1.0 Policy Purpose
The purpose of this policy is to establish the rules, requirements, and expected medical student conduct for examinations administered to students of The Warren Alpert Medical School of Brown University (“The Warren Alpert Medical School”), whether locally-designed or national licensing exams.
2.0 To Whom the Policy Applies
This policy applies to medical students in all phases of the medical education program, including those with or without exam accommodations, relevant faculty, and proctors.
3.0 Policy Statement
This policy applies to all examination types (e.g., written, Objective Structured Clinical Examination (OSCE), etc.) and includes remediation exams, makeup exams, exams taken with standard timing, and exams taken with approved accommodations. This policy does not apply to quizzes. The clerkship phase requirements herein apply to block and Longitudinal Integrated Clerkships.
3.1 Exam Administration
Examination questions and materials are the property of The Warren Alpert Medical School (or in the case of shelf exams, the National Board of Medical Examiners (NBME)). Faculty and staff are responsible for appropriately securing all questions and materials inside and outside of testing conditions to ensure exam integrity and quality.
Examinations may be administered in person or remotely. Students must arrive at the testing site, whether in-person or virtual, 20 minutes before each examination and must be in the examination room 10 minutes prior to the examination start time.
All students are expected to attend examinations at the scheduled time and stay until they finish the exam or the allotted time ends, whichever occurs first. Exam times cannot be adjusted, and students will not be allowed additional test time if they do not finish all items within their allotted time.
Trained proctors must be present during every examination, regardless of type, and exam review to monitor the exam experience and report any irregularities. Proctors may be graduate students, staff or faculty members who work on campus or in the clinical space, or temporary or contracted workers. Students must adhere to proctors’ instructions.
Food is permitted for pre-clerkship exams and must be kept in transparent packaging/container which will be inspected by proctors before the exam begins.
Exam questions will not be altered or interpreted by faculty, administration, or proctors during any examination.
Students must submit all unaltered scrap paper (e.g., not crumpled) or note boards to the proctor at the end of the examination.
See the Medical Student Handbook for the exam remediation process.
3.2 Prohibited Behaviors
Students, in any curriculum phase, must not engage in the following prohibited behaviors.
3.2.1 Unauthorized Access and Assistance
- Access or open the exam without authorization (including attempting to take an exam for another student or having someone take an exam for you).
- Access or use unauthorized resources (e.g., notes, books, electronics) during the exam.
- Give or receive assistance during the exam, including viewing or copying others' responses, discussing the exam with anyone, or helping another student cheat.
3.2.2 Unauthorized Retention and Transmission of Exam Content
- Obtain, retain, or transmit exam content in any manner (e.g., photos, notes, memory reconstruction) before, during, or after the exam or exam review period.
- Unauthorized retention of exam content includes, but is not limited to, publishing, reproducing, or communicating exam material or information to anyone, especially to students who have not yet taken the exam.
3.2.3 Disruptive Behavior; Procedural Violations
- Engage in disruptive behavior during examination time.
- Fail to submit all required testing materials (such as scrap paper or note boards) to the proctor.
Administrators of locally-designed exams shall determine which items are prohibited or permitted during examinations and may revise these determinations as necessary. A list of such items will be disseminated to students prior to the exam. Students are not permitted to enter the exam room with any prohibited items in their possession or on their person. Students who observe prohibited items or behavior by another student can report it to the proctor who will then notify the appropriate curriculum director to determine the appropriate course of action.
Refer to the respective pre-approved items lists for United States Medical Licensing Examinations (USMLE) licensing and NBME exams.
3.3 Breaks
The Warren Alpert Medical School follows a modified version of the NBME policy for shelf exams for bathroom breaks while ensuring security of the exam. The examination is still in progress during bathroom breaks, and students are not permitted to go anywhere else during the exam (e.g., smoke breaks) or check notes, smart devices, or talk to other students.
If a student requires additional breaks during an exam (e.g., lactation) they may reach out to a student support dean to discuss potential arrangements prior to administration of the exam.
Break times and frequency may be adjusted pursuant to an individual’s approved accommodations in accordance with Section 3.10.
3.4 Absences
3.4.1 Unexpected Absences
Students with unexpected absence due to an acute student support need or an unpredictable major life event must email the appropriate curriculum director or clerkship coordinator as soon as possible and inform them of the reason for missing the exam, especially if a student on clerkship rotations is able to meet the other clerkship requirements. Students must submit an Excused Absence form due to illness accompanied by a note from an in-person or telehealth visit to a health care provider who evaluated and managed the student’s health. Notes from a health services triage line are not acceptable.
3.4.2 Illness During Examination
Students who become ill during an examination shall immediately notify the proctor who will ask them to terminate the examination and seek medical attention. The proctor will notify the appropriate curriculum director. If illness during an exam is reported after exam submission, the exam will be considered complete and the retroactive report of illness will not negate a non-passing performance.
3.4.3 Extension and Makeup Examinations
For the above absences, a makeup examination may be permitted, but must be approved by the appropriate curriculum director. Makeup examinations will be scheduled as soon as practicable. Due to the logistical complexity of holding makeup OSCEs students must make every effort to attend scheduled OSCEs.
3.4.4 Unexcused Absences
An unexcused absence from a required examination will result in the issuance of a professionalism form. Repeated exam extension requests may result in a discussion regarding a student's ability to continue with the curriculum, or whether a formal leave of absence would be an appropriate course of action.
3.5 Emergencies
Emergency procedures are in place and contained on the protocol document or relayed to students prior to the examination. When prompted by the proctor, students must follow protocols to freeze their examination and evacuate the building, shelter in place, or other directions, if necessary. Since the exam is still in progress in an emergency, students may not talk about the exam, check notes, use electronic devices to access exam materials, etc. during the emergency; students may not turn on their exam device (e.g., laptop) until directed by the proctor.
3.6 Remote Examinations
Remote examinations are exams which are performed off campus, such as at home or in another space. Remote examinations are set at the discretion of the appropriate curriculum director and as administratively feasible. The Warren Alpert Medical School exam administrators will establish the requirements and protocol for remote exams. As with in-person exams, students are expected to be on time, present, and on camera until excused by the proctor.
3.7 NBME Shelf Exams
In addition to complying with this policy, students taking shelf examinations must also adhere to NBME’s Exam Rules & Conduct. Refer to admission day requirements for USMLE-administered exams. NBME policy and rules shall supersede this policy if there is a conflict regarding shelf exams only. For instance, although food is permitted during pre-clerkship exams, NBME regulations prohibit food during shelf exams, except for students with approved accommodations.
Students who are excused from their clinical rotation due to illness are not allowed to sit for a required exam on the date of their approved absence and must make up the exam on a different day. See Section 3.7.2.
The passing determination for an NBME subject shelf exam is based on the criteria used in the academic year the student completed the exam, regardless of when the clerkship rotation was completed. Passing criteria is defined as scoring at or above the equated percent correct score for the fifth percentile (5%), based on the most recently available academic year’s norms. Norms are derived from examinees of LCME-accredited medical schools who completed the exam for the first time during that year.
Students cannot progress to the post-clerkship phase unless and until all exams – including repeat and makeup shelf and OSCE – and all clerkship components are satisfactorily completed.
3.7.1 Unreadiness
Students are permitted a single shelf exam extension based on an NBME practice exam score that is below the minimum passing threshold the week of the scheduled exam . Requests to delay a shelf exam for reasons of unreadiness must be accompanied by the official practice exam report (e.g., PDF, screenshots) and sent in writing to the Associate Dean for Student Affairs and the Associate Dean for Medical Education who will mutually determine whether to approve extension requests in consultation with the Office of Academic Support. Shelf exam extensions must be requested no later than the Wednesday before the shelf exam and are granted on a case-by-case basis.
Repeated exam extension requests will result in a discussion with the Associate Dean for Student Affairs.
3.7.2 Shelf and OSCE Exam Makeups
Shelf makeup exams may only be completed during non-clerkship blocks (e.g., elective time) or at the end of the clerkship phase. Makeup shelf and OSCE exams are not offered during vacation weeks. Students must work with the Associate Dean for Student Affairs to determine an appropriate schedule.
OSCE makeup exams must be arranged with the clerkship coordinator.
Students will receive a grade of Incomplete (INC) or Existing Deficiency (ED) in the clerkship until they successfully pass the shelf exam or OSCE.
3.8 USMLE
Students who do not pass USMLE Step 1 or Step 2 CK on their first attempt must meet with a designated member of the medical school administration prior to being allowed to retake the exam.
3.8.1 Step 1
Students are expected to prepare for and take the USMLE Step 1 examination during the dedicated Step 1 study period following the completion of the pre-clerkship curriculum and prior to beginning the Clinical Skills Clerkship (CSC).
Successful completion of all pre-clerkship courses – including relevant coursework, examinations, and remediations – is a requirement for Step 1 eligibility. Students who are unable to fulfill the Step 1 requirement prior to the start of the CSC must meet with the Associate Dean for Student Affairs or Associate Dean for Medical Education to seek approval for delaying the exam; discuss their revised plans for completing the exam, which will include making suggested changes to their clinical rotation schedule; and will be referred for a consultation with the Office of Academic Support to discuss exam preparation, study skills, strategies, and address any additional concerns.
Criteria for approved Step 1 delays include:
- Academic: delay for academic reasons may include remediation exam impacting Step 1 dedicated period, or not meeting the minimum passing threshold on the final NBME practice exam one week prior to sitting for the scheduled exam date;
- Medical: delay for medical reasons may comprise of a health condition impacting a student’s ability to prepare for and sit for the exam (requires documentation from a treating provider);
- Familial: loss of a family member or an acute familial situation that adversely impacts a student’s ability to prepare for and sit for the exam may necessitate an exam delay; and
- Recommendation from a student’s Step 1 advising team to delay the exam until the conclusion of clerkship phase. Students must work with their Step 1 advising team accordingly.
Students who have been approved to delay the Step 1 examination must take and pass the exam no later than the first three months of the end of the clerkship phase (June 1st of post-clerkship phase). A student may request an extension beyond this three-month deadline, prior to its expiry, by writing to the Senior Associate Dean for Medical Education, who will approve or reject the request. If the student does not pass the exam by the approved deadline, the student will not be permitted to continue with post-clerkship phase rotations and must pursue time away from medical school until they have done so.
Students who pursue an Academic Scholarship Program (ASP) between clerkship and post-clerkship phases and have not completed their Step 1 licensing exam, must include a completion plan with their ASP application. Students are expected to complete all remediation exams during the first three months of their first ASP semester, and Step 1 within the first semester of their ASP. Students who are unable to fulfill these requirements within the stated deadlines must receive permission from the Senior Associate Dean for Medical Education to continue their ASP.
Students will be permitted to take the Step 1 examination no more than three times. Students who fail to pass the third attempt will be referred to the Medical Committee on Academic Standing and Professionalism (MCASP) for consideration of dismissal from The Warren Alpert Medical School. Depending on MCASP’s decision, the student can appeal the decision to the Dean of Medicine and Biological Sciences.
3.8.2 Step 2 CK
All medical students must take the USMLE Step 2 CK examination prior to November 1 of their post-clerkship phase. Passing Step 2 CK is a graduation requirement. Students will be permitted to take the examination no more than three times. Students who fail to pass the third attempt will be referred to the MCASP for consideration of dismissal from The Warren Alpert Medical School. Depending on MCASP’s decision, the student may appeal the decision to the Dean of Medicine and Biological Sciences.
3.9 Exam Tardiness
Tardiness for any examination after the official start of the exam is unacceptable. In such cases, a professionalism form will be issued, unless there is an extenuating circumstance communicated in advance to the appropriate curriculum director.
Students arriving 10 minutes past the official exam start time may not be permitted to sit for the exam. The proctor will instruct pre-clerkship students to discuss with the appropriate curriculum director to decide on next steps. A professionalism form will be issued, and the exam may be taken at the discretion of the appropriate curriculum director.
Tardy students who are approved to sit for the regularly-scheduled exam will not be granted additional time to complete the exam and will be required to terminate the exam at the regularly-scheduled time.
If a makeup exam is approved for tardiness, students must then work with the appropriate curriculum director on an exam makeup date.
NBME has its own established admission policy and protocols to which students are required to follow for shelf exams.
Refer to USMLE admission procedures for specific guidelines regarding test day.
3.10 Disability Accommodations
The Office of Academic Support oversees accommodations for disabilities at The Warren Alpert Medical School pursuant to the Americans with Disabilities Act (ADA) of 1990 as amended, and Section 504 of the Rehabilitation Act of 1973 (Section 504). The parameters described in this policy apply to students with exam accommodations for disabilities unless one of the approved accommodations provides an exception. The Office of Academic Support approves student accommodations for disabilities and any exceptions to this exam policy, and notifies proctors of the approved accommodations to ensure proper implementation.
Students with approved accommodations for a disability who take shelf examinations are allowed to have food during the examination due to extended examination time.
The proctor will notify the Office of Academic Support if any unauthorized resources/items are used during the examination, and the Office of Academic Support will consult with the appropriate curriculum director for next steps. The student may be asked to pause the examination until such determination is made.
If a student believes their accommodation(s) for a disability is not being properly implemented, the student should alert the proctor immediately to address the issue. The proctor will then inform the Office of Academic Support accordingly.
4.0 Definitions
For the purpose of this policy, the terms below have the following definitions:
- Academic Scholar Program (ASP):
-
A program for medical students in which they are excused from attending classes to participate in an approved research activity or other scholarly endeavor under Brown faculty supervision for a designated period of no less than one semester and no more than two years.
- Clinical Skills Clerkship (CSC):
-
The Clinical Skills Clerkship is a two-week intensive transitional clerkship occurring between the pre-clerkship and clerkship phases, focusing on introducing each clerkship and its related skills.
- Excused Absence:
-
An absence that may be excused for an acute student support need, health condition, or major life event.
- Existing Deficiency (ED):
-
Temporary grade notation that indicates the student has performed below the expected standard of performance in one component of the course (such as a shelf exam or OSCE), but the overall performance was deemed satisfactory.
- Incomplete (INC):
-
Grade notation that indicates the student was unable to complete all of the required course work, clerkship, or other rotation requirements due to circumstances beyond their control (e.g., illness or a family emergency).
- Longitudinal Integrated Clerkship (LIC):
-
During the clerkship phase of the curriculum, students who are enrolled in the PC-PM program are enrolled in the LIC which integrates the core clerkships (Family Medicine, Obstetrics/Gynecology, Pediatrics, Surgery, Internal Medicine, and Clinical Neurosciences) throughout the year-long clerkship.
- Medical Committee on Academic Standing and Professionalism (MCASP):
-
Committee that is charged with the responsibility of reviewing the academic performance and professional behavior of all students in the medical school, and determines, with the input of others, student promotion and standing.
- National Board of Medical Examiners (NBME):
-
An organization that specializes in creating and offering assessment and learning tools for every stage of the medical school journey.
- Objective Structured Clinical Examination (OSCE):
-
A method of assessing medical students’ clinical competence with particular emphasis on clinical skills (such as conducting physical exam and history).
- Shelf examination:
-
Exams offered on a particular subject (e.g., basic science) that covers content which measures learning and knowledge across different disciplines and phases of undergraduate medical school.
- Step:
-
Three separate examinations that make up the USMLE.
- Step 1:
-
Assesses knowledge on basic practice of medicine.
- Step 2 CK:
-
Assesses examinee’s ability to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision.
- United States Medical Licensing Examinations (USMLE):
-
Licensing board that administers three separate examinations (referred to ‘step’) that allopathic medical graduates must pass to be eligible for licensure and practice medicine in the United States. Such examinations are part of a physician's pathway to licensure.
5.0 Responsibilities
All individuals to whom this policy applies are responsible for becoming familiar with and following this policy. University supervisors and employees with student oversight duties are responsible for promoting the understanding of this policy and for taking appropriate steps to help ensure and enforce compliance with it.
Office of Medical Education (OME): Will ensure Excused Absence forms are processed and approved. Through the appropriate curriculum director and/or clerkship director, OME will ensure exam extensions, repeats, delays, and makeups are rescheduled pursuant to this policy.
Office of Student Affairs: Will ensure students receive support and guidance for Step 1 advising. Through the appropriate curriculum director and/or clerkship director, Office of Student Affairs will ensure exam extensions, repeats, delays, and makeups are rescheduled pursuant to this policy.
Office of Academic Support: Will ensure students receive the tools and support necessary to successfully prepare for and sit for examinations.
6.0 Consequences for Violating this Policy
Failure to comply with this and related policies is subject to disciplinary action, up to and including suspension without pay, or termination of employment or association with the University, in accordance with applicable (e.g., staff, faculty, student) disciplinary procedures, or for non-employees may result in the suspension or revocation of the user’s relationship with Brown University.
Students who violate this policy may be subject to disciplinary action and/or adverse academic action, which may include, but is not limited to, issuance of a professionalism form, suspension, expulsion, referral to the MCASP, and/or referral to the Brown University Office of Student Conduct and Community Standards pursuant to the Code of Student Conduct.
7.0 Related Information
Brown University is a community in which individuals are encouraged to share concerns with University leadership. Additionally, Brown’s Anonymous Reporting Hotline allows anonymous and confidential reporting on matters of concern online or by phone (877-318-9184).
The following information complements and supplements this document. The information is intended to help explain this policy and is not an all-inclusive list of policies, procedures, laws and requirements.
7.1 Related Policies
7.2 Related Procedures
7.3 Related Forms
- Excused Absence form (via the respective class Canvas page)
7.4 Frequently Asked Questions:
N/A
Policy Owner and Contact(s)
Policy Owner: Dean of Medicine and Biological Sciences
Policy Approved by: Provost
Contact Information:
Policy History
Policy Issue Date:
Policy Effective Date:
Policy Update/Review Summary:
Revised language to incorporate additional requirements, related policies, enhance clarity, and comply with University requirements.
Previous policy version(s) superseded by this policy:
- Policies Regarding Student Selection/Progress and Their Dissemination (in part) (former Medical School Policy No. 10-03), Effective Date: June 23, 2021.
- Passing Determination of NBME Shelf Exam (former Medical School Policy No. 13-07), Effective Date: February 17, 2021.
- Exam Tardiness (former Medical School Policy No. 13-09), Effective Date: June 23, 2021.