Assessment of Student Academic Performance

Evaluation of Performance in Courses

All medical school courses are taken pass/fail. It is the prerogative of each course director to determine the best method for assessing student performance for his or her course. Learning activities such as quizzes, short papers, laboratory exercises, problem sets, presentations, and group discussions, may be offered on a graded or ungraded basis at the discretion of the course director. Attendance and participation may be required where small group interaction is essential to mastery of material in the course. Course directors are expected to announce criteria for passing a course by the end of the second week of the quarter, with any subsequent modification only upon approval of a majority of students in the class.

Grading System

The following grading system is used to report the performance of students in all courses and clerkships taken while an MD degree candidate:

  • Pass (+) indicates that a student has demonstrated to the satisfaction of the responsible department or teaching group that he/she has mastered the material taught in the course. A marginal passing grade (M+) in preclinical or clinical courses is reported by the faculty to the student and the Medical School Registrar’s Office.
  • Fail (-) indicates that a student has not demonstrated to the satisfaction of the responsible department or teaching group that he/she has mastered the material taught in the course.
  • Incomplete (I) grades are given by Advising Deans. An incomplete indicates that extenuating medical or personal circumstances beyond the student’s control have prevented completion of course requirements. Following approval by an Advising Dean, the Course Director is notified prior to the final examination. An incomplete can be corrected in a manner specified by the department or teaching group and must be corrected within one year (unless the Committee on Student Performance specifies otherwise). When a student takes a final or makeup examination following an incomplete, it becomes a pass, marginal pass or fail. If the student does not attempt to correct the incomplete within the agreed upon time, it becomes a fail.
  • Continuing (N) indicates that the course has not concluded, and that the student is continuing the course, or that a required NBME Subject Exam in a clerkship has not yet been passed.
  • Exempt (EX) indicates that a course has been exempted by a placement examination. No credit has been granted. The student should register for “00” units so that the course appears on the transcript.

A student may not receive credit for repeating a course unless the content has changed significantly, as determined by the course director.

End-Quarter Policy Statement

The End-Quarter Period is a time of reduced social and extracurricular activity preceding final examinations. Its purpose is to permit students to concentrate on academic work and to prepare for final examinations. In Autumn, Winter, and Spring quarters, End-Quarter starts seven full days (to begin at 12:01 a.m.) prior to the first day of final exams. In Spring Quarter, final examinations begin on Friday; no classes are held on Thursday, the day before. In Summer Quarter, this consists of the weekend and the four class days preceding the final examinations, which take place on Friday and Saturday of the eighth week. (See the Time Schedule for dates.)

During the End-Quarter Period, classes are regularly scheduled and assignments made; this regular class time is used by instructors in whatever way seems best suited to the completion and summation of course material. Instructors should neither make extraordinary assignments nor announce additional course meetings in order to “catch up” in course presentations that have fallen behind. They are free, however, and even encouraged to conduct optional review sessions and to suggest other activities that might seem appropriate for students preparing for final examinations.

No graded homework assignments, mandatory quizzes, or examinations should be given during the End-Quarter Period except:

  1. In classes where graded homework assignments or quizzes are routine parts of the instruction process.
  2. In classes with laboratories where the final examination will not test the laboratory component. In such a case, the laboratory session(s) during the End-Quarter Period may be used to examine students on that aspect of the course.

Major papers or projects about which the student has had reasonable notice may be called due in the End-Quarter Period. Take-home final examinations, given in place of the officially scheduled in-class examination, may be distributed in the End-Quarter Period. Although the instructor may ask students to return take-home examinations early in the final examination period, the instructor may not call them due until the end of the regularly scheduled examination time for that course. Such a policy respects the principle that students’ final examinations are to be scheduled over a period of several days. End-quarter examinations may not be held during this period. This policy preserves the instruction time for courses and protects the students’ opportunities for extensive review and synthesis of their courses.

Final Examinations

Final examinations are scheduled by the Medical School Registrar’s Office, which posts tentative dates and times by the end of the previous quarter and final schedules by the end of the second week of the quarter. Students anticipating conflicts in examination schedules should seek to resolve them with course instructors.

Final examinations are governed by the regulations below:

  1. Students are expected to take the final examination unless at least 24 hours prior to the examination they have received formal written approval for either dropping the course from the course director or for obtaining an incomplete from an Associate Dean. Incompletes are given for significant personal or medical reasons beyond the student’s control. If a student does not appear for the examination and has not been granted a drop or an incomplete, the student will receive a fail.
  2. A three-hour period is reserved during examination week for the final in each course of more than two units. This period must be used, but not necessarily in its entirety, if an in-class examination is given. In courses with nonstandard meeting times, where ambiguity might exist about the period reserved for the final examination, the schedule should be clarified and students informed of the schedule no later than the end of the second week of the quarter.
  3. Final examinations in one- or two-unit courses are given at the discretion of the faculty. Examinations in one- or two-unit courses must be completed by the beginning of the reading period.
  4. When the final examination or its appropriate substitute is not an in-class examination (e.g., when an instructor assigns a take-home examination, paper, or project in lieu of an in-class examination), the schedule and format of the final examination, or its substitute, will be determined no later than the end of the second week of the quarter and, if changed subsequently, may be only a modification approved by the students.
  5. Students with documented disabilities may require special examination accommodations. The Office of Accessible Education determines if and what accommodations to recommend. The MD Advising Office receives the recommendation and conveys the request to the course directors prior to the examination.
  6. Feedback on written examinations is to be as complete as possible, correct answers distributed or posted promptly after the examination at a previously announced place, and students should receive their numerical score and its relationship to the class distribution curve in a manner that ensures student privacy. Students have the right to see their final examination and discuss it with a faculty member.
Correction of Deficiencies in Courses

Courses in the first two years are graded as pass, marginal performance, fail.

The faculty of every course must identify those students whose performance is marginal. A letter of marginal performance is sent to each student so identified and to the Medical School Registrar’s Office. Students receiving such notification may meet with the appropriate faculty and discuss the requirements for achieving an unqualified passing grade. Once a student achieves a “pass,” the performance will no longer be recorded as “marginal” in the student’s record. Students with more than one uncorrected marginal performance, or marginal performance in any course of eight units or more, will be counseled by an Advising Dean and reviewed by the Committee on Student Performance.

Students who fail a preclinical course must achieve a passing grade within one year of the failure and pass that course prior to undertaking clerkships if less than one year remains. Only the Committee on Student Performance has the power to change this requirement. The requirements for achieving a passing grade are determined by the responsible faculty. Students with a failing grade will be counseled by an Advising Dean and reviewed by the Committee on Student Performance.

Academic deficiencies in preclinical courses must be rectified prior to the beginning of clerkships or by a date specified by the Committee on Student Performance (which has the power in an appropriate case to modify any of the requirements in this paragraph). It is the prerogative of the department to determine the methods of correcting an academic deficiency and reassessing the student. The Committee on Courses and Curriculum is of the view that, as a general proposition, students should be given the opportunity to correct the deficiency in a timely fashion in order to prevent undue penalties (e.g., substantial financial and logistical difficulties) and to permit academic advancement when warranted.

Departments are encouraged to provide educational assistance to students failing required courses on the first-year grid, preferably during the first summer quarter following receipt of a failing grade, and to reexamine them prior to autumn quarter registration. Students failing courses on the autumn and winter quarter grids for the second year should, as a general proposition, be given the opportunity to correct these deficiencies prior to July 1 of that academic year. Students who receive an incomplete grade because of extenuating medical or personal circumstances should, once again as a general rule, be given the opportunity to correct the incomplete grade within a reasonable period of time in a manner specified by the department or responsible teaching group. Courses such as those in the Practice of Medicine sequence, where hands-on activities and small group interactions constitute a significant portion of the course, may require retaking of the course the following year.

Human Health and Disease (Q3-5): Statement on Feedback, Grading & Examinations
  1. Grading

Students receive a Pass or Fail assessment (Axess) after each quarter. The grade is based on a combined score from the scheduled module examinations, the integrated final examination, and the weekly problem sets. Students must achieve a passing sub-score in each course discipline to pass the course overall. Any student with marginal or failing performance will be expected to develop a plan of remediation with their advising Dean and the course directors.

  1. Policy for missed exams

Every student is expected to sit for each mid-term examination and each end-quarter integrated examination in the Human Health and Disease course. A formal Dean's excuse, from their medical school advisor, is required to make-up any missed course examination.

A Dean's excuse may be issued before a regularly scheduled examination to accommodate some essential extracurricular event or after an examination for illness.

A score of zero will be credited towards a student’s final score if an examination is missed without the advising Dean's excuse.

If a Dean's excuse is issued before a regularly scheduled mid-block or end-block examination to accommodate some essential extracurricular event, the student will be expected to take an examination at Stanford on the next weekday morning. If the Dean's excuse extends beyond the second date because of some essential activity away from Stanford, then the examination will be sent to the student and must be completed and returned within 24 hours. No other mid-block or end-block examination will be arranged for students with excuses granted before a scheduled examination. Failure to make such an arrangement will result in a score of zero on that examination. A student who misses an examination with a Dean's excuse for illness should contact Dr. Regula and appropriate arrangements will be made.

Every student is expected to sit for the integrated end-quarter final examination. Any student who misses the final examination and has a Dean's excuse must take a special final examination three days later. A score of zero will be credited towards a students' final score if the integrated final examination is missed without their advising Dean's excuse.

  1. Problem Sets

    The weekly problem sets are designed to complement the lecture topics. Problem sets are open-book and may be completed individually or as a study group. Answers to the weekly problem sets are provided by the Teaching Assistants at the weekly review sessions. In order to receive credit for your Problem Set: you must have at least 75% correct; complete it on-time.

Evaluation of Performance in Clinical Clerkships

Evaluation of performance in required clinical clerkships is accomplished through a combination of direct observation, multiple choice examinations, and/or standardized patient examinations. A faculty member is responsible for each clerkship. This individual meets with the students at the beginning of the clerkship to provide orientation and to explain the goals. The faculty member is also responsible for providing a written evaluation of the student’s performance and signing this evaluation, although the data may be obtained from other faculty and house staff. Written evaluations of clerkship performance should be completed no later than four weeks after the end of the clerkship. If there is disagreement concerning a written clerkship evaluation, the student should first request a review by the department chair or his/her designate. If the disagreement remains unresolved, the student may request review by an Associate Dean for Advising. If the matter is not resolved, the student may request review by the Committee on Student Performance.

Standardized Patient Teaching and Assessment Activities

The Standardized Patient teaching and assessment activities are designed to provide a simulated setting for teaching and assessment of the clinical and interpersonal skills of medical students. Real patients or actors are trained to consistently recreate the same situation or problem each time they encounter a student. The program currently focuses on three areas: Practice of Medicine (POM), Family Medicine clerkship, and Internal Medicine clerkship. Family Medicine and Internal Medicine clerkship students are assessed once at the end of the clerkship. A typical examination consists of eight stations or cases and is administered over approximately four hours. Feedback is provided in two parts: numerical scores in the area of clinical and interpersonal skills, and narrative representing the standardized patient’s overall assessment of the student’s performance.

Correction of Deficiencies in Clinical Clerkships

The faculty of every clerkship must identify students whose performance is marginal. A letter of marginal performance is sent to students so identified and to the Medical School Registrar’s Office. Students receiving such notification are required to meet with the appropriate faculty and discuss the requirements for achieving an unqualified passing grade. When a “pass” is achieved, the performance will no longer be recorded as “marginal” in the student’s record.

A student with a marginal performance will be counseled by one of the Advising Deans and reviewed by the Committee on Student Performance. All marginal performances in clerkships must be corrected prior to graduation.

Students who fail a clerkship must achieve a passing grade within one year of the failure. The requirements for achieving a passing grade are determined by the responsible faculty. Students with a failing grade will be counseled by one of the Advising Deans and reviewed by the Committee on Student Performance. Unless the failure is rectified, the student will not be permitted to graduate.

Medical Student Performance Evaluation (MSPE - A.K.A. Dean's Letter)

Medical Student Performance Evaluation (MSPE), also known as the Dean’s Letter, will be written by the Advising Deans and sent to residency program directors as part of the application to obtain positions for postgraduate training. The letter is written with the student’s input and submitted in the autumn of the student’s final year of medical school. This letter is a narrative evaluation of the student’s accomplishments in medical school. Achievements during clinical clerkships and attributes as potential house officers and physicians are major points of emphasis. Recognition of accomplishments in research, teaching, and community service is also included in the letter.

For more information about the MSPE, refer to the student resources section of the MD Advising Web site:

https://med.stanford.edu/md/advising/

 

 

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