Assessment System: NBME Subject Exam Remediations
Rationale
Learners at the Brody School of Medicine are assessed using NBME Subject Exams (commonly referred to as ‘Shelf Exams’) in both the foundational and clinical phases of the curriculum. The Executive Curriculum Committee has set the equated percent score threshold required to successfully pass a NBME Subject Exam at the 6th centile based on national yearly norms, and the 6th centile based on the quarter in which the exam is taken.
Other courses use the subject exams for formative and summative assessment as stipulated in the course syllabi. Any learner who fails an NBME subject exam is expected to retake that NBME subject exam in order to successfully remediate the relevant content. All Brody learners will be subject to the following process and parameters regarding NBME Subject Exam remediation attempts.
Scope
The Standard Operating Procedure outlines the requirements for remediation of NBME Subject Exams in both the foundational and clinical phases of the curriculum. The SOP establishes expectations to key stakeholders for required timeframes for remediating examinations, scheduling of remediation and consequences for failing to comply with these expectations.
This SOP affects learners, staff, faculty members, and course/clerkship directors of the Brody School of Medicine who administer or participate in the leadership and grading of courses and clerkships that administer NBME Subject Examinations.
Definitions
BSOM: Brody School of Medicine
CD: Course or Clerkship Director
Clinical Phase: The third and fourth academic year of the BSOM curriculum
ECC: Executive Curriculum Committee
Foundational Phase: The first and second academic year of the BSOM curriculum
NBME: National Board of Medical Examiners
OME: Office of Medical Education
Subject Exam: National exam developed by the NBME; commonly referred to as a “Shelf” or “Shelf Exam”
Testing Administrator: Office of Medical Education Staff member who is responsible for the proctoring and administration of all institutional and NBME Shelf Exams
Procedures for Implementation and Review
Minimum Passing Thresholds for NBME Subject Exams
The Executive Curriculum Committee (ECC) has set the minimum thresholds required to be considered a successful, passing attempt on a Subject Exam.
- Foundational Phase (applicable courses and Block 4): Learners must achieve a minimum equated percent score of 6th centile based on yearly norms.
- Clinical and Differentiation Phase: Learners must achieve a minimum equated percent score of 6th centile based on the designated quarter for the specific exam
- To provide uniformity the clerkship NBME Subject Exam score is converted to a percentile based on the specific quarter of the year in which the clerkship was taken
- A Learners’ quarter will be determined as follows:
- Clerkships taken in Cohort 1 and 2 are based on Quarter 1
- Clerkships taken in Cohort 3 are based on Quarter 2
- Clerkships taken in Cohort 4 and 5 are based on Quarter 3
- Clerkships taken in Cohort 6 are based on Quarter 4
- Off-cycle learners will comply with the grading scale based on the cohort number in which they completed the clerkship.
- Due to variances in national norms from year to year, the ECC will adjust the passing score such that an earlier cohort is not held to a higher standard than a later cohort. (i.e. the ECC will choose to set the passing score for quarter 3 at the 5th centile to avoid requiring a higher grade than quarter 4)
- For all remediation attempts the passing threshold will be the same as the original attempt.
Failure to Meet Minimum Thresholds
The ECC has established a standard remediation process for learners who had an unsuccessful attempt on an NBME Subject Exam.
- Foundational Phase: Learners who fail to reach an equated percentile score of the 6th centile based on national norms for an exam will comply with the following:
- The learner must remediate by re-taking the exam and achieving the minimum threshold required to pass.
- The impact on the grade will be delineated in the syllabi for the individual courses in Blocks 1-3.
- Learners in Block 4 must remediate exams prior to sitting for the USMLE Step 1 examination.
- In Block 4, achievement of the 6th centile nationally is required to pass the Systems Capstone Course. Learners who do not successfully pass the NBME exams after 3 attempts will be required to repeat Block 4.
- Clinical Phase: Learners who fail to reach an equated percentile score of the 6th centile based on the specific quarter for an exam will comply with the following:
- A learner who remediates an exam will be unable to achieve a letter grade of ‘A’ or ‘Honors’ in the clerkship, regardless of their final overall numeric grade. If their final score falls into the range of an ‘A’ or ‘Honors’, the CD will lower their final letter grade to a ‘B’ and their final numeric grade to the highest possible ‘B’.
Subsequent attempts beyond a first remediation attempt will not result in a further reduction of a letter grade beyond the reduction to a ‘B’.
- A learner will have no more than 3 total attempts (the original attempt and 2 remediation attempts) to achieve the minimum passing threshold. Learners who do not achieve this after three attempts will receive a failure of the clerkship and must retake the entire clerkship.
- There is no set timeline for remediating a failed shelf exam, however a learner cannot progress in the clinical curriculum with two unremediated shelf exam failures. Details described in Academic Achievement Policy.
- In the case of 2 concurrent failed shelf exams, a learner will have until the 2nd Friday after the end of the clerkship to remediate a failed shelf (in the event of an observed holiday, learners will have until the last business day of the second week to remediate) before it is considered ‘unremediated’.
- In the event a learner has not met all the requirements of the M3 year, including remediations, that learner cannot advance into an M4 elective or clinical rotation. They will instead be enrolled into 2 weeks of flex time to address any outstanding requirements.
- Any shelf exam remediations must be attempted by the second Friday of the flex time block. If the remediation is unsuccessful, and that learner has a 3rd attempt available for that shelf exam, they will be enrolled in another 2 week flex block and will be required to retake the shelf exam by the second Friday of the new flex block.
- A learner who remediates an exam will be unable to achieve a letter grade of ‘A’ or ‘Honors’ in the clerkship, regardless of their final overall numeric grade. If their final score falls into the range of an ‘A’ or ‘Honors’, the CD will lower their final letter grade to a ‘B’ and their final numeric grade to the highest possible ‘B’.
- Differentiation Phase: Learners must pass the Emergency Medicine NBME Subject exam with at least the 6th centile.
- Learners who fail the EM shelf exam have 8 weeks or until the first Friday of block 13A, whichever is sooner, to sit for their first retake (second take) of the exam.
- Learners requiring a second retake (third take) have until the second Friday of block 13A to do so.
Scheduling a Remediation NBME Subject Exam
- Learners who are required to remediate an exam are responsible for scheduling their remediation attempt through the NBME Remediation REDCap form: NBME Remediation Request Form.
A minimum of 48 hours (2 business days) notice is needed between scheduling a remediation date and the administration of the remediation attempt to accommodate the ordering of the NBME exam.
- Foundational Phase:
- Courses in Blocks 1-3 must be remediated during the summer and prior to the start of the upcoming M1 Orientation.
- Courses in Block 4 must be remediated prior to the last Thursday before the start of CFS and prior to sitting for USMLE Step 1. Failure to comply will result in remediation of Block 4.
- Clinical Phase: Learners must remediate their M3 exams before progressing to any clinical activities in the M4 year.
- Differentiation Phase: M4 exams must be remediated before graduation.
- Learners are strongly encouraged to remediate exams within 2 weeks of their initial attempt unless advised not to do so.
- Learners should communicate with their current Clerkship Director to ensure they are not scheduling their remediation exam date during a required experience.
- The learner must obtain approval for their desired remediation dates (2 options, M-F, 8AM-5PM) from their current clerkship director prior to completing the NBME Remediation REDCap form. This approval must be attached to the REDCap form.
- In the event the learner misses any clinical or didactic experiences for a remediation exam, the Clerkship Directors may require the learner to complete an alternative or additional clinical experience.
- Once the learner obtains approval from their current Clerkship Director, the learner will complete the NBME Remediation REDCap form.
- Remediation dates and times are based on testing room and proctor availability.
- The scheduled remediation is not confirmed until the learner has received testing logistics and confirmation from the testing administrator.
- Once a remediation date has been finalized the date may not be moved without an excused absence (see exception below).
Exception: once during any academic year, the learner may request to delay a remediation exam without seeking an excused absence as long as the request is communicated to the testing administrator. This request must be communicated to the testing administrator prior to the day of the scheduled remediation exam.
Responsibilities
There are several key stakeholders involved in the testing process. Listed below are each key stakeholder, along with their expected responsibilities and time frame for completion.
Testing Administrator
- Responsible for working with learners to schedule a remediation exam that follows the established timeframes in this SOP, and the currently approved testing schedule within OME
- Responsible for ensuring an exam is ordered and communicating logistics and confirmation to all vested parties regarding the scheduled remediation date
- Responsible for communicating with the learner regarding the need to remediate an exam.
Course/Clerkship Director
The clerkship director is responsible for meeting with the learner who must remediate an exam, to identify a remediation plan.
Medical Student (Learner)
- Responsible for completing the NBME Remediation REDCap form to schedule a date for a remediation attempt
- Learners must communicate with the current Course/Clerkship Director to ensure the scheduled remediation exam date does not conflict with educational sessions or clinical experiences. Documentation of the approval must be attached to the NBME Remediation REDCap form.
For Clerkships, it is the responsibility of the learner to work with the current Clerkship Director to make up any missed experiences.
- Learners must remediate any failed exam within the required timeframe listed below:
- Foundational Phase:
- Courses in Blocks 1-3 must be remediated during the summer and prior to the start of the upcoming M1 Orientation.
- Courses in Block 4 must be remediated by the deadline listed on the Block calendar and prior to sitting for Step 1. Failure to comply will result in referral to Promotion and Review.
- Clinical Phase:
- Learners should work with their current Clerkship Director to ensure they are not scheduling their remediation exam date during a required clinical experience.
Clerkship Directors may require the learner to complete an alternative or additional clinical experience in place of any clinical experiences missed by the learner to make up an exam.
- A learner cannot proceed in the clinical curriculum with two unremediated shelf exam failures.
- In the case of 2 concurrent shelf failures, a learner will have until the 2nd Friday after the end of the clerkship to remediate the failed shelf exam (in the event of an observed holiday, learners will have until the last business day of the second week to remediate) before it is considered ‘unremediated’.
- Learners should work with their current Clerkship Director to ensure they are not scheduling their remediation exam date during a required clinical experience.
- Differentiation Phase
- Learners who fail the EM shelf exam have 8 weeks or until the first Friday of block 13A, whichever is sooner, to sit for their first retake (second take) of the exam.
- Learners requiring a second retake (third take) have until the second Friday of block 13A to do so.
- Foundational Phase:
Schedule for Review
This procedure is reviewed and approved by the Curriculum Committees, including the Executive Curriculum Committee, Foundational Curriculum Committee, and Clinical Curriculum Committee every three years.
The NBME Subject Exam Remediation Policy is posted on the OME website to allow learners and teaching faculty/administration to reference at any time.
Related Polices
None
Applicable Laws, Regulations & Standards
LCME Standards for Accreditation of Medical Education Programs Leading to the MD Degree: Published March 2022; Standard 8, Element 2; Standard 8, Element 3; Standard 9, Element 4, and Standard 9, Element 8