Assessment and Grading

The Course or Clerkship Director is responsible for clearly delineating and communicating at the outset of the learning experience the criteria utilized for assessment and evaluation of student performance.

The Icahn School of Medicine at Mount Sinai transcript will reflect a complete and accurate grading history for all courses in the School.

Grading in Years 1 and 2 is on a Pass/Fail basis. A student who does not complete a course will receive an Incomplete. Types of situations where a student may not complete a course include illness or family emergencies. The Incomplete will change to a Pass or Fail once the student has completed the course. A student who receives a failing grade in a course will follow a remediation plan devised by the Course Director. Successful remediation of a failing grade results in a final grade of FP (Fail remediated to Pass).

Course Directors will identify the bottom five percent of passing students. Students in this score range will be designated internally as having received a “marginal pass” for tracking and monitoring purposes only. Marginal grades are considered a full Pass on the transcript. However, marginal grades are tracked by Student Affairs as part of an early warning system for students at risk of academic difficulty. As part of this system a student’s Faculty Advisor will reach out to him or her if he or she receives a marginal grade on an examination or in a course. A student who has three marginal passes in an academic year will be placed on Monitored Academic Status. See section on Academic Status for a full description.

A student who fails a course in Year 1 must remediate the course before starting Year 2. A student who fails a course in Year 2 must remediate the course before taking USMLE Step 1 and starting Year 3.  The remediation process is determined by the Course Director.

For the purposes of this policy, “test” refers to both exams and quizzes. Tests in Year 1 and 2 are administered online through Blackboard. To avoid technical difficulties during the test-taking process, students should take their test using a wired internet connection/strong and stable wireless internet connection on a computer (NOT a mobile device, smartphone, tablet, phablet). Students will not be able to submit answers using a mobile device’s web browser.

Students are strongly advised to take tests during times when the Library Help Desk is available to assist should technical problems arise. The Library Help Desk is open Monday through Friday 8 am – 8 pm, Saturday 9 am – 5 pm, and Sunday 12 pm – 8 pm.

Duration of Exam Windows

The standardized exam window for all courses opens after the final course session for the week, or by 4 pm on Friday, and closes at 8am on Monday.  When a holiday occurs on a Monday, the exam window will be extended to close at 8 am on Tuesday. For courses that end at a break (i.e., Winter break, Spring break, or end of Spring semester), the exam window will open immediately after the final session of the course and will close on the following Tuesday at 8am. If a student misses an exam window, they will receive a zero for the assessment. Students who are unable to complete an exam in the standard window for a valid reason, as outlined in the “Missed Test Policy” below, will have the option of scheduling an alternative exam window.

Duration of Quiz Windows

There is no standardized quiz window. The window for quizzes is determined by the Course Director and will be communicated to students in the course syllabus and on the Google calendar.

Exam Review Policy for Year 1 and 2 Courses

In an effort to provide expedited feedback to students after tests, quizzes administered in the first two years of medical school will be available for review online immediately after the student submits his/her quiz. Students will be able to view their own quiz, see the answer they chose and the correct answer, as well as an explanation for why the correct answer is the only reasonable option. For exams, at 9 am on the next business day after the exam closes, the Year 1 or Year 2 Coordinator will release the exam for student viewing for 7 days ONLY. Students will be able to view their own exam, see the answer they chose and the correct answer, as well as an explanation for why the correct answer is the only reasonable option.

Other options for reviewing exams include:

  • Making an appointment to go over the exam with the Course Director
  • Reviewing the exams binder in the Office of Curriculum Support (OCS).

To review the binder, students must make an appointment by contacting OCS at 212-241-7057.

Policy for Scheduling an Alternate Test Window

In Years 1 and 2, the ability to take a test (examination or quiz) online and in a window of time over several days provides students with flexibility when and where they take the test. Given this flexibility, there are only a few instances when permission to take a test outside the test window may be granted by the Office for Student Affairs. Students may request permission to take a test outside of the test window for illness or a personal emergency.

A student must request such permission from the Course Director(s) and prior to the test closing time. Should the need for permission arise suddenly and when the student cannot hear from the Course Director and the Office for Student Affairs in a timely manner (i.e., on the weekend when the exam window is open) the student may assume the request is granted. If the request is because of illness, the student must provide a physician’s note to that effect. If the request is granted, the Office of Student Affairs will arrange with the student a specified time to take the test.

The Art & Science of Medicine (ASM) course in Years 1 and 2 as well as the clerkships in Years 3 and 4 have a special focus on the teaching and assessment of clinical skills and may use any of the following in assessing a student's performance:

  • Clinical performance assessments by faculty, preceptor, or resident 
  • Oral and/or written examinations
  • NBME subject test exams
  • Written or oral presentations of a specific subject related to the clerkship or course
  • Exams using standardized patients or simulators
  • Direct observation of history taking and physical examination skills

The weight given to specific parameters may vary with an individual clerkship or course.

Each Clerkship or Course Director submits a final grade plus a comprehensive narrative paragraph. The final grades and narrative paragraphs for ASM and the third-year clerkships are included verbatim in a student's MSPE.

All reports of student performance are due in the Office of the Registrar within six weeks of the clerkship's completion.

The grading system for all required clerkships is H (Honors), HP (High Pass), P (Pass), and F (Fail). ASM in Years 1 and 2 and Introduction to Internship in Year 4 are graded Pass/Fail. Electives are graded on a system of Honors/High Pass/Pass/Fail.

A student will receive a temporary grade of Conditional (C) in the event they fail the NBME subject exam or other final exam if other assessments and clinical evaluations are satisfactory. Upon successful completion of the failed exam, the grade is revised to a Pass (P) or High Pass (HP). A student cannot get an Honors if they do not pass the shelf on the first attempt. If the student fails the exam on the retake, he or she will receive an overall failing grade and will need to retake the entire clerkship and then take the NBME exam or final exam again. Students are not permitted to retake a passed NBME subject examination.

A student can fail a clerkship based on overall clerkship score, unsatisfactory clinical evaluations or a repeated failure on an NBME subject exam or final exam. Students who behave unprofessionally during the clerkship are also at risk of failing. If a student is felt to be unprofessional to the point that evaluators do not feel that the student is a reliable, accurate reporter of clinical data and a trustworthy team member, the student will receive a failing grade. As mentioned above a student who fails a shelf exam on the second attempt also fails the clerkship overall. A student who receives a failing grade for a clerkship must retake all or part of the clerkship at the discretion of the Clerkship Director and the Promotions Committee. Upon successful completion of remediation, a student will receive a grade of Fail-Pass FP, and the narrative paragraph will describe the remediation.

Grade cutoffs are set by each clerkship director to create a goal distribution of grades that is 60 percent Honors, 30 percent High Pass and 10 percent Pass at the completion of the academic year.

All students must pass all clerkships in Year 3 to advance to Year 4.

In Years 3 and 4, a student must request permission from the Clerkship Director(s) and to miss an NBME subject examination or other clerkship examination. The policy for making up a missed NBME subject examination is below. The Clerkship Director will schedule any other clerkship exams with the student.

Shelf Exam Retake Policy and Guidelines

This policy applies to students taking the Shelf Exam due to:

  • Shelf failure
  • Excused missed test (illness, death in family, religious observance, other emergency)

Options for shelf retakes are as follows:

  • During the  Shelf Retake Day in July (students will not be charged for the exam)
  • During elective or vacation time; Monday through Friday only
  • Exceptions to this rule are made only under approval of a student’s advisor/Student Affairs and Clerkship Director
  • Student Affairs will coordinate with the curricular team to help arrange for a shelf retake. The following information is needed to make the arrangements:
    • Original test date
    • Timeframe for shelf retake (students should please provide 3 potential dates during your elective or vacation time)
  • Students may NOT complete their shelf retake during FlexTime while on another clerkship.

Guidelines for shelf retakes:

Shelf failures:

  • Students who fail a Shelf Exam must meet with their Faculty Advisor and Clerkship Director to determine when they will retake the exam.
  • Deadline for shelf retakes for the academic year is the retake day which occurs in July during the Board Review course.


Excused absences:

  • If a student anticipates that they will miss a Shelf Exam due to illness, death in family, religious observance or other emergency, they must notify the Clerkship Director and Student Affairs will coordinate with the curriculum team based on the options above.

Unexcused absences:

  • If you are unable to make up a missed exam on Shelf retake day in July, you will be charged the cost of the exam. Please check the NBME website for current cost information.
  • A check in the amount of the exam and additional fees (if applicable) is to be made out to the Icahn School of Medicine at Mount Sinai and submitted to Jennifer Reyes prior to taking the exam. 


Official transcripts of courses taken at the Icahn School of Medicine at Mount Sinai toward fulfillment of the MD degree requirements will identify a grade for each course or clerkship as described above.

Written narrative evaluations are not part of the transcript and will not be duplicated or mailed with transcripts; however, all clinical narratives for clinical courses and clerkships completed by the end of Year 3 are included in the MSPE.

If a student believes that they have received a final grade for a course/clerkship or the narrative grade paragraph does not adequately represent their performance, the student may appeal.  The outcome of the appeal will not result in a lower grade than the first grade posted by the course/clerkship director. 


  1. Within ten business days of receipt of the posted grade, the student must request a meeting to review the grade with the course/clerkship director.  The goal of the meeting is to review and understand the criteria and rubric by which the student was assessed and the grade determined. 
  2. Clerkship grades adjusted at the end of an academic year are not eligible for appeal.
  3. If after meeting with the course/clerkship director the student wishes to continue the appeal process, the student has five business days to inform the Senior Associate Dean for Student Affairs via the Grade Appeal Form.  Before the Appeal moves forward, the Senior Associate Dean for Student Affairs will consult with the Office of Assessment and Evaluation and/or course/clerkship director to determine if process was followed. 
  4. If process was not followed, the grade may be changed without completing the Appeal process and the Senior Associate Dean for Student Affairs will inform the Registrar in the Office of Enrollment Services of the grade change, if applicable.  The student’s record and official school transcript will be amended to reflect the changed grade.
  5. If process was followed, the Senior Associate Dean for Student Affairs will continue the Appeal process. 
  6. The Senior Associate Dean for Student Affairs will schedule a meeting with the Appeals Subcommittee of the Promotions Committee (Appeals Subcommittee) within ten business days after the process review is complete.  The Senior Associate Dean for Student Affairs will provide the Appeals Subcommittee with the course/clerkship grade policy, student performance data and any other information to assist with the thorough appeal process.    
  7. The Appeals Subcommittee meeting will include separate conversations with the student and the course/clerkship director. Following this, the Appeals Subcommittee may request to meet jointly with the student and course/clerkship director.  The student is permitted to have an advocate attend any or all portions of the meeting(s) described above. 
  8. Within ten business days of the meeting(s), the Appeals Subcommittee will provide a final decision via ISMMS email communication to the student, the course/clerkship director, the Senior Associate Dean for Student Affairs, and the Senior Associate Dean for Curricular Affairs.  The Senior Associate Dean for Student Affairs will inform the Registrar in the Office of Enrollment Services of the grade change, if applicable.  The student’s record and official school transcript will be amended to reflect the changed grade.
  9. The decision made by the Appeals Subcommittee is final and not subject to further appeal.     
  10. The Appeals Subcommittee will report all findings to the Promotions Committee.