Actions and Sanctions for Managing Students in Difficulty

Remediation means any plan developed to manage a student’s deficiency. SPC decides whether a student may remediate. Block, course, thread, and clerkship directors may not remediate a student’s deficiency until SPC meets and determines an appropriate course of action based on the student’s overall performance. The student may have difficulty in more than one area and a coordinated plan is needed for the student’s benefit. 

SPC’s remediation plan is based on multiple factors, including but not limited to: recommendations of the block, thread, course, or clerkship director, input from ex officio members of the SPC, input from the student’s College Mentor, and the student’s overall medical school progress. 

SPC may require that the remediation be completed before the student may continue in other coursework. Typical remediation for students with a single deficiency is listed here: 

• Fail grade in a block: SPC usually accepts the block director’s recommendation for re- examination or repeat of the block. 
• Competency not achieved in a thread: SPC usually accepts the thread director’s recommendation for taking the thread remediation course. 
• Fail grade in a non-blocked course: SPC usually accepts the course director’s or clinical skills director’s recommendation for remediation. 
• Fail grade in a clerkship: SPC usually accepts the clerkship director’s recommendation for repeat of the clerkship. 

For multiple deficiencies, SPC determines the appropriate course of action considering the student’s entire record and any extenuating circumstances presented. Actions may include consideration of dismissal, referral to Washington Physicians’ Health Program (WPHP), and/or a mandatory leave of absence. 

When a fail grade is successfully remediated, the transcript will reflect both the fail grade (in the term the course was first taken) and the passing grade (in the term in which it was repeated.) 

A student who does not remediate on the timeline set by SPC, or who fails a remediation, will be reviewed by SPC for further action. Actions may include consideration of dismissal, referral to WPHP, and/or a mandatory leave of absence. 

Students who fail Step 1 are allowed to finish the current quarter’s clerkships. Clerkships scheduled for subsequent quarters are automatically dropped to allow for study and re-take of the exam. 

When a student fails their first attempt of Step 1 and has no other deficiencies, SPC typically permits re- take. SPC may require a passing score on Step 1 before scheduling further clerkships, in light of the student’s entire record. 

When a student fails their second attempt of Step 2, SPC may permit re-take, refer the student to WPHP, and/or require a mandatory leave of absence, in light of the student’s entire record and any extenuating circumstances presented. A passing score on Step 1 is required before any further clerkships are scheduled. 

A student who fails Step 1 a third time may be considered for dismissal.

Students who fail Step 2-CK or Step 2-CS are allowed to finish any clerkships or clinical electives they have begun. Subsequent adjustments to their schedule will be managed by the ADSA and Registrar. The Step must be retaken and passed prior to the deadline for National Resident Matching Program Match certification. 

If the student has no other deficiencies, SPC typically permits re-take. A student who fails their second attempt at Step 2-CK or Step 2-CS may require an expansion and delay of graduation. A student who fails their third attempt at Step 2-CK or Step 2-CS will be considered for dismissal. 

Academic probation is an internal designation. It serves to notify a student that if performance does not improve, dismissal will be considered. Typically, SPC puts a student on academic probation for the following: 

• A fail grade in a block or a clerkship 
• Competency not achieved in 2 or more threads 
• 2 or more non-blocked course fails 
• 2 or more step exam fails 
• Any combination of deficiencies, such as 1 thread fail and 1 step exam fail 

Unsatisfactory progress in any area that falls under SPC’s purview may result in academic probation. 

A student may be removed from academic probation when the issue(s) leading to probation have been remediated and the student has completed one year of full-time coursework since being placed on probation. 

Students on academic probation may not take non-clinical electives, serve in leadership roles in student activities, pursue paid employment, work toward a concurrent degree, or any other activity that might interfere with their medical school performance without prior permission from the ADSA. 

Disciplinary probation is based on an academic integrity violation or professional misconduct. It is part of the student’s record and is reported in the Medical Student Performance Evaluation. The duration of disciplinary probation is set by SPC at the time that it is imposed. 

When a student is clearly eligible to be removed from probation, the Chair of SPC may do so. If there is uncertainty, the student’s case will be presented to SPC. Students must be removed from probation before they graduate. 

Students may request or be placed on leave of absence for personal or academic reasons, or to participate in extra academic programs such as research fellowships. Students may request personal leave to manage pregnancy, childbirth, parental leave, recovery from illness, or caregiving for a family member, among other reasons. If a student needs only a short period of time off, which will not delay graduation, the student does not need to go on leave. Going on leave to avoid failing a block, course, or clerkship is not allowed. 

Requests for leave go to the ADSA. The ADSA may approve a request for leave on behalf of SPC if there are no academic performance issues. These leaves are reported to SPC for information only. The student may return from leave and register for courses without involvement of SPC. 

Students who are not performing well academically may have leave mandated by SPC. SPC may stipulate what the student must do before returning. If no stipulations are made, the student may return from leave and register for courses without involvement of SPC. If stipulations are made, the student must petition SPC to return, demonstrating that they have met those stipulations. If stipulations are made and not met, SPC may recommend that the student remain on leave or may consider dismissal. 

In cases where SPC approves a return from leave, SPC may set requirements for continuing in the curriculum and may place the student on probation. SPC may require an interview with the student before approving a return from leave. 

Students may request up to one year of leave. Students on leave may petition SPC for a second year of leave if circumstances warrant it. If SPC grants a second year of leave, the student will be re-evaluated by SPC before returning to the curriculum. If SPC allows the student to return, certain requirements may be set, such as repeating courses already taken and being on probation. Students who need more than 2 years to resolve an issue must withdraw from the school. 

Students may request or be placed on an expanded curriculum. Expansions may be for personal reasons, to remediate academic difficulties, to complete a concurrent degree, and/or to allow time to explore career options. 

Requests to expand go to the ADSA. The ADSA may approve a request for expansion on behalf of SPC if there are no academic performance issues and the student is in good standing. These expansions are reported to SPC for information only. 

SPC will consider requests to expand during Foundations Phase or Patient Care Phase only under exceptional circumstances. Students may be mandated to expand in these phases due to academic difficulty. Even during an expansion, each clerkship must be taken in a full-time capacity, i.e. expanding a 6-week clerkship over 10 weeks is not allowed. 

Students in an extended curricular program for academic reasons must request approval to make schedule changes, take electives, or pursue additional educational opportunities such as concurrent degrees or research fellowships. Students who expand due to deficiencies are expected to dedicate full-time attention to their expanded program. 

If a student on an extended curricular program fails a block, course, or clerkship, SPC may consider dismissal. 

In rare circumstances, SPC may opt to place students on “Advance Information” status. This is used when a student has had certain types of academic or professional behavior difficulty. The objectives for using advanced information are to provide the student with additional support in the area(s) of deficiency, to ensure that there is adequate feedback to the student, and to ensure that there is adequate evaluation of the area(s) of concern. 

Advance information is managed by the ADSA. 

The academic, rural and regional affairs deans and/or SPC have the right to prohibit a student’s continuation in the clinical setting if there are concerns related to patient care or patient safety, the ability to practice with reasonable skill and safety due to a mental or physical condition, the potential for compromising compatibility and effective functioning of the healthcare team, and/or evidence of substance abuse. The medical director of the clerkship site and regional dean, if applicable, may be consulted regarding these decisions. 

The opportunity for students to participate in direct patient care places responsibility on the UWSOM to ensure that patients are not placed at risk due to a student’s mental illness, physical illness, or impairment from drugs or alcohol. A variety of situations may lead to a student being referred to WPHP. Students referred to WPHP must be endorsed by WPHP before being considered for re-entry into the curriculum. 

If a student who is being reviewed by SPC has already been referred to WPHP, the ADSA may report that information to SPC as part of the student’s overall record. Students referred to WPHP who feel the referral is unwarranted may request that SPC review their case. 

SPC may require a student be endorsed by WPHP before continuing in the curriculum when circumstances suggest that physical illness, mental illness, or substance abuse issues may be contributing to the student’s deficiencies. 

Additional information about WPHP referrals and endorsements can be found here and in the Fitness for Clinical Contact policy.

Suspension is an institutional action separating a student from continuing in the UWSOM program for a specified period of time. SPC may issue a suspension when there is clear evidence of a serious breach of UWSOM or the University’s guidelines and/or policies for personal or professional conduct, including but not limited to: 

• Documented cheating in coursework 
• Intentional misrepresentation of patient information 
• Placing patients’ care or safety at risk 
• Unacceptable behavior in the community 
• Violating the University’s student code 
• Violating local, state, or federal laws 

Upon completion of the suspension, the student will meet with SPC and present documentation to support their readiness to return and understanding and growth in the area of personal or professional conduct that was breached. If the behavior is egregious enough, the student does not show insight into their behavior as being inappropriate for a physician-in-training, and/or the student does not demonstrate satisfactory progress in the conduct area of concern, SPC may consider dismissal. 

If the student is permitted to re-enter the curriculum, SPC will place them on disciplinary probation with the expectation that their conduct will be at an acceptable level for the remainder of their tenure in the medical school. If there is another breach in personal or professional conduct, SPC may consider dismissal. 

The suspension is part of the student’s academic record and is included in administrative letters written about their performance, including the MSPE. While suspended, the student may not be involved in any medical school programs or activities and should be absent from the medical school setting. 

SPC may require that coursework or other graduation requirements be redone if there is evidence of unprofessional behavior. Example 1: a student was found to have committed plagiarism in their Scholarly Project. The student was required to start over and complete a new project fulfilling the requirement. Example 2: a student used an attending’s clinical note as if it reflected their own work with that patient. The student was required to repeat the clerkship. 

In these kinds of cases, it is important to determine whether the plagiarism was done with the intent to deceive (claim the work as his/her own) or whether it represented a poor understanding of attribution of information to original authors. 

A reprimand is typically used for less egregious breaches in professional behavior, particularly when there is evidence that the student did not intend to deceive or abuse a right or privilege. Example: a student accessed a patient’s record when they were not a member of that patient’s care team. The reprimand may include specified assignments or activities for the student to complete. The intent is to help the student understand and correct the deficiency. 

A student may be dismissed if they do not meet the academic and/or professionalism standards for graduation set by UWSOM. If a student’s record, when viewed as a whole, does not meet UWSOM’s expected level of performance, SPC may recommend dismissal even though passing grades are recorded in individual courses. A dismissal recommendation may be made at any time during a student’s medical school enrollment, and the student does not have to be placed on probation prior to being recommended for dismissal. 

Typically, dismissal will be considered for one or more of the following: 

• 2 or more block fails 
• 2 or more clerkship fails 
• Failure on repeated block, course, or clerkship 
• Additional fail grade while on probation 
• 3 or more step exam fails (same step or combination or steps) 
• Combination of fails or deficiencies in 2 or more areas, including step exam fails 
• Major or persistent breaches of professional behavior or conduct 
• Lack of compliance with UWSOM requirements 

If SPC votes to consider dismissal, a review is planned for the next scheduled SPC meeting. The student is informed that they are under consideration for dismissal and is provided a detailed description of the concerns leading to SPC’s decision. The student is given at least 14 days’ notice that they are required to appear at the next SPC meeting for their dismissal consideration review. The SPC Chair has discretion to delay the review under extenuating circumstances. 

At this meeting, the student may be accompanied by one advocate who is a member to the medical school faculty. The student must give their advocate’s name to the Student Affairs Office at least 10 days before the meeting. The presence or appearance of a student’s legal counsel is not permitted because a formal hearing and appeal are not part of the academic review process.  

The student must provide a written statement addressing the concerns leading to the dismissal consideration. The student may additionally request letters of support and other relevant documentation from outside parties for SPC to review. All written materials must be submitted to the ADSA at least 7 days before the dismissal consideration review meeting. 

At the dismissal consideration review meeting, the student presents their perspective on their difficulties and their plans to address those difficulties, and then takes questions from SPC members. The student’s advocate, if present, may also share information and answer questions. 

After the meeting, SPC votes to either recommend dismissal or some other remedy that allows the student to continue in the curriculum. 

If the decision is a dismissal recommendation, the student may request an appeal. The student must submit the request for appeal, in writing, to the Chair of SPC within 10 days of the dismissal recommendation. Appeals are heard by the Dismissal Appeal Committee (DAC.) The sole purpose and responsibility of DAC is to provide a fair and formal review of decisions made by SPC. It is composed of 3 neutral faculty members, appointed by the Vice Dean for Academic, Rural, and Regional Affairs, who do not participate in regular SPC meetings and have adequate knowledge of UWSOM’s standards to independently assess whether a student is meeting those standards. DAC convenes as soon as possible whenever a student requests a dismissal appeal. 

DAC will consider the case at a meeting which includes the student, their faculty advocate, the ADSA, and the Chair of SPC, all of whom present information about the events leading to the dismissal recommendation. DAC does not re-consider whether the student’s stated deficiencies are appropriate grounds for dismissal. The purpose of DAC’s review is to (1) consider new information that was not reasonably available during the initial SPC deliberation, (2) consider any evidence that discrimination or bias impacted the students’ academic participation or evaluation, and (3) consider any evidence that SPC’s decision-making was arbitrary or capricious. 

At the end of the meeting the 3 DAC members vote to affirm or overturn the dismissal recommendation. Decision is by majority. The decision is communicated in writing to the student within 7 days. 

If DAC affirms the dismissal, the Faculty Council on Academic Affairs (FCAA) reviews the case to ensure proper procedures have been followed. If FCAA finds that process was followed correctly, the dismissal recommendation is forwarded to the Dean. The student has up to 10 days after FCAA’s decision to contact the Dean to set a meeting to discuss the dismissal. The Dean’s decision is final and may not be appealed. 

Students may withdraw from UWSOM at any point up until the Dean sustains the dismissal. 

Students are usually allowed to continue in the curriculum during the dismissal review process. However, Deans of Academic Affairs, Student Affairs, and Curriculum, as well as SPC, may at times seek to limit the student’s presence in the curriculum. Need for mandatory Leave of Absence and/or concerns about Fitness for Clinical Contact may apply to students in the dismissal review process as they do to other students. 

If a student continues in the curriculum while under dismissal review, SPC will have oversight over what courses or clerkships may be scheduled. 

If the dismissal consideration or recommendation is based on a fail grade, the student is not permitted to remediate it until the dismissal consideration is resolved by SPC or the dismissal recommendation is overturned through the academic review process. 

If SPC’s dismissal recommendation is overturned by DAC, FCAA, or the Dean, SPC will determine the appropriate academic program and curricular schedule. This may include requiring a student to retake blocks, courses, or clerkships which were previously passed. SPC may place the student on probation, elect to provide Advance Information to block, course, or clerkship directors, require the student be endorsed by WPHP, and/or other requirements that SPC deems necessary to allow the student to make satisfactory progress toward graduation. 

Disciplinary warning or reprimand, disciplinary probation, mandated leave of absence, suspension, and dismissal may all be used in situations where the student is found to have violated UWSOM’s academic and professionalism standards. Once the breach in personal or professional conduct has been confirmed, SPC reviews the information, may interview the student, and determines an appropriate course of action. 

If a student’s overall professional development is deemed unacceptable by SPC, the student must successfully complete appropriate remediation in order to continue in the curriculum and graduate. If the student fails to complete the appropriate remediation within the time frame established by SPC, the student may be considered for dismissal. No student with un-remediated, unacceptable professional behavior will be granted the MD degree from UWSOM. 

Medical students are expected to maintain the highest standards of personal and professional conduct, both in the academic setting and within the community. Integrity is considered an essential personal quality for successful completion of the MD program. Students are expected to abide by university, local, state, and federal regulations and laws. Infractions of these standards may result in a sanction being imposed by the University of Washington or UWSOM apart from whether there is any action that may be taken in civil or criminal court. 

For behavioral misconduct outside of the educational environment, the reported incidents may be managed through a review process within UWSOM or may be referred to the University’s Community Standards and Student Conduct Office (CSSC), depending on the allegation. SPC is not involved in the investigation of the misconduct; its role is to determine the appropriate sanction once the misconduct has been confirmed. 

If CSSC performs the investigation, once the investigation is complete, CSSC will provide a report to SPC for discussion and determination of sanctions as part of UWSOM’s academic review process. This does not preclude CSSC from sanctioning the student as part of its charge as listed in the Washington Administrative Code. 

SPC may not alter the decision of CSSC, but reserves the right to impose sanctions, independent of those imposed by CSSC. SPC recognizes that there may be two parallel processes ongoing, those of UWSOM and those of CSSC. Therefore, there are two separate appeal processes, one within UWSOM and one within the University. 

For further information, please refer to UWSOM Guidelines for Managing Alleged Violations of Academic and Professionalism Standards. 

Students typically withdraw from UWSOM if they decide that medicine is not the best career path, they are unable to complete the program for academic or personal reasons, or they are being considered for dismissal. Students choosing to withdraw notify the ADSA, who informs SPC.