Progress and Promotions

Promotional Guidelines

A student is considered to have achieved adequate academic progress if they pass the sequence of courses, clerkships, and other requirements established by the Executive Curriculum Committee. The passing standards for each course and clerkship reflect the course or clerkship objectives. These objectives map to the overall graduation requirements, which are known as the Student Physician Activities (SPAs). The SPAs include the knowledge, skills, behaviors, and attitudes achieved by Emory University medical school graduates and are published in the Student Handbook. Professionalism is an integral component of many SPAs, and standards of professionalism – as contained in the SPAs and as otherwise described in the Student Handbook – are factors in consideration of adequate academic progress. Independent of the final grade, unprofessional behavior may be the sole criterion for which a student receives an intervention as described throughout this document.

Students must be aware that the Office of Financial Aid monitors the satisfactory academic progress of students. As outlined in Part V: Section 4 (Maintaining Academic Eligibility for Financial Aid) of the Student Handbook, failure to maintain satisfactory academic progress, including not completing courses/clerkships and/or not receiving satisfactory grades in them, may impact federal financial aid.

Progress and Promotions Committee

The Progress and Promotions (P&P) Committee regularly monitors the academic progress of students during the Emory University School of Medicine (EUSOM) MD curriculum (the “curriculum”) to ensure that students are performing at an acceptable level to successfully complete their present phase and to advance to the next phase. The P&P Committee reviews all students’ academic progress, discusses students who may not be making adequate academic progress, and notifies students about their concerns (each notification action an “intervention”). The P&P Committee decides whether students can advance through the phases based on EUSOM policies outlined below. P&P Committee decisions are communicated to the Executive Associate Dean (EAD) or their designee, who then provides the letters written by the P&P Committee to individual students.

Academic Advancement Criteria

All EUSOM students’ academic records are reviewed regularly to ensure adequate academic progress of students across the curriculum. At the end of each phase, the chair of the P&P Committee consults with a representative from the Registrar’s office, the Associate Dean for Student Affairs, the Associate Dean for Student Success, and the Foundations Director to review each student’s academic and professional progress to determine whether the individual is ready to progress to the next phase of the curriculum (e.g., Foundations to Applications). The names of those who have not satisfactorily met all requirements will be sent to and discussed by the P&P Committee. The P&P Committee will consider all aspects of a student’s performance in this discussion, including but not limited to course grades and adherence to the EUSOM Conduct Code, Honor Code, and EUSOM and University policies. The P&P Committee determines whether a student meets criteria to advance to the next phase using the following criteria:

1. Adequate Academic Progress: Students with passing grades in all courses/clerkships.
2. Inadequate Performance for Advancement (these students would not be promoted):
   1. Students who do not complete any course or clerkship requirement(s);
   2. Students who fail a course or clerkship and do not satisfactorily remediate;
   3. Students who fail to complete any P&P Committee-mandated activities on which promotion is contingent;
   4. Students who are on suspension;
   5. Students who have failed to satisfy expectations pertaining to professionalism.

Monitoring Student Progress

In addition to the evaluation conducted at the end of each phase, during the academic year, the P&P Committee will also regularly review the progress of all students to identify those whose performance may not be adequate for promotion to the next phase of the curriculum. The P&P Committee will take a more thorough review of any students who meet the following criteria, or whose performance otherwise suggests they may be found to have inadequate performance for advancement:

• Have received interventions from the P&P Committee in the past;
• Have two or more incompletes in any phase;
• Have one or more Unsatisfactory grades in a course or clerkship;
• Have received a professionalism report.

For expectations related to the process for reporting and responding to alleged professionalism violations, please refer to Part III: Section 13 (Professional Conduct) of the Student Handbook.

The P&P Committee will review the totality of the student’s academic and professional record at EUSOM and may at any point determine that interventions are needed according to the criteria outlined below. Professionalism is of equal concern to purely academic progress, and each situation will be considered in context. For these discussions, initial unsatisfactory grades in courses and clerkships are considered. Although successful remediation will result in a satisfactory grade on a student’s transcript, the number of remediations required of a student will form part of the discussion of a student’s academic progress.

Meeting deadlines is an important professional behavior. All course and thread requirements, as defined by the individual course and thread directors, must be completed by the deadlines assigned. Students who fail to meet deadlines without prior approval from the relevant faculty member will be referred to the Progress and Promotions Committee. The consequences of not meeting deadlines will be determined based on factors including the significance of the requirement not completed, length of time past the deadline, and the number of missed deadlines, and can range from a letter of concern up to and including dismissal. The Progress and Promotions Committee will be notified of missed deadlines by the relevant course or thread director.

P&P Committee Notifications for Students of Concern

The interventions comprising the P&P Committee’s notification actions are typically progressive in nature. However, depending on the severity or persistence of the concern, the P&P Committee may move to a more significant intervention and is not obligated to move through available options in sequence.

Letter of Concern

When the P&P Committee initially has concerns about a student’s academic or professional performance, a Letter of Concern will outline the deficit areas and recommended resources for support, including the Center for Holistic Student Success. The Letters of Concern are meant to foster a growth mindset but also to clearly delineate the consequences if the student’s performance does not improve. Letters of Concern will be included in a student’s internal academic file but will typically not appear on the Medical Student Performance Evaluation (MSPE).

The following is a non-exhaustive set of examples for which a student might be considered for a Letter of Concern:

• A student is required to remediate two Foundations examinations (end of course and/or Anatomy)
• A student has a professionalism or a clinical skills performance issue

Academic Deficiency

When a student’s deficiencies are of a more serious nature, the P&P Committee may issue a Letter of Academic Deficiency. The entirety of the student’s academic performance at EUSOM is factored into this decision. Notification of this status is intended to alert the student that, without improvement, they may have inadequate performance for advancement and ultimately may not succeed in medical school. Letters of Academic Deficiency will be included in a student’s internal academic file but will typically not appear on the MSPE.

Although not an exhaustive list, Letters of Academic Deficiency may be considered when a student:

• Must remediate three Foundations examinations (end of course and/or Anatomy) and the summed credit hours for the three courses is six or more. For this determination and those interventions below, a single anatomy exam counts as one credit hour.
• Is noted to have a deficiency in their clinical performance over more than one clerkship or course (e.g., difficulty synthesizing clinical information, poor shelf exam performance, etc.).
• Received a Letter of Academic Warning in the Foundations phase and continues to struggle in a later phase.
• Missed deadlines during Discovery.
• Has professionalism problems that form a pattern or has a single, significant professionalism transgression.

Academic Probation

When the P&P Committee has significant concern about a student’s performance and, without improvement, the student is in danger of having to repeat the curriculum or to be dismissed, the student will be placed on Academic Probation. This serves three functions:

1. Provides official documentation that the student is deficient in areas related to academic or professional performance;
2. Provides a pathway and defines a timeline the student must follow to regain good standing which may include, but is not limited to, remediation, maintaining appropriate performance standards, and/or adhering to professional expectations;
3. Describes the consequences that will result if a student does not meet stated expectations.

Typically, Academic Probation will continue until a student successfully completes the current phase. Alternative criteria by which a student may return to good standing may be set by the Progress and Promotions Committee in consultation with the EAD and/or their designee.

Academic Probation will be included in a student’s internal academic file and may be reported on their MSPE at the discretion of the MSPE Committee (for further information, see Part III, Section 9 of this handbook). Academic Probation will be reported to residency programs and licensing bodies that request this information.

The following is a non-exhaustive list of examples for which a student would be considered eligible for Academic Probation:

• A student is required to remediate four Foundations examinations (end of course and/or Anatomy) and the total for the courses is ten credit hours or more.
• A student receives an initial grade of Unsatisfactory in a clerkship or course in the Application, Discovery, or Translation phases. Remediation of the clerkship or course will be prioritized in the student’s schedule. A student may be required to stop their clerkships until they have completed this remediation.
• A student has a professionalism issue(s) that the P&P Committee members judge to be significant and highly concerning or has had repeated professionalism issues that have not improved following intervention.
• A student receives an Unsatisfactory grade on their second attempt at the End of Applications OSCE.
• A student fails USMLE Step 1 or Step 2 exam twice

Repetition

Students with ongoing academic difficulty may need to repeat a course, clerkship, or phase of the curriculum. There are two primary reasons for Repetition:

• Students may voluntarily repeat a phase because of specific events which disrupted a student's performance but which are not considered to be indicative of larger concerns about a student's overall performance capability (e.g., health, personal, or family issues). A voluntary repetition can only be approved by the EAD or the EAD's designee. In these cases, the student will repeat the course or phase without academic penalty.
• Students may opt to repeat -or may be required by the P&P Committee to repeat- a course, clerkship, or phase, out of concern that the student has not mastered the relevant learning objectives. When a student receives Academic Probation for their initial attempt at a course, clerkship, or phase, they will remain on Academic Probation until they successfully complete that phase of the curriculum. The repetition will also be apparent on the student's transcript.

The following is a non-exhaustive list of circumstances under which the P&P Committee would require a student to repeat a course, clerkship, or phase in the curriculum:

• A student is required to remediate five or more Foundations exams (end of course or Anatomy). For a student to repeat based on this criterion, they must already meet the criteria for Academic Probation
• A student fails to receive a Satisfactory grade on the second remediation attempt for the same Foundations course or exam. The student's final grade for the course will be Unsatisfactory.
• A student receives a grade of Unsatisfactory in the Discovery phase.
• A student receives a grade of Unsatisfactory in a clerkship or course in the Application or Translations phases.

When a student is repeating a phase due to performance issues, any Unsatisfactory grade during this period should be taken seriously. Students required to repeat a course, clerkship, or phase should meet with the Associate Dean for Student Success to support their successful completion of the repetition. Prior to voting on repetition of a phase, the P&P Committee chair will contact the student and invite them to meet with the P&P committee to discuss the possibility of repetition and their plans for success moving forward. The student will be advised of the right to bring a mentor/advocate with them.

Academic Suspension

Academic Suspension is considered for serious academic or professional issues that indicate the student would benefit from time away from the curriculum to manage external distractions or other concerns. Before being suspended, a student may be asked to meet with the P&P Committee and, if not, may request such a meeting. The period of suspension will typically be six months to one year and will require specific conditions to be met before the student may restart the curriculum. Students on Academic Suspension cannot restart the curriculum until the concerns that placed them on Academic Suspension have been resolved, reviewed, and approved by the EAD or their designee.

Dismissal

Dismissal is considered for serious breaches in professional conduct and/or significant academic concerns. Prior to voting on dismissal, the P&P Committee chair will contact the student and invite them to meet with the P&P Committee. The student will be advised of the right to bring a mentor/advocate with them, as well as the conduct at issue and the possible consequences. The student will be invited to discuss the issue(s) at hand and their plans to address it/them if they are not dismissed.

A student may be considered for Dismissal from EUSOM by the P&P Committee for reasons including but not limited to those listed below.

Foundations phase:

• A student is eligible for Dismissal if, due to academic reasons, they do not successfully complete all required components of the Foundations phase within two attempts at the phase.
• A student who is repeating the Foundations phase and who received Academic Probation during their initial attempt at the phase is eligible for Dismissal under the following circumstances:
  • They are required to remediate three Foundations examinations (end of course and/or Anatomy) and the summed credit hours for the three courses is six or more.
  • They are required to remediate two courses for which they received Unsatisfactory grades in their initial attempt at the phase. Note that students who are repeating the Foundations phase need to take for a grade only those courses that they haven’t successfully completed already, either with an initial or remediated grade of Satisfactory.

Discovery phase:

A student who is repeating the Discovery phase is eligible for Dismissal if they receive an Unsatisfactory grade for the repeated attempt at completing the phase.

Application or Translation phase:

• A student is eligible for Dismissal if they receive either of the following:
• Two initial Unsatisfactory grades in separate courses or clerkships.
• An Unsatisfactory grade for their second attempt at a course or clerkship.
• An Unsatisfactory grade on the third attempt at the End of Applications OSCE
• Professionalism:
• A single professionalism violation that the P&P Committee members consider egregious may result in Dismissal. This includes, but is not limited to, negligence that, in the P&P Committee’s judgment, could have led to death or serious injury. It also includes behavior that is grossly inappropriate by the standards of the medical profession.
• Multiple professionalism violations that indicate a student’s inability to achieve the level of professionalism required of a physician may also result in Dismissal.
• A student who does not complete the MD program within six years and who does not have approval to complete an additional degree or coursework is eligible for Dismissal (see below on Length of Time to Complete Degree).

Student Right to Appeal P&P Committee Decisions

Students may appeal interventions by the P&P Committee, including Academic Probation, Repetition, Academic Suspension, and Dismissal. If a student wishes to appeal, this request should be presented in writing to the EAD within 14 calendar days of receiving notification of the action. The appeal may be based on the following grounds:

• To consider new information or other relevant facts that the student appealing the decision feels the P&P Committee may not have known and that may have influenced their initial decision.
• To allege a procedural error in the P&P Committee process that may have substantially impacted the fairness of the decision.

For appeals of Academic Probation, the EAD will make the final decision on the appeal and will notify the student of that decision. For appeals of Repetition, Academic Suspension, or Dismissal, the EAD will convene an ad-hoc appeals panel of three faculty members to consider the appeal. The appeals panel will review the documentation from the P&P Committee and recommend to the EAD whether the P&P Committee’s decision should stand or be rescinded, with a different intervention to be put in place by the EAD, or the matter to be sent back to the P&P Committee for further action, in the discretion of the EAD.

The EAD will ultimately make the final decision on appeals and will notify the student of that decision. All appeal decisions are final.

Appeals should be conducted in a professional manner by the student involved. Students should be respectful of the perspective and judgment of members of the P&P Committee and appeals panel. Failure to exhibit appropriate professional behavior during the appeals process may result in immediate termination of the appeal process and filing of a professionalism report by the appeals panel.

Length of Time to Complete Degree

The standard MD program at EUSOM takes four academic years to complete, either consecutively or non-consecutively if a student chooses to engage in additional activities, including:

• Obtaining another degree (e.g., MPH, MBA, etc.)
• Spending a year doing a scholarly project (or extended Discovery)
• Taking an additional year of formal coursework

Students must have a well-defined plan for this extra time to complete their MD degree and must seek approval for these additional activities from the EAD or their designee.

Students who need time off for extenuating health, personal, or family issues may seek to take leave from full time coursework. Students considering a leave of absence should consult Part III, Section 8 of the Student Handbook.

Students who plan to obtain the MD degree with no additional degrees or certificates must complete all academic requirements of the MD degree within no more than six academic years from the date of matriculation. The academic records of students in year four will be reviewed by the Registrar and the P&P Committee to ensure students can complete the requirements by the end of six years; students who will not complete the program in four years will be monitored annually, at a minimum.

A student who fails to progress in the curriculum and who is in danger of not meeting the six-year deadline is eligible for interventions by the P&P Committee, up to and including Dismissal.

Approved leaves of absence will not be counted as part of the six academic years. However, students on leave for health, personal, or family issues or who have taken an extended time to study for a USMLE exam (for information on delaying USMLE Step 1, see Part III, section 10 of the Student Handbook) must maintain regular contact with EUSOM, respond to communications about their status, and keep the EAD or their designee informed of their plans for continuation in the program. Failure to do so may lead to referral to the Progress and Promotions Committee.

Students should also be aware that the Federation of State Medical Boards has a seven-year requirement to complete all three steps of the USMLE exam.

Inclusion of P&P Decisions in the Medical Student Performance Evaluation (MSPE)

P&P decisions are included in a student's internal academic file. Refer to the MSPE section of the MD Handbook to see which P&P decisions are included in the Medical Student Performance Evaluation.