Medical Student Exam Policy

Medical Student Exam Policy

Policy Statement

To specify the expectations and requirements for student examinations at Chobanian & Avedisian 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

During the preclerkship phase, in person exams will be administered in the L-11 testing center. See the L-11 Testing Center Policy for Policies and Procedures specific to this space.

During the clerkship phase, NBME exams will be administered remotely. Students are expected to adhere to NBME’s Exam Rules and Conduct in addition to the Remote Exam Policy guidelines outlined below.

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, course director(s), and the Associate Dean of Medical Education as listed in the syllabus policies.  All students must submit a written explanation for missing the exam to both the course director(s) and the Associate Dean of Medical Education. Students should arrange directly with the Associate Dean of Medical Education 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 student must meet with the Associate Dean of Medical Education. Student Affairs will be notified if student is in need of additional support.

  • Exams may not 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 of need for all early, late, delayed, or missed exams via email. Supporting documentation may be requested by the Associate Dean of Medical Education on rare occasions.
  • 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

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.

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 the Associate Dean of Medical Education for discussion.

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

Concerning behavior during any exam would include:

  1. Writing on scrap paper before officially beginning an exam.
  2. Not returning scrap paper at the end of an exam
  3. Wearing watches or utilizing any electronic devices (except to call in for any technical issues)
  4. Writing complete questions onto scrap paper
  5. Continuing to not follow directions after being informed by course director(s) and/or proctor(s)

Concerning behavior during a remote exam 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 in view of the camera 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. Getting up during exam or moving away from the camera
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 PISCEs 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 and Access 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 Chobanian & Avedisian SOM in March 2012 and periodically updated 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
  • Characteristics of a patient such as age, sex, gender identity, disability, socioeconomic status, native language, country of origin, and/or occupation should be mentioned within case vignettes in test items when they are important inputs into the diagnostic reasoning process.

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 Mar 14, 2019, Jun 13, 2019, Jul 9, 2020, Aug 13, 2020, and Aug 11, 2022.