EA-3302A Student Assessment - Procedures

1.0        Purpose

This policy establishes the institutional system for assessing medical student performance across all phases of the VTCSOM MD Program. It ensures alignment with LCME standards, Educational Program Objectives (EPOs), and the school’s mission to prepare patient-centered physicians who can meet the needs of diverse populations. All students and faculty are responsible for understanding and adhering to the assessment standards outlined in this policy.

2.0        Procedures

VTCSOM Procedures – Assessment, Advancement, and Graduation

These procedures operationalize the VTCSOM Student Assessment and Advancement Policy and are to be used by course and clerkship directors, faculty, academic leaders, and staff involved in student assessment, remediation, and progression decisions.

3.1 Assessment Integrity, Conflict of Interest, and System Overview

• Assessment System and Alignment
• Course assessment is centrally managed, criterion-referenced, and competency-based. All assessments are aligned with:
  • VTCSOM Educational Program Objectives (EPOs), and
  • Course-, clerkship-, and elective-level learning objectives.
• The curriculum is delivered through integrated courses, clerkships, and electives, using multiple instructional modalities (e.g., problem-based learning, self-directed learning, small group learning, team-based care simulations). Students are assessed throughout each course, clerkship, elective, and curricular phase using a strategically balanced mix of:
  • Written examinations (NBME and institutional exams)
  • OSCEs and clinical skills assessments
  • Workplace-based assessments and mini-CEX
  • Narrative evaluations
  • Simulation-based assessments
  • Running Assessment Performance (RAP) composites
  • Milestone-based assessments and other competency measures.
• Conflict of Interest and Commitment
  • All assessment activities are governed by the Faculty Conflict of Interest and Commitment Policy.
  • Faculty and students must identify and disclose any real or potential conflicts of interest that could affect the fairness or objectivity of evaluations (e.g., dual relationships, financial interests, or other biasing factors).
  • VTCSOM maintains a formal reporting and management mechanism to review, document, and address conflicts, ensuring the integrity and equity of all assessments.
• Grading Framework
  • In all components of the curriculum except required Phase 2 clerkships, grades for academic performance are reported as:
    • Satisfactory (S) / Unsatisfactory (U).
  • Required Phase 2 clerkships use:
    • Honors (H), High Pass (HP), Pass (P), Fail (F).
  • All summative assessments are intentionally developed and reviewed for:
    • Alignment with program objectives
    • Validity, reliability, and equity
    • Appropriate level of challenge and cognitive demand.
• Governance and Oversight
  • The Senior Associate Dean for Medical Education (or designee) provides each student with performance results as appropriate; documentation is kept in the student’s educational record.
  • Grades for transcripts are submitted to and recorded by the Registrar.
  • Notices of unsatisfactory performance and recurrent deficiencies are forwarded to the Medical Student Performance and Promotion Committee (MSPPC) as indicated in these procedures.
  • Assessment data (quantitative and qualitative) are regularly reviewed by several committees to support continuous quality improvement and alignment with LCME standards.
    • Phase Integration Committees (PIC-1 and PIC-2/3)
    • Medical Curriculum Committee (MCC)
    • CQI Committee

3.2 Annual Assessment Development and Review Process

VTCSOM follows a structured, yearlong assessment development cycle to ensure that examinations, OSCEs, performance assessments, and clinical evaluation tools are rigorous, fair, and aligned with EPOs.

3.2.1 Annual Blueprinting

• Each course begins with:
  • Indexed assessments and Required blueprints for high-stakes assessments (e.g., CAS exams, final exams, IFS Skills Exam, ICE, OSCEs, integrated stations).
• At least three (3) months before a course or clerkship begins:
  • The Associate Dean for Assessment and Evaluation distributes the blueprinting schedule, templates, and expectations.
  • Course and clerkship directors:
    • Ensure each assessment is mapped to course objectives and EPOs,
    • Confirm appropriate distribution of content, cognitive level, and skills emphasis.
  • Following internal review:
    • Faculty teams evaluate blueprints for completeness, redundancy, and curricular fit.
    • The Office of Educational Affairs conducts a secondary compliance review.
  • Approved blueprints:
    • Are stored in the secure Assessment Repository, with date and version tracking.
    • Are shared with students via Canvas at least two (2) weeks before the relevant assessment.

3.2.2 Standard Setting

• Formal standard setting is conducted according to an MCC-approved schedule (at least every three years) for each high-stakes assessment, but more frequently if determined by course director.
• Standards are established for the purpose and stakes of the specific assessment.
• Course/clerkship directors nominate trained content experts to serve on standard-setting panels.
• The Associate Dean for Assessment, Evaluation and Strategic Analytics selects the appropriate standard-setting method based on assessment purpose and leads the process.
• Final cut scores are:
  • Submitted to MCC for approval as part of course previews
  • Archived with full documentation in the Assessment Repository.
  • Communicated on syllabi

3.2.3 Pre- and Post-Administration Quality Control

• Pre-administration QC (Assessment Office and directors):
  • Verify item formatting and scoring keys.
  • Confirm ExamSoft/Canvas functionality and secure access controls.
  • Screen for potential sources of bias or unfairness.
  • Obtain final course director approval before release.
• Post-administration QC:
• Within five (5) business days, the Assessment Office generates psychometric reports where possible including:
  • Item difficulty and discrimination indices
  • Distractor performance
  • Reliability estimates
  • Score distributions and flagging rules.
• Course/clerkship faculty review flagged items and decide whether to:
  • Retain as is,
  • Adjust the key,
  • Exclude from scoring, or
  • Revise for future use.
• Any scoring adjustments require approval from the Associate Dean for Assessment and Evaluation and are documented in the Post-Hoc Review Log.

3.3 Grading System and Grade Submission Workflow

3.3.1 Grading Scales and Transcript Notations

• Phase 1 courses and Phase 3 electives:
  • Grades: Satisfactory (S) / Unsatisfactory (U).
• Phase 2 required clerkships:
  • Grades: Honors (H), High Pass (HP), Pass (P), Fail (F).
• Additional transcript notations:
  • Incomplete (I):
    • Assigned only when a student performing at a Satisfactory level is unable to complete course requirements due to approved medical and/or personal circumstances.
    • Converted to a final grade when remaining requirements are completed.
    • Students cannot be promoted or graduate with an unresolved Incomplete.
  • Withdrawn (W):
    • Assigned only with MSPPC approval for an approved course withdrawal or leave of absence.

3.3.2 Grade Determination and Quality Control

• Final course and clerkship grades are derived from multiple assessment components, which may include:
  • NBME examinations
  • Institutional written exams
  • OSCEs and clinical skills assessments
  • Faculty clinical evaluations and milestone scores
  • Essays, case-based assessments, simulations
  • RAP composites and other course-specific measures.
• Course and clerkship directors ensure that:
  • Correct weights and formulas are applied
  • All assessment components are accurately aggregated
  • Course-level grading is aligned with institutional grading policies.
• All grade calculations undergo a quality-control review by the course/clerkship director and, when applicable, the Assessment Office.

3.3.3 Evaluation Submission and Review

• Faculty submit clinical evaluations (e.g., One45 forms) at the conclusion of each rotation.
• Course and clerkship directors:
  • Review evaluations for completeness and internal consistency.
  • Review narrative comments for professional tone, clarity, and appropriateness, and address any concerns with evaluators.
• Students may not be disadvantaged by missing or late evaluations:
  • If an evaluator does not submit an assessment despite reminders, the director must obtain a proxy evaluation from another faculty member who directly observed the student.

3.3.4 Grade Submission Timelines

• Global timeline:
  • Final grades must be submitted to the Assistant Registrar no later than six (6) weeks after the completion of the course or clerkship.
  • Once verified, the Registrar posts grades to the official academic record.
• Phase 1 timing:
  • Harmonized Milestones (One45) and summative course grades (Canvas) are released to students on the Friday of the final assessment week.
  • Official grade submission to the Registrar occurs the following week.
• Delayed evaluations and escalation:
  • Late faculty evaluations trigger automated reminders, followed by director follow-up and, if unresolved, referral to the department chair.

3.4 Phase 1 Assessment and Grading Procedures

Phase 1 assessment has two parallel elements within each course in all three semesters.

3.4.1 Element 1 – Harmonized Milestones (P/F)

• All course learning objectives are mapped to VTCSOM EPOs.
• Each Phase 1 course director completes Harmonized Milestone ratings for each student.
• Quantitative and qualitative evidence from multiple assessments are:
  • Aggregated across all Phase 1 courses, and
  • Continuously accessible to students for review and self-reflection.
• Harmonized Milestones provide a longitudinal view of development across EPOs and support formative and summative judgments of progress.

3.4.2 Element 2 – Course Summative Grading (P/F)

• Each Phase 1 course uses multiple qualitative and quantitative assessments (e.g., NBME exams, case-based quizzes, OSCEs, essays, skills demonstrations).
• The specific assessments, pass scores, weighting, and compensatory rules are:
  • Defined in the course syllabus, and
  • Communicated to students prior to the start of the course.
• For each course:
  • Compensatory and non-compensatory relationships between assessments are described so students understand how each component contributes to the final grade.
• End-of-semester exams (especially in IFS) are:
  • Collaboratively blueprinted and developed by course content experts and the Associate Dean for Assessment and Evaluation.
  • Administered by a centralized assessment team.

3.4.3 Integrated Foundational Sciences (IFS) – Three Non-Compensatory Components

IFS uses three non-compensatory components, all of which must be passed to receive a Satisfactory grade:

• Component A – End-of-Semester Skills Exam
  • Cumulative assessment of communication/interpersonal skills, physical exam skills, documentation, ultrasound skills, and related competencies.
  • Students must pass this component at the end of the semester.
  • The blueprint and passing score are communicated at least two weeks in advance.
• Component B – End-of-Semester NBME Exam
  • Cumulative NBME multiple-choice examination covering semester content.
  • Students must pass this component at the end of the semester.
  • The blueprint and passing score are communicated at least two weeks in advance.
• Component C – Running Assessment Performance (RAP) Composite
  • A weighted, cumulative composite of all IFS course assessments across the semester (e.g., integrated case-based essay exam/ICE, PBL SPIRAL assessments, end-of-unit clinical OSCEs, integrated station assessments).
  • RAP is calculated using a predefined institutional formula, communicated in the course syllabus.
  • Students must achieve the minimum passing RAP threshold to pass IFS.

3.4.4 Other Phase 1 Courses (R&I, HSSIP, CCI, POMI)

• The R&I, HSSIP, CCI, and POMI courses determine final grades using a single weighted RAP composite, with each assessment contributing according to weights in syllabi.
• The RAP composite determines the final S/U grade.
• Grade reports for all Phase 1 courses are generated by course directors and distributed through approved learning management systems.

3.5 Learning Plans vs Remediation in Phase 1 (Early Academic Support)

VTCSOM uses both learning plans and formal remediation to support student success.

• Learning Plans (Pre-Failure, “At-Risk” Support)
  • Designed for students identified as “at risk” of not meeting course standards based on real-time RAP data or other early indicators.
  • Initiated and managed by course directors and instructional teams, typically within the semester.
  • Focus on proactive, individualized support (e.g., additional anatomy review, ExamSoft quizzes, OSCE coaching, ultrasound skills practice, focused discipline-based instruction).
  • Learning plans may be mandatory at the course level but do not automatically involve MSPPC unless there are professionalism or non-compliance concerns.
• Formal Remediation (Triggered by Summative Failure)
  • Triggered when a student does not meet an established cut score or threshold on a summative assessment or course component.
  • Managed by Academic Affairs in collaboration with course/clerkship directors.
  • Documented in the student’s official academic record and may lead to MSPPC review in the case of course failure or repeated deficiencies.
  • Applies to any summative assessment with an empirically set cut-point, including:
    • IFS NBME exams
    • IFS Skills assessments
    • OSCEs
    • PBL evaluations
    • Ultrasound competencies
    • Discipline-specific summative assessments (as listed in course syllabi).
  • After successful remediation, the student’s record reflects a Satisfactory standing, and the score is adjusted to meet the minimum passing threshold.
• Standard Setting for Learning Plans and Remediation Thresholds
  • Thresholds for both learning-plan triggers and remediation are based on empirically derived standard-setting methods, the purpose of the assessment, and the stakes.
  • Cut scores and thresholds are:
  • Reviewed and approved by MCC on an annual schedule.
  • Overseen by the Associate Dean for Assessment and Evaluation, who ensures alignment with institutional policies and accreditation standards.

3.6 Phase 2 – Required Clerkship Assessment and Grading

3.6.1 Core Framework and Assessment Components

• Success in Phase 2 is measured using objective and subjective measures at regular intervals.
• Each clerkship defines its assessment plan in the Clerkship Handbook; components may include:
  • Workplace-based assessments (direct observation, mini-CEX, case-based discussions, encounter cards)
  • Written examinations (NBME subject or equivalent)
  • Clinical skills exams/OSCEs
  • Clerkship Passport
  • Simulation exams
  • Oral examinations
  • Composite assessments.
• All required clerkships use a standardized institutional 13-item clinical evaluation form in One45:
  • Items rated on a 1–5 criterion-referenced rating scale as part of a validated global rubric.
  • Items mapped to ACGME Core Competencies and EPAs.
  • Includes space for narrative comments.
  • Item- and student-level results are reviewed annually for validity, reliability, and equity.

3.6.2 Clerkship Grade Composition

AY 2021-22 through AY 2024-25

• 50% – Composite score from the 13-item clinical evaluation form
• 40% – Written examination (NBME subject exam or approved equivalent)
• 10% – OSCEs, simulations, oral exams, or other clerkship-specific assessments

AY 2025-26 and beyond

• 50% – Composite score from the 13-item clinical evaluation form
• 25% – Written examination (NBME subject exam or approved equivalent)
• 25% – OSCEs, simulations, oral exams, or other clerkship-specific assessments

3.6.3 Evaluation Timelines and Grade Submission

• Faculty must submit clinical evaluations within seven (7) business days of rotation completion.
• Late evaluations:
  • Generate automated reminders
  • Escalate to the clerkship director, then to the department chair if unresolved.
• Final clerkship grades must be:
  • Calculated, quality-checked, and submitted to the Registrar within six (6) weeks of clerkship completion.
• This release is monitored centrally.

3.7 Reporting, Communication of Results, and Grade Grievance

• Assessment results are communicated through approved institutional platforms, including Canvas, ExamSoft, One45, and other designated systems as defined in the VTCSOM Assessment Outcome Communication and Grade Submission workflow.
• Mid-course or mid-clerkship feedback must be:
  • Provided before the midpoint of every course and clerkship,
  • Documented (e.g., in One45 for clerkships), and
  • Acknowledged by the student.
• Students who believe a grade is inaccurate or unjust may:
  • Use the Academic Grievance Policy, which defines the grade grievance procedures and timelines.

3.8 Remediation Procedures and Academic Standing (All Phases)

3.8.1 General Remediation Process

• When a student does not meet an established summative performance threshold on an assessment or course component:
  • Educational Affairs issues an official notification.
  • A remediation contract is developed using the institutional template in collaboration with the relevant course or clerkship director.
• The remediation contract must specify:
  • Required activities and learning goals
  • Timelines and deadlines
  • Reassessment method(s)
  • Faculty oversight and monitoring
  • Criteria for successful completion.
• Remediation may involve:
  • Focused content review and independent study
  • Targeted skills practice (e.g., OSCE, procedures)
  • Repeat or alternative assessment of specific competencies
  • Supplemental assignments or structured learning experiences.
• The course/clerkship director:
  • Oversees the remediation plan
  • Provides ongoing feedback
  • Documents progress.
• Upon successful completion:
  • The director signs the remediation contract.
  • Educational Affairs updates the student’s record to reflect Satisfactory status for transcript purposes.

3.8.2 Failure to Complete Remediation

• Failure to complete a remediation contract within the required timeframe:
  • Results in a grade of Unsatisfactory (U) for the associated course or component.
  • Triggers immediate MSPPC review.
• End-of-year remediation periods (often two to three weeks of independent study):
  • Follow the same completion requirements, using assessments that sample the same domain of competencies at comparable difficulty and weighting as the original course finals.
  • Failure to successfully complete end-of-year remediation may result in dismissal following MSPPC review.

3.9 MSPPC Referral and Adverse Academic Action

The Medical Student Performance and Promotion Committee (MSPPC) oversees advancement, remediation review, and dismissal decisions.

3.10 Due Process and Advancement Restrictions

• Students referred to MSPPC are afforded full due-process protections, including:
  • Formal notification of concerns and reasons for review;
  • An opportunity to respond and provide additional information;
  • Written documentation of decisions and required actions.
• Advancement restrictions:
  • Students not in good academic standing at the end of Year 1 may not begin Year 2.
  • Students not in good academic standing at the end of Year 2 may not begin Phase 2.
  • Advancement to Phase 3 requires successful completion of all Phase 2 requirements.
• Beginning with the Class of 2028, MSPPC reviews student progress at the conclusion of each curricular phase (rather than strictly by academic year).

3.11 External Assessments (USMLE) and Time-to-Degree / Advancement

3.11.1 USMLE Step Requirements and Timing

• Students must pass USMLE Step 1 and Step 2 CK to graduate.
• Students are provided a six-week dedicated Step 1 study period at the end of Phase 1 and are expected to test during or immediately following this period.
• Students not prepared to sit for Step 1 during this window must meet with the Associate Dean for Student Affairs and the Director of Academic Counseling and Enrichment Services to develop a plan.
• Step 1 failure (first attempt):
  • Student is placed on academic probation.
  • Must take the USMLE Independent Study elective as the next course (if still available).
  • If the student had already used the USMLE Independent Study elective before the first attempt, they may not take it again and instead work with Student Affairs and Academic Counseling to adjust their plan.
• Step 1 failure (second attempt):
  • Triggers MSPPC referral for a student status hearing.
• Step 2 CK:
  • Students must complete all Phase 2 clerkships and successfully complete the VTCSOM Comprehensive Clinical Skills Examination before taking Step 2 CK.
  • Students may take up to six (6) weeks of Step 2 study elective time.
  • First failure of Step 2 CK → mandatory meeting with Student Affairs and Academic Counseling to form a plan; study elective time may be scheduled or adjusted.
  • Second failure of Step 2 CK → MSPPC referral for student status hearing.
• Students who qualify for assessment accommodations must work with course instructors and/or the Associate Dean for Assessment and Evaluation to ensure appropriate supports for both institutional and external assessments.

3.11.2 Time-to-Degree and Phase Advancement Limits

• Students must complete all MD degree requirements within six (6) years from matriculation, excluding approved dual-degree pathways (e.g., MD/PhD).
• Phase 1 must be completed satisfactorily within three (3) years of matriculation.
• Phase 2 required clinical experiences and electives must be completed satisfactorily within three (3) years of beginning Phase 2.
• Failure to meet these time limits:
  • Triggers MSPPC review and may result in dismissal, with limited exceptions granted by MSPPC for documented medical or other compelling reasons.

3.11.3 Registration and Performance Standards

• Students must be registered for each course, required clinical experience, research, and elective at the prescribed times (per the VTCSOM Calendar) unless otherwise authorized by MSPPC
• Student performance is determined by achievement of prescribed objectives for each component, using the satisfactory criteria established by faculty and communicated at the beginning of each course, clerkship, or elective.

3.11.4 Research Progress Requirement

• To enter Phase 2, students must demonstrate satisfactory progress on their research project by the end of M2 Research and Independent Study.
• Graduation requires successful completion of all Research & Inquiry (R&I) components, including:
  • Final manuscript
  • Year 4 presentation
  • Abstract submission for presentation.

3.11.5 Curriculum Completion and Promotions

• VTCSOM expects students to complete:
  • Phase 1, Phase 2, and Phase 3 requirements in sequence; and
  • All academic and professionalism expectations defined by the curriculum.
• MSPPC reviews each student’s record:
  • At the end of each academic year (for current cohorts), and
  • By phase completion starting with the Class of 2028.
• Satisfactory performance in individual components does not guarantee that the student’s overall performance is sufficient for progression or graduation; MSPPC makes the final determination.

4.0        References

• EA-3301 Advancement and Graduation
• EA-3302 Student Assessment
• EA-3303 Medical Student Narrative Assessment Policy
• EA-3304 Formative Assessment and Feedback
• FA-5010 Faculty Conflict of Interest and Commitment
• Academic Grievance Policy