College of Medicine | Student Progress, Promotion, and Probation Policy

Medical Students (M.D.)

Policy Title: College of Medicine | Student Progress, Promotion, and Probation Policy
Classification: University
Reviewed by: EDAS Council and Dean’s Advisory Committee
Approval Authority: Student Progress Committee
Responsible Entity: College of Medicine
Policy Owner: COM Student Progress Committee

I. Policy Statement

The College of Medicine has a single standard for promotion and graduation of all students enrolled in the MD degree program. The College of Medicine Student Progress Committee is charged with conducting holistic reviews of the academic and professional progress concurrently for all medical students as defined by this progress policy, the Professionalism Standards Policy, and the Technical Standards for Admission, Retention and Graduation. The committee has the authority to determine the standing, disposition, and enrollment status of all students based on a combination of academic and professionalism performance information. The Progress Committee considers the student’s entire academic performance and professionalism history when adjudicating current deficiencies, concerns or Infractions. The standard of proof utilized by the Progress Committee will be a preponderance of the evidence.

II. Scope

This policy applies to all College of Medicine students enrolled in the MD Degree Program, including students enrolled in the MD curriculum as part of a dual degree (i.e., MSTP students).

III. Approval Authority

The College of Medicine EDAS (Education, Diversity, Admissions and Student Affairs) Council and the Dean’s Advisory Committee reviews the policy. The Student Progress Committee approves the policy.

IV. Purpose of This Policy

Students must meet the qualitative and quantitative standards defined below to qualify for a status of Satisfactory Academic Progress (SAP). The policy outlines these standards, the role of the Student Progress Committee in reviewing progress, and the conditions that constitute the following: unsatisfactory academic progress, academic probation, professionalism probation, dismissal, and other actions that the committee may take. The policy also outlines the Student Appeal Process and elements of due process.

V. Who Should Be Knowledgeable about This Policy

College of Medicine Students in the MD Program including MD/dual degree students
College of Medicine Student Progress Committee and Student Progress Appeals Committee
Teaching Faculty and Administrators in the College of Medicine

VI. The Policy

Qualitative Progress Standards

Preclerkship Phase (FLEX curriculum) students must successfully complete the following:

  • Pass all Curriculum Blocks
  • Pass the longitudinal Clinical Skills Course each semester
  • Complete all Academic and Professional Responsibilities
  • Pass United States Medical Licensing Examination (USMLE) Step 1
  • Complete the Clinical Competency Exam 2 (CCX2)

Clinical Phase - Year 3 - 4 students must successfully complete the following:

  • Pass all clinical rotations and courses, including clerkship OSCEs and knowledge-based exams (i.e., National Board of Medical Education (NBME) subject exams).
  • Complete all Academic and Professional Responsibilities
  • Pass the Clinical Competency Exam 3 (CCX3)
  • Pass USMLE Step 2CK and USMLE Step 2CS

Quantitative Progress Standards

  • The maximum period for the completion of the MD degree is 6 years from matriculation.
  • The maximum period for completion of the Preclerkship phase is 3 years from matriculation, inclusive of taking and passing USMLE Step 1.
  • The maximum time frame for completion of the Clinical Phase is 3 years inclusive of taking and passing USMLE Step 2CK and Step 2CS.
  • If a student in good academic standing is approved by the College of Medicine Associate Deans for Student Affairs to take a leave of absence for personal and/or medical reasons, up to a maximum of one year of leave time is not counted in the 6-year timeframe.

Good Academic Standing for each student is confirmed by the College of Medicine Dean's Office. Students are considered to be in good academic standing if they do not have any of the following: failing averages in preclerkship blocks or clinical skills course, incomplete or failing grades in clinical rotations, clinical knowledge-based exams or clinical skills exams, or a designation of academic or professionalism probation. Students who are not in good standing may be restricted from privileges available to students who are in good standing.

Progress Committee Review

At the end of each academic semester, the progress committee reviews the performance of students who are on probation, and reviews/approves for continuation all students in good academic and professional standing. In cases where an adverse action may be recommended by the committee, the student is invited to meet with the Student Progress Committee to discuss the circumstances that warranted concern. Students may be required to meet with the Student Progress Committee at any point in time in cases when their academic or professional conduct warrants concern. Determinations by the committee may result in but not limited to no action, non-punitive feedback to foster students’ professional growth, mandated supportive intervention, monitoring, mandatory leave of absence, probation, or dismissal.

 

Specific Circumstances that Warrant a Review by the Student Progress Committee include but are not limited to the following:


1. Preclerkship Years - FLEX Curriculum

  • A student who fails a block or blocks must pass an Assurance of Competency Exam (ACE) before the beginning of the next semester. If the student passes the ACE, then he/she may be required to meet with the Associate Dean for Student Affairs to develop an academic monitoring contract. If the student fails the ACE, the student is eligible for dismissal and will be referred to the committee.
  • If the student does not pass the Clinical Skills Course, the student is eligible for dismissal and will be referred to the committee.
  • If the student exhibits a pattern of unprofessional behavior or an egregious example of unprofessional behavior, the student will be referred to the committee.

2. United States Medical Licensing Examinations (USMLE)

Students must adhere to the USMLE regulations regarding the maximum number of attempts within one year (see USMLE Website). Students are expected to review the Federation of State Medical Boards State – Specific Requirements for Initial Medical Licensure to understand the implications of failed board examination attempts on licensure.

·       USMLE, Step 1

A student must pass all preclerkship blocks and the Board Preparation Course before taking Step 1 of the USMLE.

Preclerkship students must sit for the USMLE Step 1 before beginning clinical rotations, except for military scholarship students with an Army scholarship who have not completed any required military training prior to matriculation. These specific students may be permitted to complete up to 12 weeks of clerkship rotations prior to completing USMLE Step 1, provided that the Associate Dean for Student Affairs determines that this training requirement will delay the student’s graduation.

Students who are delayed significantly in taking Step 1 are required to have a passing score before being allowed to begin clinical rotations.

If any student does not pass Step 1 on the first attempt:

·        The student may choose to complete the rotation in progress, and will receive credit for the course if all required elements of the course are successfully completed.

·        The student may not begin any additional third year rotations until Step 1 is passed. The student will be registered for an Independent Study Course during this time.

·        The student is required to meet with the Associate Dean(s) for Student Affairs and is required to create an academic monitoring contract.

·        The student must complete a second attempt for Step 1 within 6 months of the first attempt. Failure to do so will result in review by the Progress Committee.

If the student does not pass USMLE Step 1 on the second attempt:

·        The student will be placed on academic probation and will remain on academic probation until a passing score is achieved.

·        The student will be registered for the Independent Study Course during this time.

·        Once a passing score is received, the student will be eligible to begin scheduled rotations.

Students who do not pass USMLE Step 1 by the third attempt and within 3 years from matriculation meet criteria for dismissal and will be referred to the Progress Committee.

              Clinical Competency Exam in Year 2 (CCX2)

Students must complete the clinical competency exam in year 2 before starting clinical rotations.

3. Clinical Years

A student who receives a grade of No Pass (NP) or Incomplete (IN) for a clinical course will be required to meet with the College of Medicine Associate Dean for Student Affairs and develop an academic monitoring contract. A student who receives a grade of No Pass (NP) will be required to repeat the clinical course and will be placed on academic probation. Probationary status is removed once the failed clinical course is successfully repeated.

Should a student receive a second Incomplete (IN) before clearing the first, the student must immediately withdraw from the current clinical rotation and satisfactorily remove both IN grades before progressing. A student who receives a second grade of No Pass (NP) in the clinical phase meets criteria for dismissal and will be referred to the Progress Committee. Year 3 students must remediate all year 3 course work prior to starting year 4 coursework.

·       Clinical Competency Exam in Year 3 (CCX3)

The CCX3 is the comprehensive clinical competence exam for the MD degree program. Students must achieve a passing score in order to receive the MD degree. Students must achieve a passing score on CCX3 prior to taking the USMLE Step 2 Clinical Skills (CS) exam. If a student fails the CCX3, a clinical skills mentor will be assigned to the student to assist in addressing areas that contributed to failure on the exam. The student must retake and pass the exam within 6 months. Failure to retake the exam during this time frame will result in a physicianship form. Students who do not pass the exam by the 2nd attempt will be referred to the Progress Committee for review; students who do not pass the exam by the 3rd attempt meet criteria for dismissal.

·       USMLE, Step 2 CK (Clinical Knowledge)

Successful completion of USMLE Step 1 is required before a student can take Step 2 CK. Students must take USMLE Step 2 CK prior to November 1 of the fourth year. Failure to take the exam by the deadline will result in notification of the Progress Committee. A passing score for Step 2CK is required for graduation; a student will not receive the MD degree until the exam has been passed. If a student matches to a residency position but will not have verification of passing Step 2CK in order to start residency by July 1, the College of Medicine Dean’s Office must notify the residency program of the circumstances.

If a student does not pass Step 2CK on first attempt:

·        The student is required to meet with the Associate Dean for Student Affairs and develop an academic monitoring contract.

·        The student must complete a second attempt for Step 2CK within 6 months of the first attempt. Failure to do so will result in review by the Progress Committee.

If a student does not pass Step 2CK on the second attempt, the student will be placed on academic probation and will remain on academic probation until a passing score is received. If a student does not pass Step 2CK on third attempt, the student meets criteria for dismissal and will be referred to the Progress Committee. The maximum time frame for completion of the Clinical Phase is 3 years inclusive of passing USMLE Step 2CK.

·       USMLE, Step 2CS (Clinical Skills)

Students must pass or successfully remediate the CCX3 prior to taking the USMLE Step 2 Clinical Skills (CS) exam. Students must register to take USMLE Step 2CS exam by March 1st of the third year.

Students must take USMLE Step 2CS prior to November 1 of the fourth year. Failure to take the exam by the deadline will result in notification of the Progress Committee. A passing score on Step 2CS is required for graduation; the student will not receive the MD degree until the exam has been passed. If a student matches to a residency position but will not have verification of passing Step 2CS in order to start residency by July 1, the College of Medicine Dean’s Office must notify the residency program of the circumstances.

If a student does not pass Step 2CS on first attempt:

·        The student is required to meet with the Associate Dean for Student Affairs and develop an academic plan.

·        The student must complete a second attempt for Step 2CS within 6 months of the first attempt. Failure to do so will result in review by the Progress Committee.

If a student does not pass Step 2CS on the second attempt, the student will be placed on academic probation. If a student does not pass Step 2CS on the third attempt, the student meets criteria for dismissal and will be referred to the Progress Committee. The maximum time frame for completion of the Clinical Phase is 3 years inclusive of passing USMLE Step 2CS.

If a student fails both the USMLE Step 2CK and Step 2CS on the first attempt, the student is eligible for dismissal and is referred to the Progress Committee for review and determination of suitability for continuing in the program.

Extended Academic Study

In cases where Student Affairs has determined that a student needs additional time to meet USMLE requirements, the student must first contact their designated Associate Dean for Student Affairs. The Associate Dean(s) for Student Affairs will meet with the student to create an academic plan for an extended plan of study. This agreement is designed to make sure the student meets all degree requirements in a timely manner. This agreement will include requirements and expectations for enrollment, along with a timeframe for completion of requirements. Because of enrollment requirements for financial aid, the plan may include enrollment for electives beyond what the student needs to meet for graduation requirements. This agreement must be signed by the student, Associate Dean for Student Affairs, and approved by the Student Progress Committee.

Sanctions for Non-compliance

At the end of each semester, students who failed to demonstrate adequate progress and/or do not meet the requirements of the agreement for an extended plan of study will be required to meet with the Student Progress Committee for failure to demonstrate satisfactory progress.

Academic Monitoring Contract

An academic monitoring contract is designed for students who demonstrate significant academic difficulty. A student will be required to meet with an Associate Dean for Student Affairs to develop a plan for improvement; the Student Progress Committee may also include specific requirements in the contract. While engaged in an academic monitoring contract, students may be required to limit co-curricular/extra-curricular roles and commitments until demonstrating improvement. Full, robust compliance with the terms of the contract is expected; failure to meet the contract requirements will be considered by the Student Progress Committee in determination of adverse actions.

Probation and Dismissal

Academic Probation

A student may be placed on academic probation or dismissed, at the Student Progress Committee’s sole discretion, when the Student Progress Committee identifies significant academic problems or failure to progress in a timely fashion. Conditions for probation and dismissal include but are not limited to the following:

·       Preclerkship Student Academic Probation:

·        Failing the Assurance of Competency Exam (ACE).

·        Clinical Student Academic Probation:

·        Failing grade for a clerkship or any other clinical course.

·        Failure to pass USMLE Step 1, Step 2CK, Step2 CS on the second attempt.

·        Failure to pass CCX3 on the third attempt.

The student will be informed of the probationary status and the conditions for removal of academic probation in writing. If demonstrable improvement does not occur during the academic probation period, the student meets criteria for dismissal. In the preclerkship phase, probationary status is removed once the failed preclerkship course is successfully repeated or the failed examination is passed, as applicable. In the clinical years, probationary status is removed once the failed clinical course is successfully repeated or the failed examination is passed, as applicable. 

Each student on academic probation is required to meet with the Associate Dean for Student Affairs to develop an Academic Monitoring Contract. Full, robust compliance with the terms of the contract is mandatory for continuation in medical school. Failure to adhere to the contract meets criteria for dismissal from medical school.

Professionalism Probation

A student will be placed on professionalism probation by the Student Progress Committee if the student demonstrates a pattern of unprofessional behavior or one particularly egregious example of unprofessional behavior. The student will be informed in writing of the probationary status. Each student on professionalism probation is required to meet with the Associate Dean for Student Affairs to develop a Behavioral Monitoring Contract. Full, robust compliance with the terms of the contract is mandatory for continuation in medical school and removal of probationary status. Failure to adhere to the contract meets criteria for dismissal from medical school.

For further information regarding student professionalism, please review the Student Professionalism Policy.

Academic Probation and Professionalism Probation Expectations

While on probation, a student must attend all required classes and activities unless the absence is approved in advance by the course instructor or the Dean’s Office, or the absence is due to a bona fide emergency. A physician must document the student’s absence from a major exam in the event of illness. Students on probation will not be permitted to complete rotations at other institutions during 4th year; students on probation will not be permitted to hold an elected office in student organizations nor represent the college at meetings. The student may not participate in activities that would entail absences from required courses.

Student Appeal Process

The student has the right to appeal a decision in cases where the Committee delivers an adverse action, which is any action that delays or interrupts the student’s progress , including but not limited to, dismissal or mandatory leave of absence; provided, however, students may not appeal a decision related to academic or professionalism probation. Student appeals are heard by the separate Student Progress Appeals Committee. To avoid a potential conflict of interest, none of the members from the Student Progress Committee may serve on the Student Progress Appeals Committee. All appeals to the Student Progress Appeals Committee must be requested in writing to the Office of Student Affairs no later than 7 calendar days following receipt of notice of the initial recommendation of the adverse action.

While the student is offered the opportunity to appeal all recommended adverse actions, the student can also choose at any point to waive their right to appeal. In addition, all appeals are completed in a timely manner with a goal of no longer than 30 days from the initial letter of intent to appeal until the completion of all appeal procedures. Unsuccessful appeals before the Student Progress Appeals Committee may be appealed directly to the Dean. Appeals to the Dean must be requested in writing no later than 7 calendar days following receipt of notice of the decision of the Progress Appeals Committee. All decisions rendered by the Dean are considered final.

Due Process

Confidentiality

Confidentiality is an essential element of due process; Student Progress Committee members and Student Progress Appeals Committee members sign confidentiality statements and are reminded at meetings that the committee discussions are confidential.

Conflict of Interest

Any persons participating in the Student Progress Committee or Student Progress Appeals Committee review process shall recuse themselves in any case where they have, or appear to have, a conflict of interest concerning the student.

A conflict of interest exists in situations where a member of the Student Progress Committee or Student Progress Appeals Committee is

a. Related by blood or marriage to the student;

b. A healthcare provider for the student, currently or in the past;

c. In or has been in a significant advising, social or business relationship with the student;

d. In a significant social relationship with a colleague who is related to the student;

e. In a workplace environment in which a colleague is related to a student;

f. Where a conflict of interest relating to the student has been previously identified; or

g. Anytime a committee member feels they have a conflict of interest that may influence the outcome of the review process

Members of the Student Progress Committee and Student Progress Appeals Committee will review the Medical University of South Carolina College of Medicine Policy on Conflict of Interest annually and will complete the Student Progress Committee Recusal Attestation.

If an investigator is deemed necessary by the Chair of Student Progress Committee, a member of the committee will be appointed as the investigator for review. The investigator will present information to the Progress Committee but will not participate in voting.

Procedure for Appearance before the Committee(s)

The student will be informed in writing of the reason for the request to appear before the Student Progress Committee for academic or professionalism issues (or Student Progress Appeals Committee). Notification will occur within three weeks of the reporting date and at least four working days before the issue is presented to the committee. The student will have prior access to and notice of the report of unprofessional behavior and/or academic concerns to be presented to committee. Students will be provided with a Student Interview Form that must be completed and submitted to the Office of Student Affairs at least 48 hours prior to the progress committee meeting. The Student Interview Form allows students to address the Progress Committee, in writing, the reasons for their referral. The Student Interview Form submitted to the Student Progress Committee will be utilized throughout any subsequent appeal process. The student has the option of being excused from any assignments or examinations for a period of up to 24 hours prior to the progress committee meeting. Students should direct all questions about process to Student Affairs in the COM Dean’s Office.

The student may appeal the decision of the Student Progress Committee before a Student Progress Appeals Committee and subsequently before the Dean of the College of Medicine (see Student Appeal Process).


During the committee review, it is the sole responsibility of the student to interact with the committee. Each student has the right to be accompanied by one support person (e.g. faculty member, family member). The support person or advisor is not permitted to represent the student. The support person or advisor may not address the committee or pose questions. The support person may actively support and advise the student, but shall have no interaction with members of the committee.

Reasonable efforts will be made to select a date that permits the student and support person to attend the meeting of the Student Progress Committee and the Student Progress Appeals Committee. A student may decline to meet with the committee. If a student does not respond to requests to appear before the committee, a certified letter will be sent to the student to ensure that notification was received. After certified notification, failure of the student to be present in the committee meeting will not delay the meeting and the committee may proceed with the review of the case and judgement including potentially adverse actions. Absence of the support person will not delay the committee meeting.

At the discretion of the Dean or her/his designee, the student may be removed from classes and clinical work during a Student Progress Committee review if there is a clear concern for the student’s well-being, a negative impact on patient care or a negative impact on the learning environment. The Dean or her/his designee may also grant permission to continue classes and clinical work after a final decision has been reached if notified in writing that the case is being appealed. Under no circumstances may a student graduate until the case and all appeals have been resolved.

The student has the right to expedient resolution of the matter, and every effort should be made to resolve the review in a timely manner. However, due to the nature of MUSC's environment and faculty member’s patient care responsibilities, unavoidable delays may occur in scheduling committee meetings. Such delays do not take precedence over the process itself and are not grounds for dismissal of concerns.

In the event a student should withdraw from school after a report is made but before the Student Progress Committee meets to review the issue, the concern will be permanently noted in the student’s file in pending review status. Should a student reapply to any College of Medicine program, the issue must be resolved prior to approval for readmission.

Adverse Actions, Probation, and the Medical Student Performance Evaluation (MSPE)

If the College of Medicine Student Progress Committee renders an adverse action, which is any action that delays or interrupts the student’s progress, or places a student on academic probation or professionalism probation, the Medical Student Performance Evaluation (MSPE) must disclose these action(s). The MSPE must also include documentation of approved leaves of absence for personal, medical, academic, or administrative reasons. In cases where adverse actions are rendered following the release of the MSPE, the Dean’s Office will amend the MSPE and will re-upload within the ERAS system. In cases where adverse actions are rendered following a residency position match, the Dean’s office will notify the student’s program director and provide details regarding the incident that warranted the adverse action.

Confirmation of Graduates

The Student Progress Committee approves students to receive the MD degree and submits this approval to the Dean of the College of Medicine. Near the completion of their studies, students are reviewed by the committee which awards the MD degree to students who have completed the degree requirements and who are judged by the committee to have demonstrated academic and professionalism competency fit for a career in medicine as evidenced in the institutional learning objectives of the MD degree program. Students must resolve all academic deficiencies and professionalism infractions in order to be awarded the MD degree.

Dual Degree Programs

The Student Progress Committee oversees the academic progress and professionalism review for all students who are completing the MD curriculum as part of a dual degree. (i.e., Medical Scientist Training Program (MSTP)). The committee makes determinations regarding promotion, satisfactory progress, and confirmation of completion of graduation requirements. A student enrolled in a dual degree program must complete all of MD requirements prior to approval to receive the dual degree.

VIII. Sanctions for Non-compliance

The policy addresses sanctions in detail.

 

IX. Related Information

See the College of Medicine policies related to progress and professionalism:
Professionalism Standards Policy
Technical Standards for Admission, Retention and Graduation
Grading and Assessment Policy- Clinical Years
Grading and Assessment Policy – Preclerkship Curriculum
Graduation Requirements Policy

X. Communication Plan

The policy is communicated to the College of Medicine students in the orientation to incoming students. It is also included in the COM policy module that all students and teaching faculty must review annually. When the language of the policy is revised, an email update is sent to faculty and to students. The policy is hosted on the College of Medicine website policy page for the MD degree program. The university bulletin links to this policy and is available on the university website.

 

XI. Review Cycle

This policy is reviewed by EDAS Council and the Student Progress Committee every three years at a minimum.

 

XII. Approval History

Approval Authority                                        Date Approved

Student Progress Committee November 20, 2015
Student Progress Committee June 20, 2018
Student Progress Committee July 24, 2019

XIII. Approval Signature

Signed by: Donna Kern, MD                                  
Title: Senior Associate Dean for Medical Education, College of Medicine