Official Transcript Grades

• The following designations are used in Axess to report performance in clerkships:
  • Pass (+) indicates that a student has demonstrated, to the satisfaction of the responsible department or teaching group, that they have mastered the material taught in the clerkship.
  • Incomplete (I) indicates that extenuating medical or personal circumstances beyond the student’s control have prevented completion of clerkship requirements. 
  • Continuing (N) indicates that the clerkship has not concluded, and that the student is continuing the clerkship or that a minor component of a clerkship (as defined by the clerkship director) is pending.
  • Grade Not Reported (GNR) indicates that a grade has not been reported by the clerkship director.

School of Medicine Internal Grades

• In addition to grades in Axess, the following designations for clerkships are tracked internally by the School of Medicine through the Medical Education Platform (MEP):
  • Continuing (N) indicates that a student has not completed all clerkship requirements and/or did not pass the written NBME subject exam or alternative departmental exam.
  • Marginal Pass (MP) indicates that a student has fallen short of meeting minimal performance standards for a pass, but has done better than a fail, and additional work or remediation is necessary to achieve a pass. There may be moderate concerns about the student’s professional behavior and/or the student’s performance has raised moderate concerns about knowledge and competence. MP grades are entered as an N grade in Axess.
    
  • Fail (F) indicates that a student has not met the minimum performance standards for the clerkship. There may be significant concerns about the student’s professional behavior and/or the student’s performance has raised significant concerns about knowledge and competence. Failing grades do not show up on the official transcript. 

Note: Students may earn a final grade of Pass (P), Marginal Pass (MP), or Fail (F) in Electives/Selective clerkships.

• Written exam requirements are set by the clerkship director.
• Clerkships may use either the NBME Subject Exam or an alternative departmental exam.
• Written examinations must be passed with a minimum score as established by the clerkship.
• Core clerkship exam thresholds for “pass” are determined by each clerkship and will be noted in the syllabus and/or at clerkship orientation.
• Students who do not pass the written exam receive a Continuing (N) grade for the clerkship and must retake either the NBME Subject Exam or the departmental exam.
• Students who do not pass the written exam on the second attempt must take an oral exam or a suitable alternative, to be determined by the clerkship director in conjunction with the Assistant Dean for Clerkship Education.
• After the third attempt at satisfying the exam requirement, the Continuing (N) grade converts to either Pass (P) or Fail (F).
• Continuing (N) grades must be corrected within 9 months of the end of the clerkship. Uncorrected Continuing (N) grades will convert to a Fail (F) after 9 months.

All required clerkships must provide students a formal mid-clerkship assessment of performance. Mid-clerkship feedback must be provided early enough to allow a student the opportunity to improve their performance before the end of the clerkship. Clerkships must maintain written documentation that mid-rotation feedback has been provided to each student.

Students who have questions or concerns about a performance evaluation in a clinical clerkship should contact the Clerkship Director to request a review. If a student’s disagreement remains unresolved, the student may request a review by the Clerkship Evaluation Committee (CEC) by completing the Request for Review form within eight weeks of the date that the final student performance evaluation was submitted in MedHub to be considered.

The CEC consists of the following members (or their designees) who will participate in each appeal or review:

• Director of Evaluation (CEC chair)
• Assistant Dean of Clerkship Education
• A Required Clerkship Director other than the director involved in the appeal
• Representative from the Educator-4-CARE program faculty
• One additional faculty member (who does not hold a formal role in clerkships or CP3) from the Office of Diversity in Medical Education, Office of Medical Student Wellness, Office of Accessible Education, Office of Religious Studies, or Graduate Life Office, etc. at the request of the student or committee.

Upon receiving a request for review, the CEC will notify the clerkship team responsible for the performance evaluation and will gather data from the clerkship team. The CEC will review the final evaluation and all submitted data, gather additional information as needed, and will generally, though it is not required, reach a decision by consensus. The student and clerkship team will be notified in writing of the final decision. The CEC convenes as needed during even clerkship periods and decisions will be released within 7 days of the meeting.

The CEC decision is considered final. Students with further concerns may choose to independently pursue the Stanford University student academic grievance procedure, though they should recognize the limited scope of review inherent in that procedure.

During the course of a clerkship, when a clerkship director becomes aware that a student’s performance may warrant a marginal pass or failing grade, the clerkship director must notify the student promptly that, in the absence of improvement, a non-passing grade is being considered. Once the director confirms the decision to assign a non-passing grade, the clerkship director must immediately notify the student about the final grade to be assigned. The clerkship director should also notify the student’s Academic Advising Dean, who will arrange a meeting with the student.

All clerkship academic deficiencies (e.g., Failure (F), Marginal Pass (MP), Continuing (N)) must be corrected within 9 months (or otherwise within a time limit specifically set by the clerkship director or the CP3 in the individual case) and prior to promotion to Eligible for the MD Degree. Requirements for correcting a deficiency will be determined by the clerkship director or the CP3. Students who receive a deficiency are required to meet with the clerkship director to set timely requirements for achieving an unqualified passing grade. For additional information, see Section 6.5: Chart of Responses to Student Issues.

Students cannot receive a Stanford MD degree with an uncorrected deficiency in a clerkship.

Clerkship deficiencies and corrections are recorded through MedHub evaluations, and are also tracked as internal “School of Medicine grades” in the Medical Education Platform (MEP) student record system, where students may view and track their academic progress.