Attendance, Rescheduling, and Withdrawing from Required Courses and Rotations

A. Attendance
Students are expected to participate in all course activities and meet all course requirements as scheduled within the T.H. Chan School of Medicine curriculum. However, on rare occasion, it may be necessary for a student to miss a required examination, due date for a paper, report or other course activity because of physician-certified illness, death in the immediate family, or other reason of comparable magnitude acceptable to the course leader or clerkship director.  When possible, the student should speak with the course leader or clerkship director in advance of missing the required activity and request an exemption. If advance notice is not feasible, the student should notify the course leader or clerkship director as soon as possible.

Students in the clinical years (CCE and AS) are considered a part of the clinical team. If a student does not report as scheduled for a clerkship or elective, or if a student is absent from a clinical rotation or other required activity without appropriate notification to the course director, clerkship coordinator and the associate dean of student affairs and will receive a grade of No Credit for the required rotation. See specific Postponement, Rescheduling, and Withdrawal policies for additional information.

B. Rescheduling a Required Course Activity
Once a course leader or clerkship director has determined that an exception shall be granted to miss a required examination, due date for a paper, report or other course activity, he/she will determine the timing and nature of any required make-up activities.  Additional information regarding attendance and time away during Core Clinical Experiences can be found in the Time Away Policy from Required Core Clinical Experiences.

C. Holidays
The institution takes federal, state and religious holidays into account when scheduling classes, assessments and other required activities. Every attempt is made to avoid major religious holidays in scheduling required activities, however it is difficult to accommodate all needs. Students should contact course leaders immediately if they identify a conflict between required course activities and a religious holiday that is not accounted for in the school list. Course leaders will do their best to accommodate students by rescheduling these required activities as feasible.

Clinical students should be aware that overnight call and working on assigned holidays is expected of third and fourth year students. State, federal and religious holidays are indicated on the School’s academic calendars but may or may not be holidays according to the student’s clinical site. Students are expected to follow the holiday schedule at their clinical site.

D. Postponing a Required Core Clinical Experience (CCE)
Occasionally it may be necessary for a student to request postponement of a required CCE. This request may be made in order to complete required FOM 2 courses or activities, to complete PhD thesis work, for health reasons or extenuating personal circumstances.

ALL students are required to attend the Transitions to Core Clinical Experience before any Core Clinical Experience can be taken, regardless of when the first rotation is scheduled. The Transitions to Clinical Years Program is a required activity and is offered once each academic year.  ALL students are also required to attend the Thematic Section Orientation as scheduled regardless of which block they will begin their rotations for that given thematic section. This is a required orientation and is only offered once per thematic section.

The CCE thematic sections involve shared academic elements across disciplines; this is most evident in shared OSCE’s, but there are also shared assignments. Students who postpone a CCE will take the integrated OSCE on the basis of the CCE(s) that they have completed and will receive a preliminary grade. This will allow students to move forward and apply for advanced electives and away electives in related fields, even though they may not have been able to complete the postponed rotation(s). The grades will be finalized when the clerkships and shared elements are completed. Students will have access to the online materials during the theme, so that they are available for review prior to the shared OSCE. Please note that course postponements may have other financial consequences for financial aid recipients. Please contact the Bursar’s Office or the Office of Financial Aid for details.

In some cases, students may require additional time for USMLE Step 1 preparation, before taking the exam and proceeding to the CCE year.   Students requiring additional time for USMLE Step 1 preparation will be identified through key FOM 1 performance data, Organ System Diseases (OSD) NBME scores, and CBSE performance.  This process typically will occur in February annually.  Students who are identified as needing additional time will be advised by the CAA accordingly.

Requests for postponements of CCE rotations for the purpose of USMLE Step 1 preparation must be supported by the Center for Academic Achievement and the Associate Dean for Academic Achievement, and presented to the CSAEB through the Associate Dean for Student Affairs at least FOUR WEEKS prior to the start of the scheduled CCE.

Detailed Process for CCE deferral for USMLE Step 1 Preparation:

1. At-Risk Student identification process before CCE EVOS
   a. Students at risk for USMLE Step 1 are identified annually in February, annually
   b. Students are identified through key FOM1 performance data, OSD NBME scores and CBSE performance
        i. CAA and ADAA consult with OSD faculty in deferral decisions
        ii. CAA and ADAA email student and LC mentor to recommend deferral of CCE
        iii. If student agrees with recommendation for CCE rotation deferral:
             1. ADAA emails request to ADSA, with cc to CAA, student and LC mentor
             2. ADAA works with ADSA/student to recommend a deferral duration (either 1A alone, or entire Thematic Section 1)
             3. Entire process is completed before the February CSAEB meeting where the changes are presented as an administrative item
             4. ADSA communicates with OSA staff to adjust CCE lottery assignments
             5. All students must complete the Transition to CCE.
        iv. If student does not agree with deferral recommendation:
             1. Student may continue to plan for 1A CCE rotations
             2. Student will continue to work with CAA, must make decision to defer as below (see step 2)

     2. Hard Deadlines for CCE Deferrals after CCE EVOS
     a.Students who decline recommended deferral through the At-Risk process outlined above will have been assigned CCE rotations through the lottery
     b. All students must complete the Transition to CCE
     c. These students will continue to work with the CAA, the ADAA and their Mentor, to determine readiness for Step 1 and readiness to begin CCE in Thematic 1
     d. Students may subsequently decide to defer all or part of Thematic 1 in consultation with the CAA and ADAA. In this case, they will need to obtain approval according to the following timeline:
          i. Deferral of only 1A:
               1. Request must be made by email to ADAA no later than 4 weeks before the start of 1A (2 weeks before the required Transitions to CCE. If a student does not meet this deadline, they must enroll in CCE for block 1A.
               2. Students who defer 1A will enroll in CAA course XX3002 for 6 credits, for the entire thematic section
               3. If students are ready for clerkships in 1B, XX3002 can be modified to be just 2 credits for 1A
               4. Students deferring 1A do not need to participate in interstitial rotations occurring during 1A, but must consult with the directors of the Interstitial course to confirm
            ii. Deferral of Entire Thematic 1:
               1.Students who will not be ready for clerkships by 1B may choose to defer the entire thematic section.
               2. Request must be made by email to ADAA no later than 4 weeks before the start of 1B.
               3. Students who defer the entire Thematic section 1 will remain enrolled in CAA course XX3002 for 6 credits, for the entire thematic section
               4. For 2A, students must notify ADAA by email by the last day of 1B. As with thematic block 1, students may defer block 2A only but if the deferral extends beyond 2A, the student must defer all of thematic block 2. The student cannot defer 2B and return to CCE for 2C.

     3. Students not ready for USMLE Step 1 by the end of Thematic Section 1
     a. Students who are not ready for USMLE Step 1 at the end of Thematic 1 may enroll in additional supportive work through the CAA during Block 2A; plans are individualized for each student, in consultation with the CAA
     b. Students must then study independently during Blocks 2B and 2C, though they may continue to utilize CAA resources, including tutoring
     c. Students must be ready to take USMLE Step 1 by the first week of Block 2C
     d. Students who have not taken USMLE Step 1 by the end of the first week of Block 2C will be brought to the CSAEB in November and could be referred to the Progress Board, to determine their ability to continue in the curriculum for the T.H. Chan School of Medicine

Process for CCE deferral for reasons other than USMLE Step 1 Preparation:

1. Submit Request in Writing to the Associate Dean for Student Affairs a written request (letter or email) indicating the reasons for the request.  The student’s request will be presented to the Clinical Science Academic Evaluation Board (CSAEB) for consideration.
2. Timing of Approval (A or B below)
   1. If the request to postpone the CCE is approved before CCE lottery: Contact the Office of Student Affairs prior to entering CCE lottery to arrange to be administratively locked out of the block that you have been approved to postpone.
   2. If the request to postpone a CCE is approved after the lottery is finalized: Submit a request in writing to the Associate Dean for Student Affairs, with copy to the Assistant Dean for Academic Achievement and forward to the appropriate clerkship director.

** Please note: Assigned CCE’s remain on a student’s official schedule until approval for the postponement is provided by the Office of Student Affairs. It is the student’s responsibility to follow up and monitor the accuracy of their educational schedule via the Peoplesoft system.

E.  Rescheduling a Postponed CCE into Advanced Studies

If a postponed CCE clerkship is being rescheduled into the Advanced Studies year, the student must participate in both the CCE and Advanced Studies Lottery process for the following academic year. It is the student's responsibility to contact Office of Student Affairs (studentaffairs@umassmed.edu) in the fall of the CCE year, prior to the Advanced Studies Lottery, to reschedule the postponed clerkship into the Advanced Studies year. The Office of Student Affairs will work directly with the student to reschedule the postponed clerkship after the CCE lottery has run and results are available.

All core clinical rotations must be completed by December (CCE Block 2C) of the year the student is expected to graduate, unless the CSAEB has approved an extension in advance of the December (CCE Block 2C) deadline. Requests for extensions to this deadline must be made in writing to the Associate Dean for Student Affairs before the end of the CCE year, prior to completion of AS year schedule planning. In general, this will occur before the end of April in the CCE year. The Associate Dean for Student Affairs will bring the request to the CSAEB at the May meeting. 

F. Postponing a Component of the Required Interstitial Course

The Interstitial Course (ISC) is a required curricular component of the Core Clinical Experiences. Interstitial topics complement the required clerkships in the Core Clinical Experiences year. The ISC is organized into three sections: ISCA in thematic section 1, ISCB in thematic section 2 and ISCC in thematic section 3. Each section is graded on a credit/no credit (CR/NCR) basis. Each section must be passed with a grade of credit (CR) in order to meet graduation requirements. Grades for each of the three ISC sections are treated in the same manner as grades for all required courses.

An unexcused failure to participate in an individual ISC experience will result in a no credit (NCR) grade appearing on the student’s transcript. When the ISC experience has been successfully remediated, a notation that the ISC section was remediated in a single attempt from an initial NCR grade will remain on the student’s permanent transcript. Makeup assignments must generally be completed within 4 weeks of the missed ISC experience. There will be a one-day grace period for submission of late makeup work. After that day (24 hours), no additional makeup work will be accepted. If not completed within the time allowed, the ISC experience will need to be remediated during the subsequent academic year.

If a student has to miss an interstitial for reasons of physician-certified illness, death in the immediate family or other reason of comparable magnitude, the student should contact the Interstitial Coordinator, preferably in advance, and arrange to remediate the interstitial either by completing it during the Advanced Studies year or by completing an equivalent educational experience as determined by the Interstitial Course director. In this case, a grade of “incomplete” will be issued and will be replaced by a grade of “CR” when the clerkship is successfully completed. If a student misses two or more Interstitial Experiences during his/her third year/core clinical year, s/he will be required to take each of the missed interstitial courses during his/her Advanced Studies year. An exception permitting alternate educational experiences may only be made by the Clinical Science Academic Evaluation Board.

G. Rescheduling or Dropping an Advanced Studies Course

It is recognized that occasionally during the Advanced Studies year it may be necessary for a student to change their schedule.

Changes to Advanced Studies Electives through POE:
Changes to Advanced Studies (AS) electives can generally be made without elective coordinator/director approval up to 30 days in advance of the elective’s start date. Electives that are listed in the PeopleSoft Online Enrollment (POE) system may be dropped by the student as long as the drop occurs more than 30 days before the start of the elective. Changes (adds and drops) within 30 days of the start date of the elective must be approved by the elective coordinator before the elective will be removed from the student’s schedule. Approval can be obtained by emailing the elective coordinator/director. Approved changes to electives should be forwarded to electives@umassmed.edu in order for the schedule change to be made in PeopleSoft. If the request to drop the elective is denied, the student will need to complete the elective as scheduled.

Changes to Advanced Studies Electives that require Coordinator Approval (non-POE):
Some AS electives can only be added to the student’s schedule by prior approval. These electives are also called “approval-required” electives. Changes to “approval-required” electives cannot be made without seeking approval via written request to the elective coordinator, regardless of the timing before the start of the elective. Generally, if the request to drop the “approval-required” elective is made more than 30 days before the start of the elective, the request will be approved. Requests to drop “approval-required” electives within the 30-day window before the start of the elective may not be approved. Requests to modify the “approval-required” electives should be emailed to the elective coordinator. Approved changes to these electives should be forwarded to electives@umassmed.edu in order for the schedule change to be made in PeopleSoft. If the request to drop the elective is denied, the student will need to complete the elective as scheduled.

Changes to Advanced Studies Required Rotations:
The required AS rotations, including the required subinternship (Medicine, Pediatrics, Acute Care Surgery or Family Medicine), Emergency Clinical Problem Solver (ECPS), Capstone and ABTS, are assigned through the lottery. Changes to required AS rotations require at least 30 days’ notice and must be approved by the rotation faculty sponsor. Approved changes to required AS rotations should be forwarded to electives@umassmed.edu in order for the schedule change to be made in PeopleSoft. If the request to drop the required AS rotation is denied, the student will need to complete the rotation as scheduled.

H. Absence Policy for Clinical Rotations

The goals of this policy are to support student wellness, to develop more uniform management of time away requests, to foster professional communication, and to minimize administrative burden of untimely or unusual requests. Attendance is mandatory for all required core clinical experiences (includes transitions, clerkships, interstitial curricula). Students must follow the schedule of their specific clerkship site (see: “Weather Watch”).

Each clinical course has an internal policy regarding make-up for missed days, regardless of reason for absence (planned or unplanned). Make-up will be required of any student missing more than two days of any single Core Clinical Experiences clerkship or Advanced Studies Elective (or more than one day of Neurology), regardless of reason for absence (planned or unplanned). Make-up will also be required of any missed days containing key, required components of the course, regardless of the amount of missed time. The course will be recorded as “Incomplete” until the required make-up is completed. The make-up plans may vary based on course length, activities missed, and availability of additional supervision. Students must contact course directors with a request for time off at least 30 days in advance for all planned absences, and as soon as possible for any unplanned absences. The course director will assign all make up activities, which may include additional projects or scheduling of additional clinical work.

Unplanned (Vital Needs) Absence Policy:

• The Unplanned Absence Policy applies to all clinical rotations, including Core Clinical Experiences, the Interstitial Curriculum and all Advanced Studies required and elective rotations.
• Students will be excused for acute illness or personal emergency (e.g. to attend a funeral) by the clinical course director. To maintain student privacy, students may state they have an "illness", "family emergency" (which includes serious illness or death of a close family member), or a "medical appointment" and are not required to disclose details. However, students may be asked to provide documentation (e.g. a doctor’s note vouching for illness).
  • Note that childcare arrangements must be made for non-critical illness of children, school closures, etc., as these are not considered emergencies.
  • Students are expected to report to work in inclement weather.
• Students must inform the clinical course director and their direct supervisors of the absence as soon as possible.
• For chronic illness issues, please refer to the ADA policy.
• Any required make-up will be at the discretion of the clinical course director.
• Unplanned Absences days will be reported to the Associate Dean for Student Affairs, who will track total number of days used.

Planned Absence Policy:

• The Planned Absence Policy applies to all clinical rotations, including Core Clinical Experiences, the Interstitial Curriculum and all Advanced Studies required and elective rotations.
• Planned absences are for significant personal, professional or academic events (conferences, interviews, weddings, family events, etc.). They are not to be used as study days, nor as vacation days.
• A maximum of two planned absence days are allowed during the entire, collective course of the Core Clinical Experiences and Interstitial Curriculum.
  
  • During the Family Medicine, Internal Medicine, OB/Gyn, Pediatrics, Psychiatry, and Surgery clerkships, students are allowed to use both of their planned absence days during a single clerkship.
  • During the Neurology clerkship, students are only allowed to use one of their planned absence days, given the short duration of the clerkship.
  • Beyond religious holidays already recognized by the T.H. Chan School of Medicine, students are allowed two additional planned absence days for observance of other religious holidays, provided it is approved in advance by the Office of Student Affairs.
• Planned absences are typically discouraged during Advanced Studies required and elective rotations, due to the flexibility of the year and opportunity for time off between elective rotations. However, planned absences may be requested and approved at the discretion of the course director.
  
  • Planned absences may not exceed 2 days per 4-week rotation unless approved by the course director.
  • All planned absences may need to be made up with extra clinical time, either on a weekend or after the rotation, at the discretion of the course director.
• Planned absence days must be approved by the course director and reported to the Associate Dean for Student Affairs, who will track total number of days used. Advance notice of at least 30 days is required for planned absences.
  • The course director will notify the student, clinical supervisors, and the Associate Dean for Student Affairs if the request is approved.
  • Approval for planned absences will not be granted if they impact key, required course components or if they create undue hardship for the course.
• Students are requested to plan absences to minimize disruption of their clinical duties if possible. Medical appointments should be scheduled to minimize length of time away from clinical or classroom A planned absence day should be used if routine medical appointment will cause student to miss the entire day. Students should review the ADA policy which may apply to students with frequent medical appointments due to chronic illness.

Final Policy for Excused Absences from CCE Approved 3/14/08.
Applicability: All CCE and AS StudentS
Responsibility: Clerkship Directors Committee
Date Revised: September 28, 2016
EPC Approved: October 3, 2016

I. Withdrawal from a Required Pre-Clerkship Course

A student may withdraw from a pre-clerkship course without academic penalty up to two weeks before the final examination or end of the course, whichever comes first. Permission to withdraw must be requested from the Basic Science Academic Evaluation Board. The student must provide the Associate Dean for Student Affairs with a written request including the reason for the withdrawal request. The Associate Dean for Student Affairs will then present the request to the Basic Science Academic Evaluation Board (BSAEB) for approval. This action may only be taken once for any specific course. The BSAEB may require or permit course withdrawal at other times during the academic year. Course withdrawal will not be indicated on the transcript once the course is successfully completed.

J. Withdrawal from a Core Clinical Experience

Policy: Students may withdraw from a Core Clinical Experience (CCE) before the established withdrawal deadline of a clerkship without penalty.  The withdrawal deadlines in CCE are as follows:

• End of week 1 of a 3 week CCE (Neurology)
• End of week 3 of a 5 week CCE (Pediatrics, Psychiatry, Family Medicine, Obstetrics and Gynecology)
• End of week 6 for the 8 to 10 week clerkships (Surgery, Internal Medicine).

This decision must be made in conjunction with the Associate Dean for Student Affairs, the student’s Learning Communities Mentor and with the agreement of the clerkship directors. Permission to withdraw must be requested from the Clinical Science Academic Evaluation Board (CSAEB). This action may only be taken once for any specific clerkship. Course withdrawal will not be indicated on the transcript once the course is successfully completed.

Explanation: Withdrawals after the above deadlines will generally be unacceptable. Students must complete the rotation and will receive a grade. In extenuating circumstances, the student may be allowed to withdraw without penalty with the approval of the clerkship director, recommendation by the Associate Dean for Student Affairs and the approval of the CSAEB. Evaluations of the student’s performance in the clerkship that were completed prior to the time of withdrawal will become part of the student’s permanent record. Generally, the student will be expected to repeat the entire clerkship. However, the clerkship director and the CSAEB may modify this requirement based on factors such as the circumstances leading to the withdrawal, the amount of the clerkship that was completed, and the student’s performance to the time of withdrawal.

Procedure:

1. Students should write a letter outlining the reasons for requesting a withdrawal from the clerkship to the Associate Dean for Student
2. The Associate Dean for Student Affairs will consult with the clerkship director regarding the request.
3. If the request is supported by the clerkship director and the Associate Dean for Student Affairs, the request will be presented to the Clinical Science Academic Evaluation Board for
4. If approved, the CSAEB will notify the student and the Associate Dean for Student Affairs.
5. The Associate Dean for Student Affairs will notify the Registrar and the Office of Student Affairs of the change so that the official enrollment record can be updated.
6. A grade of “withdrawal” will be recorded in the official record. The withdrawal (W) grade will be replaced with the official final grade when the coursework for the CCE clerkship is completed.
7. If the CSAEB is requiring a student to withdraw or postpone a CCE, the Office of Student Affairs will notify the student and the CCE Clerkship (Revised CYC 10/22/12)

K. Auditing a Pre-clerkship Course

A student may audit a pre-clerkship course only by permission of the course instructor and with the approval of the Associate Dean for Student Affairs. The student must register for the course as an auditor with the Registrar Office. When the student meets with the course coordinator, the course coordinator will inform the student which activities of the course the student may participate in (i.e. lectures, small groups, use of CAI equipment, labs). Usually, auditors will not be permitted to sit for examinations or be required to write papers. Exceptions may be made by the course coordinator. No grade will be recorded on the student’s transcript for an audited course.  A student registered for a course as an auditor may not change his/her status in that course to receive course credit. A student must be enrolled in a minimum of 9 credits in order to audit a course.

In the case of a student who is already enrolled in one or more courses for a semester and who elects, in addition, to audit one or more courses, there is no change to billing or fee schedules as a consequence of the audited course/s. (Revised 06/03/15)

L. Exam Policy FOM 1 and FOM 2**

To create an environment comparable to licensure exams and to maintain the integrity of the examination itself, the bubble sheet, pencils/pens, a simple hand-held calculator, and the exam itself are the only items to be used during exams. The use of electronic devices (MP3 players, iPods, cell phones, PDA’s, laptops, and any devices capable of recording, retrieving or transmitting text, numbers, images or sound) are prohibited without the explicit approval of the instructor. (Approved by the First and Second Year Curriculum Committees 03/06)

**Please note: The above policy refers primarily to standard paper-based exams. Guidelines that more specifically apply to computer-based exams, including both UMass Chan-generated and NBME exams, will be provided by the courses that utilize this type of assessment method.