s failure of the Required Rotation.
Related Requirements
External Regulations
Unit Policies, Standards, and Procedures
Contact Information
Primary Contact
Name: Administrative Support Specialist
Telephone: 919-962-8008
Email: paprogram@unc.edu