The Grading and Promotions Committee

Part of the penalty for longevity and experience is assignment to institutional committees thought to require mature judgment. That sometimes translates to mean committees on which no one else wishes to serve. The clinical Grading and Promotions Committee is one of those. Representatives from each department teaching in the clinical curriculum make up the committee, and we meet on Monday afternoons at 5:00 PM. Before us come the records of students who have failed to perform creditably in medical school. Those who have failed one course are commonly required to repeat the course and pass, giving up elective time to do so. Others who have failed more than one course in different years may be required to repeat even more of the curriculum. Those who fail two or more courses in the same year, according to the rules of the institution, may be dismissed from school. Students may appeal their dismissal, and almost all do. They may come before the committee to explain why they should be reinstated, and they may bring with them, to testify separately, faculty people who worked with them and think well of them. We (the committee members) listen carefully to what everyone has to say, never hurrying them, trying our best to look and be sympathetic. The witnesses are questioned (not really cross-examined), and students are frequently asked to explain or expand on what we have understood poorly. Afterward, the members of the committee discuss each student and her or his record, reviewing comments from faculty people on various clerkships, reviewing grades and previous performance, considering everyone’s testimony. Then someone makes a motion that the student’s appeal be denied or granted (with certain provisions), someone seconds the motion (usually), and more discussion ensues. Finally, the question is called, the votes are counted, the decision is made. It is usually clear-cut, but close votes occur. In the end, the committee decides and the registrar delivers the verdict the next day. Certain avenues of appeal remain for students who believe they have been unfairly treated, and once in a while the dean will get involved. But it is a solemn and usually decisive moment when the committee finally dismisses a student from school by denying the final appeal. I can see that it takes a while for committee members to learn the ropes. Not one of these decisions is easy, and we work very hard to uncover the facts in each case, including the emotional and psychological factors that contribute to poor performance. Some of the committee members are easier to influence than others, but all make a serious effort to evaluate each situation objectively, remembering that what we decide must be fair to the student and to the public. We hear a lot about how hard the students work, how devoted they are to the best interests of patients, how they arrive early, stay late, and never complain about extra work. But we have learned that good intentions and hard work do not substitute for genuine accomplishment, and sooner or later we must decide if a student is sufficiently competent to be permitted to continue in school or to graduate. We struggle mightily to do the right thing, and we are filled with compassionate, doctorly feelings. But there comes a time when our prescriptions would cease to be supportive and become positively enabling. We know we must draw the line before we reach that point, but where to draw it is rarely perfectly clear. I seldom have seriously negative feelings about anything I do professionally, but serving on this committee is a great burden. I’d quit except that I recognize the justice of the assignment, and no one would like to see a committee like this made up of people who really like the work.