College of MedicineMD ProgramPoliciesMedical Student Promotion, Dismissal, and Graduation Policy

Medical Student Promotion, Dismissal, and Graduation Policy

Policy Number: SE.09.02.170808 

Applies to: All medical students in the Washington State University Elson S. Floyd College of Medicine 

Date: 08/01/2023 

1.0 Policy Statement

It is the Elson S. Floyd College of Medicine policy to monitor student progress toward meeting standards for promotion, the granting of the MD degree, and to monitor and/or determine actions that might occur or be required, as appropriate, including remediation, academic probation, leave of absence, repetition, dismissal, and graduation. 

2.0 Definitions 

Academic Probation

Academic Probation: an action reflecting academic concerns, including professionalism concerns, resulting in requirements needed in order to allow students to be successful in the MD program and avert dismissal. Academic Probation is noted in the permanent academic record. Students on Academic Probation are not in good academic standing. 

Academic Warning

A decision designed to bring a student considered at risk from ongoing academic concerns, including professionalism concerns, to the attention of those who might help the student overcome their difficulties. 

Administrative Leave of Absence

A required leave of absence. This may be required for extensive remediation, health and/or safety of the student and/or patients. Adverse Ruling: A decision to impose academic warning, academic probation, remediation, repetition, administrative leave of absence, dismissal or to recommend that a student’s performance does not meet criteria for promotion or granting of the MD degree (graduation). 

Competence Panel

A panel of trained assessors that holistically reviews individual student assessment information and recommends course grades to course directors. 

Dean

The Elson S. Floyd College of Medicine Dean. 

Dismissal

Dismissed as a student from the MD program at the Elson S. Floyd College of Medicine. 

Fitness to Practice (Participate) Letter

A letter from an appropriate, fully licensed medical professional, stating that a student under review has been evaluated and is/will be able to consistently maintain academic and professional behavior standards during academic coursework and clinical training. 

Grade of X

A grade that indicates that coursework is ongoing or incomplete, or that a student did not meet the requirements of the course and will be undergoing remediation. Students will usually be allowed to proceed in further coursework (see Procedures Pertaining to Course Failures below). If coursework or remediation is completed successfully, the grade will be changed from an X to a Satisfactory. If remediation is not completed successfully a failing grade will be assigned. 

MSPE

Medical Student Performance Evaluation (sometimes referred to as the “Dean’s letter”) is a comprehensive assessment of a student’s performance in achieving the educational objectives of the medical school. It is not a letter of recommendation. 

PEAC

Professionalism Excellence Advisory Committee which is responsible for investigating issues related to professional behavior of students. 

Professionalism

A set of attitudes, behaviors, and expectations as defined in the Elson S. Floyd College of Medicine Medical Student Handbook Professionalism and Self-awareness section, which a student must demonstrate in academic settings (courses/clerkships), co-curricular activities and public forums. 

Readmission

The process whereby a former student who withdrew or was dismissed seeks to re-enter the Elson S. Floyd College of Medicine. 

Remediation

An activity to address a deficiency as determined by the SEPAC after consideration of a clerkship or course director recommendation, an assessment of a student’s overall academic performance, a student’s written request, or other factors deemed relevant. 

Repetition

Retaking part or all of an academic year due to substandard performance, usually following unsuccessful remediation of deficiencies, with the SEPAC determining whether the process requires concurrent or sequential repetition of other courses or clerkships. 

SEPAC

The Student Evaluation, Promotions and Awards Committee (SEPAC), which monitors the progress of students throughout the medical education program. While the majority of SEPAC time is spent evaluating student progress, the committee also makes decisions regarding superior academic achievement and student awards. The SEPAC ensures consistency in grading, remediation, and promotion decisions. 

Targeted Skills Development (TSD)

Any activity to address a gap in skills development prior to the end of a course. 

USMLE (United States Medical Licensing Exam)

A national licensing exam divided into steps given at different stages of training. For medical students, the steps are: 

  • Step 1 assesses knowledge and understanding from the Foundational years. 
  • Step 2 Clinical Knowledge (CK) assesses clinical knowledge and application.

3.0 Responsibilities 

Associate Dean for Assessment and Evaluation 

4.0 Procedures 

Table of Contents 

General Principles 

SEPAC Meetings 

  • The SEPAC meets quarterly to review student academic progress. 
  • Ad hoc SEPAC meetings are called by the SEPAC Chair to address specific concerns regarding a student’s academic progress or other urgent matters. 
Actions Available to the SEPAC 
  • Recommendations:
    • Graduation 
    • Awards/honors 
  • Decisions: 
    • Final approval of course grades as recommended by course directors 
    • Remediation 
    • Academic warning 
    • Academic probation 
    • Leave of absence (Administrative and applicable Voluntary Leaves) see Medical Student Leave, Withdrawal, and Readmission Policy 
    • Repetition 
    • Dismissal 
    • Referral to PEAC 

Determination of Course Grades 

The Elson S. Floyd College of Medicine has an established process for collecting academic performance information, including information on professional behavior, related to the Accreditation Council for Graduate Medical Education (ACGME) six core physician competencies: Medical and Scientific Knowledge, Patient Care and Health Promotion, Professionalism and Self-awareness, Practice-Based and Life-Long Learning, Systems-Based and Inter-Professional Practice, and Interpersonal and Communication Skills. 

Assessment information used for grading decisions includes examinations, workplace-based assessments, OSCEs, course deliverables, etc. The requirements to pass each course are outlined in the course-specific assessment package. 

The profession requires consistent professional behavior to ensure the safety of patients. Therefore, observations by faculty and others of the student’s behavior are monitored. Satisfactory professional attitudes and behavior are a course and program requirement. The SEPAC has the authority to review professionalism within courses and to take action based on professionalism concerns in a specific course through course grading. Irrespective of whether the SEPAC chooses to address a professionalism concern through a specific course grade, the SEPAC may address professionalism concerns documented in a particular course through the Procedures Related to Professionalism Concerns outlined below in Section II. The two processes are not mutually exclusive; addressing a professionalism concern through a course grade does not prohibit that same concern from being addressed at a program level through the Procedures Related to Professionalism Concerns below and vice versa. 

When considering course grades, the SEPAC has the authority to act accordingly within the following procedures: 

  • The Competence Panel, a panel of trained evaluators, holistically reviews each individual student’s aggregated assessment information and recommends course grades to course directors; the Competence Panel’s recommendation is also available to the SEPAC. 
  • Course directors review Competence Panel recommendations in light of overall class performance in the course and present recommended grades to the SEPAC. If a course director wishes to challenge a grading recommendation made by the Competence Panel and/or has additional information that would affect grade recommendations, the course director will present this information to the SEPAC. 
  • The SEPAC reviews the information submitted by course directors to ensure grading decisions are consistent and comparable across courses, cohorts, and clinical campuses. After review of all relevant information, including extenuating circumstances, the SEPAC has the authority to approve and/or amend final grades for all College of Medicine MD Program courses.

The SEPAC also ensures that decisions regarding remediation or other actions taken related to student progress are consistent and appropriate. Targeted skills development and/or remediation is recommended by the Associate Dean for Assessment and Evaluation in consultation with the appropriate faculty members. 

Student Appearance at the SEPAC 

  • The SEPAC may mandate an in-person meeting with the student. 
  • Students may request to appear before the SEPAC. 

Procedures Related to Student Appearances at the SEPAC 

  • If students wish to advocate for themselves and/or answer questions from the SEPAC, they must submit a request in writing to the SEPAC and the Office of Student Experience at least 48 hours in advance of the scheduled meeting. The SEPAC may or may not grant the request and/or may request that the student submit any additional information in writing to the SEPAC. 
  • A student may choose to be accompanied to the meeting by one of the following for personal support: a faculty member (including a representative from the Office of Student Experience), a staff member, or a fellow student. The support person is not allowed to speak on behalf of the student or to the SEPAC at the meeting. In their non-voting role on SEPAC, the deans from the Office of Student Experience may advocate separately, as appropriate. 

Student Access to Academic Records and Related SEPAC Proceedings 

Students may review their academic record, including professionalism concerns that have been submitted in writing. Students will have access to committee motions and official votes related to proceedings directly affecting their academic record/progress, from official SEPAC meeting minutes, per FERPA. Information about other students will be removed or redacted, unless doing so would destroy the record’s meaning, in which case comments related to other students will be de-identified (“Student A”, etc.). 

Promotions 

Promotions Decisions 

All promotions decisions are made by the SEPAC. In order to be promoted, students must: 

  • Demonstrate appropriate progress towards achievement of Elson S. Floyd College of Medicine milestones and competencies. 
  • Successfully meet all requirements for promotion to the next course, academic year or phase of the curriculum. 
  • Adhere to the professional standards of the college. 

The SEPAC must vote to approve all student promotions between year/phase levels and must vote to recommend students for graduation. 

Professionalism Competency Expectations 

Satisfactory performance throughout the medical education program requires adherence to professional standards, including Elson S. Floyd College of Medicine’s Professionalism and Self-awareness standards. 

Procedures Related to Professionalism Concerns 

A pattern of documented concerns about a student’s professionalism as part of their performance may indicate unsatisfactory overall performance when the record is viewed as a whole, even though passing grades have been assigned. In addition, a serious incident of unprofessionalism may warrant a response outside of an individual course grade. Therefore, if there is a concern regarding a student’s professionalism that is to be address outside of a course grade, the SEPAC will hold a meeting to determine whether the student violated the College of Medicine professionalism standards, and if so, what actions are appropriate. A Dean from the Office of Student Experience and/or the Associate Dean for Assessment and Evaluation meets with the student to inform the student about the concerns and provide support through the process. The SEPAC Chair may refer an alleged violation of the professional standards to the PEAC for investigation and recommendation. This group of faculty members (PEAC), appointed by the SEPAC Chair and the Office of Student Experience, are charged with the following: 

  • Investigate and review matters related to professional behavior of MD program students in order to offer advisory opinions to the SEPAC regarding the facts and degree of severity of the professionalism concerns. The results of the investigation are provided to the SEPAC Chair as an advisory opinion. The SEPAC Chair will then share the investigation and opinion with the entire SEPAC, which makes any resulting decisions within the authority of the SEPAC. 
  • Recommend policy and practice regarding professionalism issues in the MD program to the SEPAC. 
  • Review/recommend guidelines to help the students, faculty, staff and the SEPAC identify exemplary student professional behavior worthy of formal recognition. 

Regardless of whether or not the SEPAC enlists the services of PEAC, the SEPAC will make a final decision on whether the student violated the College of Medicine professionalism standards and if so, whether a program response outside of a class grade is warranted. The SEPAC’s decision is appealable only as provided in Section, Adverse Rulings. 

Procedures Pertaining to Course Failures 

Failures in Foundational Years: M1 or M2 
  • If a student does not meet the requirements of a course, the student may be allowed to undergo remediation. Generally, a student will be allowed two attempts to pass the remedial activity. 
  • Generally, students must complete required remediation during the following enrolled term. If the student does not complete remediation within that term, the student may not be allowed to register for further coursework. If it is determined that the amount of remediation exceeds what can be accomplished (skills gaps in two or more competency domains) the SEPAC may determine that the student has failed the course. 
  • If the student fails required remediation, the student may be required to repeat the course and/or may be required to repeat the academic year. 
  • If a student is in the process of remediating at the end of a term when grades are due to the registrar’s office, the student will receive a grade of X for the course. If the student is successful in completing all required remediation, the grade of X will be changed to Satisfactory. 
  • If a student is at high risk of failure, the student will receive a grade of X for the course. The student is expected to prioritize remediation and may not be allowed to proceed with further coursework until remediation is completed. The student may also be placed on academic warning, probation, and/or be placed on administrative leave until remediation is completed. Once remediation is successfully completed, the grade of X will be changed to Satisfactory. 
  • If a student fails a repeated course or fails two courses in the Foundational years, the student may be dismissed. 
Failures in Clinical Years: M3 (Longitudinal Integrated Clerkship (LIC)) or M4 
  • If a student fails a required rotation or sub-internship, the student will normally be allowed to undergo remediation. If it is determined that the amount of remediation exceeds what can be accomplished (skills gaps in two or more competency domains) the SEPAC may determine that the student has failed and must repeat the course in its entirety. If a student is at high risk of failure, the student will receive a grade of X for the course. The student is expected to prioritize remediation or repetition and may not be allowed to proceed with further coursework until remediation or repetition is completed. The student may also be placed on academic warning, probation, and/or be placed on administrative leave until remediation requirements are met. Once remediation is successfully completed, the grade of X will be changed to Satisfactory. 
  • If a student fails an elective, the SEPAC will review the student’s performance. Depending on the issue, the student may be offered remediation or may receive a Fail and may be offered the opportunity to, or be required to, repeat the elective. Note: students must complete the required number of electives to meet the graduation requirements of the program.
  • Students who fail a year 3 experience or a year 4 rotation and/or have professionalism or “fitness to practice” concerns may be required to repeat the year or to complete remediation outside the clinical setting before returning to clinical training. 
  • If a student is in the process of remediating at the end of a term when grades are due to the registrar’s office, the student will receive a grade of X for the course. If the student is successful in completing all required remediation, the grade of X will be changed to Satisfactory. 
  • If a student fails more than one required clerkship, sub-internship, elective, or required project in Years 3 and 4, the student may be dismissed. 

Failures Across Academic Years 1–4 

  • If a student fails a graduation requirement (such as a required course, sub-internship, required electives, or required projects), the student must remediate and satisfy all requirements. If the student fails the remediation, the student may be offered the opportunity to repeat the failed experience. If the student fails a repeat experience, they may be required to repeat the year, extend their MD program until they meet the required competencies, or may be dismissed from the program. 
  • If a student fails three required courses during the entire medical education program, the student may be dismissed. 

Procedures Pertaining to a Grade of X or Incomplete 

  • Students receiving a grade of X or Incomplete in a course will be monitored by the SEPAC until that grade is removed from the student’s record. 
  • If a student is at high risk of failure, the student will receive a grade of X for the course. The student is expected to prioritize remediation and may not be allowed to proceed with further coursework until remediation is completed. The student may also be placed on academic warning, probation, and/or be placed on administrative leave until remediation requirements are met. Once remediation is successfully completed, the grade of X will be changed to Satisfactory. 
  • Decisions regarding students with incomplete coursework will be made on an individual student basis by the SEPAC. Decisions may include remediation, repetition of a course, repetition of an academic year, administrative leave of absence, academic warning, academic probation, or dismissal from the program. 

Failures Related to Licensure Exams 

  • Students must attempt USMLE Step 1 (and, if successful in passing Step 1 within 3 attempts, must attempt USMLE Step 2 CK) before graduation. 
  • Inability to pass USMLE Step 1 means that a student will not be eligible for licensure or post-graduate training, but the student may continue in the MD degree program if they meet all other competency and graduation requirements. 

Academic Warning and Probation

Academic Warning 

The SEPAC may place a student on academic warning for: 

  • Concerns about academic risk (e.g., examination or course failure), including professionalism concerns. 
  • Failure to pass USMLE Step 1 or Step 2 CK. 

The SEPAC’s purpose for an academic warning is to refocus the student’s efforts to succeed. 

  • Students may be required to seek input from faculty (i.e. academic coaching) or be referred to the Office of Student Experience to address other potential barriers to success. 
  • Students may be required to temporarily suspend extracurricular activities such as Elson S. Floyd College of Medicine committee membership. 
  • The SEPAC may assign other specific conditions or expectations related to academic warning. 
  • Students will remain in good academic standing. 
  • Academic warnings will not be reported in the MSPE. 

Academic Probation 

The SEPAC may assign academic probation for any of the following: 

  • Failing grade 
  • Professionalism concerns 
  • Multiple examination failures or academic concerns in multiple competency domains 
  • Multiple academic warnings and/or other significant academic risk factors. 
Procedures and Processes for Academic Probation 
  • Students on academic probation are not in good academic standing. 
  • The SEPAC may assign other specific conditions or expectations related to academic probation. 
  • Duration of academic probation is determined by the SEPAC on a case-by-case basis. 
  • Students may be required to temporarily suspend extracurricular activities such as Elson S. Floyd College of Medicine committee membership. 
  • Students on Academic Probation may not be eligible or approved to participate in voluntary academic leave (e.g., research leave at other institutions) or away rotations. 
  • Academic probation will be documented in the MSPE. 
  • Academic probation may need to be reported to state licensing boards and clinical host agencies depending on the reason(s) for probation. 
  • Additional academic or professionalism deficiencies while on academic probation may lead to immediate dismissal. 

Resolution of Academic Warning or Probation 

  • The SEPAC reviews students on academic warning or probation at regular meetings, and/or at ad-hoc meetings called by the SEPAC Chair. 
  • For academic probation, meeting the SEPAC’s requirements will return the student to good academic standing, provided other deficiencies do not arise. 
  • Students must be in good academic standing in order to graduate. 

Dismissal 

Reasons for dismissal include, but are not limited to: 

  • Student unable to meet the promotion standards to a given academic level. 
  • Student receiving a grade of Fail in a course being repeated. 
  • Student failing to meet promotion standards after repeating a year. 
  • Student exhibiting unprofessional behavior or unethical behavior that violates the College of Medicine professionalism standards. 
  • Student failing to meet graduation requirements. 

Adverse Rulings 

Notification of Adverse Rulings Procedure 

  • Notification to the student of an adverse ruling is emailed to the student via their WSU email address, within five (5) business days of the ruling. 
  • Students must acknowledge receipt of adverse rulings by email within two (2) business days of the notification being sent. 
  • The decision of the SEPAC is final unless appealed as specified below. 

Appeal Procedure 

  • Adverse rulings eligible for appeal:
    • Failing course grade 
    • Failure to progress to the next academic year 
    • Repetition 
    • Academic probation 
    • Administrative leave of absence 
    • Dismissal 
  • Within ten (10) business days of notification of an adverse ruling subject to appeal, a student must submit a formal written appeal via email to the Dean and provide a copy to the SEPAC. 
  • Before filing an appeal, the student must meet with a Dean from the Office of Student Experience to ensure factual accuracy of the basis for appeal, review the processes and procedures, and prepare any relevant documentation for the appeal. 
  • Any student wishing to pursue an appeal must describe the rationale for the appeal in detail, specifically including any relevant information not previously considered by the SEPAC and/or a proposed alternative resolution of the issue. 
  • The student may seek advice regarding constructing the appeal portfolio from a faculty member of the student’s choice including a Dean from the Office of Student Experience. 
  • The original adverse ruling will be held in abeyance while under appeal. However, progression through degree requirements (such as continued course enrollment, research activities, internships, and clinical training activities) may be suspended. 
  • The University Ombudsman is available at any stage for advice or assistance in resolving academic complaints. 
  • Upon review of the student’s record and appeal portfolio, the Dean may elect to: 
    • Deny the appeal, allowing the committee decision to stand; 
    • Modify the decision; 
    • Make an alternate decision; or 
    • Impanel an ad hoc committee to review the case and make recommendations to the Dean. 
  • If an ad hoc committee is impaneled, it will be composed of three Elson S. Floyd College of Medicine faculty members appointed by the Dean who are not on the SEPAC. 
  • The ad hoc committee will have full investigative authority and make recommendations directly to the Dean. 
  • At the discretion of the Dean and/or the ad hoc committee, a face-to-face (in-person or virtual) meeting with the appealing student may be required. In this case, a Dean from the Office of Student Experience will be present to support, but not speak for, the student. 
  • Within fifteen (15) business days from receipt of the student’s appeal, the Dean will provide a written decision to the student, the Chair of the SEPAC, and the Vice Dean and Assistant Dean of Student Experience. 
  • The Deans for Student Experience will meet with the student to inform the student of the Dean’s decision. If the student is not available to meet, the decision will be transmitted electronically via the student’s WSU email address, with a “READ” receipt. 
  • At the next scheduled SEPAC meeting, the SEPAC Chair will present the decision of the Dean for entry into the minutes. 
  • The decision of the Dean is final unless appealed to the Graduate School Dean within 15 (fifteen) calendar days following notice of the Dean’s decision under Chapter 12E, subsection 3.d. of the Graduate School’s Policies and Procedures.
    • An appeal to the Graduate School Dean may only be filed based on process or procedural errors in the SEPAC or appeal processes. 
    • The student may contact the Graduate School Dean at gsdean@wsu.edu, 509-335-6412. 
    • It is not in the purview of Graduate School Dean to overturn whether a professionalism violation as defined by the Elson S. Floyd College of Medicine occurred; rather, it is to investigate if processes or procedures described in this document were not followed. 

Graduation 

The complete Elson S. Floyd College of Medicine Specification of Degree Requirements for Graduation with the MD Degree are specified on the WSU website. The college posts all approved policies publicly on the website. 

Procedure 

In making decisions regarding the granting of the MD degree, the SEPAC will follow the graduation requirements established by the Elson S. Floyd College of Medicine faculty. 

Degrees will be conferred on Commencement Day in the spring. Students completing requirements for a degree prior to their scheduled degree conferral date will be conferred the degree on the next official Washington State University Commencement Day. If requirements are met after their schedule degree conferral date they will be conferred their degree on the next official Washington State University Commencement Day, but students may request that the SEPAC provide a written confirmation (e.g. to a residency program director, research supervisor or employer) that all graduation requirements have been met. 

These requirements may be changed at any time to ensure that all graduates meet the required qualifications of a practicing physician. If changes in the curriculum or graduation requirements occur during a student leave of absence, the SEPAC will consult with the Curriculum Office and the Assessment Office to determine if successful re-engagement with the curriculum will require the student to repeat a course or year. 

5.0 Related Policies 

  • Assessment of Medical Student Performance Policy CU.09.03.170808 
  • Timing for Submission of Grades Policy CU.09.01.170808 
  • SEPAC Conflict of Interest Policy SE.09.04.170808 
  • Medical Student Leave, Withdrawal, and Readmission Policy EC.10.01.170912 
  • Technical Standards AD.10.02.170508 
  • Chapter 12E Graduate Student Rights and Responsibilities. Section 3 Graduate and Professional student complaint and grievance procedures for academic progress and other issues. Subsection: professional student grievance and appeal procedures.

6.0 Key Search Words 

Advancement, promotion, progress, fail, remediate, repeat, fail, academic warning, academic probation, dismissal, professionalism, behavior, leave, withdraw, readmission, graduation, appeal, grade of X, incomplete. 

7.0 Revision History

Original Approval: 4/28/2016
Policy Number: SE.09.02.160428, SE.09.02.170808
Review/Revision: 8/8/2017, 1/24/2020, 8/1/2023