2.03 Grading and Examination

The director of each course/clerkship determines the nature, frequency, content and scoring of student examinations. All formally designated examinations, including quizzes, are required of all students registered in the course or clerkship. Mid-course evaluations or interim examinations should take place no later than approximately halfway through a course or clerkship to provide timely feedback to students about their academic performance.

In the unusual event that a student is excused from an interim examination or final examination, the course or clerkship director will provide a make-up opportunity for all students.

In no case will a student be allowed to take an exam before the date and time published on the course calendar.
No examinations will be administered to an individual student via email or any other remote arrangement unless this was the mechanism by which the original exam was administered to the entire class. Absent this arrangement, to ensure a ‘level playing field’ for every member of the class, students must be physically present for all examinations and make-up examinations. See below for further details of the Examination Policy.

In the extraordinary circumstance that a student has examinations in two courses simultaneously, the student will bear the responsibility of notifying both course directors in writing. If the courses are both required, the course directors will consult with each other and the student to set the times at which their respective examinations are to be taken. If one course is required and the other elective, the student will take the exam in the required course at the scheduled time and work with the elective course director to arrange an alternative time for the elective course exam.

Students who fail a course or clerkship are required to take a re-examination and/or do remedial work. A grade of Unsatisfactory will be recorded for the course or clerkship until the student has passed the re-examination and the course/clerkship. If a student fails re-examination or the student performs unsatisfactorily in the remedial work, a final grade of Unsatisfactory is reported to the Registrar, and the student is referred immediately to the Promotion and Review Board (PRB). The PRB may require the student to retake the same or equivalent course/clerkship as approved by the course/clerkship director, Society Advisory Dean and PRB. All unsatisfactory grades must be resolved before a student may progress to the next phase of the curriculum and/or graduate (see below and Section 2.19: Satisfactory Academic Progress).

Only one opportunity will be allowed to remediate an unsatisfactory grade by repetition of a course or clerkship. If a student fails to attain a satisfactory (or better) grade upon repetition of the course or clerkship, the final grade will be Unsatisfactory, and the student will be referred to the PRB for consideration of the student’s future status in the MD program (see Section 4.03).

All unsatisfactory grades from one academic year must be remediated before a student may begin the next academic year. Any student with an unsatisfactory grade in any course or clerkship, or a substantiated concern about professional conduct or responsibility, must complete remedial work at HMS prior to undertaking any extramural educational experience (see Section 2.19).

All disciplinary cases involving a student must be resolved, and the student’s status in the School must be restored to “good standing,” before the student may receive a degree. Only students who are in good standing will be permitted to participate in commencement or related activities or exercises.

Grading System – Preclerkship

All preclerkship courses are graded Satisfactory/Unsatisfactory.
Marginal performance by a student is to be noted by the course director on the grade sheet in the appropriate column. The marginal grade will be noted in the PRB’s review of student performance but will not be part of the student's official record.
A grade designation of Incomplete signifies failure to complete course requirements because of personal illness, death in the family, or a similar compelling, serious reason, and must be resolved within a specified time or a grade of Unsatisfactory will be recorded. A grade designation of Incomplete may be given by a course or clerkship director only for those reasons and must be given before the end of a course or clerkship. A grade designation of Incomplete must be accompanied by a written explanation to the Registrar and to the student's Society Advisory Dean.
When incompletes and/or unsatisfactory grades have been remediated, the course/clerkship director should notify the Registrar, in writing, as soon as possible in order for the grade to be updated in the student's permanent academic record.
Narratives on the performance of each student are to be prepared whenever possible by the faculty of all courses having regular small group teaching sessions and in core and elective clerkships. This routinely applies to all small-group activities but may also include case-based collaborative learning (CBCL) sessions (Pathways curriculum), labs and conferences. Course directors are responsible for forwarding narratives within four weeks of the end of the course to the Registrar for inclusion in the student's official record. Copies of narratives are provided to the Academic Societies for each student's file and to the PRB for review.
Each Society regularly reviews grades and narratives of all students in the Society and may refer students to the PRB if indicated.

Examination Policy

The policy on taking examinations is designed to be fair, uniform, and transparent across courses and clerkships and across academic societies. Maintaining a standard of professional behavior applies to a student’s responsibility for taking examinations.

All students are required to take exams on the dates and times published on the course calendars posted to Canvas, including Shelf Exams in core clerkships.
For electronic assessments administered in preclerkship courses, students are required to strictly adhere to the assessment start and end times published on the course calendar. Students are expected to arrive to the assessment location in advance and are required to upload the exam file no later than the specified assessment end time.
Students may be permitted to take an exam on a date later than the one published on the course calendar for the following reasons only:
1. Failure to pass the exam.
2. Extraordinary circumstances outside a student’s control that prevent him/her from physically taking the final exam on the date published on the course calendar. Examples include:

1. Illness or accident

2. Death in the immediate family

3. Conflicts with religious obligations.

4. Conflicts with other scheduled MIT or Harvard course exams in required courses.

In the event of B2, B3, or B4 above, the student is required to notify immediately the course/clerkship director(s), who will determine whether the student may be permitted to take the exam on a date later than the one published on the course calendar, and his/her Society Advisory Dean.

In no case will a student be allowed to take an exam before the date and time published on the course calendar.
Students who are unable to take an exam for the reasons cited in B2, B3 or B4 above will be given a grade of Incomplete for the course until the exam has been taken and passed, at which time the grade will be changed on the transcript.
Students who fail to take an exam for other, non-sanctioned reasons will receive a grade of Unsatisfactory, which will be recorded on the transcript.
No examinations shall be administered to an individual student via email or any other remote arrangement unless this was the mechanism by which the original exam was administered to the entire class. Absent this arrangement, to ensure a ‘level playing field’ for every member of the class, students must be physically present for all examinations and make-up examinations.
In the event of B1 above, the student must sit for the exam on the designated make-up exam date. In the event of B2, B3, or B4 above, the student must sit for the exam immediately following the circumstance that prevented him/her from sitting for the exam, per arrangement with the course/clerkship director.

Grading System – PCE

All core clerkships in the Principal Clinical Experience (PCE) and the PCE longitudinal experiences, are graded Satisfactory/Unsatisfactory. The summative narrative assessment in core clinical clerkships becomes part of the official record. See Section 1.04: for more information about assessment in the MD Program. Formative and summative comments will be available in OASIS following submission to the Registrar for review by the student and the student’s Society Advisors. Formative and summative comments will also be available to the Promotion and Review Board (PRB) in its review of a student’s performance and/or compliance with the HMS standards of professional conduct and responsibility. Clerkship/course directors are expected to submit grades and evaluation narratives within four weeks and no later than six weeks of the end of the clerkship/course.
A designation of Incomplete ordinarily signifies failure to complete course requirements because of personal illness, death in the family, or a similar compelling, serious reason, and must be resolved within a specified time or a grade of Unsatisfactory will be recorded. A grade of Incomplete must be given if a student has not completed all components of the PCE Requirement Checklists, including the question about duty hours, may be given by a clerkship or course director for the reasons noted above, and must be given before the end of a clerkship/course. A designation of Incomplete must be accompanied by a written explanation to the Registrar and to the student's Society Advisory Dean.

Academic Difficulty during the PCE

If a student is having academic difficulty during the PCE, the PCE Director and the student’s Society Advisory Dean, in consultation with the HMS Registrar, will determine whether the student should continue the PCE or withdraw or discontinue. In either case, a remediation plan will be formulated. If the decision is to require the student to discontinue the PCE, the student should be presented at the Promotion and Review Board and placed on Monitored Academic Status (MAS) or, if the student has failed one or more clerkships, the student will be placed on Academic Probation.

Failure of Shelf Exams during the PCE

If a student fails a NBME Subject Exam (“shelf exam”) or other clerkship exams required to pass a PCE core clerkship but otherwise has passed all other aspects of the clerkship, the student will confer with his or her Society advisor to discuss the best plan for additional study and retaking of the exam; a referral may be initiated to the Office of Learning Resources and Support. A designation of “In Progress” (IP) will be posted to the transcript until the exam is passed, at which point the IP reverts to a Satisfactory (S). A vacation period that occurs within one-two months following the exam failure will often be a good time to prepare for retaking the exam on the next available exam date following the vacation. If this timing is not feasible or if a remediation plan requires more time than the next vacation period would allow, students will retake the shelf exam within one month following the end of their PCE. Students must pass all core clerkships to complete the PCE and progress to the post-PCE phase of the MD curriculum. Under some circumstances, with approval of the Society advisor and the HMS Registrar, the 12-month PCE may be extended to 13 months to accommodate retaking of shelf exams. If a student fails a second shelf exam during the PCE (or the same shelf exam a second time), at the discretion of the PCE and advising team, the student may be asked to interrupt the PCE to remediate his or her academic progress. However, under no circumstances may a student progress to the next phase of the curriculum until all shelf exam failures have been remediated and all core clerkships have been passed (see Section 2.19: Satisfactory Academic Progress).

Post-PCE

All required subinternships and clinical electives are graded Honors with Distinction; Honors; Pass; Unsatisfactory.

All Advanced Integrated Science Courses (AISC), Essentials of the Profession II, and all non-clinical elective courses are graded Satisfactory/Unsatisfactory.

Grade Appeal

As a component of a fair and formal process for assessing student performance, students may request reconsideration of their assessment results, including narrative assessments and course/clerkship grades. Please refer to Section 1.04 for the Grade Appeal policy.

Policy on Recording of Required Clinical Exercises

All students in the M.D. program participate in required clinical exercises as part of their core courses and clerkships. An important aspect of these exercises is digital video and/or audio recording of the encounters for evaluation and self-assessment. For these required exercises, students agree to assign rights for the recording to the Program in Medical Education and authorize the reproduction, digital transmission and distribution by IT/Audio Visual Communications for/to course faculty and staff for assessment purposes.

Policy and Procedures on Timely Submission of Grades and Evaluations

Ensuring the timeliness with which medical students are informed about their final performance in courses and clerkships is critically important for students’ self-assessment of their progress in developing into physicians and for the School to monitor students’ development and provide assistance when needed. Timely submission of grades is also critical for determining whether students are making Satisfactory Academic Progress and, hence, are eligible to move into the next phase of their MD program; if a student requires review by the Promotion and Review Board; if students are meeting the requirements for graduation; and for inclusion of evaluations in the MSPE and on transcripts required for the residency match process. Finally it is an accreditation requirement (LCME: ED-30) that grades be submitted within 4 weeks and no later than 6 weeks of the end of a course or clerkship.

HMS requires that all grades in all courses and clerkships be submitted no later than 4 weeks following the last day of the course or clerkship. Duplicative, fail-safe monitoring is done by the Office of the Registrar, by course/clerkship managers in the Office of Curriculum Services, and by the Office of the Dean for Medical Education. In addition, we report to the clerkship director/chair of each cross-site clerkship committee and the director of each Principal Clinical Experience (PCE) on the status of grade submission in their clerkships and PCE sites, respectively. Timeliness of clerkship grade submissions will be a regular agenda item for cross-site clerkship committees and the PCE Subcommittee.

The following procedures will be followed:

•Course and clerkship site directors are responsible for entering course/clerkship grades and evaluation comments (formative and/or summative) into OASIS within 4 weeks of the official end of the course or clerkship rotation. Course and clerkship site directors are responsible for ensuring this has taken place, even when an assistant or associate course or clerkship site director or designated staff member has been authorized to enter grades and evaluations on behalf of the director.

One week prior to the official end of the course or clerkship, an initial automated email is sent from the registrar to course directors, course managers, clerkship site directors and clerkship administrators to submit grades within 4 weeks of course or clerkship conclusion.
A second automated e-mail will be sent two weeks after the official end date of the course or clerkship rotation with a reminder to complete assessment (include note: “incomplete” grades may suffice).
The Dean for Medical Education (DME) will be notified of non-compliant courses or clerkship rotations that have not submitted all grades at the end of the 4-week period after the official end date of the course (internal submission deadline). Non-compliant individuals will receive personalized follow-up (e-mail or discussion) from the DME.
The DME will be notified of non-compliant courses or clerkship rotations that have not submitted all grades one week following the internal submission deadline (and one week prior to the LCME deadline). Non-compliant individuals will receive personalized follow-up (e-mail or discussion) from the DME and the appropriate supervisor will be notified.

Honors in a Special Field

The MD degree with Honors in a Special Field (cum laude, magna cum laude, summa cum laude) is awarded to graduating MD degree candidates who have performed original and meritorious investigation in a subject and have demonstrated ability, scholarship and special knowledge of the field in which the chosen subject is a part. An original thesis, describing basic or clinical research or other scholarly investigation (e.g., social sciences, ethics, history of medicine) must be submitted for consideration and will form the basis for an oral examination.

The MD Honors Thesis must be distinct from any prior or concurrent graduate-level thesis (e.g., MPH, PhD).

Candidates for Honors in a Special Field should speak with one of their Society Fellows, complete a Statement of Intent no later than the first week of October in the expected year of graduation and submit their full proposal to the coordinator of Honors in a Special Field (located in the mezzanine of Cannon Society). The thesis submission deadline is during the first week of February. Oral examinations are held from February through April.

HST/London Society students are required to submit their completed theses to the HST Program for evaluation and submission to the Honors process.

A student must be in good academic standing in the MD program to be considered for a degree with honors.

Last updated 2/16/21

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