Evaluation, Grading and Promotion of Students

Three Curricular Pathways are available to students. In addition to the standard four-year curriculum, two alternatives are available for students who seek additional time to pursue other interests in addition to their medical studies or to reinforce particular aspects of their medical education.

Students must complete the MD program (or MD component, if enrolled in a dual degree program) in no more than six (6) years. Exceptions must be approved by the Student Evaluation and Promotions Committee (SEPC). For students enrolled in the MD/PhD program, the PhD portion must be completed within no more than 5 years.  Exceptions must be approved by the Student Evaluation and Promotions Committee (SEPC).  Other degrees must be completed within the time-frame specified by the individual program.

• Standard Curriculum: The Standard Curriculum leads to the completion of the MD degree in four (4) consecutive years following matriculation into BU.
• Modified Curriculum: A BU 3 or 4 student in good academic standing may apply for a Modified Curriculum for research, internships, clinical experiences, additional educational opportunities, or personal reasons. In the Modified Curriculum, the curricular year is extended beyond 12 months.

1.3 Decelerated Curriculum:

A student who experiences academic difficulties in the 3rd or 4th curricular years may request, or may be required by the SEPC, 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. BU 3 and 4 students may enter a Decelerated Curriculum for up to a maximum of 12 additional months. Performance of a student admitted to the Decelerated Curriculum may be reviewed by the SEPC at any of its meetings. All subsequent failures for a student in the Decelerated Curriculum will result in review by the SEPC and may result in dismissal from BU (see section 5).

Students in the 1^st and 2^nd year curriculum do not have the option to enter into a modified or decelerated curriculum. A student who experiences academic, personal or family difficulties in the 1^st and 2^nd curricular years may petition the SEPC for a leave of absence.

The Academic Record includes the unabridged documents and electronic images maintained by the Office of the Registrar that reflect the academic history of the student at Boston University.

In addition to serving as a record of courses taken and grades, the student’s Official Transcript documents the student’s participation in the Modified/Decelerated curriculum, transfer into BU, interruptions in the student’s progress through the curriculum, and any administrative actions including Suspension or Dismissal.

2.1 Student Evaluation: Students are evaluated by the standards set for each course and clerkship according to the competencies defined by the Medical Education Committee. Grades are informed by many factors, including faculty evaluations. All grades are forwarded to the Registrar.

2.2 Grades and Definition of Grades: Once a student initiates a course or clerkship, a grade will be recorded. The BU grading system is used to define levels of competence and must be expressed as one of the grades listed below. BU students must earn Pass or higher for all courses to be eligible for promotion and graduation.

First and second year courses

Pass (P): Awarded when a student’s work in a course meets or exceeds the minimum requirements for competence in that course.

Fail (F): Awarded when a student’s work in a course fails to meet the minimum requirements for competence in that course.

Third and fourth year courses and clerkships

Honors (H) Awarded only for third and fourth year clerkships and rotations and signifies that the student’s performance exceeds the standards of competence in that rotation.

High Pass (HP) Awarded only for third and fourth year clerkships and rotations. Indicates performance that has consistently demonstrated competence in that rotation,  but not at the level necessary for Honors.

Pass (P): Awarded when a student’s performance in a rotation meets the minimum requirements for competence.

Fail (F): Awarded when a student’s work in a rotation  fails to consistently meet the minimum requirements for competence. .

 For students who do not complete a course or clerkship, one of the following two grades may be given:

Withdraw (W): Assigned as the final grade in any course from which the student withdraws. The Withdraw grade can be assigned at any time prior to the completion of a course. A student who is assigned a grade of Withdraw from any course will be required to retake the entire course before promotion or graduation.

Incomplete (I): Due to extenuating circumstances, when  one or more requirements of the course, clerkship, or rotation has not been completed, the grade of Incomplete will be assigned. If a student is unable to complete a required part of the course, clerkship, or rotation before the grade submission deadline, the student may receive an Incomplete if the student is otherwise progressing as expected  in that course, clerkship, or rotation. The Course /Clerkship /Rotation Director will provide a plan for the student to complete the course.

An Incomplete grade is an internal grade marker and will not remain on the on the Official Transcript once it has been remediated. All incomplete grades must be resolved within one year of the original start date of the course or clerkship. If not remediated within one year, the Incomplete will be converted to a Fail grade which will appear on the Official Transcript.

Transparency of Transcript

Grades for all courses will appear on the Official Transcript. All Incomplete and Fail grades must be remediated in order for the student to be eligible for promotion and graduation. Any repeated course will be listed on the transcript and the word “Repeat” will appear next to the course name. Courses in the first two years of the curriculum in which a student receives a grade of Fail but is able to remediate by an additional examination will appear on the transcript as “Fail/Pass.” A transcript note will be made to designate that the remediation was completed by an additional examination.

If a student receives a grade of Fail in a third or fourth year rotation due to a shelf exam failure , the student will have the opportunity to remediate the failing grade by re-examination. Upon earning a passing score, the final grade will be recalculated as specified in the course syllabus and will appear on the transcript as a Fail/(Remediated Grade). A transcript note will be made to designate that the remediation was completed by re-examination.  A shelf exam failure in a second clerkship  requires appearing before the SEPC (see section 3)

If a student fails a third or fourth year clerkship for reasons other than or in addition to failure of the end of clerkship examination, the student will receive a Fail grade and will be required to repeat the clerkship. The grade for the repeated clerkship will be calculated based on the grading criteria outlined in the course syllabus for Pass, High Pass, or Honors independent of the prior Fail.  The original Fail grade will remain on the transcript. The original summative evaluation narrative will be included in the MSPE, in addition to the summative evaluation from the repeated clerkship.

Grade Reconsideration: The Module, Course, Clerkship, and Rotation Directors determine grades in consultation with the course or clerkship faculty based on the criteria described in the module or clerkship syllabus.

A student who chooses to appeal a grade must follow these procedures:

1. Contact the Registrar to review the grade appeal process. The Registrar will serve as a liaison between the student and Department to ensure that all requirements are met.
2. Submit a written grade appeal to the Module, Course, Clerkship, or Rotation Director no more than 15 business days after the date on which the grade is officially recorded in the Registrar’s office.

A student 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. PISCEs or Doctoring Leadership Committee, Chair of the Department [clerkships]): The leadership committee must provide a written decision to the student within 15 business days of receipt of the appeal.
  • The Associate Dean of Medical Education: The Associate Dean must provide a written decision to the student within 10 business days of receipt of the appeal. The decision of the Associate Dean is final.

The Module, Course, Clerkship, or Rotation Director must provide a written decision to the appealing student within 30 calendar days of receipt of the appeal.

BU 3 and 4: A student should contact the Clerkship or Rotation Director with any specific concerns about their final grade and/or narrative evaluation .  Preceptors provide recommendations based on observations of the student’s clinical skills but do not provide a final grade for students. Students should not reach out directly to their preceptors about their evaluations.

If the student contends that a grade was due to  discrimination based  the student’s protected class status (i.e. gender, race, sexual orientation, ethnicity) the student should file an appeal with the Appropriate Treatment in Medicine (ATM) Committee.

2.3 Professional Behavior:

Professionalism is a core competency and critical component of the student’s overall performance in medical school and lapses in such may be reported by the faculty at their discretion. Additional details describing the mechanism for reporting as well as potential consequences of unprofessional behavior are available at: https://www.bumc.bu.edu/camed/education/academic-affairs/policies/professionalism/. If professionalism concerns are reported, the Course Director, Clerkship Director, or Rotation Director, they must meet with the student to review the reported concerns and work with the student and the Student Affairs Office to develop a remediation plan.

An egregious or persistent lapse in a student’s professional conduct must be reported directly to the Associate Deans for Medical Education and Student Affairs who may then refer the matter to the Disciplinary Committee or the SEPC for further action.

3.1 Student Early Intervention Process(SEIP)

The SEIP is intended to identify students who are demonstrating difficulty meeting the behavior, knowledge and skills defined for courses in their curricular year and/or the administrative responsibilities and professional behaviors expected of a medical student in the curriculum. (See examples below).

The Student Early Intervention Committee (SEIC) will determine if a student is at risk for not progressing successfully through the curriculum and provide recommendations forrequired tutoring, modifications of student schedules, meeting with Academic Enhancement Office specialists, meeting with an Associate Dean, advisor or coach and/or other actions such as referral to the Student Evaluation and Promotion Committee (SEPC). All recommendations are intended to provide additional support to ensure successful progression through the curriculum and are subject to review and approval by the Student Evaluation and Promotion Committee (SEPC) for final disposition. Information on the students progress may be shared with course and clerkship directors to provide support for the student.

 

In the preclerkship phase, the SEIC is comprised of the course directors and course managers for that academic year, the Associate Dean for Medical Education (ADME), Associate Dean for Student Affairs (ADSA) or designee and Academic Enhancement Office (AEO) representative. In the clerkship phase, the SEIC is comprised of the Clerkship directors for that academic year, the ADME, and the ADSA or designee. In each phase of the curriculum, the SEIC meets quarterly and reviews all students. Examples of reasons SEIC will refer directly to SEPC include

• Repeated lapses in meeting course expectations (i.e attendance, course assignments) despite notification by course director
• Pattern of concern in performance including marginal performance on end of year assessments
• Repeated lapses in attendance to mandatory sessions
• Repeated lapses in responding to communication, which may include but not limited to correspondences from administrators, course directors and/or deans
• Two clerkship exam failures or one clinical failure in the clerkship or post clerkship phase

The process of referral from SEIC to the SEPC is as follows:

1. After students of concern are identified by SEIC, the ADME or designee emails SAO Senior Policy Officer with the list of names for the SEPC meeting, including name of student, year and reason for SEPC referral.
2. The ADSA and ADME discuss optimal timing for the student’s appearance at the SEPC (which meeting, taking into account their academic schedule, scheduled exams, personal concerns and other).
3. The Senior Policy Officer in the SAO notifies the students via email that they have been placed on the SEPC agenda by the SEIC at least seven business days prior to the SEPC meeting, including the reason for the referral to the SEPC.

3.2 Student Evaluation of Professionalism:

Professionalism is a core competency and critical component of the student’s overall performance in medical school and lapses in such may be reported by faculty, at their discretion. Initial episodes of unprofessional behavior should be addressed as a learning opportunity and with a sole focus on remediation. Additional details describing the student code of conduct  and the mechanism for reporting as well as potential consequences of unprofessional behavior are available at: https://www.bumc.bu.edu/camed/faculty/medical-student-disciplinary-code.

Egregious and/or repeated lapses in professional conduct related to either clinical or course/clerkship responsibilities, may require further action, including discussion by appropriate SEIC, referral to Physician Health Services the Disciplinary Committee or the SEPC, with formal monitoring and documentation of progress. Clear communication between student and supervising faculty is of paramount importance, and prompt and specific feedback must be shared directly with the student. The end goal of all interventions regarding professional conduct is to foster and support the student’s development as a physician. Students must be directly informed of the behavior of concern, as close to the event as possible, by the individual who observed the unprofessional behavior. Students must have the opportunity to respond to concerns and participate in the development of remediation plans.  Students are made aware of the expectations for professional conduct via:

1. BU Medical Student Disciplinary Code of Academic and Professional Conduct, with particular emphasis to Section 1.2 and Appendix
   1. https://www.bumc.bu.edu/camed/faculty/medical-student-disciplinary-code/
2. The Clerkship syllabi
   1. Section on Assessment and Grading (Clerkship Grading Policy-Professionalism),
   2. Section on Student-Professional Comportment;
3. Association of American Medical Colleges
   1. EXHIBIT A: AAMC Teacher Learner Expectations

 Recurrent concerns, even if deemed minor, identified via SEIC will be shared with the Student Affairs Office and the student’s core advisor for formative purposes.  A referral to the Professionalism Resource Service should be strongly considered at this time. Professionalism concerns that did not result in referral to the SEPC but are determined to be significant by the clerkship director may be included in the student’s final clerkship narrative, but will not be reflected in the MSPE’s Professionalism Summary Section.

1. If an SEIC identifes persistent lapses in professional behavior, as defined in the BU Code of Conduct, the SEIC will draft a Letter of Professionalism Concern (LOPC) and submit to the Medical Education Office.  The student will also receive a copy of the LOPC

Format of the LOPC:

• Description of the concerning behavior with sufficient detail, including specific dates and locations, and the direct, specific and timely feedback provided to the student.
• LOPC sent to the SAO and AME for formative coaching and to the MEO for tracking.
• The SEIC will recommend a remediation plan with expected timeline for resolution or improvement, and follow up, if indicated.

Two or more LOPC in an academicyear results in referral to the SEPC for review  and appropriate action, if any, or any single LOPC after the student has been previously referred to the SEPC for professionalism concerns will result in a return to the SEPC.  A  single LOPC, if triggered by a serious occurrence,can result in immediate reference to the SEPC

Professionalism concerns referred for review by the SEPC or the Disciplinary Committee are considered for inclusion in the Medical Student Performance Evaluation (MSPE) Professionalism section, as decided by the relevant committee, and may be reportable to relevant licensing boards.

3.3 Student Evaluation and Promotion Committee (SEPC)

The role of the Student Evaluation and Promotion Committee (SEPC) is to: 1) Consider student petitions for exception to school policy, 2)  holistically review students who are not progressing successfully through the curriculum as expected and determine appropriate actions and 3) determine students’ readiness for promotion from one phase of the curriculum to the next or graduation.

Students will be referred to the SEPC directly or via the SEIC (described above) when there is lack of academic progress as defined by:

• Two or more module failures in the preclerkship phase of the curriculum.
• Failure of a remediation exam in the preclerkship phase.
• Fail in the End of Second Year Assessment (EOSYA) or End of Third Year Assessment(EOTYA)
• Students who were previously referred to the SEPC for academic or professionalism concerns and continue to demonstrate academic or professionalism difficulties

 SEPC actions may include: recommendation for coaching, course work remediation, referral to Physician Health Services, referral to the Professionalism Referral Service, or disciplinary measures in accordance with applicable BU policies, including probation, suspension or dismissal. The SEPC meets monthly, or as necessary, to assess student readiness for evaluation and promotion for all four years of MD curriculum.

In accordance with BU policies and standards, the SEPC Evaluates a student’s academic and professional body of work, and makes recommendations in the best interest of academic progression and patient care;

SEPC acts upon written petitions from students who request an exception from school policies, reviews any student’s deficient performance and takes appropriate action; reviews students who may not meet the maximum time for BU degree completion; acts on requests for more than one re-examination, including end-of-clerkship exams.

3.3.1 Composition:  The Composition of the SEPC is outlined in Article 5, Section G5 of the Boston University Chobanian & Avedisian School of Medicine Bylaws on Faculty Central at: https://www.bumc.bu.edu/camed/faculty/faculty-handbook-and-school-bylaws/BU-bylaws/. A member of the SEPC who may have a conflict of interest in a particular case, such as having served as the student’s advisor, personal physician, or who is the Director of a Course/Clerkship being discussed, shall be recused from that student’s case.

3.3.2 Expedited Procedures: The SEPC Chair, after discussion with the Associate Dean of Student Affairs, may, in place of a formal meeting, email SEPC members to request approval of a student’s petition. SEPC members may approve the petition or request a meeting for resolution. In addition, the Associate Dean of Student Affairs may act on petitions from students who are in good academic standing without previous lapses in professional conduct or previous appearances before the SEPC. Such actions may include approving or denying petitions:

• for a Leave of Absence (LOA) for personal reasons;
• for a medical LOA;
• to enter a Modified curriculum; and
• to return to the curriculum from a LOA.

3.4 Student Generated Petitions: All student petitions must be prepared in consultation with the Associate Dean of Student Affairs (or designee) and must comply with the rules established by the Faculty of Medicine governing evaluation, grading, and promotion. All petitions must be typed, dated, signed, addressed to the SEPC, and received by the Office of Student Affairs at least three (3) business days before the scheduled meeting, unless an emergency prevents the student from complying with the deadline.

3.5 Procedure: The process of student referral to the SEPCs described below.

 Process of referral to the SEPC:

 All students on the SEPC’s agenda will be notified by email of the date, time, and location of the meeting at least THREE business days prior to the meeting. Students will be informed of the right to appear at the meeting and/or to submit a written statement to the SEPC. A student is not required, but is strongly encouraged, to attend the meeting. Within 24 hours of notification, a student must contact the appropriate Student Affairs officer to indicate whether or not the student will attend.

A student may bring a faculty advisor to the SEPC meeting. The advisor may present information to the SEPC, but will not participate in the general discussion about the student. Neither the student nor the advisor may be present during discussion, deliberation, or voting on the petition. Attorneys are not permitted to attend SEPC meetings.

Records and other documents relating to a student on the SEPC’s meeting agenda are available to Committee members prior to or at the meeting. Upon request, the student will have the opportunity 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, Clerkship Director, or Rotation Director before the SEPC acts on any reports or evaluations.

SEPC decisions are based upon the student’s entire academic and disciplinary record, if any, at the time of the meeting. SEPC actions may include, but are not limited to, requiring:

• to repeat the year
• a Decelerated Curriculum or a LOA
• probation for a defined period
• suspension
• Referral to Physician Health Services for further assessment or monitoring
• dismissal from BU.

The Chair will communicate the SEPC’s decision to the student in writing within 10 business days.

A student who plans to appeal the SEPC’s decision and notifies the Registrar in writing of their intent to appeal, may remain registered and participate in courses or clerkships during the appeals process (outlined below in Section XX), until they either miss the deadline for the next appeal or the Dean upholds the SEPC decision (even if an appeal is submitted to the Boston University Provost).  No course or clerkship grades obtained during the appeal period will be recorded on the student’s medical school transcript if the SEPC decision is upheld. Students are responsible for tuition charges during this period.

3.6 Disciplinary Proceedings Reports to the SEPC: When a student in the MD or any of the combined MD programs has been found responsible for violating any disciplinary code of academic or professional conduct of the University, the SEPC shall be notified of the University’s final  determination. The SEPC may review the final decision and the student’s complete academic record and may determine if other action is appropriate. If a student in a combined degree program is brought to the respective promotions or disciplinary committee, the SEPC shall be notified.

3.7 Committee Records Retention: Records of all SEPC meetings, as well as meetings of the Committee on Appeals, will be kept for six (6) years after the graduation or separation of the students on the agenda.

4.1 Composition: The composition of the Committee on Appeals is outlined in Article 5, Section G7 of the Boston University Chobanian & Avedisian School of Medicine Bylaws on Faculty Central at: https://www.bumc.bu.edu/camed/faculty/faculty-handbook-and-school-bylaws/BU-bylaws/. A committee member who may have a conflict of interest in a particular case, such as having served as the student’s advisor, personal physician, or who is the director of a course/clerkship being discussed, shall be recused from that student’s case.

4.2 Procedures:

Appeals must be submitted in writing within ten (10) business days after a student receives written notice of a SEPC decision. The Associate Dean of Student Affairs may grant an extension of the filing deadline if requested within the 10 day period. The Committee on Appeals will hear any appeal of a SEPC decision and take such action as it finds appropriate with respect to the original decision.

Students may elect to appear before the Committee on Appeals alone or accompanied by a faculty advisor. The advisor may present information to the committee but will not participate in the general discussion about the student. Neither the student nor the advisor may be present during discussion, deliberation, or voting on the appeal. Attorneys are not permitted to attend meetings of the Committee on Appeals. If a student, referred to Physician Health Services (PHS) by the SEPC, chooses to appeal PHS’ determinations, the student must sign an unrestricted release of information, allowing PHS to share information with the Appeals Committee.

The Committee on Appeals may grant or deny a student’s appeal, or may modify the SEPC’s decision.

The recommendations of the Committee on Appeals should comply with the Policies and Procedures for Evaluation, Grading, and Promotion of Boston University Chobanian & Avedisian School of Medicine MD Students.

The Chair of the Committee on Appeals will communicate the Committee’s decision to the student in writing, ordinarily within ten (10) business days.

The Committee on Appeals will report all decisions to the Dean of the Chobanian & Avedisian School of Medicine.

4.3 Additional Appeals: A student may submit a written appeal to the Dean of the Chobanian & Avedisian School of Medicine within ten (10) business days after receipt of the written decision of the Committee on Appeals. The Dean may affirm, modify, or reverse the decision, or remand matters to the Committee on Appeals or the SEPC for reconsideration, and will communicate the decision and rationale to the student in writing. The student may, within ten (10) business days of receipt of the Dean’s decision, submit a written appeal to the Provost of Boston University Medical Campus. In addition, the student may, within ten (10) business days of receipt of the Provost’s decision, submit a written appeal to the Boston University Provost.

The appeal to the Boston University Provost is the final appeal.

5.1 Qualifications for Promotion: To be promoted to the next curricular year, medical students must meet all requirements of the current curricular year and satisfactorily adhere to all University standards. A student’s academic and professional performances are both subject to evaluation.

Students in “good academic standing” perform at a passing level in all courses and their overall progress renders them eligible for promotion.

5.2 Failure to Qualify for Promotion:

Students who are not in good academic standing include those who:

• Fail any courses/clerkships until it is remediated
• Are on probation
• Are suspended.

5.3 Repeat Year:

 A student who fails two courses will be referred to SEPC. A student who is given the opportunity to remediate an assessment (exam, OSCE), who then fails the remediation assessment, will return to SEPC and be required to repeat the coursework in the next year and will be placed on probation. If the student fails the repeat course, then the student is at risk for dismissal.

A student will be allowed to repeat only one of the four curricular years.

5.4 Probation:

Probation is a serious disciplinary step and can lead to dismissal. Probation is not noted on the student’s transcript, but will be included in the student’s Medical Student Performance Evaluation and becomes a part of the  the student’s Academic Record . The probation will be available to appropriate external professional organizations that request such information, including, but not limited to, state medical registration boards. Probation status may be reported to the Board of Registration in Medicine when seeking a license.

If a student is required to appear before SEPC for a continued or new concern (academic or professionalism), the student is at risk for being placed on probation. If SEPC has concerns a student is not remediating deficiencies adequately, a student may be placed on probation. Any student repeating a year (first or second year) will be placed on probation. A student may also be placed on probation for repeated, sustained professionalism concerns.

Upon remediation of all Fail grades, and with continued satisfactory performance, the student may petition the SEPC to be removed from Probation. Any student placed on probation will be reviewed at the end of the academic year. A determination will be made whether they are removed from probation and allowed to continue in the curriculum or will continue on probation. Probation status may be shared with one or more course or clerkship directors – including the student’s past performance in previous  courses and clerkships. Any future Fail grade, puts the student at risk for dismissal.

A student on Probation continues in the curriculum, but is not in good academic standing, will be monitored by the  SEPC and is required to meet the standards and remediation requirements set forthby the SEPC. A student on probation is not allowed to remain in any leadership roles within extra-curricular activities, unless allowed by the SEPC.  Students on probation are not permitted to participate in away rotations.

 5.5 Suspension:

 The SEPC  may suspend a student whose professional or academic performance is of significant concerns. . When the health, safety, or welfare of students, patients, or other members of the BU community are deemed to be at risk due to the behavioral or presence of the student, the student may be placed on suspension.

Any student who is suspended will be notified in writing within ten (10) business days of the date of the Suspension. The notification will include the length of the Suspension (up to one year) and outline any requirements for the student’s return to the curriculum. A Suspension will be noted on the student’s transcript and on the student’s academic record.

Suspended students are required to comply with the requirements of the SEPC . Suspended students are prohibited from participating in the curriculum are not permitted to avail themselves of any Boston University services on any Boston University campus or participate in any BU extracurricular activities, and are required to turn in all BU and Boston University property, including, but not limited to, identification cards.

 When a suspended student returns to BU, the student will be placed on Academic Probation for a period of time to be determined by the SEPC.

 5.6 Dismissal: BU reserves the right to dismiss any student, including a student on a LOA, for failure to maintain a satisfactory Academic Record, including acceptable professional behavior. A student may also be dismissed for not complying with SEPC requirements regarding prior performances.  A student who is dismissed from BU may petition the appeals committee (see Section 4) for reinstatement.

Grounds for Dismissal from BU include, but are not limited to:

• Failure to comply with decisions of the SEPC or the Committee on Appeals.
• Three or more final grades of fail within a curricular year.
• After re-examination, any Fail grade within the same curricular year.
• Failure to pass USMLE Step 1 after three attempts.
• Persistent or egregious breaches of the student code of conduct

Dismissed students are required to turn in all BU and Boston University property, including, but not limited to, identification cards.

A Leave of Absence (LOA) is defined as one semester or more away from the curriculum. Absences of less than one semester are defined in section 6.3, below.

Students are required to complete the medical school curriculum within a maximum of six (6) years, inclusive of any periods of LOA. The SEPC must approve any exception to this requirement.

A student may petition the SEPC for a LOA for academic, personal, financial, administrative, or non-urgent medical reasons. A petition for a LOA should be prepared in consultation with the Associate Dean of Student Affairs or designee and must articulate the reasons for the requested LOA.

If a student initiates a LOA before the completion of a course or clerkship, the student will receive a grade of Withdraw for that course/clerkship. A student on an approved LOA is a matriculated student; however, that student is not registered for any courses in the Chobanian & Avedisian School of Medicine curriculum. For a student requesting LOA related to academic difficulties, the SEPC may impose curricular requirements to be completed upon the student’s return to the curriculum.

6.1 Medical LOAs:

6.1.1 Student-initiated Medical LOA:

A student’s petition for a medical LOA should include:

• A letter from the student’s treating healthcare professional documenting that a medical leave is necessary and its likely duration.
• Any plans the student has to address any current academic difficulties or those that might result from an extended period away from the curriculum.

6.1.2 School-initiated Medical LOA:

If the Associate Dean of Student Affairs has evidence that a BU student may be a danger to themselves or to others, or is not fit to perform functions required of a medical student in non-clinical, clinical, or laboratory settings, the Associate Dean may act immediately to remove the student from the curriculum and place them on an emergency absence, pending full evaluation by the SEPC or Disciplinary committees. The Associate Dean will meet with the student to inform them of the nature of the fitness concerns and need to put them on emergency LOA while allowing for an opportunity to respond.

The student will then be required to come before either the SEPC or Disciplinary Committee, which may take the following actions:

• Temporarily suspend the student from participating in all or part of the BU program, if deemed warranted to protect the safety and well-being of the student or others in the University community, including BU’s affiliates.
• Require the student to provide satisfactory evidence of fitness, which may include the results of a medical evaluation of fitness by the student’s treating medical provider or by the Physician Health Services of the Massachusetts Medical Society to determine whether the student can perform safely and reliably. The student must consent to allow their medical provider to provide relevant medical information to a health care provider designated by BU to advise the Associate Dean and the SEPC.

If the circumstances suggest that the student is unfit, the SEPC or Disciplinary Committee may, based on the situation, ask the student to do any or all of the following:

• Take a LOA for a specified duration.
• Receive treatment as appropriate during the LOA.
• Enter a treatment program and monitoring program, (e.g. Physician Health Services).
• Withdraw from the Chobanian & Avedisian School of Medicine if remediation of unfitness is unavailable as an option, or has been reasonably tried without success.
• Dismiss from the Chobanian & Avedisian School of Medicine

If, at any time, the student refuses or materially fails to comply with a request made by the Associate Dean of Student Affairs in conformity with this Section of the policy, the Associate Dean may proceed according to 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 LOA at the request of the Associate Dean and/or to enter a treatment or monitoring program, then the Associate Dean of 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 and continuing in 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 non-compliance 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 cannot be remediated. 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 a student requests an accommodation for a disability, the student’s request will be evaluated in consultation with the Boston University Office of Disability Services and the Dean of the Chobanian & Avedisian School of Medicine.

6.2 Other LOAs: A student’s petition must include the reason for requesting a non-medical LOA, the expected duration of the LOA, and should describe the student’s plan to address any current academic difficulties or those that might result from an extended period away from the curriculum.

The Associate Dean of Student Affairs may approve a LOA for a student in good academic standing and will notify the SEPC Chair and Registrar of any LOA approval. A petition for a non-medical LOA from a student who is not in good academic standing must be submitted to the SEPC for review, unless the SEPC Chair authorizes the Associate Dean of Student Affairs to act on the student’s petition.

6.3: Excused Absences: A request for an excused absence of less than one semester is not considered a request for a LOA. The Associate Dean of Student Affairs may grant emergency absences from the curriculum and will notify the SEPC Chair, the Registrar, and the ADME. The SEPC may bring a student who is not in good academic standing or who has more than one emergency absence before the Committee for further discussion.

6.4: Delays in the Curriculum for USMLE Step 1: The Associate Dean of Student Affairs, after consultation with the Academic Enhancement Office may permit a student to delay taking the Step 1 exam. A student in this position may be permitted to delay the first block of third year to continue USMLE Step 1 preparation. This action will be reported to the SEPC. A student who fails the USMLE Step 1 must meet with a dean in the  Student Affairs Office to develop a plan to retake Step 1, and may not begin the next third year block until Step 1 has been retaken. Postponing the start of the third year curriculum may result in delay of graduation.

6.5 Petition for Return from a LOA: For reinstatement to the curriculum after any LOA, a student must file a written petition with the SEPC. The Associate Dean of Student Affairs may approve routine petitions to return to the curriculum for students in good academic standing. The SEPC must review petitions from a student whose absence was related to academic or professionalism issues.

When requesting to return from a medical LOA, the student must be evaluated by BU’s Student Health Services (SHS). All students returning from a medical LOA (including those related to mental health) must begin the return process by submitting the paperwork  accessible at the Student Health Services site (https://www.bu.edu/shs/files/2017/06/loa-instructions.pdf).

SHS may either determine that a student has been satisfactorily reviewed, and thus able to return to the curriculum, or may deem “further review required” and refer a student to Physician Health Services prior to allowing the student to re-enter the medical curriculum. Students reviewed by SHS will receive a letter from SHS outlining its assessment. Medical details are not shared with the SEPC members, except by the student or at the student’s request. Confidentiality of the student’s medical information will be protected to the extent possible, consistent with the needs of the University.

 6.6 Two-Year Limit on Absences from Curriculum: The maximum time allowable for completion of the medical degree is six (6) years. Time taken for LOAs (whether a single leave or multiple leaves) counts towards the six year period.                                                                                      

6.7 Withdrawal: A student who seeks to leave BU permanently should prepare a request to withdraw in consultation with the Associate Dean of Student Affairs. The withdrawal is effective on the date the completed Withdrawal Form is received by the Office of the Registrar.

To facilitate communication concerning student performance, BU employs the following means of communication:

7.1 Administration-Student Communication is by Boston University email. All students are expected to maintain and regularly access their BU email accounts. Checking email, at least daily, is strongly recommended.

In addition, Boston University requires students to provide a local street address, telephone number, e-mail address, emergency contact, and cell phone, using the Student Link. Failure to maintain current contact information may result in disciplinary action.

7.2 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), found at http://www.bu.edu/reg/general-information/ferpa/.

8.1 First and Second Year Students

8.1.1 Narrative Evaluations of First and Second Year students that raise concerns to the Associate Dean of Medical Education or SEIC may result in review of a student’s record by the SEPC for possible action, up to and including Suspension and Dismissal.

8.1.2 Final Course and Clerkship Grades: A student will not be promoted with any Fail, Withdraw, or Incomplete grades in required courses. A student may be at risk for dismissal from BU for:

• Two or more Fail grades within one academic year
• Failure of a remediation exam.

8.1.3 Remediation of Course Grades by Reexaminations: Remediation of a course occurs when a student receive a failing grade for the course.  If a student fails a course, they must take the remediation exam on one of the scheduled remediation days. A single round of assessments will be administered before the start of the second or third curricular years at a time selected and coordinated by the Medical Education Office and the Course Directors. If a student fails two or more courses, they must petition the SEPC for permission to remediate those courses and take the remediation assessment. Any failure on the remediation assessment results in a final fail grade for the course/rotation. The student must request permission from the SEPC to repeat the course/rotation.

8.1.4 Repeating the First or Second Curricular Year: The SEPC will require any student repeating the first or second curricular years to retake all courses in which the student received a Fail grade. To be eligible for promotion, a student must earn a grade of Pass in each repeated course after remediation. Students shall not be permitted to take a remediation examination for repeated courses unless specifically allowed by SEPC. A student may not repeat the first or second curricular year more than once. A student must pass all components of a full curricular year within two academic years.  A student who is required to repeat a year is not allowed to repeat any subsequent year. A student may petition the SEPC to enter a modified or decelerated curriculum in the third or fourth year.

 8.1.5 USMLE Step 1: Each student must take the USMLE Step 1 examination to be promoted to the third curricular year. Each student must pass the USMLE Step 1 examination to be promoted to the fourth curricular year. Any student who fails USMLE Step 1 for the first time may finish their current rotation. The student’s course of study will stop until Step 1 has been re-taken, after which, the student may re-enter the curriculum. If the student fails Step 1 a second time, the student must leave the curriculum and may not re-enter until the student passes Step 1. If a student fails USMLE Step 1 three times, the SEPC may dismiss the student.

End of Year Assessment (EOYA):

Students must pass end of year summative assessments to progress through the curriculum.  Students must complete the defined remediation of any failed end of year assessment. In the third year, students must pass the end of year assessment remediation by November of the following academic year.  Failure to remediate by November of that year will result in delayed graduation.  Students who fail an EOYA may have subsequent curricular schedules modified/adapted by the ADME.

8.2 Evaluation and Grading of Student Performance in the Third and Fourth Year

8.2.1 Third Year Requirements: All BU 2 students must take USMLE Step 1 prior to the first day of their first clerkship block n order to begin the third year.

The transitional clerkship provides an introduction to basic ward procedures, clinical skills training. Prior to entering the third year curriculum and starting clerkships, a student must attend  the transitional clerkship and complete all compliance obligations, including ensuring that the student’s health records comply with BU rules.

Any student with one Fail grade (for any reason besides an exam) in the third year will be reviewed by the SEPC. A student with at least two Fail grades (for any reason including exams) in the clerkships must appear before the SEPC.

A student will not be permitted to take any fourth year rotations until the student has passed all third year requirements, unless otherwise allowed by the SEPC.

USMLE Step 2: Any student who plans to graduate must take the Step 2Clinical Knowledge (CK). A student must have registered and scheduled a date for USMLE Step 2Clinical Knowledge (CK) exam by May 1 of the year prior to the student’s projected graduation.

Each student must take USMLE Step 2 CK

• by November 1 of the academic year in which the student is graduating
• and, in order to be certified in the match

8.22 Fourth Year Requirements: To graduate, 36 weeks of fourth year rotations are required, including 8 weeks of required rotations and 28 weeks of electives.

Of the 36 weeks, 20 weeks must be taken within the BU system (including the 8 weeks of required rotations); up to 16 weeks may be taken at an outside medical school or hospital.

A student must submit the 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 BU 4.

A student is not permitted to change the fourth year schedule after Block 18 has commenced.

All required 4th year rotations must be completed at Boston Medical Center or one of BU’s core training sites.

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 electives are included as part of this limit. A student may petition the SEPC for an exemption

A student who plans to take a fourth year extramural elective under the auspices of another medical school, institution, or organization must follow guidelines required by the registrar.  The student will evaluate the elective upon their return.

The International Health Program Director must approve all International Health rotations, whether arranged through the BU International Health Program, or arranged independently by the student. The Director may consult with the appropriate BU 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 BU. A student planning a research project for elective credit must submit all required paperwork at least six weeks prior to beginning the research project.

Up to eight weeks of Fourth Year elective credit may be awarded 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).

Any additional time spent doing a research project will not be eligible for elective credit. Research projects conducted outside BU will count as an outside elective for credit.

8.23 Method of Evaluation and Recording of Grades: Grades for all courses, clerkships, rotations, and electives taken for credit by  students in their 3^rd and 4^th curricular years, including those taken in excess of degree requirements, will be recorded on the transcript and will be subject to BU promotions guidelines.

8.24 Standards and Requirements for Promotion: Notwithstanding 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 professional performance by the SEPC, which will then take appropriate action.

BU 4 students are ineligible to graduate with any Failing, Withdraw, or Incomplete grades in any course taken during the third and fourth curricular years.

8.25 Remediation of a Fail grade: A student must remediate any Fail grade, according to the requirements established by the clerkship, rotation or elective at a clerkship or rotation site within the BU system approved by the Clerkship or Rotation Director.

• Remediation of a Fail grade in any clinical clerkship, rotation, or elective is not allowed while a student is enrolled 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 without SEPC approval

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. A student must remediate all third year grades at the beginning of the fourth curricular year at the earliest possible date, depending on availability.