This is an archived copy of the 2021-22 catalog. To access the most recent version of the catalog, please visit http://catalog.utexas.edu/.

Academic Policies and Procedures

The Academic Policies and Procedures are guidelines to help students navigate academic tasks and understand policies concerning enrollment and attendance, examinations, student performance and grading, and more. All medical students are subject to the academic regulations of the University and are responsible for making certain they meet all requirements and deadlines.

Academic Advising

Each student is provided with informal and formal feedback about their academic performance. Formal assessment comes in mid-course feedback sessions and in weekly competency checks. Students that are identified as being at academic risk are asked to meet with the course director and/or an academic advisor, and/or the Associate Dean of Student Affairs. Coaching in time-management, resource management, learning strategies, test-taking skills, tutoring and other services are available. In addition, all students are encouraged to meet with faculty, an academic advisor or the Associate Dean for Student Affairs at any time to improve their academic performance.

Academic Grievance Policy

Scope

This policy applies to grievances, which include academic actions or decisions based on student academic performance that directly affect a student’s academic status or standing, such as, but not limited to, being required to repeat a course or year of study, being placed on probation, being suspended from the program, or being dismissed from the Dell Medical School program. When a student is affected by an adverse academic action or decision made by the Medical Student Academic Standing Committee (MSASC), the student may appeal the action or decision using the process described below.

This policy does not apply to grievances for a course or clerkship grade. See Appeal of a Grade.

Policy

A student may appeal any decisions of the MSASC. Any adverse action based on academic performance alone will be deferred until the grievance is resolved. Adverse actions based on conduct or professionalism will be in effect until the grievance is resolved. 

A student must file written notice of their grievance with the Chair of the Medical Student Academic Standing Committee within 10 business days from the date the written notice of decision was received. In the written grievance, the student must describe in detail the rationale for their grievance and propose a resolution. The student has the right to meet with the Associate Dean for Student Affairs to review the processes and procedures related to filing an academic grievance and to discuss the preparation of appropriate documentation for an Ad Hoc Appeals Committee to review and consider.

The Chair shall appoint three faculty members to an Ad Hoc Appeals Committee who will hear the appeal of an adverse event for any individual student, with one to serve as chair. Faculty members will be selected by the MSASC Chair based on the appeal being considered. Faculty members invited to serve on the appeals committee are expected to recuse themselves from service if any conflict of interest exists. 

The Ad Hoc Appeals Committee shall schedule a hearing date within 30 business days of the written student grievance being received by the MSASC Chair. The Ad Hoc Appeals Committee may choose to meet with any faculty, administrator, or other person in order to understand context. The student may appear before the Ad Hoc Appeals Committee to make a statement and respond to questions. The students may bring an ally to the hearing. If that ally is an attorney providing legal advice, the Ad Hoc Appeals Committee Chair must be notified 10 days before the hearing and an attorney representing the school shall be present. The MSAS Chair will be responsible for writing up the decision, in consultation with the Ad Hoc Chair. 

The MSASC shall notify the student, in writing, of the Committee decision within 10 days of the hearing date. 

In the event the student is dissatisfied with the Ad Hoc Appeals Committee decision, the student may file a written appeal to the UT Austin Dell Medical School Executive Vice Dean for Academics within 10 business days of the date the written decision was received. The student's appeal to the Executive Vice Dean for Academics must include a justification statement for the appeal and copies of all documentation the student provided to the MSASC. Upon review of the student's record and appeal, the Executive Vice Dean for Academics may meet with the student, or others, before rendering a decision to the Ad Hoc Appeals Committee, or modifying that decision. Within 10 business days from receipt of the student’s appeal, the Executive Vice Dean for Academics shall provide a written decision to the student, with copies sent to the Associate Dean for Student Affairs, the Associate Dean for Undergraduate Medical Education, and the Chair of the Ad Hoc Appeals Subcommittee.

The decision of the Executive Vice Dean for Academics is final. Any sanctions being deferred pending the resolution are immediately placed into effect.

Academic Standing Policy

Scope

To progress through the curriculum, be promoted to the next curricular year, and ultimately to graduate, medical students must meet all requirements of the current year, and satisfactorily adhere to all stipulated academic, professionalism and conduct standards and to all university and UT System rules and regulations.

Policy

Students must successfully complete and pass all required curricular courses, milestones, exams and other requirements, including professionalism expectations, to progress and graduate. Infractions of professionalism or conduct expectations can result in adverse academic actions up to and including dismissal, even if a student has passed all other aspects of the curriculum.

The Medical Student Academic Standing Committee (MSASC) is responsible for determining academic actions, including adverse actions, should a student not perform satisfactorily. The MSASC meets and reviews each student’s performance at the end of each semester and as needed when academic deficiencies, including professionalism and conduct issues, occur. Any member of the MSASC shall recall themselves from any discussions in which a reasonable person, if aware of all the facts, might deem that a conflict of interest exists. A student may ask, or be requested, to appear before the MSASC for discussion prior to a vote by the committee on academic standing for that student. 

Academic actions may include, but are not limited to: additional remediation, extended time for completion of requirements, repeating portions of the curriculum, leave of absence, or dismissal. The decisions of the MSASC will be enforced by the Administration, unless the student chooses to appeal. 

A student may appeal a decision of the MSASC as detailed in the Academic Grievance Policy

Academic Workload and Duty-Hour Policy

Scope

Medical student workloads must support students’ learning while maintaining an appropriate level of engagement with the learning environment. The specific details of these expectations will vary somewhat depending on the phase of the educational program, clinical specialty, or rotation, but must take into account the impact of fatigue on learning and patient safety, reinforce the fact that duty-hours restrictions, like other compliance requirements for physicians, are consistent with the necessity of meeting professional standards and ensure balance between educational priorities, service needs of the clinical setting, and the students’ personal wellness. The duty-hour restrictions on students during clinical clerkships and courses are modeled after the American Council on Graduate Medical Education (ACGME) guidelines for residents.

Policy

Course and Clerkship Directors are expected to plan and manage courses, including all scheduled activities and expected independent work, within the academic workload and duty-hour parameters approved by the Dell Medical School’s Undergraduate Medical Education Curriculum (UMEC) Committee. It is the responsibility, as a part of professionalism, for the student to abide by medical school requirements regarding duty-hour restrictions. Violations of the Academic Workload and Duty-Hour Policy should be reported to the Office of Medical Education.

Preclerkship Curriculum (MS1)

The preclinical courses are organized into module blocks of varying lengths, using various teaching and learning formats. The preclinical curriculum includes block and longitudinal courses that have scheduled activities and learning events.

Workload Limits:

  • Maximum of 20 hours of required scheduled activities per week
  • Approximately two hours of assigned preparation materials per each hour of required scheduled activities averaged over the course of a week.
  • Students in good standing may take student enrichment electives, which will not count towards required activities or duty-hour limits.

For all required content, no matter the venue (lecture, case discussions, small group discussions and exams), a scheduled hour is logged as a formal instruction hour.

The total workload for an average student in the MS1 preclinical year must be kept to a maximum of 60 hours per week. This should provide time for the student’s personal wellness and social engagement.

Clinical Clerkships and Clinical Rotations (MS2 and MS4)

Clinical clerkships and rotations vary in length. Students are assigned to various clinical sites and work under the supervision of designated faculty and residents. During clinical clerkships and courses, medical students are expected to participate in all required clinical and didactic activities. Examples of such activities include: direct patient care, patient rounds, patient documentation, case conferences, and interactive lectures. Students are expected to assume increasing levels of responsibility and accountability for healthcare delivery, as appropriate under the supervision of faculty and residents. The amount of time needed for a student to adequately meet their responsibilities varies depending on rotation, and can include overnight call.

Duty-hour expectations include all required activities in the clinical years; therefore, if a student has clerkship duties and additional expectations from a longitudinal course, the hours are added cumulatively and in total must remain within the duty-hour limits.

MS2 and MS4 students are expected to abide by the following duty-hour limits (modeled after ACGME guidelines for residents):

  • Must be limited to 80 duty hours per week 
  • Must be scheduled for in-house call no more frequently than every third night, when averaged over a four-week period
  • Must be limited to a maximum of 24 hours of continuous duty in the clinical setting and up to four hours of additional time may be used for activities related to patient safety, such as providing effective transitions of care, and/or education. 
  • Must not be assigned additional clinical responsibilities following 24 hours of continuous in-house clinical duty.
  • Should have 8 hours free of clinical duty between shifts. They must have at least 14 hours free of clinical duty after 24 hours of in-house clinical duty.

Students should report duty-hour violations to the Clerkship Director or Coordinator. 

The Office of Medical Education will continuously monitor violations to the Academic Workload and Duty-Hour Policy and will alert the clerkship director, or other departmental leadership, and the Undergraduate Medical Education Curriculum Healthcare Delivery Subcommittee of any violation during a student’s MS2 and MS4 years.

Non-clinical Courses (MS3)

The courses scheduled in the Innovation, Leadership and Discovery phase of the curriculum are highly individualized and variable based on a student’s customized plan of study. On average, a student should not be expected to have a total workload of greater than 60 duty hours per week.

Appeal of a Grade Policy

Scope

Grades are generated by the course/clerkship director. Should there be a disagreement about a grade assignment in a course or clerkship, the student may appeal the assigned grade.

Policy

The University of Texas at Austin Dell Medical School students have the ability to timely appeal all grades and evaluations and to have that appeal resolved in a timely manner.

The procedures for a grade appeal are:

  1. A student must file a written appeal with the course or clerkship director within five business days from the date the grade was posted. In the written appeal, the student must describe in detail the basis for the appeal and propose a resolution. Without unanticipated extenuating circumstances affecting the testing experience, performance on a written exam will not be considered as part of an appeal. 
  2. The course or clerkship director will review the written appeal. The course or clerkship director will provide the student a written decision within five business days of receipt of the student’s written appeal.
  3. Should the student be unsatisfied with that decision, the student may file a written secondary appeal to UT Austin Dell Medical School Associate Dean of Undergraduate Medical Education within five business days from receipt of the course or clerkship director’s written decision. The student's secondary appeal must include a justification statement articulating why the appeal is warranted, along with all documentation provided to the course or clerkship director in conjunction with the initial appeal. Upon review of the student's record and appeal portfolio, and within five business days from receipt of the student’s secondary appeal, the UT Austin Dell Medical School Associate Dean for Undergraduate Medical Education will provide a written decision to the student and course or clerkship director. The UT Austin Dell Medical School Associate Dean for Undergraduate Medical Education may:
    1. Allow the course or clerkship director decision to stand;
    2. Modify the course or clerkship director’s decision; or
    3. Make an alternate decision.

Any unsatisfactory grade will be forwarded to the Medical Student Academic Standing Committee for administrative action, if needed.

Attendance and Absence Policy

Scope

Attendance contributes to a student’s education and professional identity formation. Healthcare professionals have a fiduciary responsibility to ensure they cover their clinical responsibilities. Practicing this duty with peers and teaching faculty fosters professional identity formation and is therefore a part of the professionalism competency at Dell Medical School.

Policy

Attendance is required for many educational activities and strongly encouraged for all others. Course/Clerkship syllabi will clearly outline the attendance expectations for educational activities. Attendance expectations are in accordance with duty hour guidelines. Note that some clinical, laboratory, and other experiences are impossible to make-up without repeating the entire course and/or academic year.

Attendance Expectations

Small Group Sessions (e.g. PILLARS, IPE, DOCS, laboratories, etc.) 
  • Attendance Expectation: Required
  • Rationale: Professional responsibility to the student's small group. Active learning requires participation for maximal benefit. Content will not be covered elsewhere; participation is required for maximal benefit. Clinical skills develop through guided practice. Clinical practice cannot be replicated passively. Achieving inter-professional competencies requires interaction with colleagues. 
Large Group Interactive Sessions
  • Attendance Expectation: Strongly encouraged
  • Rationale: Interaction requires participation for maximal benefit. 
Clinical Experiences (e.g. core clerkships and electives)
  • Attendance Expectation: Required
  • Rationale: Clinical application and practice cannot be replicated with passive activities. Professional identity formation requires working with role models and participating in patient care responsibilities. 
MS3 Year
  • Attendance Expectation: Varies
  • Rationale: Dependent on the educational path of the student. Will be agreed upon prior to beginning MS3 year. 

Absences

Absences may be excused under certain circumstances as listed below. In the event of any absences, the course/clerkship/elective director will determine on a case-by-case basis if the student will be assigned further clinical work, a makeup assignment, or a combination of both. 

Medical

Physician and therapy appointments are excused. A signed medical note may be required. 

University Holidays

Students are not expected to be in attendance on official University Holidays unless performing clinical rotations. While on clinical rotations, students are to follow the schedule of the clinical site they are assigned. Expectations are at the discretion of the clerkship/rotation leadership. 

Religious Holy Days

A student who misses classes or other required activities, including examinations, for the observance of a religious holy day should inform the instructor as far in advance of the absence as possible, so that arrangements can be made to complete an assignment within a reasonable time after the absence.

Jury Duty

Medical students may frequently be exempted from jury duty, due to clinical expectations. If not, the school will make every effort to provide make-up opportunities for missed experiences.

Absence for Military Service

See the Absence for Military Service policy under Attendance in the General Information Catalog.

Unforeseeable Events

Students who miss educational activities for unforeseeable events such as illness, family, or other emergency, must notify the course director and the Associate Dean for Student Affairs. Either of these may require documentation. Documentation of illness will not require a specific diagnosis.

Weather or Unsafe Conditions Related Absence

If the clinical site is closed or in an emergency staffing status, students are not expected to attend clinical courses. 

Should the clinical site be closed or on an emergency staffing status, students may contact the clinical supervisor (course or team director) and request to report. Two factors should be considered during this request: the safety of the student to travel from their current location to the clinical site, and the level of patient responsibility the student has. (Didactics or observing have minimal patient responsibility, active participation in procedures or an Acting Internship would involve higher patient responsibility.) 

For example: A student with a higher level of patient responsibility such as an Acting Internship, may request to attend in order to support patient care, if they feel confident that travel is safe given their circumstances. 

Regardless of the status of the clinical site, the location from which or through which student must travel may not be safe. Students should consider public school and government office closures as well as travel advisories from police or other government authority. If the student believes it is unsafe to travel, they should call the course or team director and make them aware. The absence will be excused. 

Tardiness

In addition to any course policy in the syllabus, excessive tardiness may be considered as a conduct matter by the Professionalism committee.

All absences and tardiness for required educational events will be recorded and monitored. The course/clerkship director will consult with students to discuss absences and any work that needs to be completed due to absences. The Associate Dean for Student Affairs is notified to provide support when appropriate and to monitor for repeated patterns.

Electives and Away Clinical Rotation Policy

Scope

Elective opportunities are intended to allow students the to opportunity to explore their particular career interests.

Policy

The University of Texas at Austin Dell Medical School curriculum encompasses 20 weeks of required electives that must be taken during the MS3 or MS4 years. No more than eight weeks of required electives may be taken elsewhere. Students are strongly encouraged to consult with faculty and their Academic Advisors and use electives to both explore potential career choices and to broaden their medical expertise. The student's Academic Advisor, or their designee, must approve the student's electives prior to beginning the experiences. 

Additionally, all off-campus elective rotations must be approved by the Office of Student Affairs at least one month before the off-campus elective rotation or course begins. Credit will not be given for any off-campus elective rotation or course that has not been approved in advance.

The Office of Student Affairs has a centralized system to review the proposed off-campus elective prior to approval, to ensure the return of a performance assessment of the student while on the off-campus elective, and to retain an evaluation of the off-campus elective by the student. The decision to approve an off-campus elective will take into account the following information and any other information deemed appropriate by the dean’s office:

  • Potential risks to the health and safety of patients, students, and the community
  • The availability of emergency care
  • The possibility of natural disasters, political instability, and exposure to disease
  • The need for additional preparation prior to, support during, and follow-up after the elective
  • The level and quality of supervision
  • Any potential challenges to the code of medical ethics adopted by the home school

Paperwork that must be submitted to the Office of Student Affairs prior to approval of an off-campus elective rotation includes: the "Course Approval" form, a written letter or email of acceptance from the physician preceptor with the start and end dates of the course/rotation, and a course description of learning objectives and responsibilities during the rotation. Forms must include a complete address and telephone number for the off-campus location and residence address for the student while at the off-campus site. Forms will not be approved after the rotation has already begun.

Leave of Absence, Withdrawal and Dismissal Policy

Scope

Students are expected to proceed through the Dell Medical School curriculum to graduation in a continuous, uninterrupted fashion. 

However, a student may temporarily separate from the curriculum via an approved Leave of Absence or permanently separate from the curriculum via a Withdrawal or Dismissal, for academic, personal, or other reasons. Students may also consider a Modified Academic Load for requests less than one semester in length. 

Policy

Leave of Absence Options

There are three types of Leave of Absence, two of which may be requested by a student and the third, initialed by the school (Personal, Enrichment, and Involuntary). Each of the three types can range from one semester to one year.

The following guideline applies to all Personal or Enrichment leaves:

  1. The student must submit a written application to the Associate Dean for Student Affairs. The request should describe the rationale for requesting the leave, a projected date of return, and proposed conditions to be met prior to return. 

The following guidelines apply to all three types of leave: Personal, Enrichment, or Involuntary. 

  1. The student must agree to remain in regular contact with the school while on leave. 
  2. An intention to return must be submitted in writing to the Associate Dean for Student Affairs no later than 30 days before the date approved for re-entry along with evidence that all conditions for re-entry have been met. 
  3. A leave of absence does not obviate the requirements for timely completion of curriculum milestones, including USMLE examinations or graduation requirements pertaining to the class that they student will join on re-entry. 
  4. Any leave of absence will be noted on the MSPE. 
  5. Any student who fails to return from a Leave of Absence by the designated date shall be considered to have resigned from the Dell Medical School. 
Personal Leave

A student in good academic standing may request a Personal Leave of Absence for medical reasons, family reasons including maternity or paternity, or other personal reasons. The request for a medical leave requires a supporting letter from the student's personal physician or the personal physician of the family member in question. Details of the medical reason will not be detailed in the supporting letter but the physician may suggest a recommended length for the leave. A Personal Leave must be approved by the Associate Dean for Student Affairs or their proxy. A "Fitness for Duty" assessment may also be required as a stipulation for return for medical leaves. The Medical Student Academic Standing Committee (MSASC) will be made aware of any student that has been approved for Personal Leave at their next meeting. A student may request to extend Personal Leave beyond one year with a supporting letter from the student's personal physician and approval of the MSASC. 

Enrichment Leave

A student in good academic standing may request an Enrichment Leave of Absence for purposes of education, research, or service activities, e.g. research fellowship, Peace Corps, additional degree, or military service. The request for an Enrichment Leave must be approved by the MSASC for one year maximum. The MSASC may set conditions for return, i.e. clinical skill refresher course. The student has the right to appear before the MSASC before a decision is made. 

Involuntary Leave

The MSASC can initiate an Involuntary Leave due to poor academic performance or professional conduct. Any student in danger of being placed on Involuntary Leave has the right to appear before the MSASC before that decision is made and to subsequently appeal any decision of the Committee subsequently. The MSASC, in consultation with the Associate Dean for Student Affairs and the Associate Dean for Undergraduate Medical Education, will identify conditions for remediation and return. Involuntary Leave cannot exceed one calendar year. See the Academic Grievance Policy for details. 

Withdrawal

A student may withdraw from medical school by submitting a written letter of resignation to the Executive Vice Dean for Academics. This is a permanent action and a withdrawn student is not eligible for re-admission. 

Students are strongly encouraged to meet and discuss with the Associate Dean for Student Affairs, before submitting a withdrawal request.

Dismissal

Dismissal is an action that may be taken by the Medical Student Academic Standing Committee to permanently separate a student from the medical school. A dismissed student is not eligible for re-admission to the same degree program. The dismissal decision can be based on unacceptable academic or professional performance.

Students will be notified of dismissal in writing and, where possible, verbally by the Associate Dean for Student Affairs or their proxy. The verbal notification is a courtesy. The written notification is the official notification of the adverse action.

Students may appeal a dismissal decision through procedures outlined in the Academic Grievance Policy.

An Alternative to Leave: Modified Academic Load

On occasion, a student may request or faculty may recommend the need for a short-term delay in the curriculum. This is not an official leave and is not reported on the transcript. It is available to a student facing a short-term inability to met a portion of the curriculum requirements due to medical, family, or other reasons. The Modified Academic Load (MAL) allows the student to remain enrolled with a modified academic load for a short, defined, period of time rather than request a semester- or year-long Personal Leave for these same reasons. For example, a student may drop one clerkship but continue enrollment and participation in longitudinal concurrent courses. The MAL requires a request in writing to the Associate Dean for Student Affairs including a rationale for the request and identification of curriculum elements to be continued during this modified period. The request requires approval by the Associate Dean for Undergraduate Medical Education after consultation with course directors where attendance or assignments will be impacted. 

Student Academic Performance and Grading Policy

Scope

Students at The University of Texas at Austin Dell Medical School will be evaluated in multiple ways, each to be outlined in individual course syllabi and as described in other policies. Faculty and staff are responsible for disseminating student evaluation methods in writing to students in the course syllabus prior to the start of each course. Methods of assessment may include: narrative feedback, exams, written/computer-based reviews, participation, Objective Structured Clinical Exams (“OSCEs”), peer review, oral presentations, etc.

Policy

The Dell Medical School has established committees to oversee the educational program and to monitor academic performance of its medical students. The Undergraduate Medical Education Curriculum (UMEC) Committee is the body that provides central oversight and makes recommendations to the Dell Medical School’s Dean and Executive Vice Dean for Academics regarding the overall design, management and evaluation of a coherent and coordinated curriculum. The Medical Student Academic Standing Committee (MSASC) is charged with reviewing the academic progress and professional development of each student during all components of the four-year medical education program and making recommendations to the Dean and Executive Vice Dean for Academics accordingly. The primary responsibility of the MSASC is to recommend for graduation only those candidates who have satisfactorily completed all graduation requirements and demonstrated consistent professional conduct appropriate for a physician.

Each course director will submit a grade no later than four weeks after rotation completion, including narrative. All grades are processed through the Office of Medical Education and submitted to the Dell Medical School's Records Office who will transmit to the Registrar's Office. Upon assigning a non-passing grade, the course director must provide timely written notification to the student. The Associate Dean for Undergraduate Medical Education and the Associate Dean for Student Affairs are to be copied on that notification. 

The academic standard for successful completion of the preclinical courses, clerkships, and clinical courses are determined by the course directors, clerkship directors, and course directors, respectively, each adhering to a grading rubric approved by the UMEC Committee. The process by which a student may appeal a grade or evaluation received is set forth in the medical school's Appeal of a Grade policy. 

Grade Definitions

P - Pass: Successfully completed all course requirements

F - Fail: Did not successfully complete all requirements, no credit given

H - Honors: Met a specified higher level of performance. Clinical Courses of four weeks or longer duration and in the Innovation, Leadership and Discovery Block 

PR - Pass after Remediation: Successfully completed all course requirements but required additional time or testing opportunities beyond those described within the course syllabus

W - Withdrawal: Student withdrew from the university

X - Temporary: Temporary delay of grade due to extenuating circumstances approved by the Office of Medical Education. An X will be changed to another grade when student has completed coursework. If the student does not complete the coursework within a designated time period, the grade will be changed to Fail

Q - Drop: Student dropped the course: A "Q drop" is recorded on the transcript when the course is dropped after 20% of the workdays in that course have been completed. (a "delete drop" is not recorded on the transcript) 

I - Incomplete: Permanently incomplete

For dual-degree courses, the grade submitted by the course director, in accordance with the grading system in use by that school is reported on the transcript. 

United States Medical Examination (USMLE) Policy

Scope

The United States Medical Licensing Examination (USMLE) is jointly sponsored by the National Board of Medical Examiners and the Federation of State Medical Boards. A passing score on each portion of the USMLE is accepted by medical boards in every state as evidence of core competency to practice medicine.

The University of Texas at Austin Dell Medical School has established policies pertaining to the timing and passage of the USMLEs in order to optimize career outcomes for students and to ensure that graduates meet all related licensing requirements.

Policy

In order to graduate from The University of Texas at Austin Dell Medical School, students must take and pass the USMLE Step 1 and the USMLE Step 2 CK (Clinical Knowledge). A student who receives three failing grades on any combination of these required licensure exams will be considered for dismissal by the Medical Student Academic Standing Committee. A student who wishes an extension to the timeline, may submit that request to the Dell Medical School's Associate Dean for Student Affairs. An extension may then be granted by the Medical Student Academic Standing Committee. 

USMLE Step 1

  • Students must take the USMLE Step 1 prior to September 1 of the MS-3 year of the medical curriculum.
  • A student will not be promoted to the MS-4 year until a passing score is obtained. 

USMLE Step 2 CK

  • Students must pass the USMLE Step 2 CK prior to graduation. 
  • Students must take step 2 before November 15 of the MS-4 year.