Last updated on December 2nd, 2021

Alternative Pathways

During post examination Academic Advising meetings, students not likely to achieve performance standards may be offered the option to join the Interactive Team Instruction (ITI) delivery of the MD program or to opt for the Credit Remediation (CR) option. The ITI is designed to offer students with additional academic support to better equip them to achieve performance standards. Those who, despite all available support, are not likely to achieve standards by the end of a course may choose the CR option.


Students in the MD program are expected to be adaptive, self-directed learners who can capably integrate what they know and apply their knowledge clinically. This cognitive process may occur independently during and following an academic lecture; likewise, it may occur during and following interactions with others. Teaching and learning in the MD program includes required activities such as academic lectures, , small group discussions, laboratory sessions, clinical experiences, and formative and summative assessments. Additional optional activities are also available: open lab hours, faculty office hours, peer-to-peer facilitated reviews, and academic support seminars. Students are encouraged to take advantage of the many varied opportunities for learning and academic development that are available to them. Most students matriculate into the traditional, Live Lecture-based Delivery  format (LLD) of the MD curriculum. While lectures are the foundation of this delivery format, approximately 50% of contact hours are in small groups and laboratories where students have opportunities for faculty interaction, collaborative learning, and academic support.

The ITI utilizes an instructional pedagogy that provides interaction with faculty and incorporates frequent collaborative active learning based on videos of lectures. The small group discussion and lab components are identical to the traditional LLD   format. Students progress through the ITI in an instructor-guided small-group setting. Multiple choice questions, discussions, and clinical cases introduced at key points during the ITI review of lectures serve as catalysts for the clarification of concepts. The instructors of the small groups ensure that all questions raised by students are effectively addressed in the ITI session. The ITI incorporates academic support through Learning Strategies Seminars given by the Department of Educational Services (DES) and individual Learning Strategies Advising meetings.


Following every examination period, the Academic Progress Review Committee (APRC) reviews student performance and identifies students with performance trends that indicate students are at risk of not achieving performance standards. Subsequently, during mandatory advising meetings, Academic Advisors meet individually with these students to discuss program requirements and standards, identify obstacles to progress, and consider opportunities for improvement. Performance data indicate that many students who do not meet performance standards in the traditional Live Lecture-Based delivery format of the MD curriculum (LLD) make significant improvement in the ITI delivery format; therefore, Academic Advisors may encourage students to choose the ITI delivery format. Students who choose this option by the established deadline transition to the ITI sessions and schedule and must remain there for the remainder of the academic term.

At the end of the academic term, the APRC makes recommendations to the Senior Associate Dean, Basic Sciences related to students who are achieving well above minimum requirements transitioning back into the Live Lecture delivery, students with sub-par performance remaining in the ITI for an additional term, and students with at-risk performance transitioning into to the ITI for the following term. The APRC makes all determinations about student progression in the ITI delivery format at the end of each term.


The Four-Year MD program is designed to be continuous without interruption. Any timeline extensions could impact students’ ability to graduate on time. Nonetheless, some students encounter academic setbacks which may be resolved with an opportunity to remediate courses. The APRC identifies students who are not likely to meet academic standards by the end of an academic term and recommends that they be granted a CR option, which is an extension of their timeline by one academic term. Students may also choose the CR option without a recommendation from the APRC. Students without a CR recommendation from the APRC, who are considering a CR, are required to meet with an Academic Advisor in AADS to discuss how the CR option may impact their program timelines prior to choosing the CR option.

The CR allows students to repeat the course once if they are not likely to meet academic standards for progress. Deadlines for the CR option are posted prior to the final exam of the last course module.

Students who opt for the CR will not take any summative assessments after the CR option is registered (final exam, OSCE, lab exams – any summative assessment detailed in the course syllabus); however, they must participate in all remaining scheduled academic activities in the academic term as per course requirements described in the course syllabi. In addition, they must complete a CR Final Assignment at the end of the term and present it in person on the day of the scheduled final exam. Students who fail to complete stipulated course requirements forfeit the CR and earn an F grade for the course.

The Medical Excuse Policy for course examinations also applies to the CR Final Assignment. Students with an approved excused absence will be permitted to complete the CR Final Assignment as per the Completion Examination schedule. Students who receive an approved Incomplete (“I”) for an exam or a CR Final Assignment must take the completion of their CR Assignment in person as per the master School of Medicine schedule (published on the OEP/Registrar site (

Completion examinations are held within the week following the final examination. Students should consider this completion examination period when scheduling end of term travel.

Students without a Medical Excuse for the CR Final Assignment, who fail to complete or submit the CR  Final Assignment,  will receive an incomplete grade for the course, at the end of the term. They must then appear before a Faculty Panel for Academic Professionalism to appeal for the opportunity to rectify this and to explain their failure to complete the CR Final Assignment. Students must then contact the Course Director to arrange the completion of the CR Final Assignment in accordance with the completion examination schedule. Failure to resolve the missing CR Final Assignment by the specified deadline will result in the student forfeiting their CR option and receiving a Failing grade for the course.

Students who comply with all CR requirements will receive a grade of CR on their transcript, repeat all term coursework in the ITI delivery format, and adhere to all policies related to participation in the ITI delivery format.

Students are not charged tuition for their repeat of the course, but administrative fees will apply.

Students who take the CR option are at risk of not meeting the MD program’s satisfactory progress guidelines and will be placed on Monitored Academic Status (MAS) by the Academic Performance Review Committee (APRC). Student should note that although no final numeric grade is issued for the credit remediated (CR) course, during an APRC (performance review) or CAPPS (appeals review), a CR is viewed as an academic setback should the student subsequently fail to meet academic or timeline standards.

If a CR has been taken in the first year of the MD program, an additional CR may be allowed in the second year. Presuming students have no prior academic setbacks or timeline delays (i.e., F grades, Leave of Absence) and only one previous CR, they may be granted an additional CR  in accordance with the following rules (as per the table shown):

  1. One CR granted during Year 1 (Term 1 or Term 2) and one CR granted during Year 2 (Term 3, 4, or 5); or
  2. Two CRs granted in Year 2 (Term 3, 4, or 5). A Term 5 CR applies to both the PCM501 and the BSFCR course, which, together, will constitute one CR.


Year 1 Year 2

Year 1 Year 2
CR Options: Term 1 Term 2 Term 3 Term 4 Term 5
Option 1a CR No CR CR No CR No CR
Option 1b CR No CR No CR CR No CR
Option 1c CR No CR No CR No CR CR
Year 1 Year 2
CR Options: Term 1 Term 2 Term 3 Term 4 Term 5
Option 2a No CR CR CR No CR No CR
Option 2b No CR CR No CR CR No CR
Option 2c No CR CR No CR No CR CR
Year 1 Year 2
CR Options: Term 1 Term 2 Term 3 Term 4 Term 5
Option 3a No CR No CR CR CR No CR
Option 3b No CR No CR CR No CR CR
Option 3c No CR No CR No CR CR CR

Students who use the CR option are at risk of not meeting the minimum academic standards of the MD program and will remain or be placed on MAS. Students with prior academic setbacks or timeline delays (F, LOA, APRC/CAPPS stipulations) may be ineligible for one or both CR options.

Note: In year 2, Terms 3 and 4 CRs are counted separately— a CR in Term 3 counts as 1 CR, and a CR in Term 4 counts as a separate CR. If a Term 5 CR is taken, students will repeat both PCM501 and BSFCR. These are considered one CR.