National Standardized Examinations

National Board of Medical Examiners (NBME) Subject Exams

NBME Subject Examinations are an important part of the educational process, evaluating the performance of a large, representative group of examinees at the same stage of training. These exams are used throughout the curriculum as one part of the evaluation process. Students are required to take NBME Subject Examinations at scheduled times and locations. Those students granted accommodations for testing must make sure that clerkship coordinators and Dr. Hairston are aware of their need for accommodation. It is required for students to email the clerkship director and clerkship coordinator with their DAS letter at the beginning of each clerkship.

Individual arrangements will be made for the student at each exam in accordance with the specified accommodations.

To prevent additional charges, exam orders must be placed at least 22 days prior to the testing date. Therefore, it is important for the Office of Medical Education and Student Affairs (OMESA) to know well in advance the number of students scheduled to test at every exam. Unapproved absences from NBME exams will result in the student being charged for any additional costs associated with rescheduling of the examination.

For NBME examinations, students MUST test during the exam time (and date) supported by the medical school. A published exam schedule is available through the OASIS calendar.

To ensure the security of NBME materials and compliance with testing regulations, all NBME subject exams must be administered by trained proctors in an NBME-approved testing site.

Arriving Late for an NBME Exam or Missing Examinations

It is considered part of professional behavior and the responsibility of the student to arrive on time for scheduled examinations with their Emory ID cards.

Emory designates a Chief Proctor for NBME exams. It is the responsibility of the Chief Proctor and their designees to assure that NBME exams are given in strict accordance with NBME policy. As per this policy, a student may be admitted to a testing room up to 30 minutes after the exam has started, provided the student's name is on the check-in roster and the Chief Proctor approves the late start. Students arriving late for an exam will be expected to end the exam at the same time as other examinees; no extra time will be allotted to compensate for their tardiness.

For any student who is more than 30 minutes late for the exam, the NBME must be contacted by the Chief Proctor to seek approval for taking the examination. The Chief Proctor and their designees are not required to allow any student to start an exam late if doing so will be excessively disruptive to the other students.

United States Medical Licensing Examinations (USMLE)

The USMLE is an examination series with three complementary steps, the first two of which are graduation requirements for Emory University School of Medicine, in addition to academic requirements outlined earlier. Students must successfully pass Step 1 and Step 2 Clinical Knowledge to graduate from Emory University School of Medicine.

USMLE Step 1

In addition to successful performance during the Foundations phase, students must also earn a passing score, as set by the USMLE, on Step 1 examination of the United States Medical Licensing Examination (USMLE) prior to beginning the Application phase of the Emory University School of Medicine curriculum.

The deadline for taking USMLE Step 1 is three weeks before the start of the Application phase. Prior to taking USMLE Step 1, all academic requirements of the Foundations phase, including any necessary remediation, must be completed. For students who do not meet these deadlines, the school cannot guarantee Application, Discovery and Translation schedules that will permit the student to graduate at the expected time. Any delay in taking USMLE Step 1 must be approved by the Associate Dean for Student Success. Delays will be considered for illness, personal and family emergencies, and if recommended by the Associate Dean for Student Success.

Students are offered an EUSOM Step 1 Guide, regular Step 1 workshops, EUSOM tutors, and 1:1 Step 1 planning sessions through the Center for Holistic Student Success. Any delays or failures will be discussed with the Associate Dean of Student Success and any further delays will be discussed with the Associate Dean of Student Affairs, Clinical Services specific to date choices and their impact on scheduling and graduation (see chart above for implications by date of exam).

Students who do not meet these deadlines for completion of academic requirements and for taking and passing USMLE Step 1 may be referred to the Progress and Promotions Committee for consideration of academic sanctions related to failure to progress. This includes consideration for dismissal from the MD program if a student has three unsuccessful attempts to pass Step 1.

The following guidelines have been adopted regarding failure to pass the first administration of Step 1 of the USMLE. A student whose overall academic record warrants promotion, but has failed Step 1, has two options to gain promotion into the clinical years:

Option A:

• Student re-takes the test at the next available administration in partnership with the Associate Dean of Student Success to discuss both narrative (well-being, life events) and paradigmatic variables (data driven readiness measures)
• Once the examination has been re-taken, the student may begin clinical work prior to receiving their score.
• If a passing score is achieved, the student will continue the Application phase
• If a passing score is not achieved, the student will cease Application phase course work and be allowed to retake the examination a 3rd time.
• Emory School of Medicine gives a limit of 3 attempts at Step 1 until the student is reviewed by Progress and Promotions for failure to progress and recommended for dismissal.
• A student may appeal to the Progress and Promotions Committee to ask for a 4th attempt at Step 1. The National Board of Medical Examiners allows only 4 attempts total for any student. After a fourth failed attempt, the student would be dismissed from medical school.

Option B:

grants a year's time during which the student is encouraged to obtain remedial help and engage in an intense review of the basic sciences, with retake of the examination by the deadline of the following year (3 weeks prior to the start of the Application phase). If the test is passed by that time, the student then enters the Application phase with the following class (see chart above with implications by test date).

Students will work with the Associate Dean of Student Success to decide on test readiness based on passing at least two practice NBME exams.

Students must delay taking Step 1 until they have passed two NBME practice exams (CBSSA, CBSE, or Free 120). UWorld has validity, but NBME is the measurement for test readiness.

An inability to pass a practice Step 1 exam, can be for many reasons, such as:

• Wellbeing
• Foundational knowledge gaps
• Test taking experience and confidence
• Question strategy
• Endurance
• Life Events
• Physical or mental health concerns
• Pressure of time

Any delay in taking Step 1 may have repercussions on the ability of a student to graduate in four years. For a student intending to graduate in four years, time taken in delayed entry to the clerkships (Application phase) must be made up later from the time allocated in the curriculum for Step 2 CK study and residency interviews. For students on-cycle, Step 2 CK study time is a 4-week period and residency interviews are also a 4-week period. For every delay, you will take away weeks from this 8-week period. Once the 8 weeks is gone, that means you graduate a year later to ensure enough time for all clerkships, electives, Discovery, and beyond.

Any student who delays Step 1 more than three months from the beginning of the Application phase will rejoin the class below them the following March, granted that the student has successfully passed Step 1 (See chart above on implications by test date).

Any student who delays taking Step 1 should have regular check-ins with Dr. Christen Hairston (Associate Dean for Student Success) and Dr. Stacy Higgins (Associate Dean for Student Affairs, Clinical Services) so that support and student schedules can be maximized. In addition, students need to meet with a representative from the Office of Financial Aid to understand the potential impact on their financial aid package.

USMLE Step 2 Clinical Knowledge (Ck)

Students are encouraged to take Step 2 CK as soon as feasible after the Application phase. At the latest however, students must take Step 2 CK by October 1st of their senior year. Students who plan on completing a dual degree are required to take Step 2 CK prior to leaving the MD program to begin their second degree. MD/PhD Students are expected to complete Step 2 as soon as possible following the completion of the Application phase. They must complete Step 2 before they begin laboratory rotations in preparation for PhD enrollment.

Passing Step 2 CK is a requirement for graduation. Students will have no more than 3 attempts to pass USMLE Step 2 CK. A student who has three unsuccessful attempts to pass Step 2 CK of the USMLE will be considered for dismissal from the MD program by the Progress and Promotions Committee.