Navigating Academic Probation and Exam Failure at UCLA Medical School

The path through medical school is rigorous, and students may encounter academic challenges. This article outlines the policies and procedures at the UCLA David Geffen School of Medicine (DGSOM) and the UCLA College regarding academic probation, failing grades, and strategies for returning to good standing. It also addresses related policies at Michigan State University (MSU) for a broader perspective.

Understanding Academic Standing at UCLA DGSOM

The David Geffen School of Medicine at UCLA has a detailed system for monitoring student academic performance and addressing difficulties. The Committee on Academic Standing, Progress, and Promotion (CASPP) is responsible for reviewing student academic standing and determining any changes. Several categories define a student's standing:

Good Academic/Professional Standing: This signifies successful completion of all courses and clerkships, satisfactory evaluations, adherence to UCLA and DGSOM policies, and no instances of unprofessional conduct.
Experiencing Academic/Professional Difficulty: This informal designation is applied when a student encounters initial academic setbacks. It is removed once the issue is resolved. Events leading to this designation include:
- One course or clerkship failure.
- Two course or clerkship failures in one academic year.
- Three incomplete clerkships (including those due to failed or missed shelf exams).
- One failure of a USMLE (Step 1, 2 CK) exam.
- Failure to meet USMLE policy.
- A violation of the DGSOM Honor Code, Professionalism Policy, or UCLA Student Conduct Code.
- Professional conduct deemed concerning by CASPP. Students in this category are strongly encouraged to seek available resources.
Academic/Professional Probation: This is a formal designation recorded on the Medical Student Performance Evaluation (MSPE). Students placed on probation have 12 months to improve their standing. Events leading to this designation include:
- Three course or clerkship failures in one academic year.
- Failure of a retest exam.
- Violations of the DGSOM Honor Code, Professionalism Policy, or UCLA Student Conduct Code.
- Professional conduct deemed concerning by CASPP.
Dismissal: This is the most serious outcome and can result from:
- Failure to improve academic/professional standing within the 12-month probation period.
- Four course or clerkship failures in one academic year.
- Failure to meet remediation terms for a failed course or clerkship.
- Failure to meet DGSOM USMLE policy.
- Violation of the DGSOM Honor Code, Professionalism Policy, or UCLA Student Conduct Code, or unprofessional conduct deemed severe by CASPP.
- Failure to successfully complete the M.D. program.

Core Clinical Clerkships: Grading and Failure Policies

Core clinical clerkships at UCLA DGSOM are graded on a Pass/Fail basis. These clerkships include Emergency Medicine, Family Medicine, Internal Medicine, Neurology, Obstetrics and Gynecology, Pediatrics, Psychiatry, and Surgery. To receive a "Pass," students must complete all clerkship requirements and achieve the minimum passing standard for both clinical performance and the National Board of Medical Examiners (NBME) Shelf Exam.

Clinical Grade Contribution

The Clinical Grade is determined by the Clerkship Chair in collaboration with the Clerkship Grading Committee, using a rubric that assesses 13 clinical skills:

History Taking
Physical Examination
Fund of Knowledge
Differential Diagnosis Development
Treatment Plan Generation
Medical Record Documentation
Oral Presentations
Communication with Patients and Families
Communication with the Interprofessional Team
Humanism
Integrity and Work Ethic
Commitment to Learning
System-Based Practice

Each skill is rated using criterion-based anchors across four performance levels. A Total Evaluation Score is calculated as a percentage of the total possible score. A score greater than 48% results in a passing clinical performance grade. In addition to the Total Evaluation Score, students must meet a minimum performance standard in all 6 ACGME Competencies:

Patient Care (Clinical Skills 1 and 2) - 50%
Clinical Knowledge (Clinical Skills 3, 4 and 5) - 33%
Interpersonal Skills (Clinical Skills 6, 7, 8 and 9) - 50%
Professionalism (Clinical Skills 10 and 11) - 50%
Practice-Based Learning (Clinical Skill 12) - 50%
Systems-Based Practice (Clinical Skill 13) - 25%

Final Examination (NBME) Grade

The minimum passing standard for the NBME Shelf Exam is set based on annual national percentile exam reports for each required clerkship. A passing score is typically above the 5th percentile.

Course Failure Policy in the Core Clinical Clerkships

Fail 1 clerkship exam (NBME shelf exam): This results in an Incomplete grade, but does not immediately change the student’s academic standing. The student can retake the exam after two weeks of study without clerkship obligations.
Fail retest of a clerkship exam (NBME shelf exam): The clerkship grade remains Incomplete, and the student's standing is changed to Experiencing Academic/Professional Difficulty. A third attempt is permitted after another two weeks of dedicated study.
Fail second re-test of clerkship exam (third attempt of NBME shelf exam): This results in a grade of Fail/No Credit and a change in standing to Academic/Professional Probation. The student is required to repeat the entire clerkship. Passing the clerkship examination on the fourth attempt results in a transcript notation indicating the course was repeated. Failing after repeating the clerkship (four failures total) may lead to a referral to CASPP for consideration of dismissal.

Multiple Incomplete Clerkships

Failing exams in two different clerkships allows the student to retake both exams. However, failing or not sitting for exams in three different clerkships results in the student being unable to progress in the curriculum. The student's standing changes to Experiencing Academic/Professional Difficulty, and enrollment in an Independent Study course is required until at least one clerkship shelf exam is passed.

USMLE Requirements

Passing the United States Medical Licensing Examination (USMLE) Step 1 and Step 2 exams is a graduation requirement at DGSOM.

Key USMLE Policies:

Students must take Step 1 before starting MS4 electives.
Passing scores on Step 1 and Step 2 are required by the NRMP rank list verification deadline.
Students cannot take time off during the Pre-clerkship year for USMLE preparation.
Students cannot take time off during clerkships to prepare for their first attempt at either Step 1 or Step 2.

USMLE Failure Consequences:

One Failure: A first-time failure on Step 1 results in the Experiencing Academic/Professional Difficulty designation. The student can complete the current MS4 elective but cannot begin further electives until the exam is passed.
Two Failures: Failing Step 1 twice results in Academic/Professional Probation. The student cannot return to the curriculum until the exam is passed. Failure to pass within one year of the second failing score may lead to referral to CASPP for dismissal.
Three Failures: Failing Step 1 three times results in referral to CASPP for consideration of dismissal.

Academic Probation in the UCLA College (Undergraduate)

While the above primarily addresses the medical school, undergraduate students in the UCLA College also have academic performance standards to meet.

Expected Cumulative Progress (ECP)

Undergraduates are expected to make steady progress toward their degrees. ECP guidelines provide guideposts for academic progress. Students are encouraged to work with academic counselors in their College advising units.

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ECP Probation

Students may be placed on ECP Probation if they are not meeting minimum progress requirements.

Minimum Progress Requirements

Students must complete an average of at least 13 units per quarter.
A certain number of units must be completed after each two-quarter period.
Summer Session units count toward expected cumulative progress but cannot offset the 13-unit minimum per quarter requirement.

Factors Affecting Progress

Incomplete grades count as units completed for the quarter in which the 'I' grade is removed.
Approved repeats of classes are considered.
Withdrawal from a quarter can affect progress.

Academic Disqualification

Students who do not meet the progress requirements may be subject to academic disqualification. Students may contest disqualification actions.

Additional Considerations: MSU Policies

While the primary focus is on UCLA, understanding similar policies at other institutions can be helpful. At Michigan State University (MSU), academic probation and dismissal policies involve similar concepts:

Academic Probation: Students whose cumulative grade-point average falls below 2.00 are placed on probation for one semester. They may be required to see an academic advisor, and a hold may be placed on their registration.
Final Probation: If a student's grade-point average remains below 2.00 during probation, they may be placed on final probation.
Recess: Students with 30 or fewer credits earned at MSU may be recessed (required to leave the university) if their grade-point average is not at least 2.00 after final probation. The recess period is at least one full academic year.
Dismissal: Students may be dismissed if they have repeated 21 or more credits. A second recess is considered a dismissal. Students who have been dismissed must remain out of school for at least two years.

Strategies for Success and Returning to Good Standing

Seek Academic Advising: Regularly meet with academic advisors to discuss performance, identify areas for improvement, and develop strategies for success.
Utilize Resources: Take advantage of tutoring services, writing centers, and other academic support resources offered by the university.
Address Underlying Issues: Identify and address any personal or external factors that may be affecting academic performance, such as time management, study skills, stress, or health concerns.
Communicate with Instructors: Talk to professors and clerkship directors to seek clarification on course material, understand expectations, and discuss any difficulties.
Develop Effective Study Habits: Implement effective study strategies, such as active recall, spaced repetition, and concept mapping.
Time Management: Develop a structured schedule that allocates sufficient time for studying, attending classes, and other responsibilities.
Prioritize Well-being: Maintain a healthy lifestyle by getting enough sleep, eating nutritious meals, and engaging in regular exercise.
Seek Support: Connect with friends, family, or a therapist for emotional support and guidance.
Petition for Waivers (Undergraduate): Undergraduate students facing progress issues may petition for waivers of certain requirements, explaining any extenuating circumstances.

Double Major Considerations (Undergraduate)

Undergraduate students pursuing a double major should consult with their department and advising unit to ensure they can complete all requirements within a reasonable timeframe. A Double Major Petition should be filed with the L & S advising unit. Completing a double major is not guaranteed and requires maintaining at least a 2.0 GPA and making satisfactory progress toward the degree.

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