Medical Student Exam Policy

Medical Student Exam Policy

Policy Statement

To specify the expectations and requirements for student examinations at Boston University School of Medicine.

Defined Terms

In this policy, an examination includes all written summative experiences across the four-year medical school curriculum.

Responsible Parties

The Medical Education Committee (MEC) and the Associate Dean of Medical Education are responsible for ensuring that the  policies and procedures outlined below are upheld and addressing any compliance concerns that arise with students, course and clerkship directors.

Course/Clerkship Directors and Coordinators are responsible for administering exams per the policies and procedures outlined below and ensuring that internally-developed exams meet these policies.

Medical Students are responsible for complying with the sections of these policies that address postponing or modifying exam schedules; excused absences, scheduled exam times, and shelf exam laptop certification.


Student Related
Postponing or modifying exam schedule; Excused absences

A student who is unable to take a scheduled exam due to medical or family emergency must immediately notify the course coordinator and/or course director(s) as listed in the syllabus policies. In an emergency where the course coordinator or course director(s) cannot be reached, students must contact the Associate Dean of Medical Education at  All students must submit a written explanation for missing the exam to both the course director(s) and the Associate Dean of Medical Education. The Associate Dean of Medical Education may ask students to provide supporting documentation for their absence. Students should arrange directly with the course director(s) to take make-up exams due to acute illness or emergency that can be made up within 3 days. If the exam cannot be taken within 3 days of the original date, the course director(s) and student must notify the Associate Dean of Medical Education. Student Affairs will be notified if student is in need of additional support.

  • Exams are not to be postponed or taken early, unless for a compelling reason, e.g. personal illness or family emergency, or if approved by the Associate Dean of Medical Education
  • Students must provide a written explanation for all early, late, delayed, or missed exams via email. Documentation may be necessary in rare situations.
  • Students who arrive late may take the exam with remaining time, at the discretion of the course director(s)
  • Students who miss an exam, unexcused, will receive a zero for that exam
Shelf Exam Laptop Certification Process

Prior to testing, students are required to follow certification procedures as provided on the Alumni Medical Library website. Pre-certification is an important step in preparing for the NBME exams as it helps identify potential software conflicts and issues prior to the exam, and visiting the Library Help Desk after failing a certification allows our Library staff to troubleshoot these in advance of the exam. Students who fail to certify their computer prior to the administration of an NBME exam may be unable to take the exam on the scheduled date, which may affect their overall grade.

Clerkship Scheduled Exam Times

NBME exams will be administered in the afternoon, due to a pattern of NBME technical difficulties. Students are expected to report for their exams per the start time provided by their clerkships. End times provided are approximate, based on starting the exam on time without any complications. NBME technical difficulties, personal laptop issues, and/or weather issues have the potential to substantially delay examination end times; students should take this into account when scheduling travel (flights or any other travel arrangements) after examinations. While it is the rare occurrence, NBME online difficulties have delayed end times by over 4 hours. The school does not guarantee end times and will not reimburse or reschedule a student who misses an airline flight due to an extended NBME end time.

Remote Exam Policy for Concerning Behavior/Academic Misconduct

If a student is suspected of concerning behavior, they will be notified in writing and required to meet with course director(s) after the first occurrence. If concerning behavior(s) are identified in a second exam, the student will be referred to the Associate Dean of Medical Education for discussion.

Anyone suspected of cheating would be immediately referred to the Disciplinary Committee

Concerning behavior is defined as but not limited to:

  1. Not showing complete test taking environment after being asked prior to starting exam
  2. Not showing scrap paper at start and end of exam after being asked; paper must be torn up at the end of the exam
  3. Not showing full face/sitting squarely throughout exam even after being informed by course director(s) and/or proctor(s)
  4. Wearing watches or utilizing other electronic devices (except to call in for any technical issues)
  5. Getting up during exam or moving away from the camera
  6. Writing complete questions onto scrap paper
  7. Continuing to not follow direction after being informed by course director(s) and/or proctor(s)
Faculty Related
Exam Timing

All internally-developed multiple choice exams will be timed on average at 90 seconds per question in alignment with the USMLE and NBME exam timing. Please see exam writing guidelines below. Exams in PrISM can be timed up to 120 seconds per question.

* Students with academic accommodations: The timing of exams will be adjusted in accordance with accommodations as approved by Disability Services.

Scoring Adjustments (for Internally-Developed Exams)

If faculty determine that questions on an internally-developed exam must be adjusted or removed after the exam has been administered (typically due to more than 1 correct answer or no correct answer), the exam will be re-scored against the remaining number of questions (e.g. If two questions are removed from a 30 question exam, the exam will be re-scored based on the total correct of the remaining 28 questions). Grading will then be based solely on the remaining valid questions.  Any changes in the exam scoring will be posted on Blackboard and will apply to all students. All courses should include this policy in their syllabi.

Exam-Writing Guidelines

All internally-developed multiple choice questions should be consistent with recommendations of the NBME. The NBME provides an Item Writing Manual, “Constructing Written Test Questions for the Basic and Clinical Sciences” via their website. The guidelines in this section were adopted by BUSM in March 2012 and updated in 2019 to meet current NBME recommendations.

Question Attributes

  • All faculty should create questions that average 60-65 words (ranging from approximately 10-140 words) to maintain consistency with USMLE type questions.
    • Short Vignette: approximately 50-60 words
    • Long Vignette: 75 or more words
  • Vignettes may be clinical or experimental, and followed by 1-4 questions
  • Include graphics, tables, images, or schematics when appropriate/relevant
  • Include one or more pieces of relevant information
  • May provide extraneous information
  • Cannot include false information

Question Types

  • The majority of questions should be 2nd or 3rd Recall type questions should be rare.
    • Identify or recall basic information (Bloom level 1)
    • Interpret information in the vignette (Bloom level 2)
    • Apply basic information to the scenario (Bloom level 3)

Response Attributes

  • Only one best answer
  • 4-10 response options
  • Short (1-15 words)
  • Lettered (A, B, C…)
  • In alphabetical or logical order
  • Distractors may be partially correct
  • Numeric values displayed consistently (e.g., A. 70%, B. 80% A. 70%, B. 80 percent)

Prohibited item types

  • Choose the worst answer (e.g. “All of the following are true EXCEPT”, “Which of the following is FALSE”)
  • Select multiple best answers (e.g. “Answer choices B & C are correct”, “All of the above”)
  • Questions that stress test-taking skills not represented on the USMLE (e.g. matching, ordering)

 Related Policies and References

Approved by the Medical Education Committee on November 9, 2017.
Revised by the Medical Education Committee on March 14, 2019, June 13, 2019, July 9, 2020, and August 13, 2020.