Policies and Procedures for Evaluation, Grading, and Promotion of Boston University School of Medicine MD Students
Boston University School of Medicine (BUSM) is committed to high academic and professional standards for its curriculum, faculty, and students. These policies and procedures should guide faculty and students in achieving their educational goals.
Four Curricular Pathways are available for students. In addition to the standard four-year curriculum, alternatives are available for students who wish to have time to pursue other interests along with their medical studies or to reinforce selected aspects of their medical education. To be eligible for graduation, each student must satisfactorily complete the required courses, electives, clerkships, and rotations for each of the four curricular years at BUSM as well as all other BUSM and University requirements, including payment of tuition and other charges and other fiduciary responsibilities. The current federal requirement for Satisfactory Academic Progress for eligibility for federal loan programs is a maximum time to degree completion of 150% of the program length. Exceptions need to be approved by the SEPC. Thus BUSM students in all curricular pathways are expected to complete the four-year program in no more than six years: three years to complete the first and second curricular years, and three years to complete the third and fourth curricular years. The Standard Curriculum leads to the completion of the MD degree in four consecutive years following matriculation into BUSM: two years of pre-clerkship basic science courses, and two years of clinical clerkships and rotations. The student is registered as full time each semester and is charged full tuition. A BUSM 3 or 4 student making satisfactory academic progress may apply for a Modified Curriculum for research, internships, clinical experiences, additional educational opportunities, or personal reasons. The curricular year is extended beyond 12 months. The student is registered as full or part time, depending on the number of credit hours, and is charged for specific credit hours. Students who encounter academic difficulties after the first five weeks of any semester for the third and fourth curricular years may request, or may be required by the Student Evaluation and Promotion Committee (SEPC, see below) to enter the Decelerated Curriculum. The remaining courses of that curricular year will be spread out over an extended period as determined by the SEPC. BUSM 3 and 4 students may enter the Decelerated Curriculum for periods up to a total of an additional 12 months. For the semester of entry into the Decelerated Curriculum, tuition charges cannot be adjusted. For subsequent semesters in the Decelerated Curriculum, the student is charged for specific credit hours, and is registered as full time or part time, depending on the number of credit hours. Performance of students admitted to the Decelerated Curriculum may be reviewed by the SEPC at any of its meetings. Students in the Decelerated Curriculum are subject to normal guidelines governing promotions and must remediate a Fail or Incomplete grade. The total number of courses remediated in a curricular year cannot exceed the limits established for other students in the relevant policy statement.
1. Curricular Pathways
1.1 Standard Curriculum:
1.2 Modified Curriculum:
1.3 Decelerated Curriculum:
Four Curricular Pathways are available for students. In addition to the standard four-year curriculum, alternatives are available for students who wish to have time to pursue other interests along with their medical studies or to reinforce selected aspects of their medical education.
To be eligible for graduation, each student must satisfactorily complete the required courses, electives, clerkships, and rotations for each of the four curricular years at BUSM as well as all other BUSM and University requirements, including payment of tuition and other charges and other fiduciary responsibilities.
The current federal requirement for Satisfactory Academic Progress for eligibility for federal loan programs is a maximum time to degree completion of 150% of the program length. Exceptions need to be approved by the SEPC.
Thus BUSM students in all curricular pathways are expected to complete the four-year program in no more than six years: three years to complete the first and second curricular years, and three years to complete the third and fourth curricular years.
The Standard Curriculum leads to the completion of the MD degree in four consecutive years following matriculation into BUSM: two years of pre-clerkship basic science courses, and two years of clinical clerkships and rotations. The student is registered as full time each semester and is charged full tuition.
A BUSM 3 or 4 student making satisfactory academic progress may apply for a Modified Curriculum for research, internships, clinical experiences, additional educational opportunities, or personal reasons. The curricular year is extended beyond 12 months. The student is registered as full or part time, depending on the number of credit hours, and is charged for specific credit hours.
Students who encounter academic difficulties after the first five weeks of any semester for the third and fourth curricular years may request, or may be required by the Student Evaluation and Promotion Committee (SEPC, see below) to enter the Decelerated Curriculum. The remaining courses of that curricular year will be spread out over an extended period as determined by the SEPC. BUSM 3 and 4 students may enter the Decelerated Curriculum for periods up to a total of an additional 12 months. For the semester of entry into the Decelerated Curriculum, tuition charges cannot be adjusted. For subsequent semesters in the Decelerated Curriculum, the student is charged for specific credit hours, and is registered as full time or part time, depending on the number of credit hours.
Performance of students admitted to the Decelerated Curriculum may be reviewed by the SEPC at any of its meetings. Students in the Decelerated Curriculum are subject to normal guidelines governing promotions and must remediate a Fail or Incomplete grade. The total number of courses remediated in a curricular year cannot exceed the limits established for other students in the relevant policy statement.
2. Academic Record and Official Transcript
The Academic Record comprises the unabridged (as of the class starting in 2010) documents and electronic images maintained by the Office of the Registrar that reflect the academic history of the student at the institution. This chronological listing of the student’s total quantitative and qualitative learning experiences and achievements also includes the AMCAS application file, SEPC petitions, SEPC letters, evaluation forms, Supplemental Student Evaluation forms, grade change forms, the Medical Student Performance Evaluation (formerly known as the Dean’s Letter), final transcript, USMLE scores, LOA forms, Withdrawal forms, Dismissal forms, disciplinary records, and other documents.
The student’s official academic transcript documents participation in the Alternative/Modified/Decelerated curriculum, transfer into the medical school, interruptions in the student’s progress through the curriculum, and actions including Academic or Disciplinary Suspension or Academic Dismissal.
2.1 Student Evaluation:
Each department or faculty or other organized teaching program evaluates students by means they judge appropriate to their respective courses, and forwards evaluations to the Registrar with a copy to the Associate Dean for Student Affairs. The Registrar provides grades for failing students to the SEPC and to the Associate Dean for Academic Affairs.
2.2 Grades and Definition of Grades:
The BUSM grading system is used to report grades for all courses. Evaluation of student performance must be expressed as one of the following grades:
H (Honors) is used only for third- and fourth-year clerkships and rotations and indicates that the student’s performance and achievement are outstanding. Consistent performance at this level throughout the curriculum is required for graduation with Academic Honors.
HP (High Pass) is used only for third- and fourth-year clerkships and rotations and indicates performance just short of Honors, exceeding satisfactory or acceptable performance.
P (Pass) indicates an acceptable performance and achievement. Consistent performance at this level throughout the curriculum is expected of a student qualified for promotion and graduation. BUSM students must have all Pass grades to be eligible for promotion and for graduation.
I (Incomplete): Work in the course, clerkship, or rotation is incomplete.
If a student is unable to complete a course, clerkship, or rotation due to circumstances beyond his or her control (e.g., an emergent illness in which the student is incapacitated), the student may receive an Incomplete if s/he is in good standing in that course, clerkship, or rotation. The Course Director/Clerkship Director/Rotation Director will provide a plan for the student to complete the course.
Students must contact the appropriate Course Director or Clerkship/Rotation Director and the Associate Dean for Student Affairs in advance whenever possible to explain any inability to take a scheduled examination or to meet other course obligations. If the Course Director or Clerkship/Rotation Director finds the reason acceptable, e.g., serious illness or a death in the immediate family, arrangements should be made for the student to complete the course requirements as soon as possible. If the reason is unacceptable, then the “Incomplete” grade is inappropriate, and a grade of “Fail” (see below) will be given.
Incomplete grades will become internal grade markers and will not appear on the official transcript. Incomplete grades must be remediated within a year of the original start date of the course or clerkship. If not remediated in that time frame, the Incomplete will become a Fail grade.
W (Withdraw): Assigned as the final grade in any course in which the student withdraws. The grade can be assigned at any time prior to the completion of a course. Students who are assigned a grade of “Withdraw” will be required to retake the course.
F (Fail): Work in the course was at a level of quality too low to meet the minimum requirements determined by the department or faculty.
All Incomplete (I) and Fail (F) grades must be remediated prior to promotion, or, for BUSM 4, prior to graduation. When the SEPC judges that a student is qualified for promotion or for graduation, grades of H (Honors), High Pass (HP), P (Pass), and F (Fail) followed by a P (Pass) for repeated courses are recorded in the official transcript.
Exemption: Prior to matriculation, students may apply for an exemption from courses for which they previously completed coursework outside of BUSM. Applications should be directed to the individual Course Directors who determine the credentials necessary to award exemption status (which may include satisfactory completion of a placement examination). The official transcript will record these courses as “Exempt.”
Repeat: The transcript will record the word “Repeat” next to the grade for repeated courses.
Grade Reconsideration: The Module, Clerkship, and Rotation Directors determine grades in consultation with the course or clerkship faculty based on the thoughtful and careful consideration of the criteria described in the module or clerkship syllabus.
A student who chooses to appeal the grade decision should follow these guidelines:
- Contact the BUSM Registrar to review the grade appeal process. The Registrar acts as a liaison between the student and department to ensure that all requirements are met.
- Submit a grade appeal in writing to a Module, Course, Clerkship, or Rotation Director no more than 15 business days after the date the grade is officially recorded in the Registrar’s office.
- The Module, Course, Clerkship, or Rotation Director must provide their grade appeal decision to the student in writing within 30 calendar days of receipt of the appeal.
- BUSM 3 and 4: First contact the Clerkship or Rotation Director with any specific concerns about their clinical evaluation. Do not contact preceptors directly about grade complaints or reviews before talking with the Rotation Director. Preceptors provide recommendations based on their observations of the student’s clinical skills and do not provide a final grade for their students. Revised preceptor grades thus are advisory and require discussion with the Clerkship Director.
- Students may request sequential reviews of the appeal in the following order within 10 calendar days of receipt of the appeal.
- The relevant course leadership committees (e.g., PrISM [BUSM 1] or DRx Leadership Committee [BUSM 2], Director of Medical Education office [IP or ICM], Chair of the department [EPH, HBM, clerkships]). The leadership committee must provide their grade appeal decision to the student in writing within 15 calendar days of receipt of the appeal.
- The Associate Dean of Academic Affairs. The Associate Dean must provide their grade appeal decision to the student in writing within 10 calendar days of receipt of the appeal. The decision of the Associate Dean is considered final, and cannot be further appealed.
A student files an appeal with the Appropriate Treatment in Medicine (ATM) Committee only if they feel their grade was:
- based on discrimination (i.e., gender, race, sexual orientation, ethnicity)
- adversely affected by an unresolved grading policy error (i.e., conflicting grading policies exist within a single module or clerkship)
2.3 Comportment and Professionalism:
Many important facets of a student’s medical training and subsequent professional practice cannot be measured by conventional quantitative examination. Examples include personal responsibility, sensitivity and adaptability to the needs of others, and the ability to form effective and respectful working relationships with peers, to cope with stressful situations, to accept and respond appropriately to constructive criticism and other attributes.
Issues of professionalism are considered a measure of the student’s overall performance in medical school, and may be reported as appropriate by the faculty. The Course Director, Clerkship Director, or Rotation Director will provide a reasonable opportunity for students to meet to discuss any report of comportment deficiencies.
3. The Student Evaluation and Promotion Committee (SEPC)
The SEPC meets at least monthly, or as needed, to oversee student evaluations and promotions for all four years of the MD curriculum. The committee reviews the following and takes appropriate action in accordance with BUSM policies and standards, to:
- Monitor student’s academic and comportment performance and take appropriate action.
- Act upon written petitions from students who request a waiver from promotion policies.
- Review any student’s deficient performance and take appropriate action.
- Review students who may not meet the maximum time frame for AAMC recommended degree completion.
- Act on requests for more than two re-exams.
- Vote on remediation programs, reexaminations, and promotions.
- Report its decisions regarding student promotions to the Dean for executive action.
Please refer to Article 5, Section G5 of the Boston University School of Medicine Bylaws on Faculty Central.
3.2 Expedited Procedures:
The SEPC Chair, after discussion with the Associate Dean for Student Affairs, may, in lieu of a formal meeting, email the committee members requesting approval of a student’s petition, which members may approve or request a meeting for resolution. The Associate Dean for Student Affairs may act on petitions from students in good academic standing without comportment issues or appearances before the SEPC and report these decisions to the SEPC for the following:
- Petitions for emergency medical leaves and medical leave of less than two weeks (requires a health care professional note),
- alternative or modified curricular changes, and
- students returning to the medical curriculum from academic enrichment, dual degree programs, or from an approved LOA.
3.3 Student-Generated Petitions:
Students requesting a LOA, Decelerated Curriculum, or another modification to the curriculum or the Promotions Policies should prepare their petition in consultation with the Associate Dean for Student Affairs and/or a faculty advisor. Petitions must be in accordance with the rules established by the Faculty of Medicine governing evaluation, grading, and promotion. The SEPC will review the student’s entire Academic Record when considering her/his petition.
All petitions must be typed, dated, signed, and addressed to the SEPC, and received by the Student Affairs office at least three working days before the scheduled meeting unless there are emergent issues.
All petitions from students not in good academic standing, with comportment issues or recurrent appearances before the SEPC, including petitions for Expedited Procedures, must be acted on by the SEPC.
All students on the agenda of the SEPC must be notified via email of the meeting’s date, time, and place that they have the right to appear before the SEPC and/or submit a written statement to the committee. Students must contact the appropriate Student Affairs officer within 24 hours of notification to indicate whether they will attend.
The committee will request the attendance of all students facing dismissal. Although attending the meeting to answer questions or to speak on their own behalf is generally in students’ best interest, they may choose to submit a written statement in lieu of addressing the committee. The SEPC may act whether or not students exercise their right to address the committee, verbally or in writing.
Students who elect to appear before the committee may bring a faculty advisor of their choice. The advisor may present information and may be asked to participate in the general discussion about the student. The student may not be present during the discussion on the petition or performance issues. Neither the student nor the advisor may be present during deliberation or voting on the petition or performance issues. Legal counsel for the student may not attend meetings of the SEPC.
Records and letters relating to a student scheduled on the agenda of a SEPC meeting are available to committee members prior to or at that meeting. The student has the right to review in advance all documents to be submitted to the committee. The student should have the opportunity to discuss adverse reports or evaluations with the appropriate Course Director or Clerkship/Rotation Director before the SEPC acts on these adverse reports or evaluations.
Decisions rendered by the SEPC are based upon the student’s entire academic and disciplinary record at the time of the meeting. The SEPC may, at any of its meetings, review a student’s entire academic record of academic and behavioral performance and take appropriate action. Such action may include, but is not limited to, requiring a Repeat Year, a Decelerated Curriculum, a LOA, Academic Probation, Academic Suspension, or Academic Dismissal.
The SEPC may recommend in writing, specific special arrangements for students, for example, those with a failing grade, or any documented unprofessional behavior:
- Assignment to regular meetings with the Director of Academic Enhancement, a Student Affairs Dean, and/or a faculty mentor for a stated purpose
- Rapid intervention by the Associate Dean for Student Affairs in the event of unprofessional behavior or academic problems
- Fulfillment of an existing educational plan, which would be included in the student’s academic record
The Chair of the SEPC will write the recommendation in consultation with the student. The Associate Dean for Student Affairs will monitor the student closely and if the student continues to have academic difficulties, provide appropriate assistance. The Associate Dean for Student Affairs will provide reports of the student’s progress to the SEPC.
The Chair of the SEPC will communicate the committee’s decision to the student in writing, ordinarily within 10 business days.
3.5 Disciplinary Proceedings Reports to the SEPC:
Whenever a student in the MD or any of the combined MD programs has been found guilty of misconduct under a disciplinary code of academic and professional conduct of the School or University, upon final disciplinary adjudication by the University, the SEPC will be provided copies of the letter charging the student with specific misconduct and of each decision (initial decisions, decisions after hearing, decisions after appeals), in accordance with the applicable disciplinary procedure.
The SEPC will review the final disciplinary decision together with the complete academic record of the student and may determine whether, taking this information as a whole, the student is professionally and academically qualified to be promoted, or to graduate, from the MD or any of the combined MD programs. Prior to making any adverse determination, the SEPC will give the student notice and an opportunity to be heard at a SEPC meeting. Any action by the SEPC is subject to appeal to the Committee on Appeals, then to the Dean of the School of Medicine, the Medical Campus Provost, and finally to the Boston University Provost.
3.6 Committee Records Retention:
Records of all SEPC meetings as well as meetings of the Committee on Appeals include one copy of all documents presented at the meeting as well as the minutes of the meeting. These records will be kept for six years after the graduation of the students on the agenda.
4. Committee on Appeals
Please refer to Article 5, Section G7 of the Boston University School of Medicine Bylaws on Faculty Central.
The Committee on Appeals will hear any student appeal of a decision of the SEPC affecting that student, and takes such action as it finds advisable concerning the original decision. All decisions of the Committee on Appeals are reported to the Dean of the School of Medicine.
Appeals must be submitted in writing within 10 working days after a student receives written notice of a SEPC’s decision. The Associate Dean for Student Affairs may grant an extension of the filing deadline, if requested within the 10-day period.
Students may elect to appear before the Committee on Appeals alone or accompanied by a faculty advisor of their choice. The advisor may present information and may be asked to participate in the general discussion on the student. The student may not be present during the discussion on the petition or performance issues. Neither the student nor the advisor may be present during deliberations or voting on the petition or performance issues. Legal counsel for the student may not attend meetings of the Appeals Committee.
The Committee on Appeals may grant or deny a student’s appeal, or it may modify the SEPC’s original decision.
The recommendations of the Committee on Appeals should comply with the General Policies and Procedures governing evaluation, grading, and promotion of students, as adopted by the Faculty of Medicine.
Students whose academic progress is interrupted by a decision of the SEPC (including, but not limited to Academic Dismissal, Academic Suspension, a required repeated curricular year, or a required LOA), who appeal this decision, may not register for or participate in courses, clerkships, or rotations while an appeal is pending.
The Appeals Committee chair communicates the committee’s decision to the student in writing, ordinarily within 10 business days.
4.3 Further Appeals:
A student may submit a written appeal to the Dean of the School of Medicine within 10 working days after receipt of a written decision of the Committee on Appeals. The Dean may affirm, modify, or reverse the decision of the Committee on Appeals, or remand matters to the Committee on Appeals or the SEPC for reconsideration, and will communicate in writing his/her decision and rationale to the student, the Committee on Appeals, and the SEPC. The student may, within 10 days of receipt of the Dean’s decision, submit a written appeal to the Provost of Boston University Medical Campus and ultimately to the Boston University Provost.
5.1 Qualifications for Promotion:
To be promoted to the next curricular year, medical students must meet all requirements of the current year, and satisfactorily adhere to all University standards.
To continue and progress through the curriculum, to be promoted from year to year and, thus, ultimately to graduate from BUSM, each student must be deemed qualified by the Student Evaluation and Promotion Committee (SEPC) based on standards and requirements described in this Statement of Procedures and in the written Policy Statements of the Student Evaluation and Promotion Committee. Students’ academic and behavioral performances are equally subject to evaluation. Students are expected to be honest, conscientious, respectful, and reliable in carrying out their assignments. Their behavior toward colleagues, faculty, staff, patients, and others with whom they interact in their roles as medical students is expected to be appropriate, reasonable, and considerate—consistent with medical professional standards.
Students in good academic standing perform at a passing level in all courses and their overall progress renders them eligible for promotion.
Students who are academically deficient include those who:
- fail any courses;
- are on academic probation; or
- are suspended.
Satisfactory Academic Progress describes students who are in good academic standing as defined above, or who are participating in, or eligible for, established procedures of academic remediation, including repeating courses and taking make-up examinations, or who are registered in a decelerated curriculum. Students who are not maintaining satisfactory academic progress include those on academic probation, or who have been suspended. BUSM has adopted the current federal requirements for Satisfactory Academic Progress of a maximum time for degree completion of 150% of the program length.
5.2 Failure to Qualify for Promotion:
The SEPC may, at any of its meetings, review the student’s record of academic and behavioral performance of any student who fails to qualify for continuation or progression within the curriculum or for promotion from year to year and take appropriate action.
5.3 Repeat Year:
Students who have exceeded the limits of Fail grades permitted for their curricular year and will be required to repeat all courses with initial Fail grades for that curricular year. A student will be allowed to repeat only one of the four curricular years. During the repeat year, the student will be registered as part time or full time depending on the number of credit hours and will pay additional tuition prorated according to the number of repeated credit hours.
5.4 Academic Probation:
The SEPC may place a student whose academic or comportment performance does not meet BUSM standards on Academic Probation. A student on probation is actively engaged in academic activity but is monitored by the school administration, and must meet certain standards or additional remedial requirements. Failure to meet these standards may lead to additional action by the SEPC. The SEPC or Appeals Committee will determine the nature and duration of the Academic Probation. The fact that a student was placed on Academic Probation is not included on the student’s transcript and need not be included in the student’s Medical Student Performance Evaluation (Dean’s Letter) at the discretion of the Associate Dean for Student Affairs, provided that the issue leading to probation is described. This information will remain part of the student’s academic record, and will be available to appropriate external professional organizations that request such information, such as state medical registration boards.
5.5 Academic Suspension:
The SEPC or Appeals Committee imposes Academic Suspension on a student due to seriously deficient academic performance. Students on Academic Suspension are required to present and carry out acceptable plans for remediation and/or enhancement and maintenance of readiness to return to the curriculum. Unless expressly permitted by the committee, students on Academic Suspension may not engage in any activity in the School’s curriculum, are not allowed the use of student services on all Boston University campuses, and are required to turn in all BUSM and Boston University property, including, but not limited to, identification cards.
Students will be notified in writing of an Academic Suspension, its duration, and criteria for return to the curriculum. Academic Suspension will be recorded in the student’s transcript and in the student’s academic record.
5.6 Academic Dismissal:
BUSM reserves the right to dismiss any student for failure to maintain a satisfactory academic record, including acceptable professional comportment. A student whose academic progress is halted by Academic Dismissal will not be allowed to continue with courses, clerkships, or rotations currently under way, or to register for courses, clerkships, or rotations while an appeal of this decision is pending. The following constitute grounds for academic dismissal from BUSM:
- Failure to comply with decisions of the SEPC or the Committee on Appeals
- Four or more Fail final grades within a curricular year
- After reexamination, any Fail grades within a curricular year
6. Leaves of Absence (LOAs)
A LOA is defined as a semester or more away from the curriculum. Absences of less than a semester are defined and addressed in 6.3.
Students are expected to complete the medical school curriculum within six years, and the SEPC must approve any exception to this policy.
A student may petition in writing to the SEPC for a LOA for academic, personal, financial, administrative, or non-emergent medical reasons. All petitions for LOAs should be prepared in consultation with the Associate Dean for Student Affairs or her/his designee and must state the reasons for the requested LOA.
If a student must initiate a LOA before the completion of a course or clerkship, the student will receive a grade of Withdraw. A student, while on an approved LOA, is a matriculated student; however, s/he is not registered for any courses in the School of Medicine curriculum. The SEPC may impose academic conditions relating to any LOA. (All LOAs count toward the expected six-year time frame for BUSM curriculum completion. Exceptions to this policy may be made by the SEPC.)
6.1 Medical LOAs:
The student’s petition should include:
- A letter from the student’s treating health care professional documenting the medical basis for the LOA and its likely duration. The student will also need a letter from either the treating physician (or a physician designated by the Associate Dean for Student Affairs and the SEPC).
- Any plans the student has to address any current academic difficulties or those that might result due to an extended time away from the curriculum.
The Associate Dean for Student Affairs will develop a written timeline with the student documenting all required contact with the OSA during the LOA as well as the Assistant Dean assigned to monitor and support the student, to be reviewed at the next SEPC meeting. The SEPC may require further evaluation of the student including an assessment by the Physician Health Services of the Massachusetts Medical Society or another external independent evaluation as deemed pertinent to the case.
Students will need a letter from their treating health care provider or a physician designated by the OSA or SEPC, assessing his/her medical fitness to return, prior to re-entering the curriculum. Confidentiality of the student’s medical information will be protected to the extent possible consistent with the needs of the institution.
School-Initiated Medical LOAs: If the Associate Dean for Student Affairs has evidence that a BUSM student may be a danger to him/her self or to others, or is unable to perform functions required of a medical student in nonclinical, clinical, or laboratory settings, the Associate Dean may act, either in accordance with the following guidelines or, immediately, under the Student Disciplinary Code of Academic and Professional Conduct, whichever is deemed appropriate under the circumstances.
The Associate Dean will request a meeting with the student, inform the student of the reason for questioning the fitness of the student, and give the student an opportunity to respond.
The Associate Dean will require the student to go before the SEPC, which may request the student, in writing, to:
- Temporarily absent him/herself from attendance at all or part of the School program, if deemed warranted to protect the safety and well being of the student and others in the School community, including the School’s affiliates.
- Provide satisfactory evidence of his/her fitness, which may include the results of a medical evaluation of fitness by his/her treating physician/psychotherapist, or by the Physician Health Services of the Massachusetts Medical Society or an unaffiliated physician/psychotherapist designated by the SEPC, to determine whether the student can perform safely and reliably. The student must consent to allow his/her physician/psychotherapist to provide relevant medical information to a physician or psychotherapist designated by the School to advise the Associate Dean and the SEPC.
If the evidence indicates that the student is unfit, the SEPC may request the student to take steps as appropriate based on the evidence, including but not limited to one or more of the following:
- Take a Medical LOA for a specified duration.
- Receive treatment as appropriate during the LOA.
- Enter a treatment and monitoring program, (e.g., the Massachusetts Medical Society’s program for impaired physicians and medical students).
- Withdraw from the School of Medicine if remediation of unfitness is unavailable as an option, or has been reasonably tried without success.
If the student at any time refuses or materially fails to comply with any request made by the Associate Dean in conformity with this Section of the policy, the Associate Dean for Student Affairs may then proceed under the Student Disciplinary Code of Academic and Professional Conduct. The student will have the rights of hearing and appeal provided under that Code.
If the student agrees to take a Medical LOA at the request of the Associate Dean and/or to enter a treatment or monitoring program, then the Associate Dean for Student Affairs in conjunction with the SEPC and/or with Physician Health Services may require continued medical monitoring and reporting to the Associate Dean as a condition of re-entering the curriculum. In addition, if the student has been or will be out of the curriculum for a significant period of time, the SEPC will establish any necessary academic requirements for return to the curriculum.
Continued or repeated noncompliance with monitoring required in accordance with this policy or continued or repeated lack of medical fitness may lead to a determination by the Associate Dean in conjunction with the SEPC and/or the Physician Health Services that underlying causes of unfitness are not remediable. The Associate Dean may then recommend to the SEPC that the student be suspended or dismissed from the curriculum for repeated lack of fitness. If the student claims to have a disability, such determinations and recommendations will be made in consultation with the Boston University Disability Services office and the Dean of the School of Medicine.
6.2 Other LOAs:
A student’s petition should state the reasons for requesting the Non-Medical LOA, the expected duration of the LOA, and describe plans for the period of leave that address any current academic difficulties or those that might result due to extended time away from the curriculum.
The SEPC must grant non-medical LOAs. The Associate Dean for Student Affairs may grant emergency or urgent LOAs and will copy the SEPC chair and the student will petition the SEPC.
6.3 Excused Absences:
Requests for excused absences of less than a semester are not considered LOAs. The Associate Dean for Student Affairs may grant emergency or urgent absence from the curriculum and will copy the SEPC chair. The SEPC may bring a student who is not in good academic standing or with more than one emergency absence that the Associate Dean for Student Affairs brings before the committee for further discussion. Students may request a delay in the normal progression of the BUSM curriculum for non-emergent or non-urgent issues after consultation with the OSA, and must submit a written petition to the SEPC which must approve any such delays.
Delays in the curriculum for Step 1: Students with prior academic difficulty who require additional time to prepare for the USMLE Step 1 and possible immediate action may be approved by the Associate Dean for Student Affairs and reported to the SEPC. Students who fail the USMLE Step 1 must meet with a Dean in the OSA to devise a plan to retake the Step 1. If it is in the best interest of the student to delay 1 block before being stopped to attend a prep course or other most appropriate individual academic plan, this may be granted by the Associate Dean for Student Affairs and reported to the SEPC. The record of these plans will be kept by the Director of Academic Enhancement and will be available to the SEPC as needed if a student has further academic difficulty.
6.4 Academic Concerns and Conditions Relating to Absences from the Curriculum:
Any absence from the MD degree curriculum, whether requested by a student or initiated by the School, raises issues of academic continuity and readiness to return to the curriculum, particularly if the student has prior academic difficulties. Independent of the reasons for the LOA, SEPC may take academic action based on past academic or behavioral deficiencies or to avert future deficiencies due to time away from the curriculum. Such academic action may include notifying the student of the seriousness of past deficiencies, and/or concerns relating to a requested period of time away from the curriculum. The student may be required to propose an acceptable plan of activity or remediation to be completed during the absence.
Whether a student is permitted or required to take time away from the curriculum (whether by Academic Suspension, Disciplinary Suspension, or by LOA), the SEPC or Appeals Committee may require the student to develop, present, and obtain approval from the committee for a plan of academic remediation or a plan to minimize academic discontinuity, or both, as appropriate to the circumstances. Plans should be prepared in consultation with the Associate Dean for Student Affairs or his/her designee.
Plans of remediation should be designed to enhance the student’s insight into any deficiencies in his/her performance and to ensure adequate progress toward remediating any deficiencies. Such plans may include, for example, engaging in professional or social service activities to enhance professional skills and insights and taking steps to assess whether there may be underlying personal or medical factors contributing to any deficiencies in academic performance (e.g., by obtaining a medical, neurological, and/or psychiatric assessment and undertaking treatment, if recommended as a result of such assessment).
Plans to minimize academic discontinuity should include specific proposals for time away from the curriculum, such as engaging in activities to practice or maintain needed skills, and to develop or enhance professionalism and educational mastery (e.g., reading, research, clinical activity, health service activity).
The SEPC may require students to consult with a faculty advisor, in addition to the Associate Dean for Student Affairs, for assistance in preparing their proposed plans for the period of absence from the curriculum and in monitoring the students’ success in carrying out their approved plans.
6.5 Notice to Students at Risk of Probation or Dismissal Due to Absence from the Curriculum:
Academic difficulty severe enough to warrant Academic Dismissal precedes some absences from the curriculum, whether requested by a student or required by the SEPC. In connection with any absence from the curriculum, the SEPC will review the entire Academic Record of any student who has a deficient Academic Record and will determine whether the student is in jeopardy of immediate Academic Dismissal. If so, the committee will notify the student in writing that s/he is in such jeopardy of immediate Academic Dismissal based on his/her Academic Record, describing the deficiencies in the letter of notification.
If the committee approves, or requires, an absence from the curriculum (and related plans) for such a student, the student will remain in jeopardy of Academic Dismissal until and unless s/he is allowed, in the discretion of the SEPC, to re-enter the curriculum.
In lieu of Academic Dismissal, the SEPC may allow a student to attempt to demonstrate evidence during an absence from the curriculum sufficient to justify to the committee, in its discretion, another chance to re-enter the curriculum.
If the plans submitted by such students are unacceptable to the committee or if the student fails to carry out accepted plans during an approved absence in a satisfactory manner, the committee may dismiss the student based on the deficiencies that previously placed the student in jeopardy of immediate Academic Dismissal.
6.6 Petition for Return from a LOA:
For academic reinstatement to the curriculum after any period of absence from the curriculum, students must file a written petition addressed to the Associate Dean for Student Affairs, who may approve routine petitions to return to the curriculum for students in good academic standing without prior comportment issues or recurrent appearances at the SEPC.
The SEPC must review petitions from students whose absence was related to academic or behavioral difficulties. Any student who has been absent from the curriculum for academic reasons or professionalism issues will be requested to appear before the SEPC before the student re-enters the curriculum. Failure to appear will be taken into account by the committee when reviewing the student’s readiness to return. The Associate Dean for Student Affairs and the Senior Policy Officer must receive petitions at least three working days prior to the scheduled SEPC meeting. Exceptions to this policy can be made for students with urgent issues that are time sensitive.
Students must provide acceptable evidence as to their readiness to re-enter the curriculum and their completion of any previously accepted plan of remediation of academic deficiencies or of activities to minimize academic discontinuity. Evidence may include reports from professionals with whom the student worked or consulted during the absence from the curriculum, if relevant to academic readiness to return. Students are expected to provide reports from such professionals if an accepted plan of remediation included consultation with healthcare professionals regarding underlying causes of academic deficiencies and treatments if recommended. The Associate Dean for Student Affairs will present such reports of fitness to return to the SEPC.
After review of a student’s petition and evidence the Associate Dean for Student Affairs can determine that:
- students in good academic standing without comportment issues or recurrent appearances at the SEPC have satisfactorily demonstrated readiness and fulfilled all conditions contained in their accepted plans of remediation and/or accepted plans to enhance or maintain readiness to return, and report this to the SEPC, or
- the student has not satisfactorily demonstrated readiness to return, fulfilled all conditions contained in accepted plans of remediation or enhanced or maintained educational continuity, and refer the student to the SEPC. SEPC can either:
- Allow the student to return to the curriculum, subject to additional requirements related to deficiencies in the student’s performance of his/her plan.
- Disallow the student’s petition to return to the curriculum and dismiss the student either because the:
- student has previously been notified of this policy that s/he was at risk of Academic Dismissal based on deficiencies existing prior to the absence from the curriculum; or
- student’s extensive time away from the curriculum has resulted in unacceptable academic discontinuity.
6.7 Two-Year Limit on Absences from Curriculum:
The total time taken for LOAs (whether a single leave or multiple leaves) may not exceed two years during the entire period of enrollment at BUSM. The SEPC may dismiss a student whose absences exceed two years unless the student is eligible under applicable disability laws to a longer period of absence.
A student who has been dismissed because of absence of more than two years who wishes to return to BUSM must reapply for admission. The BUSM Admissions Committee makes the decision as to readmission, which is not guaranteed.
A student who wishes to permanently leave BUSM should prepare the request to withdraw in consultation with the Associate Dean for Student Affairs, who will inform the SEPC, unless the student requests that this information be confidential. The withdrawal is effective on the date the completed Withdrawal Form is received in the Office of the Registrar.
7. Channels of Communication
To facilitate and regularize communication concerning student performance, BUSM employs the following:
7.1 Administration-Student Communication:
This communication is mainly via Boston University electronic mail. Students must regularly access and maintain their BU email accounts. Daily checking is strongly recommended.
Students may view their grades through the student password protected Individual Student Profile (ISP), which includes grades, contact information, and course schedules, maintained on the website of the Office of the Registrar.
BUSM requires each student to keep his/her current local street address, telephone number, beeper number, email address, cell phone, and fax number updated through the Individual Student Profile on the Office of the Registrar’s website for emergency notifications.
The Course Directors, the Clerkship Directors, and the Rotation Directors forward grades to the Office of the Registrar for inclusion on the student’s ISP.
Students are responsible for regular review of their Academic Record, via the Office of the Registrar website. Students should review their Academic Records at least twice a year in the pre-clerkship years, and grades at the completion of each course, and at least six times per year in the clinical years.
7.2 Faculty-Student Communication:
Faculty are the proper sources of information during a course. The teaching faculty should provide students with feedback about their academic progress during a course. The nature and frequency of such communication may vary from course to course, depending on the student/faculty ratio, faculty contact time, curriculum schedules, the nature of the learning task, etc. How students will get feedback should be explicit at the beginning of each course. The pre-clerkship faculty may inform students of their exam grades. Students who feel the need for more detailed or more frequent feedback should contact the faculty or department involved. Students on the required clerkships must receive mid-clerkship feedback from supervising faculty so they may remediate any deficiencies before the end of the clerkship.
7.3 Faculty-Administration Communication:
The Associate Dean for Student Affairs will provide a summary of relevant data in a student’s academic record only upon written request of a department chairperson or faculty member who has legitimate educational interest in the information. A student may inform a dean in the Student Affairs office of a medical or personal emergency requiring absence from a course or clerkship, who will then inform the course or clerkship director(s).
7.4 Family Educational Rights and Privacy Act:
All access to information within student records is governed by the policies of the University Registrar in compliance with the Family Educational Rights and Privacy Act (FERPA).
8. Standards and Requirements for Review of Evaluation, Grading, and Promotion of Students by BUSM Year
8.1 First- and Second-Year Students
8.11 Qualitative Evaluations:
Qualitative evaluations of First- and Second-Year students that raise concerns to the Associate Dean for Student Affairs may result in review of a student’s record by the SEPC for possible action, up to and including Academic Suspension and Academic Dismissal.
8.12 Requests for Entry to the Modified Curriculum:
Students must submit all requests for entry to the Modified Curriculum in writing to the Associate Dean for Student Affairs. The Associate Dean for Student Affairs may grant an executive approval for students in good academic standing and without comportment issues or SEPC appearances. Students with prior academic or comportment issues require SEPC approval. The action taken and grounds for approval will be conveyed in a letter to the student, with copies filed in the student’s academic record and retained in the permanent record of the SEPC.
Students admitted to the Modified Curriculum are subject to the guidelines governing promotion.
8.13 Final Course and Clerkship Grades:
A student will not be promoted with any Fail, Withdraw, or Incomplete grades in required courses. A student will be subject to Academic Dismissal from BUSM for:
- Four or more Fail grades within an academic year.
- After re-examinations, any Fail grade within an academic year.
8.14 Remediation of Course Grades by Re-Examination:
Administer a single round of re-examinations before the start of the second or third curricular years at a time selected and coordinated by the Academic Affairs office and the course directors. Post remediation schedule on the OAA webpage. First- and second-year students sign up through the OAA Administrator and the OME DRx Administrator, respectively. Third-year students who are remediating Shelf examinations sign up directly through the Clerkship Administrator.
Students who fail to meet the standards for promotion after final grades become available at the end of the curricular year must petition the SEPC for permission to remedy more than two Fail grades. Normally, a student may not remediate more than two courses, either by means of a re-examination, or other method determined by the Course Director. Under unusual circumstances, however, a student may petition the SEPC for permission to remediate a third course.
8.15 Repeating the First or Second Curricular Year:
The SEPC will normally require students repeating the first or second curricular years to retake all courses in which they had originally received a Fail evaluation before remediation. To be eligible for promotion, students must attain a grade of Pass in each repeated course after remediation.
Students may not repeat the first or second curricular year more than once. A student who repeats the first curricular year may not repeat the second year.
During the repeat year, the student will be registered as part time or full time depending on the number of credit hours, and will pay additional tuition prorated according to the number of repeated credit hours.
8.16 USMLE Step 1:
Each student must pass USMLE Step 1 Examination to be promoted to the fourth curricular year and to graduate from BUSM.
All BUSM 2 students in good standing, i.e., without any prior academic deficiencies, must take USMLE Step 1 by the first day of the BUSM 3 Orientation and begin the third year on the first day of the third curricular year.
Preparation to take USMLE Step 1 should not be allowed to compromise a student’s effort in any pre-clerkship course, clinical clerkship, rotation, or elective taken for academic credit. Preparation for Step 1 is not an acceptable reason for inability to fulfill course requirements, which should result in a grade of Fail rather than an Incomplete.
A student who fails USMLE Step 1 must arrange to meet with the Associate Dean for Student Affairs or his/her representative within two weeks of the receipt of the examination scores to identify the reasons for the failure and to construct a plan to help the student prepare to retake the examination. The Director of Academic Enhancement will keep a file of the plans which will be available to the SEPC as needed.
Any student who fails USMLE Step 1 for the first time may finish the current rotation. The student’s course of study will then stop until s/he retakes the Step 1 after which, the student may re-enter the curriculum. If the student again fails Step 1, the student will leave the curriculum and may not continue until s/he receives a passing score on the Step 1.
The SEPC may, at its discretion:
- Require the student to repeat courses or clerkships, or to pursue a modified or decelerated course of study upon returning to the curriculum;
- Academically dismiss the student if s/he fails Step 1 of the USMLE three times; or
- Take such other action, as the committee deems appropriate.
8.2 Evaluation and Grading of Student Performance in the Third and Fourth Year
8.21 BUSM Policy on Medical Student Hours:
Medical Student Hours should not exceed the 80 hours/week averaged over four weeks, similar to the ACGME standards for residents. Clerkship Directors should organize teaching activities early in the day to allow affected students to leave. This policy will be reviewed in the third-year orientation.
8.22 Third-Year Requirements:
A required orientation to the third year, which precedes the first third-year clerkship, provides an introduction to basic ward procedures, clinical skills training, and VA conducted CORI checks and fingerprinting, as well as a review of professional demeanor in the clinical setting and prevention of exposure to blood-borne pathogens. Student’s health records must be in compliance.
The required third-year curriculum includes 1 four-week elective and 7 clerkships (Family Medicine, Internal Medicine, Obstetrics/Gynecology, Pediatrics, Psychiatry, Surgery, and Neurology), which must be taken within the BUSM system.
This third-year elective, chosen from the BUSM elective catalog, does not fulfill fourth-year requirements (see 8.23). Elective preceptors determine specific electives’ availability.
Students assigned a first block elective should consider Research, Quality Improvement, an Instructional Project, or Radiology. Students who do not choose an elective are assigned a general radiology elective.
USMLE Step 2: Each student must take USMLE Step 2, Parts A and B by November 1 of the academic year in which they are graduating. All students applying for residency must take the Step 2 CS and CK.
All students must have registered and scheduled dates for their USMLE Step 2:
- Clinical Skills (CS) exam by January 31 of the year prior to their graduation
- Clinical Knowledge (CK) exam by June 1, 11.5 months prior to graduation
8.23 Fourth-Year Requirements:
The process of selecting the fourth-year rotations begins in January of the third year. To graduate, 36 weeks of fourth-year rotations are required, including 12 weeks of required rotations (which includes a 4-week selective) and 24 weeks of electives.
Of these 36 weeks, 20 weeks must be taken within the BUSM system (including the 12 weeks of required rotations); up to 16 weeks may be taken at an outside medical school or hospital.
Students must submit their final fourth-year schedule, signed by the student’s Field-Specific Advisor, to the Office of the Registrar no later than the beginning of Block 11 in BUSM 4.
Students must make any subsequent changes using an Add/Drop Form obtained from the Office of the Registrar. Students are not permitted to change their fourth-year schedules after the beginning of Block 18.
Any student who has not submitted a final and complete schedule with 36 weeks of rotations by the end of Block 11 may be required to meet with the SEPC.
Three four-week rotations are required in BUSM 4: Geriatrics, a Sub-internship, and one selective (Ambulatory Medicine or a Surgical Subspecialty), which must be taken within the BUSM system.
Elective Rotations including Research: All electives taken for credit in excess of degree requirements will be recorded with grades on the transcript.
Limit of time in specialties: Credit will be granted for no more than 16 weeks of fourth-year rotations and/or electives in any one specialty. Research is included as part of this guideline.
Students may arrange outside electives at LCME-accredited United States medical schools. If these electives are part of an accredited fourth-year curriculum, credit will be given without prior BUSM department approval. The appropriate BUSM department must approve outside electives that are not part of the accredited fourth-year curriculum at an accredited United States medical school prior to the start of the elective.
The International Health Program Director must approve all International Health rotations, whether arranged through the BUSM International Health Program, or arranged independently by the student. The Director may consult with the appropriate BUSM department as to the suitability of an independently arranged rotation.
Fourth-Year Research Elective for Credit: A student in good academic standing is encouraged to consider a research project within or outside BUSM. A student planning a research project for elective credit must submit all required paperwork at least six weeks before beginning the research project.
Up to eight weeks of fourth-year elective credit may be granted for a research project. (After successful completion of the PhD, an MD/PhD student may be given up to 8 weeks of credit in the fourth year.)
Additional time spent doing a research project will not be eligible for credit. The completed paperwork must include the Research Approval form, a letter from the proposed research preceptor confirming the preceptor’s willingness to serve in this role, a summary of the proposed project, a description of the role and responsibilities of the student, and the method by which the student’s performance will be evaluated and graded. Credit for research will not be granted retroactively. Research projects conducted outside BUSM will count as an outside elective for credit.
8.24 Method of Evaluation and Recording of Grades:
Grades for all courses, clerkships, rotations, and electives taken for credit by BUSM third- and fourth-year students, including those taken in excess of degree requirements, will be recorded on the transcript and will be subject to BUSM promotions guidelines.
The academic performance of students on all clinical clerkships and rotations is evaluated using a combination of academic and behavioral criteria. Students will be evaluated on the BUSM Clerkship or Clinical Rotation Evaluation Form for all BUSM rotations according to categories that include, but are not limited to, knowledge and problem-solving ability, clinical skills, and professional attributes. A mid-clerkship formative review with the preceptor or clerkship director is required for accreditation of the medical school in all required clerkships and rotations for all students and must be completed online and documented by both parties.
The clerkship or rotation director must submit a final grade and written evaluation of each student’s academic and behavioral academic performance to the Registrar’s office within six weeks of the conclusion of a rotation. If at the mid-clerkship evaluation there is evidence to show that a student is not meeting the expected level of competency, then the student must be informed and offered assistance in acquiring the competencies that are lacking.
The final clerkship or rotation grade is recorded on the BUSM Clerkship or Clinical Rotation Evaluation Form, sent by the Registrar to the Rotation Director for each student registered for the rotation and returned to the Registrar, who records the final grade.
All final grades of Fail, Withdraw, and Incomplete will be brought to the attention of the SEPC.
8.25 Standards and Requirements for Promotion:
Irrespective of the final grade assigned for a clinical clerkship or rotation, adverse comments in the performance narrative, or unsatisfactory ratings in any portion of a student’s final evaluation, may result in review of a student’s entire record of academic and behavioral academic performance by the Student Affairs office and/or the SEPC, which will then take appropriate action.
The Associate Dean for Student Affairs will review all third- and fourth-year grades and will present students with any failing grade to the SEPC for action.
Third-year students will not be promoted to the fourth curricular year with any Failing, Withdraw, or Incomplete grades in any required clerkship, rotation, or elective.
Fourth-year students are ineligible to graduate with any Failing, Withdraw, or Incomplete grades in any clerkship, rotation, or elective taken during the third and fourth curricular years.
8.26 Remediation of a Fail Grade:
A student will remediate any Failing grade in a clinical clerkship, rotation, or elective, according to the requirements established by the clerkship, rotation, or elective. Failing grades must be remediated at a clerkship or rotation site within the BUSM system approved by the Clerkship or Rotation Director.
- The plan to remediate the grade must be reviewed and approved by the SEPC.
- Remediation of a Failing grade in any clinical clerkship, rotation, or elective should not be allowed to compromise a student’s efforts in any other course or rotation being taken for academic credit.
- No student will be allowed to repeat any clerkship, rotation, or elective more than once.
Timing of Third-Year Grade Remediation: All third-year Fail and Incomplete grades must be remediated before a student is eligible for promotion to the fourth year. Students must remediate all third-year grades at the beginning of the fourth curricular year no later than the second curricular block. They are expected to participate in the process of selecting the required fourth-year rotations beginning in January of the third year, and to sign up for elective rotations beginning in March of the third year, but may not participate in any of the fourth-year rotations prior to successfully remediating all third-year deficiency grades.
A third-year student who has received Incomplete or Fail grades because of failing to pass a final clerkship examination is expected to:
- Take and pass the clerkship make-up examination(s) no later than the second block of the fourth year. The student may not receive credit for any fourth-year rotations or electives taken until the clerkship examination failure is remediated.
- Meet with the Clerkship Director to determine which electives, if any, may be taken during the study period.
- Meet with the Registrar to arrange for an appropriate fourth-year schedule considering the requirements for the make-up examination, and
- Meet with the clerkship director or staff to schedule the re-examination.
8.27 Serious Issues Identified During a Clinical Clerkship or Rotation:
Clerkship or Rotation Directors may deal directly with any students who experience academic difficulty or professional comportment issues that seriously impedes their ability to perform appropriately in the clinical setting, but must consult with the Student Affairs Deans to resolve the problem or develop a remedial plan.
For particularly egregious behavior, the Clerkship or Rotation Director may temporarily remove the student from the clerkship or rotation and notify the Associate Dean for Student Affairs. The Clerkship or Rotation Director will submit a written report assessing the performance of the student during the clerkship or rotation and the reasons for removal to the Associate Dean for Student Affairs who will use the disciplinary code to determine whether the matter is referred to the Disciplinary Code Committee or the SEPC. The Disciplinary Code Committee or the SEPC will then meet to examine the issue and recommend appropriate intervention or action, based upon the student’s entire academic record of academic and behavioral performance. The student may not continue any clerkship or rotation until the final decision of the SEPC or the Disciplinary Code Committee.
Approved by the BUSM Executive Committee on July 22, 2015