Grading Policy - Clinical Years (Clerkship & Advanced Electives)

  1. Overview

    • (1.1) This policy describes the procedure for assigning final clerkship grades for DGSOM medical students.  In March 2022, the Medical Education Committee voted in favor of core clerkships being graded on a Pass/Fail basis effective as of the 2022-2023 academic year.  Grading of 4th-year electives remains unchanged as described below.  An Overall Clerkship Grade is reported on each student’s transcript.  
    • (1.2) The policy is updated annually at the beginning of each academic year and applies to all students completing clerkships/electives within that year. 

  2. Overall Grades for Core Clinical Clerkships

    • (2.1) The Core Clinical Clerkships include Emergency Medicine, Family Medicine, Internal Medicine, Neurology, Obstetrics and Gynecology, Pediatrics, Psychiatry, and Surgery. The possible grades for each Core Clinical Clerkship are: Pass, Fail, or Incomplete. Grades are submitted and available for student review within six weeks of clerkship completion.  The Clerkship Chair may assign the Incomplete grade to either the clinical or final examination grade (which in turn translates to an Incomplete overall grade) when either the clinical work is of passing quality but is incomplete, or the final examination has not been taken.  A grade of Incomplete in core clerkships is resolved after the student satisfactorily completes clinical coursework, as specified by the Clerkship Chair, and/or the final examination or the time to meet those requirements expires. The Incomplete grade remains on the transcript until resolved and all Incomplete Clerkships must be passed before proceeding to 4th year coursework.
    • (2.2) For the Core Clinical Clerkships, an Overall Clerkship Grade of Pass or Fail is assigned.  In order to receive a grade of Pass, students must complete all clerkship requirements and achieve the minimum passing standard for both clinical performance and the National Board of Medical Examiners (NBME) Shelf Exam.  

  3. Clinical Grade Contribution

    • (3.1) The Clinical Grade is calculated and reviewed by each Core Clerkship Chair in collaboration with the Clerkship Grading Committee. The Clerkship Chair and Grading Committee use a rubric tallying 13 possible evaluations of clinical skills for the Core Clerkships.  
    • (3.2) The Clinical Skills on the DGSOM-UCLA Clerkship Evaluation Form include: 
      1. History Taking
      2. Physical Examination
      3. Fund of Knowledge
      4. Differential Diagnosis Development
      5. Treatment Plan Generation
      6. Medical Record Documentation
      7. Oral Presentations
      8. Communication with Patients and Families 
      9. Communication with the Interprofessional Team
      10. Humanism
      11. Integrity and Work Ethic
      12. Commitment to Learning
      13. System-Based Practice
    • (3.3) Each clinical skill is rated using criterion-based anchors along four levels of performance.  For each clinical skill, the evaluator will choose the descriptor amongst the four possible options that best describe the student’s performance. If an evaluation of a clinical skill is not possible due to lack of observation, the evaluator should select “Unable to Evaluate/Insufficient Contact.”  For each Core Clerkship, the Clerkship Chair(s) and Site Director(s) will produce a summative evaluation as well as a composite narrative. 
    • (3.4) The Clerkship Chair in collaboration with the Clerkship Grading Committee assigns a Clinical Performance Grade by calculating a Total Evaluation Score from a compilation of the individual evaluations of clinical skills received, which is a percentage value of the total score possible. Because the number of clinical skills assessed may vary by clerkship, each Total Evaluation Score is calculated as a percentage. If a student receives evaluations for all 13 clinical skills, the denominator for the percentage calculation is 13; if only 9 competencies are assessed, the denominator is 9.  Each Evaluation Score will then be calculated as a ratio against the highest score possible – the highest score possible being that which would be arrived at if all clinical skills were scored at the highest level. For example, if 9 items are submitted, the maximum score is 36 (4 X 9); for all 13 clinical skills, 52 (4 X 13). Each student is evaluated by descriptive anchors and these are assigned a value on a scale 1-4. A null value is assigned for designations of "insufficient contact or unable to comment" for any of the clinical skills. Based on a review of the total evaluation scores and the evaluator comments, the Clerkship Chairs have ultimate oversight of the final grades assigned for each clerkship.
    • (3.5) The Total Evaluation Score is then used to arrive at the Clinical Performance Grade. A total evaluation score > 48% will result in a clinical performance grade of Pass. A total evaluation score of <48% will result in a clinical performance grade of Fail.
      In addition to earning a Total Evaluation Score of at least 48% as above, to pass the clinical course, the student must meet a minimum performance standard in all 6 ACGME Competencies.  The 6 ACGME Competencies are listed below, along with the percentage of total available points required to PASS. 
      1. Patient Care (Clinical Skills 1 and 2) – 50% 
      2. Clinical Knowledge (Clinical Skills 3, 4 and 5) –33% 
      3. Interpersonal Skills (Clinical Skills 6, 7, 8 and 9) – 50% 
      4. Professionalism (Clinical Skills 10 and 11) – 50% 
      5. Practice-Based Learning (Clinical Skill 12) – 50% 
      6. Systems-Based Practice (Clinical Skill 13) – 25% 
    • (3.6) Student evaluation forms will be assigned to residents, fellows, attendings, and at times, other licensed health professional faculty as follows:  
      1. Clerkship Site Coordinators will obtain the list of residents, fellows, and attendings (and other licensed health professional faculty if applicable) with whom students have worked. When clinical service structure allows, the site coordinators will confirm the list of supervising physicians using the student schedules and resident, fellow and attending schedules. When discrepancies exist, the site coordinator will contact the supervising physician to confirm the appropriateness for evaluation. 
      2. Supervising physicians who have had sufficient contact to fairly evaluate student performance on at least one clinical skill will be expected to complete individual evaluations. 
      3. A composite of all individual evaluations submitted will be utilized in assessing student performance, with collaboration between Site Directors and Clerkship Chair(s) in assigning the final clinical performance grade. 
      4. A narrative assessment of each student’s performance is compiled utilizing the individual comments provided by evaluators, and the most representative descriptions from the “comments” section will be incorporated into the Medical Student Performance Evaluation (MSPE) letter for residency applications at the discretion of clerkship leadership. Prior to finalizing the summative evaluation, the narratives and comments are reviewed for language that may suggest bias.  The “feedback” section of the narrative evaluation will serve to provide meaningful feedback to the student about their clinical performance with recommendations for improvement.  Comments from the “feedback” section do not appear in the MSPE.  
    • (3.7) Students are alerted by email when a clerkship summative evaluation has been finalized and submitted to the Dean’s Office. Students who feel there is an error in their evaluation may request a review with the Clerkship Chair(s) to better understand their evaluation. This request must be submitted in writing to the Clerkship Chair(s) within 14 days of grade submission. Edits to the summative evaluations will be limited to errors such as incorrect names or pronouns, grammar, etc.  Clerkship Chairs do not add or delete comments from the MSPE section of the summative evaluation once submitted to the Dean’s Office.  Evaluations may not be revised by completing additional work with the exception of an incomplete.  

  4. Final Examination (NBME) Grade

    • (4.1) The NBME Shelf Exam minimum passing standard is set based on annual national percentile exam reports for each required clerkship.  The percentile score is Pass >5th percentile and Fail: < 5th percentile. 
    • (4.2) Percentile data is obtained from annual reports from the NBME for each of the eight clinical subject (shelf) exams. The scores corresponding to the percentile nearest (but above or equal) to the 5th percentile are identified at the beginning of each academic year, based on the last academic year.  
    • (4.3) The National Board of Medical Examiners (NBME) ensures that each reported subject examination score is an accurate reflection of the responses for an examinee.  This is based on reliable scoring and reporting techniques backed by a variety of quality control and verification procedures by the NBME.  Given the above, DGSOM does not submit requests to the NBME for score re-checks on behalf of students. 

  5. Required Clerkship Radiology Course

    • (5.1) Students also complete asynchronous radiology modules relevant to each clerkship and take and pass a written radiology examination during each core clerkship. These scores are compiled upon completion of the clerkship year to arrive at a final radiology examination grade.  A minimum cumulative score of 70% is required to pass the course.  This grade does not appear on the transcript.    

  6. Course Failure Policy in the Core Clinical Clerkships

    • (6.1) Fail 1 clerkship exam (NBME shelf exam): 
      1. One clerkship exam failure will result in an Incomplete grade.  There is no change in the student’s academic/professional standing after the first clerkship exam failure.  There is no requirement for the student to suspend clerkship activity. 
      2. The student is permitted to retake the exam for a second attempt on a designated exam date following two weeks of study with no required clerkships. 
    • (6.2) Fail retest of a clerkship exam (NBME shelf exam):
      1. The student’s grade for that clerkship will remain Incomplete.  The student’s standing is changed to Experiencing Academic/Professional Difficulty.  There is no requirement for the student to suspend clerkship activity. 
      2. The student is permitted to retake the exam for a third attempt on a designated exam date following two weeks of study with no required clerkships. 
    • (6.3) Fail second re-test of clerkship exam (third attempt of NBME shelf exam):
      1. Three exam failures on the same clerkship will result in a grade of Fail/No Credit.  The student’s standing is changed to Academic/Professional Probation.  The student is required to repeat the clerkship in its entirety. 
      2. If the student repeats the clerkship and passes the clerkship examination on the fourth attempt, the grade will appear on the transcript with an asterisk designating that the course was repeated. 
      3. If the student fails the exam after repeating the clerkship (now a total of four failures on a single exam) this may result in a referral to CASPP for consideration of dismissal. 
    • (6.4) Students with Multiple Incomplete Clerkships
      1. If a student fails exams in two different clerkships, the student does not need to suspend future clerkship activity. The student is permitted to retake both failed exams on two different designated exam dates following two weeks of study for each exam with no required clerkships. 
      2. If a student fails or does not sit for exams in three different clerkships (three incomplete clerkships when adding exams either not taken or failed) the student will not be permitted to move forward in the curriculum. The student must drop their next clerkship(s) and enroll in an Independent Study course until at least one clerkship shelf exam has been taken and passed.  Students with two or fewer incomplete grades due to exam failures or missed exams will be permitted to remain in the curriculum but will need to retake the failed exam(s) at a later date, after two weeks of dedicated study time on an exam administration date. 
    • (6.5) Clinical Failure
      1. If a student fails the clinical portion of a clerkship, the student will receive a grade of “Fail” and must remediate by repeating the clerkship in its entirety, including the final examination, even if the exam was previously taken and passed. 
    • (6.6) Clinical Remediation Failure
      1. The only acceptable grade for remediation is “Pass." A grade of "Fail" upon remediation is not acceptable and will result in recommendation for dismissal to CASPP. 

  7. Overall Grades for Fourth Year Clinical Electives at DGSOM at UCLA

    • (7.1) Fourth-year clinical rotations (400 level, 300 level and 200 level with the exception of global health) are graded using the 4-tier Clinical Grade system of Honors/ High Pass/ Pass and Fail.  The UCLA Clinical Grading Rubric will be used to arrive at the Clinical Performance Grade as follows: 
      1. Total Evaluation Score 88-100% = Honors Clinical Grade Performance
      2. Total Evaluation Score 75-87% = High Pass Clinical Grade Performance
      3. Total Evaluation Score 48-74% = Pass Clinical Grade Performance
      4. Total Evaluation Score <48% = Fail Clinical Grade Performance

        As no written examinations are administered for fourth-year electives, the Clinical Performance Grade will be the Overall Grade for designated fourth-year elective rotations. Students must also meet the same minimum competencies as described in section 3.5 above for core clinical clerkships to pass graded fourth-year electives. 
    • (7.2) To achieve a Clinical Performance Grade of High Pass in a 4th-year clinical rotation, in addition to a total summative evaluation score of 75-87%, there can be no Clinical Skill evaluated at criterion level 1 on the summative evaluation, and the student must achieve a criterion level 3 or 4 in each applicable Professionalism Competency (Clinical Skills 10 and 11) as evaluated on the summative grade.  
    • (7.3) To achieve a Clinical Performance Grade of Honors in a 4th-year clinical rotation, in addition to a total summative evaluation score of > 88%, there can be no Clinical Skill evaluated at criterion level 1 or 2 on the summative evaluation, and the student must achieve a criterion level 4 in each applicable Professionalism Competency (Clinical Skills 10 and 11) as evaluated on the summative grade.
    • (7.4) A narrative assessment of each student’s performance is compiled utilizing the individual comments provided by evaluators, and the most representative descriptions from the “comments” section will be incorporated into the Medical Student Performance Evaluation (MSPE) letter for residency applications at the discretion of the Course Chair. The “feedback” section of the narrative evaluation will serve to provide meaningful feedback to the student about their clinical performance on the elective with recommendations for improvement.  Comments from the “feedback” section do not appear in the MSPE. 
      Based on review of the total evaluation scores and the evaluator comments, the Course Chair(s) have ultimate oversight of the final grades assigned for each course. As with clerkship grades, all narratives are reviewed by the course chair for bias prior to submission.  
    • (7.5) Course Chairs are asked to meet with students whose performance is failing in order to provide the student with feedback and recommendations to improve their performance.  In addition, the Associate Dean for Student Affairs will also be notified by the Course Chair as soon as possible of students who have been determined to be at risk of failing the course. 
    • (7.6) All performance evaluations and assessments must be submitted within four weeks of the conclusion of the course.  Students are alerted by email when an elective course grade has been finalized and submitted to the Dean’s Office. Students who feel there is an error in their clinical grade may request a review of their summary evaluation with the Course Chair to better understand the grade assigned. This request must be submitted in writing to the Course Chair within 14 days of grade submission.  Edits to the summative evaluations will be limited to errors such as incorrect name or pronouns, grammar, etc.  Clerkship Chairs do not add or delete comments from the MSPE section of the summative evaluation once submitted to the Dean’s Office.  Grades may not be revised by completing additional work with the exception of an incomplete. 

  8. Clinical Experiences in Fourth Year that are Pass/Fail

    • (8.1) The following courses are graded Pass/Fail: Global Health, Research, Special Electives and 100 level non-clinical electives.  The transcript will indicate a grade of P  (Pass) or F (Fail). 
    • (8.2) Students on away electives may be evaluated with the host institution’s evaluation system or with the DGSOM Elective Evaluation Form. The DGSOM transcript will report the grade as P or F.  The MSPE will include the evaluation narrative if submitted by the deadline for evaluations to be included in the MSPE. 

Approved by MEC in March 2022; Updated by Educational Affairs in August 2023

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