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Evaluation of Student Performance

Students must satisfactorily complete all components of the educational program to be eligible for promotion and graduation. In keeping with the goal of a balanced and coherent educational program, the Case Western Reserve University School of Medicine seeks to identify potential academic problems early and to provide interventions as necessary to assist all students in meeting academic standards.

Examination Policy

Foundations of Medicine and Health SSEQs are administered in proctored classrooms, and answers are expected to represent each student’s own work. All National Board of Medical Examiners (NBME) Tests are administered following NBME guidelines. Students are required to sign an Examinee Acknowledgement Form (See Appendix I) before the first examination is administered. All students must take the examinations in the assigned facility on the scheduled examination date and time. Students who are not able to take a Foundations of Medicine and Health Curriculum examination at the scheduled date and time because of illness or emergency must contact their Society Dean before the examination. When an acute illness or other emergency arises less than 24 hours before an examination, students should contact their Society Dean to report the situation. When deemed appropriate, the student will be granted official approval to defer the examination, and personnel will be notified.

Disabilities and Accommodations

The School makes accommodations available to those students who, because of a documented disability, require accommodations. Students who seek accommodations must follow procedures outlined in the Technical Standards. More information is available on the Disability Resources website.

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Foundations of Medicine and Health Curriculum

Student assessment in the WR2 Curriculum is designed to accomplish three goals: 1) drive the types of learning and inquiry that are goals for the WR2 Curriculum; 2) ascertain whether students attain the level of mastery set as a goal for graduates of Case Western Reserve University School of Medicine; and 3) prepare students for medical licensure. These three goals are accomplished through multiple assessment methods.

Student performance is assessed by a variety of methods with special emphasis on scientific reasoning, comprehension, and problem solving (e.g., synthesis essay questions, multiple-choice, laboratory practical). Performance of each component within the Block is designated as “Meets” or “Does Not Meet Criteria.” Students who do not meet criteria are identified to their Society Deans and the Block Leader (see the Remediation of Foundations of Medicine and Health Curriculum section). Information concerning examination performance and class rankings is not part of the student’s permanent record. However, examination scores are recorded for students participating in the Medical Scientist Training Program. The following assessments are used in the Foundations of Medicine and Health:

  1. Assessment of students’ participation in weekly Case Inquiry (IQ) groups by faculty facilitators, based upon observable behavior and focused on contributions to the group content, skills at critical appraisal of resources, and professional behaviors.
  2. Synthesis Essay Questions (SEQs). Weekly, formative, open-book synthesis essay questions are assigned in which students are given a brief written clinical problem and are asked to describe its occurrence and explain its scientific foundations. Throughout a teaching block, students are expected to study the content of both weekly SEQs, but they are required to submit only one of two SEQs at the end of each week. They then compare their answers to an ideal answer. Students are expected to construct answers in their own words independently. The practice of "copy and paste" verbatim from various online sources defeats the purpose of the SEQ assignment, results in lost learning opportunity, and wastes IQ faculty time, and is thus discouraged.
  3. Summative Synthesis Essay Questions (SSEQs) are designed to measure medical knowledge at specific points in the curriculum. SSEQs are closed-book assessments with no more than 5 scenarios that, collectively, take approximately 4 hours to complete. SSEQs are based on the synthesis essay questions (SEQs) that students completed in an open-book fashion throughout the block. In the final week of the block, SSEQs present concepts from previous exercises in new contexts and require a more sophisticated level of concept integration. These summative assessments are scheduled at the end of each large teaching module (every 3-4 months) and are graded by faculty who are content specialists.
  4. Structure Practical Exercises. These assessments generally occur in the final week of blocks 1-6 and integrate anatomy, histopathology, and radiology through clinical scenarios and questions that ask for anatomic localization and histopathologic identification. Students are required to demonstrate mastery in gross anatomy and histopathology separately, i.e., poor performance in one area does not compensate for high performance in the other.
  5. Self-Assessment Multiple Choice Questions (MCQs). Students may use these MCQs throughout the block as study aids and self-assessment.
  6. Cumulative Achievement Tests (CAT). At the end of Blocks 2-5, students complete a secure formative MCQ achievement test, based on content covered in the current teaching block as well as on content from previous block(s). These exams are designed using test question resources available through the National Board of Medical Examiners (NBME). Tests become progressively longer by 20 questions throughout the Foundations of Medicine and Health. These formative tests enable students to gain perspective on their overall progress and preparedness for the USMLE Step 1.
  7. Student progress in Foundations of Clinical Medicine is measured by small group facilitator assessment in the Tuesday Seminar course, direct observation, and preceptor(s)’ evaluation of clinical skills and patient-based activities, required FCM assignments, and OSCE examinations.
  8. Professional Learning Plan. The Professional Learning Plan is created by students to teach them how to use the continuous quality improvement model to improve their academic performance. In the first 20 months of the medical school curriculum, students meet in medium-sized groups to work on their PLP with other members of their Society. The first meeting, starting in Block 2, is held at mid-block. Students complete an on-line structured plan in which they identify an area of focus for improvement, usually drawn from feedback they have received, and come up with a plan for remediation. When they attend the mid-block meeting, they share this plan with their colleagues. This vetting process allows students to hone their plan. Students then have the remainder of the block to carry it out. The week following the end of the block, the students come together again in a group to share their evidence for completion of their PLP. These meetings allow students to share best practices with one another on how best to master the material of medical school.

Required Assessment Tools to Measure Achievement of Learning Goals in WR2

During the Block
Purpose: Ongoing Self-check of Learning

End of the Block
Purpose: Cumulative Achievement & Pass-Fail Determination

End of the Block
Purpose: Ongoing Self-check of Learning Retention and Board Preparation

End of Blocks 4, 6, & in 4th Year
Purpose: Mastery of 9 Competencies  for Promotion and Graduation

Learning Objectives

IQ Group Facilitator Assessment

Cumulative Achievement Test

Learning Portfolio

Weekly Multiple Choice Questions

Summative Synthesis Essay Questions (SSEQs)



Weekly Synthesis Essay Questions (SEQs)

Structure Practical Exercise




Peer Feedback

Foundations of Clinical Medicine Assessment



Mid-Block PLP meeting

Clinical Immersion Exercise




Professional Learning Plan



Foundations of Clinical Medicine (FCM) encompasses the pre-clinical curriculum. The guiding principle is that early exposure to patients, with direct observation by experienced faculty physicians, is optimal for both professional development of students as doctors and for assessment of clinical skills. FCM has four interrelated components: clinical skills training (Physical Diagnosis 1-3), patient-based experiences (CPCP), the Tuesday Seminar course, and Communication Workshops.

Students are evaluated formatively throughout the year on each aspect of FCM. Summative evaluations are employed as well and include preceptor evaluations, peer reviews, and objective structured clinical examinations. At the end of each block of the Foundations of Medicine and Health Curriculum, students receive a designation of “Meets Expectations” or “Does Not Meet Expectations” for FCM. These designations are approached in a manner consistent with assessment in Foundations of Medicine and Health.

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Summative ePortfolios

The WR2 curriculum is a competency-based curriculum with 9 Core Competencies and 25 Educational Program Objectives that students are expected to have achieved upon graduation from the School of Medicine.

Competencies – The knowledge, skills and behaviors a student must demonstrate to meet the performance standards for an MD degree from CWRU. The Competencies and Educational Program Objectives may be found on the Western Reserve2 Curriculum website.

Achievement of competencies is demonstrated in a variety of ways; some by written exam performance, others through narrative essays accompanied by supporting evidence in a portfolio.

Summative ePortfolio: Narrative essays are written by students with accompanying evidence and shared with faculty reviewers for purposes of assessment. These essays are accompanied by supporting evidence to demonstrate how a student is progressing with respect to meeting the milestones aligned to the Educational Program Objectives of the CWRU SOM curriculum.

Students submit Summative ePortfolio essays at 3 points of time during the WR2 curriculum: at the end of Year 1, at the end of Year 2 (as they enter their clinical or research years), and after core clerkship rotations.

Students submit an essay on each assigned competency. Each essay must:

The essays are reviewed by faculty reviewers using the following criteria:

Reviewers provide feedback/comments and one of three possible ratings for each essay: Meets Expectations, Meets Expectations with Targeted Areas for Improvement, or Does Not Meet Expectations. A rating of “Does Not Meet Expectations” for any essay will result in an overall rating of “Does Not Meet” expectations. Students are provided an opportunity to revise any essays that do not meet expectations, working with their Society Dean, faculty and administrative support staff, as appropriate. Successful completion of each of the 3 portfolios, i.e., achieving the designation of “Meets Expectations,” is a requirement for the MD degree from the School of Medicine.

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Student Affairs, Revised March 1, 2017


Core Clinical Rotations


Students in Core Clerkships will receive a grade of Honors, Commendable, Satisfactory, or Unsatisfactory based on performance on two components: (1) Clinical Performance and (2) NBME subject examination performance.



A. Dimensions of clinical performance that are assessed: Patient Care, Knowledge for Practice, Interpersonal and Communication Skills, Professionalism, Teamwork and Interprofessional Collaboration, Research and Scholarship, and Reflective Practice. Student performance is observed and assessed by attending physicians, fellows and residents in the inpatient and ambulatory settings. Clinical performance is assessed as “Outstanding”, “Above expectations”, “Meets expectations”, or “Substantial Room for Improvement”.

B. Additional clinical requirements
Completing and logging the identified core clinical conditions as part of the clerkship is a requirement for completing the clerkship. Students who have not completed this requirement will receive a grade of “Incomplete” until this requirement is satisfied.

Some clerkships may have additional clinical requirements that must be met to pass the clerkship. These are described during orientation.

Attendance and participation in the Friday afternoon seminar series is required.

Please see guidelines for your class for more detail.



Students who do not meet (DNM) expectations in either the clinical performance or shelf exam requirement must successfully remediate that requirement.

Shelf Exam Policy for the Basic Core Clerkships

Students must pass the shelf exam in order to pass the clerkship.

  1. If a student DNM the shelf exam (and is ineligible to receive Honors for the shelf exam portion of the clerkship assessment), they must retake the exam at a time that is set by the Director of Assessment and the Society Deans. The Clerkship is listed as Incomplete pending this retake.
  2. If a student DNM the shelf exam a second time, the grade will remain incomplete and a referral will be made to the Committee on Students in consultation with the Society Deans. The Clerkship Directors in the discipline involved will make a recommendation to the Committee on next steps for the student.

Approved by the Committee on Student Assessment in February, 2011
Amended in July, 2011
Amended in July, 2012
Amended in July, 2014
Amended in July, 2015
Student Affairs, Revised August 24, 2015
Student Affairs, Revised September 12, 2016

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Research and Scholarship

Medical students identify a research mentor for their research block. A written research proposal must be approved by their research mentor and Assistant Dean for Medical Student Research and submitted 6 weeks before the start of the research block.  Requirements for the mandatory research block include submitting their research dates, submitting their research proposal, two progress reports (one due after each 8 week block of research), and the MD thesis and completing the 4th year survey. The schedule should be submitted to the Office of Medical Students Research. All of the other requirements are due online at the student's ePortfolio MyResearch site by the designated deadline given at this site. The MD Thesis should be written as a scientific paper appropriate for the field. The MD Thesis It is due on Feb 28 of the 4th year. A complete description of the requirements can be found at the website for the Office of Medical Student Research.

The student MD Thesis is reviewed by a faculty panel. A complete rubric can be found on the Office of Medical Student Research website.

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Year 1 and 2 Electives (not required)

First and Second year electives are mini-courses, sponsored by CWRU faculty and students, that occur in the first and second year of the M.D. program. There is a wide variation in course format. Instructors are encouraged to provide narrative comments on student performance that may be used as excerpts in the Medical Student Performance Evaluation (MSPE). First and Second year electives are not required to meet graduation requirements and should be scheduled so as not to interfere with Foundations of Medicine and Health or Foundations of Clinical Medicine activities.

First and Second year electives fall within two categories. The first category includes courses that are valuable enrichment opportunities, but they are not acknowledged on the transcript. The second category includes courses that meet the Electives Policy criteria and will be acknowledged on the transcript as a zero-credit elective.

More Information

Year 3 and 4 Clinical Electives (required)

The Clinical Elective program provides opportunities for students to pursue electives in areas of personal interest. A description of the elective offerings and expectations for student performance is available in the Elective Catalogs provided by the Registrar. Student performance is evaluated as honors, commendable, satisfactory, unsatisfactory, and achieved or exceeds competencies. An incomplete designation must be rectified. Instructors are encouraged to provide narrative comments on student performance.

Drop Policy: Students must secure their Society Dean’s permission in order to drop an elective. No drops are permitted less than 30 days before the start of an elective rotation unless approval has been granted from the rotation leader or designee. See: 

Drop/Add Policies (Registrar's Office).

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Promotion Guidelines

Academic Expectations for the Foundations of Medicine and Health (FMH) 

Students must achieve passing marks in all components of the Foundations of Medicine and Health curriculum. If a student does not meet expectations in any block, remediation is required.
Students are required to remediate all basic science subject committees in order to emphasize:

The Committee on Students approves all student promotions and approves students for graduation.



WR2 Remediation in Foundations of Medicine and Health
The Following components make up the end of block ratings
(note that some components will not be represented in some blocks) 
            1. SSEQs
            2. Structure Practical Exercise
            3. Cumulative Achievement Test
            4. Final Case Inquiry Faculty Assessment
            5. Medium Group Faculty Assessment
            6. Foundations of Clinical Medicine
            7. Clinical Immersion Exercise / Field Experiences
            8. Professional Learning Plan / Society Dean Advising Meeting

Definition and consequences of end-of-block ratings:
Achieves or Exceeds competencies; overall satisfactory achievement of criteria: the student has met expectations for all components of the block.

Does not meet criteria:  3 possibilities

  1. Targeted remediation required - Students will receive this rating if they do not meet criteria for any of the following:
    • Structure Practical Exercise (Gross Anatomy / Radiology and Histopathology)
    • Final Case Inquiry Faculty Assessment
    • Medium Group Faculty Assessment
    • Foundations of Clinical Medicine
    • Clinical Immersion / Field Experiences
    • Professional Learning Plan / Society Dean Advising Meeting

    Students are required to meet with their Society Dean to discuss the process of remediating targeted component(s). Evidence of successful remediation must be provided in the portfolio. For an overview of the targeted remediation process, please see the Targeted Remediation Process document.

    Deadlines: Targeted remediation for Blocks 1-4 must be completed prior to the start of Block 5. Targeted remediation for blocks 5 and 6 must be completed before the student can continue with any curricular activities beyond the Foundations of Medicine and Health at the end of Block 6. Note that the Structure Practical Exercise is a component of each of blocks 1-6. Exceptions to this timing must be approved by the student’s Society Dean and the Director of Student Assessment and Program Evaluation.

  2. SSEQ remediation - Students who do not meet criteria for the SSEQ examination are required to remediate. All students are required to pass a parallel form of the assessment designed by block faculty.
  3. Deadlines:  Block 1 SSEQ remediation must be completed by the end of winter break of the same academic year. SSEQ remediation for Blocks 2-4 must be completed prior to the start of Block 5. SSEQ remediation for Blocks 5 and 6 must be completed before the student can continue with any curricular activities beyond the Foundations of Medicine and Health at the end of Block 6. Exceptions to this timing must be approved by the student’s Society Dean and the Director of Assessment and Evaluation.

  4. Incomplete - Student is unable to achieve the objectives of the block due to illness or emergency. Students will work with their Society Dean and corresponding block faculty/staff to develop a suitable schedule for fulfilling block requirements.

(Remediation Policy revised 7/28/16)

Referral to Committee on Students (COS):

A student record will be provided to COS if identified (“Does Not Meet” expectations) in the same assessment component or competency twice throughout Foundations of Medicine and Health (SSEQ, Structure, IQ, professionalism, etc.), or if a student is identified in 3 or more different assessment components. After the review, COS may request to see the student at a subsequent meeting.
For complete COS policies see the Committee on Students section in the Student Handbook.

*Approved by Student Assessment Committee 07/28/16

* Approved by the Committee on Medical Education 07/28/16

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Grade Appeal Policy1

  1. A student wishing to appeal the grade received in a particular block, clerkship, or AI rotation should first attempt to resolve the matter by meeting with the block, clerkship, or AI rotation director(s). The request for a meeting should occur within 10 business days of release of the student’s grade to the student.
  2. If the student has attempted resolution via the block, clerkship, or AI rotation director(s) without success and would like to pursue the matter further, the student may file a formal written appeal with the Co-Chairs of the Student Assessment Committee who will gather the facts and work to resolve the matter. The appeal must be made within 25 business days of release of the student’s grade to the student, and must follow the format below. The Co-Chairs of the Student Assessment Committee (or designees) shall investigate the matter and make a decision to sustain the appeal or deny the appeal.
  3. If the student is not satisfied with the resolution after following the above processes, then the student may appeal the decision. The student should forward the formal written appeal to the Vice Dean for Medical Education of the School of Medicine within 10 business days from the time the decision was conveyed to the student. The Vice Dean will consider the student’s arguments and may either dismiss the appeal or appoint an appeal panel.

    Witnesses may be called at the discretion of the chair of the appeal panel. No legal counsel is permitted in the appeal hearing. However, a student may request that a faculty member or another student be present in the capacity of an advisor to provide the student advice but may not represent the student or directly question or cross-examine witnesses. A family member may not serve in this role. The appeal panel will make a recommendation to the Vice Dean. The Vice Dean will make a decision to sustain or deny the appeal.
  4. If, after being notified of the decision, the student feels that the School of Medicine did not properly follow its established procedures, then an additional written appeal may be forwarded to the Dean of the School of Medicine within 10 business days and may only appeal on the basis of procedural issues. This step exhausts the student’s appeal options and the Dean’s determination is final.

1Note that this policy applies to University Program students since grades are not assigned to students in the College Program.

2To file an appeal, submit a Word document to containing the information listed below. If you do not receive email confirmation of receipt of the appeal within a week, please resubmit.

   Your name:
   The block, clerkship, or AI rotation:
   Site (if applicable):
   Date that you completed it:
   Grade received:
   Grade you believe you earned:
   Your attempts to resolve the matter with the block, clerkship, or   AI rotation director:
   Justification and rationale for this assertion:

(Grade Appeal Policy approved by CME 10/27/16))

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WR2 Conscientious Behaviors/Professionalism and the Professionalism Working Group
Medical professionalism incorporates three essential characteristics: expert knowledge, self-regulation, and fiduciary responsibility to place the needs of the patient ahead of the physician’s self-interest. The basis for the conscientious behavior curriculum is to offer students a supportive environment in which to learn the skills of medical professionalism. We describe the procedures in our curriculum to identify and help students with this competency focusing on a learning orientation rather than performance orientation.

At the end of each Block, the Conscientious Behavior Team (CBT) will review all lapses in conscientious behaviors as part of the final Block assessment (e.g., failure to complete assignments, evaluations, or assessments by the due date; lack of responsiveness to email requests pertaining to the curriculum; attendance and or tardiness at required activities). The following steps are taken when the CBT identifies a lapse in a student’s performance during a Block:

  1. 1st lapse: CBT will send an email to the student regarding the specifics, with a copy to the student’s Society Dean. The student will be asked to acknowledge receipt of the email, explain what happened regarding the lapse in a reply email, and schedule to meet with his/her Society Dean to discuss this.
  2. 2nd lapse: The student is assigned an “Incomplete” for the Block, referred to the Professionalism Working Group (PWG), and the student’s Society Dean is notified. PWG will assign the student to a coach who will work with the student to identify the behaviors surrounding the lapse and help the student develop steps to correct them. [The Society Dean will address issues of life stressors, health, illness or disability as part of the advising relationship. The Society Dean will ensure that the student receives support from Educational Support Services, Tutoring/Consult Tables, UHS/UCS, and Disability Services.] Coaching will commence as soon as possible and continue for a time typically not to exceed 3 months. The coach may give the student an assignment or ask for a reflection, and may follow-up for a defined time to determine that the student is on track. If an assignment or reflection is part of coaching, it will be forwarded to PWG, and PWG will determine if the assignment/reflection meets criteria. Upon meeting criteria, the “Incomplete” will be changed to “Meets”. If the assignment does not meet criteria, the student will be given an opportunity to revise and resubmit. If after the second request, criteria are not met, the student’s grade will be changed to “DNM” whereupon PWG will review progress and recommend next steps.
  3. 3rd lapse: If coaching is still in progress, a grade of “Incomplete” may be assigned. If the student has completed coaching and this is another lapse, the student receives a “DNM” with referral to PWG and notification of his/her Society Dean.
    1. The Society Dean will ensure that the student has support from Educational Support Services, Tutoring/Consult Tables, UHS/UCS, and Disability Services.
    2. PWG will discuss the situation and decide to provide more intense coaching or to refer the student to the Committee on Students (COS).

In addition to identification of professionalism issues during the academic blocks, students may be referred to PWG for the following reasons:

  1. For identified deficiencies in interpersonal and communication skills.
  2. For identification through an Early Concern Form* which is one part of a larger longitudinal professional behaviors and relationships curriculum. When an Early Concerns Form is filed, PWG discusses the issues (with the student de-identified) and identifies a plan to support the student in meeting professional standards in a constructive framework.
  3. Through referral by the Committee on Students. When a student is presented to COS as a result of a lapse in Professionalism, COS may refer the student to PWG for evaluation and development of an improvement plan and tracking the outcomes.

PWG supports students in their professional development towards becoming a physician, and develops an individualized plan for coaching the students.

In addition to the procedures to address lapses in conscientious behaviors described above, some lapses in professionalism may result in immediate referral to COS and consideration for dismissal. These lapses may include but are not limited to, actions such as dishonesty, cheating, and falsifying patient information.

Early Praise
Students are expected to adhere to high standards of professional behaviors throughout their medical school education. For times when a student’s actions go above and beyond expectations of professional behavior, an Early Praise Reporting Form may be submitted by anyone in the School of Medicine community. The purpose of this reporting form is to identify students and recognize them for their extraordinary effort. Early Praise Forms are reviewed by PWG and disclosed to the student through the student’s Society Dean. The Early Praise may be included as evidence in the student’s ePortfolio. The identity of the individual filing the early praise form is confidential and is not disclosed at any time.

Early Concerns
We take a quality improvement approach to professional behaviors – students are learning professional behaviors and how to maintain them under stressful conditions in the profession of medicine. We have included an Early Concerns component to the curriculum so that concerns – small or big – can be identified at early stages and assistance provided. This component builds upon similar programs at other medical schools and upon recommendations by focus groups of CWRU SOM students. Professional relationships and behaviors and their lapses can occur across a broad range of interactions and venues – with peers, with faculty, with staff; in class, in offices, in hospitals, in clinics, in personal interactions, etc.

Published and maintained by the Office of Student Affairs and the Academic Societies
Revised 10/02/16


Published and maintained by the Office of Student Affairs and the Academic Societies
Revised 06/26/18