School of Medicine: Policies

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Policies

Programs/Courses

• Policy on Academic and Professional Advancement
• Policy on Enrollment and Withdrawal from Courses and Clerkships
• Leave of Absence, Withdrawal, and Readmission Policy

Objective: The purpose of this policy is to promote student academic achievement, maintain academic and professional standards (knowledge, skills, attitudes and behaviors) and achieve fairness and consistency in decisions regarding students with academic or professional deficiencies. It is the policy of the School of Medicine to give every qualified and committed student the opportunity to graduate; however, the School reserves the right, in its sole and absolute discretion, to make judgments about who has or has not demonstrated the necessary qualifications to earn the M.D. degree and to practice medicine competently.

Outline of Policy: All academic deficiencies, patterns of unprofessional behavior and egregious violations of professionalism will be presented to the Academic Standards and Achievement Committee (ASAC) that acts on behalf of the faculty of the School of Medicine. This policy specifies how the ASAC will deal with student academic deficiencies in courses, clerkships, electives, the Clinical Practice Examination (CPX) and with failures on the United States Medical Licensing Examination (USMLE) Step 1 and Step 2 examinations, including compliance with the Standards for Academic Standing (see end of this document).

Definition of Academic Failure: The courses and electives in the pre-clerkship and post-clerkship phases of the Next Generation Curriculum, the Family Medicine, Perioperative Medicine, and Geriatrics clerkships and the surgical subspecialties are graded as pass/fail (P/F); any F constitutes a failure. The other clerkships are graded with letter grades (A, B, C or F). A score of 70% or higher is required for successful completion of each course and clerkship. A score lower than 70% constitutes an F; each F constitutes a failure and is documented on the official transcript and the Medical Student Performance Evaluation (MSPE). Additionally, a second failure of the Clinical Performance Development-1 c (CPD-1 c) Observed Structured Clinical Examination (OSCE) or failure of the CPX will be referred to ASAC for review and action and will be reported on the MSPE.

Professionalism: Professional attitudes and behaviors are components of the 12 Competencies Required of the Contemporary Physician that enable the independent performance of the responsibilities of a physician and therefore are a requirement for the successful award of the degree of Doctor of Medicine^1-4 The School of Medicine’s Professionalism Objectives establish general standards applicable to all students in the School of Medicine. However, it is the responsibility of the faculty and the ASAC, as appropriate, to interpret and apply the general Professionalism Objectives to specific situations in which concerns are raised about student performance or behaviors.

Evaluation of professional attitudes and behaviors is an integral part of a student’s assessment and generally is accomplished through observation and narrative recording. “Praise/Concern” Cards⁵ and written narratives are assessment tools used to describe behaviors in areas of altruism; honesty and integrity; caring, compassion and communication; respect for others; respect for differences; responsibility and accountability; excellence and scholarship; leadership and knowledge and other skills related to professionalism. These professional attitudes and behaviors are monitored and recorded throughout undergraduate medical education.

Any breach of professionalism resulting in a recorded observation, e.g., Professionalism Concern Card, letter, written report, etc., must be addressed with the student by his/her College Dean and documentation of the discussion must be recorded. If a student receives three or more written observations of concern or is cited for a single egregious breach of professionalism, notice will be sent to the ASAC for review. A student identified as having a pattern of unprofessional behavior may be directed to further counseling and /or to supportive remediation and/or placed on academic warning or academic probation⁶ or if the professional violations are severe, a student may be dismissed from school even if he/she has passing grades in all courses. The ASAC will assess the severity of the problem, the management and the consequences, including possibly reporting the behaviors in the student’s Medical Student Performance Evaluation (MSPE). Egregious behaviors, e.g., assault on or threat to a patient, patient’s family member, student, GME trainee or faculty member, conduct that may constitute a felony, etc., regardless of whether criminal prosecutions are initiated or pursued, will be referred immediately to the ASAC, irrespective of whether previous observations of concern exist, with the recommendation for dismissal from school.

Grading during the Pre-clerkship phase: The pre-clerkship phase of the Next Generation Curriculum comprises the first three semesters of the educational program. This phase consists of six graded courses: Integrated Systems I (first semester), Integrated Systems II (second semester), Integrated Systems III (third semester), Clinical Performance Development 1 (all three semesters and designated as CPD-1 A, CPD-1 B and CPD-1 C), Social Issues in Medicine (either semester one or two during the first year) and the Transitions Course. Each of these courses assigns a pass/fail grade.

Integrated Systems I consists of the following course components or “systems”: Cells to Society, Foundations of Medicine (FoM), Cells, Tissues and Mechanisms of Disease (CTMD) and Microbes and the Immune System (MIS). Integrated Systems II consists of the following course components: Musculoskeletal Integument System (MSI), Gastrointestinal System (GI) and Mind, Brain and Behavior (MBB). Integrated Systems III consists of the following course components: Cardiovascular System (CV), Pulmonary System (Pulm), Renal System, Endocrine-Reproductive System (Endo-Repro) and Hematology (Heme). In order to receive a passing grade for an integrated system course, a student must have an average score for all components/systems of 70% or above, and must achieve a score of 60% or above for each component/system.

Clinical Performance Development 1 (CPD-1) is a three semester course with the designations of CPD-1 A, B or C. Performance is assessed during each semester and each student is provided formative narrative feedback including opportunities for remediation if skills are not developing at an appropriate and expected pace. Each student will receive a single P/F grade for CPD-1 at the end of the third semester (CPD-1 C).

Social Issues in Medicine is a one semester course that occurs during the first two semesters with half of students taking the course in the first semester and half in the second semester. A single P/F grade is assigned at the end of the first year.

In order to progress to the third semester of the curriculum, a student must have demonstrated professional behavior, and have achieved 70% or higher on Integrated Systems I and Integrated Systems II, and have passed each component within these two courses with a score of 60% or higher, and have received a P for Social Issues in Medicine, and be progressing satisfactorily in CPD-1. Failure to meet any one of these criteria will result in a referral to the ASAC for review and action. Any requirement for remediation must be completed prior to the beginning of the third semester.

Successful completion of the third semester requires a score of 70% or higher in the Integrated Systems III course, a score of 60% or higher on each of the components/systems within Integrated Systems III, and a grade of P in CPD-1. Failure to meet any one of these criteria will result in a referral to the ASAC for review and action. Any requirement for remediation must be completed successfully prior to sitting for USMLE Step 1.

Summative Examinations: A passing score on a summative examination within a course is 70%. Students achieving less than 60% on a summative assessment will be referred to the ASAC with the recommendation from the respective system leader for remediation. Generally, if the student is in good standing professionally, has done well formatively, and has no other academic deficiencies, he/she may be allowed to take a reexamination. The reexamination score, if passing, will be an additional score factored into the cumulative total. If the summative examination is failed the second time with a score lower than 60%, the ASAC will review the student’s performance again and decide either to allow the student to make a third attempt at a reexamination or repeat the course. The final decision regarding reexamination rests with the ASAC. Failure to pass a summative on the third attempt constitutes a failure of the system and therefore failure of the course. Any approved summative reexaminations must be retaken in the semester break immediately following the course in which the failure occurred.

With regard to anatomy practical examinations, a score of 70% or higher is passing. Individual anatomy practical exam scores factor into the respective organ system grades, e.g., an anatomy practical examination score in MSI factors into the MSI grade and an MBB anatomy practical exam score factors into the MBB] grade. Anatomy practical examinations also are graded as a thread across the Integrated Organ System in which they occur, i.e., Integrated Organ Systems II or III. A cumulative score of 70% or higher across the anatomy thread is required to sit for USMLE Step 1. Students achieving a cumulative anatomy score of less than 60% for Integrated Organ Systems II (consisting of anatomy practical examinations from MSI, GI and MBB) or Integrated Organ System III (consisting of anatomy practical examinations from CV, Pulmonary, Renal and Endo-Repro) will be referred to ASAC and require remediation. Any remediation required by ASAC will include all anatomy from the semester failed, and reexamination will be at the discretion of the anatomy director as to whether it will be conducted with preserved specimen or a comparable electronic means. Reexamination must occur in the semester break immediately following the course in which the failure occurred.

One component of the CPD evaluation within the first 18-month curriculum is the OSCE. The OSCEs for CPD-1 a (end of fall semester) and CPD-1 b (end of spring semester) are formative; students will receive narrative feedback regarding their performance with advice on remediating any deficiencies noted. The OSCE for CPD-1 c is summative and a passing grade is required to pass CPD-1 and begin clerkships. A failure on the CPD-1 c OSCE is referred to ASAC for review and action. Typically, ASAC allows a student in good standing to remediate and retest. A student required to repeat the summative OSCE must complete the second examination prior to the end of the third semester. A second failure OSCE-1 c results in an F in CPD-1 and the student will be referred to the ASAC for review and action and will be reported in the MSPE.

Promotion to Clerkships: Students who demonstrate professional behavior and who achieve a passing grade in Integrated Systems I, Integrated Systems II, Integrated Systems III, CPD-1 and SIM are eligible to sit for USMLE Step 1. Once a student has taken USMLE Step 1, he/she may progress to clerkships. If notification of a failing score on Step 1 is received after a student has begun a clerkship, he/she generally will be allowed to complete that clerkship. The student will be removed from subsequent clerkships until a passing score has been achieved. Students in the dual MD/PhD degree program must take USMLE Step 1 prior to entering the PhD portion of the program and must pass Step 1 in order to continue in the graduate program.

Remediation of Academic Deficiencies in Clerkships: A passing cumulative numerical score of 70% must be achieved in order to pass a clerkship. The score achieved correlates to an assigned letter grade of A+, A, A-, B+, B, B-, C+, C or C-. Earning a cumulative score of less than 70% constitutes a failure and automatic referral to ASAC, and also requires repeating the clerkship and all its requirements. Even if a student numerically achieves a passing score of 70%, the Clerkship Director may refuse to pass a student based upon poor clinical performance and/or concerning issues of professionalism. In this circumstance, the clerkship director will make a recommendation to the ASAC regarding his/her concerns with appropriate documentation. If clinical failure is upheld by the ASAC, remediation likely will include repeating the clerkship. When a clerkship requires repeating it will be noted in the MSPE, and the student’s transcript will show two enrollments in the same course with two separately determined and reported grades.

USMLE Subject Examinations: A passing score on each subject (shelf) examination will be set by the annual Hofstee recommended passing score determined by the National Board of Medical Examiners. Not achieving this score constitutes a failure of the examination and therefore a deficiency for the clerkship. The student will be assigned an Incomplete on his/her transcript until the deficiency is removed when the examination is passed. Students who do not achieve a passing score on a shelf examination will be referred to the ASAC with the recommendation from the clerkship director for appropriate remediation. Generally, if the student performed well clinically and is in good standing professionally, the student would be able to take a reexamination unless the score on the subject examination is so low that removing the deficiency still will result in a failure. The reexamination grade, if passing, will remove the deficiency from the course; however, the initial score is the only one that will be factored into the final clerkship grade. The final grade then will replace the Incomplete on the transcript. A second failure of the shelf exam will be referred to the ASAC for review and action. Should the ASAC permit the student to take the shelf examination a third time and the student passes, the clerkship deficiency will be satisfied; however, the first score is still the only one calculated into the clerkship grade. Failure to pass a shelf examination on the third attempt constitutes a failure of the clerkship and will be referred to the ASAC for review and action. If approved, shelf reexaminations will occur at the completion of the student’s third year. Depending upon the timing of the clerkship with the deficiency, a student with an outstanding deficiency in a single clerkship may be allowed to continue into the elective portion of the curriculum but will not be allowed to take an elective in the discipline of the clerkship deficiency until the deficiency has been remediated. All core clerkships (Geriatrics is not included in the core) must be passed before a student can sit for USMLE Step 2.

Remediation of Academic Deficiencies in Geriatrics and Advanced Clinical Electives (ACEs): A passing cumulative score of 70% must be achieved in order to pass the Geriatrics Clerkship in fourth year. Earning less than a 70% constitutes a failure and requires repeating the clerkship and all its requirements. The ACE is a required single 4 week clinical experience selected by the student and is graded Pass/Fail. Students must achieve a passing grade in this course to receive credit. Remediation of a deficiency in an ACE is required. A student must pass the Geriatrics clerkship as well as their selected ACE in order to meet graduation requirements.

Remediation of Academic Deficiencies in Electives: Remediation of a deficiency in an elective is not required, however the student will not receive credit toward the MD degree for that elective. A student must complete all required electives and meet the elective credit requirements in order to meet graduation requirements.

Incompletes and University Withdrawals: An Incomplete may be assigned to a course or clerkship on a student’s transcript should an emergent situation, e.g., death of immediate family member, illness or accident, etc., arise after the student successfully has completed the majority of the requirements. An Incomplete cannot be assigned as a grade when the student is failing the course or clerkship. When the requirements have been completed, the Incomplete will be removed and replaced by the course or clerkship grade. An Incomplete grade will become an F one year after it is issued if not remediated. Grades of W will not be changed or removed. Grades of F will not be changed after remediation.

Should a student need extended time off from medical school, interrupting a course or clerkship, the student must request a leave of absence or withdrawal per School of Medicine Leave of Absence, Withdrawal, Readmission Policy. Any course or clerkship in progress will be graded as W. If and when the student is readmitted from a withdrawal, the ASAC will determine how much, if any, of the course or clerkship will need to be repeated. The grade of W will remain on the student’s transcript.

Graduation: In order receive the recommendation from the ASAC for graduation and conferral of the MD degree, a student must satisfy all academic and professionalism graduation requirements with no outstanding deficiencies. In addition, passing scores on the USMLE Step 1, USMLE Step 2 clinical knowledge and the USMLE Step 2 clinical skills are required for graduation.

Steps 1 and 2 of United States Medical Licensing Examination (USMLE): In order to advance to the clerkships, a student must successfully complete the pre-clerkship curriculum and must have taken USMLE Step 1 at least 10 days before the Transition course. A student may begin the clerkships pending notification of his/her Step 1 score. If notification of a failing score on Step 1 is received after a student has begun a clerkship, he/she generally will be allowed to complete that clerkship. The student then will discontinue clerkships in order to concentrate on retaking and passing Step 1. The Step 1 examination may be taken no more than three times. Three failures of Step 1 will result in the student’s dismissal from the School of Medicine, without recourse to the appeals process. After successful completion of the core clerkships, the student must take both parts of Step 2 of the USMLE (2 CK and 2 CS). Passing both Step 2 CK and Step 2 CS is required for graduation. Students are allowed a total of three attempts to pass each of the two Step 2 examinations; failure to pass either Step 2 examination for a third time will result in dismissal from medical school, without recourse to the appeals process. Students must pass all required clerkships and take USMLE Step 2 CS and 2 CK no later than November 1 of their last academic year in medical school to ensure an opportunity for remediation prior to residency match and graduation, should a failure occur. Students may register for but not sit for USMLE Step 2 components prior to completion of clerkships.

Clinical Practice Examination: Students are required to take and pass the Clinical Practice Examination (CPX) after the completion of the clerkships. This is a requirement for graduation. Students failing the CPX are referred to ASAC and are required to review their performance and address their deficiencies with an assigned attending. Failure of the CPX will be reported on the MSPE.

Overall Time Limits: All of the requirements for graduation, including passing Steps 1, 2 CK and 2 CS of the USMLE, must be completed within six years from the date the student matriculated in the School of Medicine. Students in the combined MD/PhD and MD/JD degree programs must complete graduation requirements for both degrees in a maximum of eight years from the date of matriculation; graduation requirements for students in other dual degree programs must be completed within seven years. Exceptions to this policy are rare, and must be approved by the ASAC.

Procedure for Handling a Deficiency or Failure:

• The Course, System or Clerkship Director notifies both the student and the School of Medicine Registrar/College Dean of deficiencies.
• The student is withdrawn from clinical responsibilities (if applicable).
• The student is required to meet with his/her College Dean. At this meeting, the Policy on Academic and Professional Advancement is discussed and the student is notified of the next ASAC meeting. The ASAC meetings usually occur monthly.
• The student is added to the agenda for the ASAC.
• Students may submit a written statement, results of a drug test, results of a Counseling and Psychological Services (CAPS) screening or any other relevant data to ASAC and/or request to meet in person with ASAC.
• All students subject to dismissal or who may be required to repeat an academic period will be offered the opportunity to meet with ASAC.
• The ASAC reviews each student’s academic record, takes into account any other relevant information or data and recommendations from a Course or Clerkship Director, and determines remediation or other action based upon the Policy on Academic and Professional Advancement.
• The Chair of ASAC notifies the student in writing of the Committee’s decision.
• If applicable and approved, the Office of Student Affairs schedules the remediation required by the ASAC in collaboration with Course or Clerkship Directors.
• In the cases where a student is asked to repeat an entire segment of the curriculum or is dismissed from the School of Medicine, he/she can appeal the decision of the ASAC following the Appeals Process described below.
• ASAC decisions regarding promotion or graduation due to failure to pass Steps 1, 2 CK or 2 CS of the USMLE or dismissal resulting from three failures cannot be appealed.

Academic Appeals Process:

• If the ASAC requires a dismissal from the School of Medicine or repetition of an academic period, the notification to the student will provide the option of an appeal and a description of the appeals process. This option will not be granted to those students failing to pass Steps 1, 2 CK or 2 CS of the USMLE within three attempts. The student may formally request that the Associate Dean for Student Affairs appoint an ad hoc Appeals Committee to review the decision of the ASAC. The student must file his/her appeal no later than 14 days from receipt of notification or lose the right to appeal.
• The three-person ad hoc Appeals Committee is drawn from a pool of 10 faculty members named by the Associate Dean for Student Affairs, none of whom are current members of the ASAC. The student selects one member, the Senior Associate Dean for Education selects one member, and the Dean selects the third member (who chairs the ad hoc Appeals Committee). The Associate Dean for Student Affairs serves as staff liaison, ex officio, without vote.
• The student is permitted to inspect his/her entire medical school file, including any material upon which the decision of the ASAC was based.
• The student is permitted to have counsel, to submit affidavits and exhibits and to summon witnesses at the Appeals Committee hearing. Legal counsel may be present to provide advice, but legal counsel will not be permitted to participate actively in presentation of testimony, examination/cross examination of witnesses or oral arguments.
• The Appeals Committee is to conduct a hearing as soon as possible (ordinarily within 14 days) and will uphold, modify or reverse the decision(s) of the ASAC.
• The Appeals Committee will provide the student with all the evidence against him or her, including the academic grades and written evaluations, and will base its recommendations upon the evidence presented at the hearing.
• The Appeals Committee will send its decision, along with a written record of its proceedings, to the Dean of the School of Medicine.
• The decision of the Appeals Committee will be final.

Standards for Academic Standing:
A student is in “good academic standing” if the student makes satisfactory progress, defined as progressing at a pace of completion allowing the student to meet academic requirements to achieve the Doctor of Medicine degree within a six-year limit (150% of the program length) set from matriculation.

A student receives a warning or probation of “not in good academic standing” if making inadequate academic progress that threatens their ability to achieve the Doctor of Medicine degree within a six-year limit set from matriculation as determined by the Academic Standards and Achievement Committee.

The following are standards for each phase of the curriculum used to make the measurements determining whether or not students are maintaining Satisfactory Academic Progress (SAP).

Pre-clerkship Phase:
A student is declared “not in good academic standing” if he/she has failures or an unsatisfactory in any course or system that are not successfully remediated at the time of the first day of class, third semester.

A student is declared “not in good academic standing” if he/she has >2 course Incompletes and/or Withdrawals and if the Incompletes or Withdrawals are not remedied at the time of the first day of class, third semester.

A student is declared “not in good academic standing” if he/she has failures or an unsatisfactory in any course that are not successfully remediated at the time of the first day of period one of the clerkships.

A student is declared “not in good academic standing” if he/she has >2 course Incompletes and/or Withdrawals and if the Incompletes or Withdrawals are not remedied at the time of the first day of period one of the clerkships.

A student is declared “not in good academic standing” if he/she does not pass USMLE Step 1 on the second attempt.

Clerkship Phase:
A student is declared “not in good academic standing” if he/she has >2 deficiencies (failing 2 or more clerkships with an “F”) and if the deficiencies are not remediated at the time of four months from the end of the 48-week clerkship period.

A student is declared “not in good academic standing” if he/she has >2 Incompletes or Withdrawals and if the Incompletes and/or Withdrawals are not remedied at the time of four months from the end of the 48-week clerkship period.

A student is declared “not in good academic standing” if he/she fails to pass the CPX by November 1 (a prerequisite for USMLE Step 2 CS, a graduation requirement) of the year prior to graduation.

Post-clerkship (Elective) Phase:
The student is declared “not in good academic standing” if not making adequate academic progress to achieve the Doctor of Medicine degree within the time limit set from matriculation.

The student is declared “not in good academic standing” if he/she receives two or more unsatisfactory elective evaluations.

Footnotes:
1. Papadakis MA, Hodgson CS, Teherani A, and Kohatsu ND. Unprofessional Behavior in Medical School Is Associated with Subsequent Disciplinary Action by a State Medical Board Acad Med. 2004;79:244 –249.
2. Papadakis MA, Loeser H, Healy K. Early detection and evaluation of professional development problems in medical school. Acad Med. 2001;76:1100–6.
3. ABIM Foundation, ACP-ASIM Foundation, and European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136:243-6.
4. Teherani, Arianne, Hodgson, Carol S, Banach, Mary, Papadakis, Maxine A. Domains of unprofessional behavior during medical school associated with future disciplinary action by a state medical board. Academic Medicine. 80(10 Suppl):S17-20, 2005.
5. “Praise/Concern” cards are modeled after the Praise/Early Concern Note (American Board of Internal Medicine, 1996, Project Professionalism, pg 25-26) designed for residents and fellows. Modifications were made by the University of Virginia Office for Medical Education to make the card suitable for undergraduate medical students and for easy access via the web.
6. Academic warning is a specified period in which the student’s academic and/or professional deficiencies must be remediated or he/she will risk progression to academic probation. Academic probation is a specified period in which the student remains enrolled and whose academic progress and/or professional behaviors are monitored closely with periodic required reviews by appointed faculty. If deficiencies or failures are not rectified according to the remediation plan set by the ASAC within the specified period of time, the student is subject to dismissal from the University. Only academic probation is reflected on the MSPE.

Pre-clerkship and Post-clerkship Courses:
Note Courses cannot be dropped in the pre-clerkship curriculum without withdrawing from the University.

Drop without penalty (course removed from transcript)
If a student withdraws or goes on a LOA from the School of Medicine prior to completion of 10% of the timeframe of a course, the enrollment will be voided.

Drop with W grade
After completion of 10% of the course, a grade of W will be assigned. If the student re-enters the course, he/she will be reenrolled in the course according to the Leave of Absence, Withdrawal and Readmission Policy.

Withdrawal deadline
After 80% of a course is completed, students can no longer receive a W grade. If there are extenuating circumstances, and if it is feasible, a student may petition for a grade of Incomplete. Feasibility is determined by the course director after a review of the coursework not completed and other practical considerations in accordance with the School of Medicine’s Policy on Academic and Professional Advancement.

Electives (including Advanced Clinical Electives)

Adding a Fourth Year Elective:

• Electives must be added at least one month prior to the start of the Elective.
• Students add Lottery Electives through OASIS.
• In order to enroll in an arranged elective, a student must secure in writing approval from the elective supervisor who also notifies the Office of Student Affairs for entry into OASIS.
• Participation in electives at non-UVA, LCME-approved sites requires submission of an acceptance letter (or email) to the Office of Student Affairs.
• Participation in electives at non-LCME approved sites that are not listed on the Student Source or in the Electives Handbook requires submission of a Specially Arranged elective form to the Director of the 4th Year Program.
• Participation in research electives requires submission of a Research Proposal form to the Director of the 4th Year.
• Participation in international electives requires submission of the UVA SOM International Elective Form to the Office of Student Affairs. Additional requirements include submission of the International Studies Office online form, documentation of having received the CDC vaccination requirements, documentation of evacuation insurance and attendance at required orientation.

At the discretion of the Director of the 4th Year Program, a student may add a UVA elective through the Friday prior to the beginning of the elective on Monday. The scheduling form, signed by the elective supervisor and approved by the student’s advisor, must be received in the Office for Student Affairs by Friday.

Dropping an Elective:

• Dropping an elective requires the approval from the Office of Student Affairs no later than 28 days prior to the start of the elective.
• To drop an arranged elective, students must obtain approval from the elective supervisor, which must be forwarded to the Office of Student Affairs.
• Dropping an elective after the deadline, unless approved by the Director of the 4th year Program, will result in no credit for the elective. Exceptions may be considered for reasons such as illness requiring extended absenteeism, family emergencies, extreme hardship or a change in career goals.
• Students will lose one week of credit for each week (or partial week) for which the drop request is past the deadline.
• Students who drop after the deadline cannot earn credit for other elective work during the period of the dropped elective.

Clerkships (including Geriatrics)

Drop without penalty (clerkship removed from transcript)
With the approval of the student’s college dean, a student may drop and void registration in a clerkship only before 10% of the clerkship has been completed.

Drop with W grade
After 10% of the clerkship is completed, but before the withdrawal deadline, a grade of W will be assigned. If the student subsequently re-enters the clerkship, he/she will be reenrolled in the clerkship according to the Leave of Absence, Withdrawal and Readmission Policy.

Withdrawal deadline
After 80% of a clerkship is completed, a student can no longer drop. If there are extenuating circumstances, and if it is feasible, a student may petition for a grade of Incomplete. Feasibility is determined by the clerkship director after a review of the work not completed and other practical considerations in accordance with the School of Medicine’s Policy on Academic and Professional Advancement.

When a student’s course of study is interrupted, the interruption is categorized either as a leave of absence or a withdrawal. In general, a leave of absence is intended for a student who is in good standing, who needs to suspend his or her enrollment for a short period of time (for example, due to a medical condition), and who intends to return to the School of Medicine immediately following a leave of absence of a specific timeframe. A withdrawal generally is intended for other situations, such as when a student needs to suspend his or her enrollment for a longer period of time or does not intend to return to the School of Medicine. The process for return following a leave of absence is less demanding than readmission following a withdrawal. Regardless of the time of the absence or withdrawal, the graduation requirements for the MD degree only must be completed within six years of matriculation. For students in the MD/PhD and MD/JD dual degree programs, graduation requirements must be completed within eight years; graduation requirements for students in other dual degree programs must be completed within seven years.

1. Leave of Absence

a) Description and Conditions
The Associate Dean for Admissions and Student Affairs has the authority to grant or deny a request for a leave of absence (LOA). A student who is in good standing may submit a written petition requesting a LOA to the Associate Dean for Admissions and Student Affairs. The petition should provide an explanation of the reasons for the requested leave and the expected length of the leave. If the LOA is not granted, the student may instead withdraw from the School of Medicine.

A student may be granted only one LOA, and any further absence will be considered a withdrawal. A LOA normally is granted for no more than one year; under no circumstance will a LOA be granted for more than two years.

If a student is granted a LOA from the School of Medicine, interrupting a course or clerkship, a grade of W (withdrawal) will be entered on the transcript, designating uncompleted coursework. If/when the student is then re-enrolled, the Academic Standards and Achievement Committee (ASAC) will determine how much of the course or clerkship graded with a W will need to be repeated. If the student is re-enrolled in the course, the final grade will appear in the term in which the coursework is completed. The grade of W remains on the transcript along with any grade subsequently achieved.

Any student requesting a LOA also must meet with the Director of Financial Aid as a condition of approval from the Associate Dean for Admissions and Student Affairs. The meeting may be held in person, by interactive video-conference or by telephone, but not by email or other electronic means. Any student on a LOA must continue to abide by the University’s student conduct requirements. The Associate Dean for Admissions and Student Affairs may impose additional conditions upon which the leave is granted.

b) Return from LOA
A student who has satisfied all of the conditions of his or her leave of absence may request a return to the School of Medicine by submitting a request to the Associate Dean for Admissions and Student Affairs and the School of Medicine Registrar (email: som-registrar@virginia.edu) at least sixty (60) days prior to the return date requested. The student must meet any additional conditions that are deemed warranted by the Associate Dean for Student Affairs and Admission upon return to registration.

A student granted a LOA for medical reasons will require subsequent medical clearance from the Student Health Center as a condition for returning. All students returning from LOA must re-attest to their ability to meet the Technical Standards, with or without reasonable accommodation.
A student who has failed to comply with any conditions of his or her LOA, or who does not return to the School of Medicine within the length of time granted, will be deemed to have withdrawn voluntarily, and any request for readmission, as long as the six year time limit still can be met, must be determined by a vote of ASAC.

2. Withdrawals

a) Description and Conditions
There are four types of withdrawals from the School of Medicine—medical, academic, administrative or voluntary. University policy dictates that a grade of W will be entered for each course or clerkship the student attempted but did not complete. The grade of W will remain on the transcript.

• Medical Withdrawal—only approved with recommendation of a physician. Applications for withdrawal for medical reasons must be made in writing to and approved by the Associate Dean for Admissions and Student Affairs. Subsequent medical clearance from the Student Health Service is required for readmission.
• Academic Withdrawal—by action of the ASAC in accordance with the Policy on Academic and Professional Advancement, the Criteria for Graduation Policy, and the Policy on Technical Standards Required for Matriculation, Progression and Graduation. These withdrawals may be for academic or professionalism deficiencies, or for dismissal.
• Administrative Withdrawal—by action of the School of Medicine Office of Student Affairs and/or the University Dean of Students. On rare occasions an emergency may arise in which the health of a student, faculty member, patient, or other member of the community is placed at risk by the presence of a student. In such an unusual situation, the Associate Dean for Admissions and Student Affairs, in consultation with the University Dean of Students, may suspend a student provisionally pending formal consideration of the relevant issues by the appropriate committee, e.g., ASAC, University Judiciary Committee, at the earliest possible opportunity.
• Voluntary Withdrawal—an action taken when a student voluntarily leaves the School of Medicine. Applications for withdrawal must be made to the Office of Student Affairs and must be approved by the Associate Dean for Admissions and Student Affairs. Students who withdraw voluntarily from the University will have the notation “Withdrew: DATE” recorded on their permanent academic record and their official transcript. Any courses that have not begun will be dropped from the student’s record. A grade of W will be entered for each course or clerkship in progress at the time of withdrawal. The grade of W will remain on the transcript.

b) Readmission

• Unless dismissed by the University or the School of Medicine, a student who has withdrawn may seek readmission by submitting a request to the Associate Dean for Admissions and Student Affairs and the School of Medicine Registrar (email: som-registrar@virginia.edu) at least sixty (60) days prior to the return date requested.
• A longer period of notification might be necessary if scheduling of clerkships or electives is involved. Acceptance for readmission will depend on availability of positions in the clerkships/electives. Applications for readmission will be kept on file and will be considered in the order received, as positions become available. Students who withdraw before taking Step 1 and the Transition Course (Introduction to the Clerkships) can re-apply for the spring semester in the next academic year. Once enrolled the student can take Step 1 and the Transition Course (only offered once per year). Clerkship assignment will be based on current availability and any assignments made prior to the withdrawal will not be reserved.
• All students returning from a withdrawal must receive clearance from the University’s Dean of Students to return. This will be coordinated by the School of Medicine’s Registrar.
• A student granted a withdrawal for medical reasons will require subsequent medical clearance from the Department of Student Health as a condition for readmission.
• A student withdrawn for academic, professionalism or administrative reasons or a student who has academic or professionalism deficiencies at the time of withdrawal must be reviewed and approved to return by ASAC. Students whose request for readmission is denied by ASAC will have the right of appeal, per the Policy on Academic and Professional Advancement.
• All students returning from a withdrawal must re-attest to their ability to meet the Technical Standards, with or without reasonable accommodation.
• If granted readmission, the student will be required to adhere to any changes in policy or curriculum that occurred during the absence.
• Students who have been dismissed will not be offered readmission.
• Repeated courses: Students approved for readmission will be re-enrolled in any courses that were graded W or F at the time of withdrawal. Both of these grades remain on the transcript, along with subsequent grades. The ASAC will determine how much of the course or clerkship will need to be repeated to satisfy requirements. They will make this decision with consideration of the recommendation of the Course/Clerkship Director and based upon the Policy on Academic and Professional Advancement. The chair of ASAC will notify the student in writing of the committee’s decision. Failed courses will be repeated in their entirety.
• Students whose period of withdrawal is greater than two years must reapply to the School of Medicine through the Office of Admissions.
• The School of Medicine reserves the right to impose any additional conditions upon a student seeking readmission after a withdrawal, and to refuse consideration based on the relevant time limit on matriculation to graduation. (see paragraph one of this document)
• All students must graduate from the School of Medicine within six years after matriculation – time spent withdrawn counts in the six year time limit. For students in the MD/PhD and MD/JD dual degree programs, graduation requirements must be completed within eight years; graduation requirements for students in other dual degree programs must be completed within seven years.