The American medical system puts its entrants through rigorous testing before they can become licensed to practice. While this vetting process is generally a positive thing, the National Board of Medical Examiners (NBME) does not always account for an applicant's unique personal circumstances.
The NBME and other gatekeepers often rely heavily on blanket policies and practices. If you have an issue with a shelf exam or other aspects of your medical education, you may benefit from someone who cares about your circumstances—not catch-all policies. An attorney-advisor will provide the personalized representation that you deserve.
Joseph D. Lento and the Lento Law Firm will determine the exact issue you're facing, then embark on a path to resolve that issue. Our team is familiar with shelf exams and the NBME more generally. We've helped other hopeful medical professionals move past apparent roadblocks in their medical career paths. We'll work diligently to move you to the next step in your own medical career.
Shelf Exams Are an Unavoidable Stepping Stone for Most Medical Students
If you're pursuing a career in medicine, then shelf exams are generally unavoidable. Yet, many medical students fail to achieve a passing score on these exams. If you've had issues with your shelf exam, then you're not alone.
The more information you have about shelf exams and the body that administers those exams, the more empowered you may be to find a resolution to your struggles.
What Is the National Board of Medical Examiners (NBME)?
The National Board of Medical Examiners is an organization that offers medical assessments and other services to medical programs and other health organizations.
The NBME has a large presence in medicine, as it writes the United States Medical Licensing Examination (USMLE). Aspiring medical professionals must complete this three-step exam before they can receive their medical license.
The NBME's influence extends to medical students. The NBME writes subject-specific shelf examinations using questions that have been retired from the USMLE. Medical programs purchase shelf examinations from NBME and then administer them to students through web-based platforms.
All medical students should become familiar with the NBME and its examinations, as this board looms large in the American medical framework.
What Are Shelf Examinations?
Shelf examinations are academic-style tests that medical students generally complete during their clinical clerkships. Shelf examinations are:
- Standardized
- Tailored specifically to one's field of medical study
- Internet-based
- Subject-based
Shelf exams relate to one of seven clerkships that a student may take:
- Internal medicine
- Family medicine
- Pediatrics
- Obstetrics and gynecology
- Surgery
- Neurology
- Psychiatry
Medical students must generally complete their required shelf exams on the last day of their clinical rotation in the third year of medical school. You will generally have to answer 110 questions within 165 minutes.
Medical programs may generally structure the shelf exam as part of a student's overall evaluation. The shelf exam generally counts for a large percentage of the clerkship grade, meaning that one cannot typically advance to residency if they don't pass their shelf exams.
What Is the Purpose of Shelf Examinations?
Like most examinations, shelf examinations are intended to test a medical student's knowledge in their chosen field. Even more so than other collegiate exams, shelf exams are high-stakes—should the exam-taker pass the test, they'll move a step closer to caring for real-life patients. Should they fail a shelf exam, a student may find their medical ambitions compromised.
Medical programs rely on shelf exams for multiple reasons. To the administrators of such medical programs, a shelf exam may:
- Serve as a standardized method for assessing all students
- Help determine how well a student is absorbing experiences in the field and in the classroom
- Identify a medical student's areas of weakness
- Affirm that a student is prepared, or unprepared, to advance further in their medical education and training
However, a medical program views a shelf exam's purpose; these tests are established stepping stones in the American medical hierarchy. For the vast majority of medical students, passing shelf exams is a difficult but necessary hurdle.
How Do Medical Students Prepare for Shelf Exams?
Medical students may prepare for their shelf exams in a number of ways. Preparation may include:
- Researching the study habits of current medical professionals who successfully completed their shelf exams
- Speaking personally with those who have successfully completed shelf exams—especially the specific shelf exam you will be completing
- Using flashcards to familiarize yourself with exam-related concepts and terminology
- Hiring a tutor experienced in your specific shelf exam
- Completing practice tests
- Creating a detailed study schedule
- Reviewing USMLE material, as shelf exams and the USMLE may be similar in style and substance
Every medical student has unique learning styles and preferences. Take any steps that you believe will improve your performance on your shelf exams.
Even with dogged preparation, though, many medical students struggle with their shelf exams.
What Types of Questions Do Shelf Exams Pose?
Shelf exams generally pose hypothetical clinical scenarios to the examinee, requiring them to think critically and provide the most accurate answer. The clinical scenarios that the examinee may or may not be scenarios that they've encountered during their clerkship.
How Is a Shelf Exam Graded?
Though shelf exams are generally graded based on a national average, different medical programs have their own baseline for a passing score.
Schools generally assess shelf examinees not based on a specific number of points but on the percentile within which their score falls. Depending on the specific shelf exam and school, qualifying percentiles can range from the 4th to the 22nd percentile, with several schools generally pegging the 11th percentile or better as passing score.
When Do You Learn Whether You've Passed Your Shelf Exam?
The time it takes for you to receive your shelf exam score depends on your medical program's procedures. The turnaround time for shelf exam scores could range anywhere from one week to more than a month.
You may speak with knowledgeable parties in your medical program to determine when you can expect your shelf exam scores.
What Issues Can Aspiring Doctors Have with Shelf Exams?
Many realities make shelf examinations difficult. Potential challenges to success on a shelf exam include:
Time and Load Management
The timing of shelf exams means that you'll be actively engaged in your clinicals at the time that you must prepare for your shelf exams. While this sort of multitasking is par for the course for medical professionals, it is a challenging reality nonetheless.
Carving out the time necessary to prepare for a shelf exam is difficult and may become even more difficult if you:
- Are dealing with physical, psychological, or emotional problems
- Are experiencing difficult personal circumstances, such as the loss of a family member or relationship problems
- Are working to support yourself during medical school
- Have any other personal circumstances that strain your time or personal wellbeing
Even without any extenuating circumstances, a shelf exam is no layup. These are unforgiving tests that medical students may fail multiple times.
Technical Difficulties
Harvard University literature notes that simply completing a shelf exam involves a series of tech-related steps and requirements. Students who complete NBME exams at Harvard must:
- Ensure that their computer passes certification (which generally requires a meeting with the university's IT department)
- Quit applications, restart their computer, and ensure that no applications automatically restart when the computer reloads
- Disable firewalls and Bluetooth
- Enable certain browser software and connect to a private Wi-Fi network
Exam takers must also ensure that their laptop is powered up throughout the test. The point of listing these steps is this: Taking a shelf exam online—as you must—is not as straightforward as it may seem. Between a medical program's efforts to prevent cheating and ensure privacy and security, much can go wrong technologically. Such issues may include:
- Being locked out of the exam software because your computer does not fit certain criteria
- Mid-exam interruptions related to software updates, changes in Wi-Fi connectivity, and other tech-related problems
- Inability to certify or install software on a computer that is old or otherwise incompatible
- Battery or power supply-related issues
Technical issues may prevent you from taking your test, may interrupt your exam, and may ultimately result in an incomplete or low score. There may be ways to appeal for a re-testing or other resolution following technical problems.
Medical or Psychological Issues
If you have any physical or cognitive disabilities or psychological conditions, then you may face additional challenges when taking a shelf exam. Conditions that may interfere with a shelf exam include:
- Attention deficit hyperactivity disorder (ADHD)
- Dyslexia
- Panic attacks
- Conditions that cause abnormal noise sensitivity
- Any other condition that could make it more difficult to complete an academic examination
As literature from the University of Michigan Medical School explains, certain shelf examinees may be entitled to special accommodations, including:
- Extended testing time: Depending on the nature of one's disability, a shelf examinee may be afforded additional time equivalent to 25%, 50%, 75%, or 100% of the original testing period.
- Additional or extra break periods: If you are afforded additional breaks, then you may receive psychological benefits that improve your odds of success. When seeking accommodations, you may request a specific amount of time for breaks and a specific number of breaks.
- Taking your shelf exam over multiple days: You may be permitted to take your shelf exam over multiple days rather than in one sitting.
- Taking your shelf exam in a quiet, private environment: Quiet testing conditions should be a given, but you may take additional steps to ensure a private testing environment.
You may be entitled to other accommodations, including those reserved for students who are deaf or hard of hearing.
Miscellaneous Issues
Other issues that could interfere with your performance on a shelf exam include:
- Issues with your glasses or contacts
- Environmental distractions, like fire alarms or nearby construction
- Human-caused distractions, like noisy conversations or nearby activity
Much can go wrong before or during your shelf exam. When unanticipated challenges arise, then your score may suffer. However, failing a shelf exam is not the end of the road for your medical career. You generally have multiple opportunities to complete your required shelf exams successfully.
How Many Times Can You Take a Shelf Exam?
The number of opportunities you have to pass a shelf exam may vary by school. At the University of Missouri-Kansas City School of Medicine, a medical student has two opportunities to pass a shelf exam before they must re-enroll in their clerkship.
It is critical that you understand your medical school's shelf exam allowances. This is the only policy that matters to you. An attorney-advisor will quickly determine how many testing opportunities you're afforded and whether there is a way to secure any additional opportunities for you.
Consequences of Failing to Pass a Shelf Exam
There are negative consequences any time you perform below expectations in medical school. The consequences of failing a shelf exam may harm you in both the short- and long-term.
Consequences if You Fail to Pass a Shelf Exam Once:
The first time you underperform on a shelf exam, you may:
- Lose out on Honors from your medical school: Johns Hopkins Medicine explains that an Honors distinction is contingent on your shelf exam score.
- Receive a grade of “Unsatisfactory” or an equivalent mark: You will likely need to rectify this grade before you can advance further in your medical studies or training.
- Have to remediate the shelf exam: Remediation is another way of saying “retake.” Remediating an aspect of your medical education, including a shelf exam, may delay your graduation and impose additional expenses.
- Experience psychological harm: Performing poorly on a shelf exam may have significant psychological ramifications. You may experience feelings of defeat, inadequacy, or even despair. While you will likely regroup and turn your eye towards the next shelf exam attempt, you must account for the psychological consequences of failing a shelf exam.
Every medical school student is different. You may experience additional types of harm because of a less-than-adequate shelf exam performance.
If you fail a shelf exam more than once, then the consequence may become increasingly serious.
Consequences if You Repeatedly Fail to Pass a Shelf Exam:
Should you fail a shelf exam more than once (and especially if you fail the exam more than twice), then you may:
- Eventually face dismissal from your medical school: At the Icahn School of Medicine at Mount Sinai (ISMMS), students who fail a shelf exam more than twice will fail their clerkship and must meet with the school's Promotions Committee. If the student fails the shelf exam again (either one more time or multiple more times), then dismissal may be the resulting consequence. Shelf exam-related dismissal policies can vary between different medical programs.
- Become a far less attractive candidate for residency and jobs: The negative effects of a failed shelf exam can compound. As you fail each time, you may delay your graduation further and add more gaps within your transcripts. You'll need to explain these delays and gaps to residency admissions boards and prospective employers. Even if you rebound admirably from failed shelf exams, blemishes on your record can be detrimental to your residency and job prospects.
- Lose earning power and career fulfillment: Having as many employment options as possible is always a professional benefit. With more employers vying for your services, you have greater power to pursue a fulfilling, well-paying career in medicine. Should shelf exam issues diminish you as a professional prospect, you'll likely have fewer jobs to choose from.
Though it's difficult to project the future, the effect of a failed shelf exam on your quality of life is not a positive one. If you've already failed a shelf exam, then you may have the option to appeal based on extenuating circumstances. For some medical students, the more realistic goal may be to avoid dismissal, remediation, and other possible consequences stemming from a failed shelf exam.
Whatever your current circumstances are, speaking with an experienced attorney-advisor may benefit you.
How Can an Attorney-Advisor Help With Non-Misconduct Shelf Exam Issues?
All is not lost if you've failed one or more shelf exams. While you would have preferred to pass these exams, your focus now should be on mitigating any further harm. An experienced attorney-advisor can help you get back on track towards your goals in medicine.
Attorney-advisor Joseph D. Lento can serve you by:
Helping You Apply for Disability-Related Accommodations
Testing accommodations are meant to be taken advantage of. If you're entitled to accommodations or simply believe that you might be entitled to accommodations, then we'll contact your medical program about getting the testing conditions you deserve.
You should never let pride or general hesitancy stand in the way of accommodations. If you can get special accommodations, you should. This is especially true if you've already failed a shelf exam one or more times. You can't afford not totake advantage of special accommodations.
Helping You Appeal a Shelf Exam Score
It is not always possible to appeal a shelf exam score. Literature from Tulane University School of Medicine, for example, states that “Your shelf exam is a national exam written by the NBME and your score is final.” In many cases, your best bet may be to plan for success on subsequent shelf exam attempts, whether that is by securing accommodations or through other means.
Still, it may be worthwhile to explore appeal and appeal-like steps related to a shelf exam. An attorney will determine whether you have grounds for, and the ability to, appeal a shelf exam result.
Helping You Earn Extra Attempts to Take a Shelf Exam
Policies on shelf exam allowances are generally native to each medical program. If you are seeking additional attempts for a shelf exam, then lobbying your school may be most appropriate.
Your attorney may address your school about:
- Securing one or more additional shelf exam attempts, whether you're facing re-enrollment, remediation, dismissal, or other consequences
- Removing a failed shelf exam from your record
- Taking any other appropriate actions related to past or future shelf exams
Shelf exams are a particularly tricky issue, as a third party—the NBME—issues and grades the exam. Because of the ramifications of shelf exam scores, though, it is worthwhile to have your attorney pursue all possible resolutions.
Appealing a Dismissal Related to Your Shelf Exams
If you're facing dismissal because of repeated shelf exam issues, then you may be entitled to a hearing, appeal, and other features of due process. Dismissal causes permanent harm to your reputation, and it's essential that you fight it by all available means.
Defending Your Rights
Much of an attorney-advisor's role is defending a client's rights. Whether it is ensuring that you receive due process, protecting you from making harmful statements, or dealing with your university as your proxy, our team will defend you throughout our time as your advisors.
Who Should Hire an Attorney-Advisor for a Shelf Exam Issue?
Anyone dealing with a shelf exam issue may benefit from having an attorney-advisor. An advisor's role may be different for each student. At the very least, an attorney-advisor can give you advice on your current circumstances. In more substantial roles, an attorney-advisor may secure a tangible resolution and help you progress in your medical career.
Reasons to Choose the Lento Law Firm to Assist You
Our team deals with various Offices of General Counsel (OGC) for medical programs. Rather than resorting immediately to litigation, we work with medical programs. Offices of General Counsel generally have the power to resolve student-related issues and may offer you a settlement that you are pleased with.
Every move matters when it comes to your medical education and career. The Lento Law Firm has helped countless medical students, and we specialize in medical school issues. Let our tenacious, compassionate team work for you. Call the Lento Law Firm today at 888.535.3686 for a no-obligation consultation. You may also contact us online about your shelf exam issue.
We also specialize in misconduct-related shelf exam issues. If you face allegations of misconduct revolving around a shelf exam, contact our team as soon as possible.
