Policy 170(d): Grading, Progression and Academic Standing in the Doctor of Medicine (MD) Program

1.  Purpose 

This policy establishes and communicates a standard for determining acceptable overall academic, professional and clinical performance towards achievement of the curriculum’s learning outcomes in the Doctor of Medicine (MD) program (the “Program”) at Toronto Metropolitan University (the “university”), to provide all students in the Program a measure of academic standing that is transparent and based on uniform definitions and categories while providing consistent rules for progression through the Program.

2.  Application, Scope and Policy Objectives

This policy applies to all MD program students. This policy also applies to all clinical faculty/facilitators/preceptors/assessors, staff, and administrators in the School of Medicine (the “School”) involved in the progression process. It describes the processes by which final grades, academic standings, and eligibility to graduate are earned and recorded on students’ official academic records. The objectives of this policy are:

• to establish a consistent minimum standard for demonstrating the knowledge, skills, and abilities of course and program outcome.
• to provide a consistent and fair system for determining students' eligibility to graduate.
• to provide all students with a system of academic standing that is based on uniform definitions and categories for their academic progress from first enrolment to graduation.

3.  Definitions

See APPENDIX  A. 

4.  Principles

The values stipulated in the university’s Senate Policy Framework are applicable and fundamental to this policy.

4.1  Integrity 

The university and School respect the importance of accuracy and integrity with respect to students’ official academic records for all stakeholders including students, clinical faculty/facilitators/preceptors/assessors, and external stakeholders such as patients, prospective employers, government, donors, and other academic institutions. The Office of the Registrar is responsible for ensuring student records and official transcripts are a credible reflection of students’ academic abilities and accomplishments.

4.2  Consistency  

The university and School support and advance the principles of consistency, fairness, and objectivity in the application of all rules and procedures that contribute to the completeness and integrity of students’ official academic records. 

4.3  Clarity

Information regarding the determination of grades, academic standings, and graduation requirements will be clear and transparent. Students, clinical faculty/facilitators/preceptors/assessors, and staff should understand the rules and processes used for determining and assigning grades and academic standings, and the determination of the necessary academic elements required to graduate.

4.4  Timeliness 

Processes used in the determination of academic requirements that will have an impact on students’ academic records should be applied with emphasis on timeliness to allow students the necessary time to address issues and expedite resolutions effectively.

4.5  Equity 

People in different circumstances may require different treatment (equity); this equitable treatment leads to equal access to opportunity and success; and while both equality and equity are related to fairness, equity is about being fair by taking differential circumstances into account (see Senate Policy Framework).   

4.6  Competency-Based Medical Education (CBME):

CBME is an approach to designing health professions’ education that is focused on outcomes, namely graduates' abilities,and competencies. CBME uses statements of expected abilities of graduates, to guide teaching, learning, and assessment. Learning activities are deliberately sequenced to provide opportunities to progress from a novice to a competent graduate. With a CBME approach, the curriculum and programmatic assessment support learners’ development of competence. The developmental structure of CBME facilitates every learner’s progress toward the desired level of ability at the time of graduation. Under CBME, course duration does not guarantee a degree of learning.

4.7  Programmatic Assessment 

Programmatic Assessment is founded on the premise that a multitude of low-stakes samples of a learner’s progress on competency achievement is superior to a small number of high stakes tests – using various types of assessment to monitor competencies for a graduating TMU medical student. Assessments have two goals: 

• Assessment for learning – focusing on using assessment as an opportunity for feedback and for students’ ongoing improvement (i.e., for growth); and 
• Assessment of learning – focusing on students’ achievement of their learning outcomes and meeting their targets for each course and Program Learning Outcomes at the end of Year 1 and each of the 3 Phases of the program.

4.8  Social Accountability

The Program has been purposefully developed, community informed, and evidence based to align with the School of Medicine’s social accountability mandate as well as its vision, mission, values, program objectives, and student learning outcomes. It is rooted in principles of community-driven care and cultural respect, humility and safety, with Equity, Diversity, Inclusion, Accessibility, Anti-Racism and Reconciliation, Decolonization, and Indigenous Resurgence (EDIAA-RDIR), and health equity intentionally embedded across all aspects of the Program.

4.9  Academic Accommodation 

All processes and procedures associated with this policy are to be carried out in accordance with relevant law and university policies concerning the academic accommodation of students (see Policy 159: Academic Accommodation of Students with Disabilities and Policy 150: Accommodation of Student Religious, Indigenous and Spiritual Observance).

5.   Academic and Clinical Evaluation

5.1   Program Requirements 

5.1.1.   All curriculum requirements included in the Academic Calendar for the MD Program must be met as published.

5.1.2.  Students must complete all courses in accordance with the Program’s curriculum requirements.

5.1.3.  All students must achieve the defined milestone of competency for progression within each Phase of the program to be recommended for progression and graduation.

5.1.4. All students must meet the Standards of Professional Conduct for Students in the Doctor of Medicine (MD) Program outlined in Senate Policy 175 and in the MD Program Student Handbook for progression and for graduation.        

5.2    Courses and Grades 

5.2.1.  Final academic performance in each course in the MD program is recorded on the student's academic record and official transcript as Pass, Incomplete, Fail or other course performance designations as appropriate (see APPENDIX B).

5.2.1.1. Numerical scores for assessments within a course, where applicable (e.g., Mastery Assessments) shall be used only to track progress of individual learners, and shall not appear on transcripts.

5.2.2.  Final grades will be approved by the UGME Competence Committee and verified by the Associate Dean, UGME.

5.2.3.  Student achievements will be documented in the School of Medicine’s Learning and Assessment Management System (LAMS) in a Portfolio using the relevant assessment data including narrative comments from assessors. 

5.2.4.  Course grades and academic standings for each student will be shared with the Office of the Registrar by the Program each year and will be included on the academic record and official transcript.

5.2.5. Final official grades may be appealed. See Policy 168: Grade and Standing Appeals.

6.   Academic Standing and Progression

6.1  Students enrolled in the MD program are assigned an academic standing at the end of the first year and at the end of each of the three Phases of the Program. The academic standing is an indication of academic and clinical performance in the Program. 

6.2 Academic Standing Definitions

6.2.1.  Progressing: An academic standing of Progressing will be assigned to students who have (1) successfully completed all necessary courses and demonstrated the expected level of competence, and (2) met all professionalism standards as outlined in Senate Policy 175: Standards of Professional Conduct for Students in the Doctor of Medicine (MD) Program. Students assigned a Progressing standing may continue in the Program.

6.2.2.  Progressing with Support: An academic standing of Progressing with Support will be assigned to students who have not demonstrated the expected level of competence in one or more required learning experiences, but the UGME Competence Committee has deemed that these can be addressed while the student continues in the program. Students who have achieved an Incomplete (INC) in one (1) course in the current year or Phase may be able to Progress with Support and will be assessed by the UGME Competence Committee on a case-by-case basis. Students with a Level 1 or Level 2 Lapse of Professionalism may also be assigned this standing at the discretion of the UGME Competence Committee. Students with a Progressing with Support standing must establish a Progression Plan to continue in their studies (see Procedures 3.5.2).

6.2.3.   Not Progressing: An academic standing of Not Progressing will be assigned to students for any one of the following reasons:

6.2.3.1. a Fail grade in one or more courses

6.2.3.2. failure to successfully demonstrate the expected level of competence in one or more required learning experiences, and the UGME Competence Committee deems that these cannot be addressed while the student progresses in the program.

6.2.3.3. failure to meet the conditions specified in the Progression plan.

6.2.3.4. a Level 3 or 4 Lapse of Professionalism as per Senate Policy 175: Standards of Professional Conduct for Students in the Doctor of Medicine (MD) Program; and/or

6.2.3.5. two or more Incomplete (INC) grades.

Students assigned a Not Progressing academic standing must establish a Remediation Plan, and at the discretion of the UGME Competence Committee, may be required to:

6.2.3.6. repeat a required course(s) or Phase,

6.2.3.7. take a mandated leave of absence. (Refer to the School of Medicine’s Policy on Leave of Absence for Students in the Doctor of Medicine (MD) Program.)

The student cannot progress to the next year of study in the curriculum until the deficits are addressed.

6.2.4.  Dismissal from Program (DFP): Students will be assigned a Dismissal from Program standing for any one of following reasons:

6.2.4.1. failure to successfully achieve the outcomes and conditions specified in the Remediation Plan;

6.2.4.2. failure of a course for a second time;

6.2.4.3. failure to complete the Program within 6 (six) years of admission to the Program, unless granted a timespan extension (refer to Section 7 of this Policy);

6.2.4.4. Students may be assigned a Dismissal from Program standing for a Level 4 Lapse of Professionalism as per Senate Policy 175: Policy on Standards of Professional Conduct for Students in the Doctor of Medicine (MD).

6.3 Disciplinary Standings Assigned in Accordance with Policy 60: Academic Integrity

6.3.1.  Disciplinary Withdrawal (DW): An academic standing where a student is permanently withdrawn from their program of study and fully withdrawn from the University as a whole for a period of at least 2 (two) years. After serving the specified period, a student assigned a DW academic standing may apply to other TMU programs/certificates at the University. A DW will be placed on both the student’s academic record and official transcript and cannot be removed.

6.3.2. Expulsion: An academic standing involving permanent removal of a student from the University. Students who are expelled from the University shall not be allowed to register or enroll in any class or program of the University. Expulsion shall be permanently noted on a student’s academic record and official transcript and cannot be removed. 

6.4 Academic Standing Appeals

A standing appeal is a request for a standing to be reviewed or changed based on the grounds for appeal and evidence supplied by the student to support their case.

6.4.1. Students should refer to Senate Policy 168: Grade and Standing Appeals to appeal the following academic standings:

• Dismissal from Program (DFP)
• Decision of Not Progressing
• Decision of Progressing with Support

6.4.2. Students should refer to Senate Policy 60: Academic Integrity to appeal a Disciplinary Withdrawal or Expulsion standing.

7.  Timespan

7.1. The MD Program at TMU is designed as a 3-Phase, 4-Year program. The maximum timeline for completion is 6 (six) years from admission to the program to graduation.

7.2. Under extenuating circumstances, such as unexpected health conditions, students may be granted permission by the Dean to extend the timespan to graduate, with only one extension granted. In order to graduate, a student will be required to meet the academic requirements in effect when the extension is granted or such alternative requirements as may be stipulated by the School in keeping with the University’s academic policies.

7.3. The Dean’s decision not to extend the timespan to graduate can be appealed directly to the Senate Appeals Committee (see Policy 168: Grade and Standing Appeals).

8.  Eligibility to Graduate

8.1.  Students who have submitted an application to graduate for the relevant graduation cycle will be reviewed by the UGME Competence Committee for graduation-eligibility. 

8.2.  Students will be eligible to graduate if they have;

• Successfully completed each phase including all Senate-approved courses for the MD Program as outlined in the Academic Calendar for the MD Program,
• demonstrated meeting the graduation level of competence for each UGME program-level learning outcome and,
• not have any unremediated Lapses of Professionalism.

8.3.  All graduating students will receive the degree of Doctor of Medicine. There will not be any degree granted with the terms “With Distinction” or other similar terms.

8.4.  The student academic record is closed to changes once an academic credential (e.g., degree) is conferred.

8.5.  Graduation occurs twice per year, in Spring and in Fall.

9.   Interpretation and Application

The interpretation and application of this policy is the responsibility of the Dean, School of Medicine, who also makes final decisions when required, under this policy. 

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Related Policies/Procedures

Senate Policy 60: Academic Integrity

Senate Policy 61: Student Code of Non-academic Conduct 

Senate Policy 135: Final Examinations

Senate Policy 150: Accommodation of Student Religious, Aboriginal and Spiritual Observance

Senate Policy 157: Establishment of Student Email Accounts for Official University Communication

Senate Policy 159: Academic Accommodation of Students with Disabilities

Senate Policy 168: Grade and Standing Appeals

Senate Policy 175: Standards of Professional Conduct for Students in the Doctor of Medicine (MD) Program Senate

Policy on Leave of Absence for Students in the Doctor of Medicine (MD) Program

Policy on Timely Formative Feedback to Students in the Doctor of Medicine (MD) Program

Appendix A

Definitions 

Academic Coaches

Clinical faculty assigned to support a small cohort of student’s academic and professional development by using assessment data as collected by the programmatic assessment system. The academic coaches provide early and timely academic support to each student, and offer feedback to the Undergraduate Competence Committee.

Academic Record

A student’s internal record of academic performance in course work and other relevant information retained by the University and used as the basis for the official transcript. The academic record is also used for advising purposes.

Academic Standing

A determination based on established progression requirements, which includes achievement of the expected competency in required learning experiences, meeting professionalism standards, and the final course grades at the end of Year 1 and at the end of each of the 3 Phases of the program. It is used to determine a student's eligibility for progression and graduation.

Alternatives Assessments

Assessments that are replacement academic evaluations of student achievement, that are prepared and/or approved by a clinical faculty member in response to a student with demonstrated extenuating circumstances which resulted in missing or non-completion of an assessment.

Assessments

In line with Programmatic Assessment (PA), multiple different assessment approaches and tools to sample student progress over time are utilized in the UGME curriculum, including: Progress Testing (PRT); Formative written assessments; Small group assessment; Laboratory assessments; Workplace-based assessments (WBAs); Project-based assessments; Standardized Clinical Assessments – which incorporates Objective Structured Clinical Examinations (OSCEs) and Simulated Performances (Sim).

Assessors 

Individuals assessing students’ learning and skills development in the TMU MD Program. Assessors may include clinical faculty, other healthcare providers, community-based individuals, and patients in an organization affiliated with the School. All assessors are oriented to their role and the tools used as part of the program of assessment through appropriate training.

Associate Director, Curriculum

The clinical faculty member responsible for overall leadership of a course in the MD program.

Competencies 

The UGME program-level learning outcomes, grouped thematically under 8 (eight) roles, with the expectation that a competent graduating future physician seamlessly integrates the competencies of: Health Advocate; Collaborator; Professional; Leader; Scholar; Communicator; Medical Expert (the integrating role); Self.

Clinical faculty

All Members appointed to the School of Medicine in accordance with TMU’s Board of Governors Clinical Faculty Policy.

Director, Curriculum

A senior leader in the MD program with direct responsibility and oversight for all learning within a Phase. The Director of Curriculum for Phase 2 is also the Associate Director, Curriculum, for the Clerkship course.

Entrustable Professional Activities

Entrustable professional activities, or EPAs, are the tasks and responsibilities expected of a professional. EPAs are typically observable and measurable, and represent behaviours that can be independently executed once a learner has met an expected competence level.

Final Course Grade 

A measure of a student’s final academic performance in a course. Students receive their official final course grade only from the Registrar’s Office. Refer to Appendix B for Course Performance Designations.

Formative Feedback

Written or verbal feedback provided to students during their learning process to help them identify strengths and areas for improvement. This feedback is intended to guide and improve students' learning journey by providing not just a decision, but a communication of methods and/or approaches to improvement.

Learner Affairs Unit

The unit in the School of Medicine that supports learners' success and professional development by providing wellness and financial literacy resources, accommodation implementation, career advising, mentorship opportunities and oversees learner engagement initiatives. The LAU plays a key role in mistreatment prevention and response, fostering a supportive and inclusive environment for all learners (focusing on MD program, postgraduate trainees)

Learner Progress Unit

The unit in the School of Medicine that is responsible for the oversight, implementation and ongoing improvement of academic supports and progression-related processes within the School of Medicine. The unit fosters MD program student success through highly individualized academic coaching and learning plans. The LPU also guides/advises, implements and monitors the assessment of learners

Learning and Assessment Management Systems (LAMS)

A software platform for organizing and mapping curriculum and assessment elements for medical students across multiple years and learning assignments. This is used to deploy, display, gather, curate, and collate assessments for use by the Program Council, coaches, students, relevant  clinical faculty/facilitator/ preceptor/assessors, and staff in the MD program, and the UGME Competence Committee using secure databases with permission layers. Students will be able to add artefacts which are part of the expected assessment (e.g., reflections). 

Learning Plan

A plan of study developed by the student and relevant parties (e.g., relevant clinical faculty member) which outlines appropriate support and expected outcomes.

Leave of Absence

Time away from enrolment in the MD program, for academic or non-academic reasons that is more than two consecutive weeks and no more than two consecutive years in a required term of studies.

Official Transcript 

An official transcript is the complete record of a TMU MD Program student’s academic history. The official transcript also displays admission to and withdrawal from the program of study and other credits granted towards a program. All official transcripts are complete and unabridged. Partial transcripts are not issued. An official transcript is issued and certified by the Office of the Registrar and has security features that verify its authenticity. 

Phase

A designated timeframe within the four-year MD program. Phase 1, the Foundations Phase, starts in September of Year 1 and lasts for 17 months. Phase 2, the Clinical and Community Immersion Phase, begins in the 18th month of the program and runs through to the 34th month, spanning another 17 months. Phase 3, the Professionalization Phase, commences in the 35th month of the program and continues until the end of April of Year 4, lasting 8 months.

Progression Plan 

A formalized plan of study developed and agreed to by the Student Progress Subcommittee and UGME Competence Committee, in consultation with the student, when a student is assigned a standing of Progressing with Support. It outlines what must be achieved and may also allow the student to continue in their program of study. It defines the maximum and/or minimum number of courses that can be taken, assigns specific courses and required outcomes, and recommends academic support.

Registrar’s Office (Office of the Registrar)

The office at TMU is responsible for ensuring the accuracy and integrity of student records and that official transcripts are a credible reflection of students’ academic abilities and accomplishments. 

Remediation

A process of addressing and correcting deficiencies in a student’s knowledge, skills or understanding of the course material, professional achievements and/or performance. This process, overseen by a designated clinical faculty member, contains a learning plan that attempts to understand root causes (to prevent recurrence); has a defined timeline and milestones; and offers additional support as needed.

Remediation Plan

A formalized plan of study developed and agreed to by the Student Progress Subcommittee and UGME Competence Committee, in consultation with the student, when a student is assigned a standing of Not Progressing. It outlines what must be achieved in order for the student to remain in the program. It defines the maximum and/or minimum number of courses that can be taken, assigns specific courses and required outcomes, and recommends academic supports.

Required Learning Experiences

An educational unit (e.g., course, block, clerkship rotation or longitudinal integrated clerkship) that is required of a student in order to complete the MD program.

Student Progress Subcommittee

A subcommittee of the UGME Competence Committee that makes recommendations on student progression, academic standing, and graduation eligibility using integrative data from a portfolio of assessments aimed at achieving MD Program Learning Outcomes and Entrustable Professional Activities (EPAs). The subcommittee comprises School of Medicine clinical faculty who are not academic coaches and are independent from the direct assessment of medical students.

Timespan

The maximum period of time to complete a program's curriculum and graduation requirements, calculated starting from admission to the program to graduation.

UGME

Undergraduate medical education.

UGME Competence Committee

A standing committee of the UGME Program Council tasked with monitoring student assessments and feedback in order to make academic standing decisions. The committee comprises School of Medicine clinical faculty who are not academic coaches and are independent from the direct assessment of medical students.

Year

The MD Program is a four-year program that is split across three phases. (Refer to the definition of “Phase” above.)

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Appendix B

Course Performance Designations 

DEF (Deferred) - an interim grade assigned during the investigation of academic misconduct (as described in Senate Policy 60: Academic Integrity). The DEF grade will be replaced by an official course grade upon resolution of the matter.

FLD (Failure in a Pass-Fail course) - failure to meet the minimum satisfactory standards for a course with a pass/fail designation (as predefined in the course outline). 

INC (Incomplete) - an interim grade assigned when the identified course or section of a course assessment component is not completed to the level of competency identified by the program. The INC grade will display on the student academic record and official transcript until the grade change is submitted and processed on the student record (See Procedures, Section 3). The INC grade will lapse to a Failed Grade if the outstanding work is not submitted and graded by the established timeline.

INP (In Progress) - indicates course work in progress with at least one more term of formal course registration and study required for completion; the designation of INP is neither a credit nor a failed course attempt.

PSD (Passed) - satisfactory performance in a course (as pre-defined in the course outline).

Other Abbreviations 

CBME – Competency-Based Medical Education: an outcomes-based approach to the design, implementation and evaluation of education programs and to the assessment of learners across the continuum that uses competencies or observable abilities. 

EDIEDIAA-RDIR - Equity, Diversity, Inclusion, Accessibility, Anti-Racism & Reconciliation, Decolonization, and Indigenous Resurgence.

EPA – Entrustable Professional Activity: units of professional practice that capture essential competencies in which learners must become proficient before undertaking them independently. 

LAMS – Learning and Assessment Management System

LAU - Learner Affairs Unit 

LPU - Learner Progress Unit

MD – Doctor of Medicine

OSCE – Objective Structured Clinical Examination

PA – Programmatic Assessment

PRT – Progress Testing

WBA – Work-Based Assessment

TULO – TMU UGME Learning Outcome

Procedures: Policy 170(d) Undergraduate Medical Education, Grading, Progression, Academic Standing 

The Grading, Progression, and Academic Standing Procedures (the “Procedures”) outline the processes to be followed in carrying out the Grading, Progression, and Academic Standing in the Doctor of Medicine (MD) Program Policy and the roles and responsibilities of students, clinical faculty/facilitators/preceptors, and other assessors, the Dean or designate, and Senate.

1.  Programmatic Assessment                      

1.1  Programmatic Assessment (PA)            

The Grading, Progression, and Academic Standing Procedures (the “Procedures”) outline the processes to be followed in carrying out the UGME Grading, Progression, and Academic Standing policy and the roles and responsibilities of students, faculty, teachers, and other assessors, Dean or designate, and Senate

• Outcomes of a curriculum described as a series of statements on the expected abilities of graduates, called a competency framework. 
• Many samples of students’ progress in achieving the outcomes competencies over the course of the curriculum. Each sample is but a data point of relatively low stakes with feedback for improvement provided to students to support their learning and development.
• Multiple different assessment approaches and tools to sample student progress over time. 
• Multiple assessors provide a variety of inputs into student progress.

1.2  Student Portfolios

Student portfolios, housed in the LAMS software platform, are a collection of evidence of the students’ learning and achievements supporting progressive competency. 

1.2.1. The student portfolio contains the various assessments, data, and other evidence of learning. Relevant narrative comments of assessors and supervisors will be housed in the student record on the LAMS and will support progression decisions and appeals (where relevant) by the UGME Competence Committee and Student Progress Subcommittee. Final course grades will be communicated via the academic record and official transcript.

1.2.2. The LAMS will be used by academic coaches, students, relevant clinical faculty/facilitators/preceptors/assessors, and staff in the MD program, and the UGME Competence Committee and the Student Progress Subcommittee. This will serve as a tool for the UGME Competence Committee and Student Progress Subcommittee to review data to provide feedback and to make decisions about unofficial final course grades, academic standings, Learning, Progression, and Remediation Plans, and graduation eligibility.

1.2.3. The student portfolio provides transparency for students to enable them to reflect on their learning to date, develop self-awareness, and establish learning plans. It will also help academic coaches guide students in their learning. Students are able to add artifacts which are part of their expected assessment (e.g., reflections)

1.2.4. The records retention schedule will follow TMU’s Records Retention Policy.

1.3. Continuous Formative Feedback

Using the continuous formative feedback offered by the programmatic assessment system, the academic coaches, the UGME Competence Committee, and the Student Progress Subcommittee will review students’ progress using the online LAMS dashboard(s) every 2 months. Students at-risk for Progressing with Support or Not Progressing will be offered appropriate support, which may include a Learning Plan, to help them succeed.

2.  Final Course Grades 

2.1. The Associate Director, Curriculum is responsible for viewing, in a holistic fashion, all assessments in the student portfolio for a course and indicating whether the student has met the predefined standard for the course and expected level of competence for the course outcomes.

2.2. The Associate Director, Curriculum will assign a final course grade of Pass, Incomplete, Fail or other course performance designations, as appropriate (See Appendix B).

2.3. Where the coursework is incomplete, the Associate Director, Curriculum may assign an Incomplete (INC) grade and stipulate what is required to complete the course, with the conditions for completion determined by the UGME Competence Committee. The INC grade is an interim grade that will display on the student record and student transcript until a grade change is submitted. Refer to Procedures, Section 9: Incomplete Grades.

2.4. Where there is an investigation of academic misconduct (as described in Senate Policy 60: Academic Integrity), an interim Deferred (DEF) grade will be applied. The DEF grade will be replaced by an official course grade upon resolution of the matter.

2.5. For each course in a given year, students must complete the prerequisite course to progress to the next year level of that course, unless otherwise specified by the UGME Competence Committee (e.g., a Progression Plan that is underway).

2.6. The final course grades will be approved by the UGME Competence Committee and validated by the Associate Dean UGME. The designated individual from the UGME Office will then submit all final course grades to TMU’s Registrar’s Office by the date as outlined in the annual Academic Calendar for the MD Program. 

2.7. Final course grades are considered official as per the date outlined in the “significant dates” section of the Undergraduate Medical School Calendar each year.

2.8. Final course grades may not be posted or disclosed to students by any clinical faculty, facilitator, preceptor, or assessor. Final course grades cannot be displayed to students in the LAMS course shell. Students will receive their official final course grades only from the Registrar’s Office, available for viewing in MyServiceHub.

2.9. Final Course Grades can be appealed (see Policy 168: Grade and Standing Appeals) 

2.10. Final course grades will display on the student’s academic record and official transcript.

3.  Incomplete Grades 

3.1. The designation of “Incomplete” (INC) indicates the identified course or section of a course assessment component is not yet successfully completed, though is expected to be completed as per the conditions determined by the Associate Director, Curriculum and UGME Competence Committee.

3.2. The designation INC is an interim grade and is not counted as credit to fulfill prerequisite requirements and program requirements. INC designations appear on the official transcript and academic record until it is or is not successfully completed.

3.3. Associate Directors, Curriculum assigning a grade of INC must complete the MD Program Incomplete Grade Request Form within 7 (seven) working days of assigning the grade of INC. 

3.4. Students with extenuating circumstances that impact completion of an assessment(s) may also request a final grade of INC by petitioning the Associate Director, Curriculum within 7 (seven) working days of the circumstances cited as driving the INC request.

3.5. The Associate Director, Curriculum will determine the date by which the incomplete work must be finalized. This will be forwarded to the UGME Competence Committee for confirmation. Following this, the date and Page 187 of 370 (Senate Agenda) plan will be communicated to the student and recorded in the academic record. The MD Program will retain a copy of the Incomplete Grade Request Form for the School’s student file.

3.6. In extenuating circumstances, such as an unexpected health condition, the student may request approval from the Associate Director, Curriculum for a one-time extension to the original INC completion date agreed to on the Incomplete Grade Request Form. When granting an extension, the Associate Director, Curriculum will consider the student’s academic progress in the program. The UGME Competence Committee must approve the extension request. All extensions must be reported to Student Records using the Incomplete Grade Request Form. The form must include the final extension date.

3.7. Once the outstanding course work is successfully completed and (where applicable) submitted by the student for grading, the Associate Director, Curriculum will arrange for the work to be graded and submit a revised final course grade to the UGME Competence Committee for confirmation. It will then be submitted to the Associate Dean UGME to send to the Registrar’s Office using the Automated Grade Revision Process or other established procedures.

3.8. If the identified course or section of a course assessment component is not completed as identified, by the Associate Director, Curriculum, and UGME Competence Committee, the INC designation will lapse to a Fail (FLD) grade. 

3.9. The student may be assigned a standing of Progressing with Support with an INC grade in a course, based on assessment of the student's profile and determination by the UGME Competence Committee. Students who have more than one INC grade will be assigned a standing of Not Progressing. If a student has 2 or more INCs outstanding by the end of the timeline established by the UGME Competence Committee, they will be required to repeat the year/phase.

3.10. Students assigned a Standing of Not Progressing at a time when they have an outstanding INC grade must resolve the INC prior to appealing the standing decision.

3.11. Students will be required to resolve outstanding INCs to be considered for graduation-eligibility.

4. Grade Revisions 

4.1. Associate Directors, Curriculum are responsible for submitting grade revisions. Grade revisions are submitted to the UGME Competence Committee for approval.

4.2. Once the revision has been authorized, the UGME Competence Committee must submit the form to the Registrar’s Office for updating.

4.3. The Registrar’s Office will update the grade revision to the student’s academic record in MyServiceHub. 

4.4. All final course grades will be displayed on the student’s academic record and official transcript.

5. Course Repeats 

5.1. All course attempts including repeated courses are recorded on the official transcript and academic record and cannot be removed.

5.2. Only failed courses can be repeated. No course can be repeated more than once (two attempts in total). If students fail a course for a second time, they will be assigned an academic standing of Dismissal From Program (DFP)

6.  Academic Standing 

6.1. At the end of Year 1 and at the end of each of the 3 (three) Phases of the MD program, the academic standing of students will be determined by the UGME Competence Committee. Following a review of students’ portfolios by each Associate Director, Curriculum and a determination of the grade within each course, the UGME Competence Committee will undertake a holistic review of each student file along with decisions about professionalism and Learning or Remediation Plans, if needed.

6.2. The UGME Competence Committee may refer students to the Student Progress Subcommittee to help develop Learning, Progression or Remediation Plans, to assess whether a student has met the conditions of their Progression or Remediation Plan for that year/Phase (where relevant), and to recommend an academic standing based on their holistic review of the student’s portfolio (See Procedures, 4.1, 4.4)

6.3. Academic standing at the end of Year One and at the end of each of the three phases will be determined by a holistic review of the following assessments and progression requirements:

• course grades;
• adherence to professionalism standards of the Program and School;
• relevant workplace-based assessments;
• Entrustable Professional Activities (EPA) assessments;
• expected level of completion for projects assigned to the phase;
• all formative quizzes that are part of the assessment system;
• summative OSCEs;
• laboratory assessments;
• required peer-related and community/patient-based feedback with reflections in the individual portfolio;
• attendance record and completion of assignments for any community immersion experiences, as outlined in the requirements of a course(s); and 
• any other required assessments for individual learning; and
• outcomes of a Progression or Remediation Plan, where relevant.

6.4. Based on these criteria, a students' academic standing will be classified into one of the following 3 stages of progress: 

6.4.1. Progressing: The student has successfully completed all necessary courses and demonstrated the expected level of competence in all required learning experiences. The student has also met all professionalism standards as outlined in Senate Policy 175: Standards ofProfessional Conduct for Students in the Doctor of Medicine (MD) Program, including no unremediated lapses of professionalism.

6.4.1.1. Phase 1: There are two progression decision points in Phase 1. At the end of Year 1, the student has successfully completed all the Year 1 courses and has demonstrated the expected level of competence in all required learning experiences, as articulated in the course outline. At the end of Year 2 (completion of Phase 1), the student has successfully completed all the Year 2 courses and has demonstrated the expected level of competence in all required learning experiences. The student has no unremediated Lapses of Professionalism in their file.

6.4.1.2. Phase 2: At the end of Phase 2, the student has successfully completed all Clerkship required learning experiences and has demonstrated the expected level of competence in the required courses. The student has no unremediated Lapses of Professionalism in their file.

6.4.1.3. Phase 3: At the end of Phase 3, the student has successfully completed all the requisite electives, the self-selected focused learning activity, and the modules to support transition to Postgraduate Medical Education. The student has demonstrated the expected level of competence in required courses and graduating level of competency in all program learning outcomes. The student has no unremediated Lapses of Professionalism in their file.

6.4.2. Progressing with support: An academic standing of Progressing with Support will be assigned for any one of the following reasons:

• The student has not demonstrated competence at the expected level in one or more required learning experiences but the UGME Competence Committee has deemed that they can be addressed while the student continues in the program. Students who have achieved an Incomplete (INC) grade in one (1) course in the current year or Phase may be able to Progress with Support and will be assessed by the UGME Competence Committee on a case-by-case basis.
• Students with a Level 1 or Level 2 Lapse of Professionalism may also be assigned a Progressing with Support standing, at the discretion of the UGME Competence Committee.

6.4.2.1. Students assigned an academic standing of Progressing with Support must develop a Progression Plan in collaboration with the Student Progress Subcommittee and relevant parties (e.g., Associate Director, Curriculum). The Progression Plan must be signed by the student and the Chair of the UGME Competence Committee (or delegate) within 10 working days of finalization.

6.4.2.2. If the student fails to sign the Progression Plan within 10 working days of finalization, they will be considered as not meeting the conditions of the plan. This will result in reassessment of their standing by the UGME Competence Committee.

6.4.3. Not progressing: An academic standing of Not Progressing will be assigned to students for any one of the following reasons:

• Failure in a course or courses
• Failure to successfully demonstrate the expected level of competence in one or more required learning experiences and/or to meet other conditions as specified in a Progression Plan;
• A Level 3 or 4 Lapse in Professionalism as per Senate Policy 175:Standards of Professional Conduct for Students in the Doctor of Medicine (MD) Program; and/or
• Two or more Incomplete (INC) grades

6.4.3.1 Students assigned a “Not Progressing” standing must develop a Remediation Plan in collaboration with the Student Progress Subcommittee and relevant parties (e.g., Associate Director, Curriculum). The plan must be signed by the student and the Chair of the UGME Competence Committee (or delegate) within 10 working days of finalization.

6.4.3.2 If the student fails to sign the Remediation Plan, they will be considered as not meeting the conditions of the plan. This will result in reassessment of their standing by the UGME Competence Committee.

6.4.3.3. The UGME Competence Committee may also recommend required actions for the student, including:

• repeat a course(s) or Phase;
• take a mandated leave of absence, (Refer to the School of Medicine’s Policy on Leave of Absence for Students in the Doctor of Medicine (MD) Program).

6.4.3.4. After considering the recommendation of the Student Progress Subcommittee, the UGME Competence Committee will confirm the standing of Not Progressing. The student cannot progress until the outcomes of the Remediation Plan have been achieved.

6.4.4. Dismissal from Program (DFP): Students will be assigned a Dismissal from Program standing for any one of the following reasons:

• Failure to successfully achieve the outcomes and conditions specified in the Remediation Plan
• Failure of a course for a second time;
• Failure to complete the Program within 6 (six) years of admission to the Program, unless granted a timespan extension (refer to Section 10 of this Procedure).

Students may be assigned a Dismissal from Program standing for a Level 4 Lapse of Professionalism as per Senate Policy 175: Policy on Standards of Professional Conduct for Students in the Doctor of Medicine (MD) Program.

6.5. The decisions of the Student Progress Subcommittee will be reviewed by the UGME Competence Committee, who will then share their decisions with the Associate Dean UGME for validation. Academic standing decisions will be recorded in the LAMS, with electronic notification to the student

6.6. The final Academic Standing will be recorded on the student’s official transcript by the Registrar’s office. 

6.7. The UGME Competence Committee may make recommendations, to the Associate Dean, UGME or other relevant parties, that are appropriate in the circumstances, including, without limitation, for a student to request a leave of absence to allow for addressing health, academic or personal issues impacting their learning and progression. If a student declines the recommendations, the UGME Competence Committee will assess next steps on a case-by-case basis.

6.8. Standing decisions of Progressing with Support, and Not Progressing, and Dismissal From Program can be appealed (see Policy 168: Grade and Standing Appeals).

7.  Voluntary Withdrawal 

7.1.   A student who chooses not to continue in a program must officially withdraw from the program. Withdrawn students will not be entitled to use the services of the University or the program.

7.2.  A student who voluntarily withdraws from the MD Program may re-apply through the Ontario Medical School Application Service (OMSAS) and will be treated as a new applicant to the MD program. Readmission is not guaranteed and may be subject to conditions.

8. Discontinuation

8.1. A student who has not enrolled and has not completed any courses for two (2) or more consecutive years will be discontinued from the MD Program and will not be eligible to continue in the MD program.

8.2. Students will be notified of their status by email or mail, as appropriate.

8.3. Discontinued students from the MD program who wish to resume studies, must apply for readmission through the Ontario Medical School Application Service (OMSAS) and will be treated as new applicants to the MD program. Readmission is not guaranteed.

9.  Timespan to Complete Degree 

9.1.  Once per academic year, after the enrollment period, any student who has exceeded their time for completion of the program will have a “hold” applied to the academic record. The hold will restrict the student from enrolling in future courses.

9.2.  Under extenuating circumstances, students may petition the Vice Dean, Clinical Education or designate for an extension to these time limits.

9.3.  An extension will only be granted to students whose progress is fully satisfactory. No registration will be permitted beyond the extension deadline. 

9.4.  Students must request the extension prior to the last day of classes for the term in which the time limit will expire Students who do not apply for a timespan extension by this timeline will be “discontinued” and may no longer be eligible to continue in their program of study. The student in this situation will be required to reapply for admission to the program.

9.5.  Students requesting a timespan extension must submit electronically the following information to the Vice Dean, Clinical Education:

• an explanation for the reason for the request including any extenuating circumstances
• a detailed and realistic academic plan of study and timeline for completion during the extension period including length of the extension being requested
• supporting documentation to demonstrate the extenuating circumstances 

9.6.  If a timespan extension is approved by the Vice Dean, Clinical Education or designate, the hold on the record will be updated to reflect the extension end date.

9.7.  All documentation including the Vice Dean, Clinical Education or designate’s approval, the study plan and the extension date must be forwarded by the UGME Office to Student Records to retain permanently in the student’s record.

9.8.  Once the extension date expires, the student will no longer be able to enroll in further courses. 

9.9.  If the request for a timespan extension is denied or if a further extension is being requested, students may appeal to the Dean of the School of Medicine, who will consider the case and provide a decision.

9.10. To appeal the Dean’s decision, the student may then appeal directly to the Senate Appeals Committee (SAC) for a final consideration of their request. This is a SAC Timespan Extension Appeal.  

10. Appealing the Denial of a Timespan Extension to the Senate Appeals Committee (SAC)

10.1. If the student chooses to appeal the Dean of the School of Medicine or designate’s decision regarding a timespan extension request, or if a subsequent further extension is being requested, the appeal will be considered by the Senate Appeals Committee (SAC).

10.2. In the case of an appeal of a denial, the student must request the appeal within 10 (ten) business days of the denial. 

10.3. Students must provide the following information by email to senate@torontomu.ca

• Senate Appeals Committee Timespan Appeal Form
• a letter to the Senate Appeals Committee expressing why the request should be considered
• any new evidence not previously submitted (if applicable)
• all previously submitted documentation to the Dean or designate including their decision
• explanation of the reason for the request including any extenuating circumstances
• a detailed and realistic academic plan of study and timeline for completion during the extension period
• supporting documentation 
• in the case where a further extension is being requested, a student must also provide a letter explaining the reason why the plan of study from the first timespan extension was not completed

10.4  A Notice of Review will be sent to the student within 10 (ten) business days of their SAC Timespan Appeal being received and will include when the review of their appeal will occur together with the names of the panel members conducting the review.

10.5  The student will not attend the SAC review. The review will be based on the official transcript and documentation provided by: 

• The Student
• The School     

10.6  The SAC will consider the extension as applicable in the MD program of study.

10.7  The SAC decision will be issued by email within 10 (ten) business days of the review.

10.8  SAC decisions are final and not appealable.

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11.  Program and Graduation Requirements

11.1   Using predetermined standards for expected competence in each course, the UGME Competence Committee will recommend students for the MD degree designation upon satisfactory demonstration of graduation competence in all MD Program outcomes.

11.2   Students must be registered with a full course load during the academic year except under exceptional circumstances and with prior approval of the UGME Competence Committee.

11.3   Students will be reviewed in May of Phase 3 of the MD program by the UGME Competence Committee for graduation-eligibility. 

11.4   Students who are not progressing and hence unable to graduate may appeal this decision (see Policy 168: Grade and Standing Appeal).

11.5   Students may elect to withdraw their application to graduate for personal, career, or academic reasons and reapply in order to convocate in a subsequent convocation.

11.6   Graduation occurs twice per year, in Spring and Fall. Students must submit an application to graduate within TMU’s applicable deadline dates. 

11.7   Criteria for Obtaining the MD: In order for students to be recommended for graduation by the UGME Competence Committee and the Associate Dean UGME, there must be:

• documentation demonstrating progression across phases; 
• completion of all program requirements which includes achieving a grade of Pass in all program courses and a final standing of ‘Progressing’ in each of the three Phases; and completion of all assigned remediations where applicable.
• not having exceeded 6 (six) years of study in the program since matriculation unless sanctioned by decisions from the program’s appeals process; and,
• no unremediated Lapses of Professionalism.

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Related Policies/Procedures 

Senate Policy 60: Academic Integrity

Policy Policy 61: Student Code of Non-academic Conduct 

Senate Policy 135: Final Examinations

Senate Policy 150: Accommodation of Student Religious, Indigenous and Spiritual Observance

Senate Policy 157: Establishment of Student Email Accounts for Official University Communication

Senate Policy 159: Academic Accommodation of Students with Disabilities

Senate Policy 168: Grade and Standing Appeals

Senate Policy 175: Standards of Professional Conduct for Students in the Doctor of Medicine (MD) Program Senate