Melvyn H. Schreiber, MD, Editor

THE GRADING AND PROMOTIONSCOMMITTEE

Part of the penalty for longevity and experience is assign-ment to institutional committees thought to require maturejudgment. That sometimes translates to mean committees onwhich no one else wishes to serve. The clinical Grading andPromotions Committee is one of those.

Representatives from each department teaching in theclinical curriculum make up the committee, and we meet onMonday afternoons at 5:00PM. Before us come the recordsof students who have failed to perform creditably in medicalschool. Those who have failed one course are commonlyrequired to repeat the course and pass, giving up electivetime to do so. Others who have failed more than one coursein different years may be required to repeat even more of thecurriculum. Those who fail two or more courses in the sameyear, according to the rules of the institution, may be dis-missed from school.

Students may appeal their dismissal, and almost all do.They may come before the committee to explain why theyshould be reinstated, and they may bring with them, to tes-tify separately, faculty people who worked with them andthink well of them. We (the committee members) listen care-fully to what everyone has to say, never hurrying them, try-ing our best to look and be sympathetic. The witnesses arequestioned (not really cross-examined), and students are fre-quently asked to explain or expand on what we have under-stood poorly.

Afterward, the members of the committee discuss eachstudent and her or his record, reviewing comments from fac-ulty people on various clerkships, reviewing grades and pre-vious performance, considering everyone’s testimony. Thensomeone makes a motion that the student’s appeal be deniedor granted (with certain provisions), someone seconds themotion (usually), and more discussion ensues. Finally, thequestion is called, the votes are counted, the decision ismade. It is usually clear-cut, but close votes occur. In theend, the committee decides and the registrar delivers the ver-dict the next day.

Certain avenues of appeal remain for students who be-lieve they have been unfairly treated, and once in a while thedean will get involved. But it is a solemn and usually deci-sive moment when the committee finally dismisses a studentfrom school by denying the final appeal.

I can see that it takes a while for committee members tolearn the ropes. Not one of these decisions is easy, and wework very hard to uncover the facts in each case, includingthe emotional and psychological factors that contribute topoor performance. Some of the committee members are eas-ier to influence than others, but all make a serious effort toevaluate each situation objectively, remembering that whatwe decide must be fair to the student and to the public.

We hear a lot about how hard the students work, howdevoted they are to the best interests of patients, how theyarrive early, stay late, and never complain about extra work.But we have learned that good intentions and hard work donot substitute for genuine accomplishment, and sooner orlater we must decide if a student is sufficiently competent tobe permitted to continue in school or to graduate.

We struggle mightily to do the right thing, and we arefilled with compassionate, doctorly feelings. But there comesa time when our prescriptions would cease to be supportiveand become positively enabling. We know we must draw theline before we reach that point, but where to draw it is rarelyperfectly clear.

I seldom have seriously negative feelings about anything Ido professionally, but serving on this committee is a greatburden. I’d quit except that I recognize the justice of theassignment, and no one would like to see a committee likethis made up of people who really like the work.

Melvyn H. Schreiber, MDUniversity of Texas Medical BranchGalveston, Tex

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