Shelf Exam Issues for Medical Students

Students attending medical school in the United States are required to take several standardized tests before they can even hope to receive their medical license. These exams are challenging and intense, even for seasoned medical professionals. The intention is to help weed out students who might be better suited to a different profession outside of medicine or a different specialty within it.

When you are applying to medical school, you understand how difficult your experience there will be. There is so little time and so much to learn, and because of this, you might be tempted to find an easier route. But if a medical student is even suspected of cheating, there will be lifelong consequences, including potentially being banned from medical school altogether.

If you or someone you love has been accused of compromising the validity of an examination, the USMLE and NBME will launch a thorough investigation. At the Lento Law Firm, Attorney Joseph D. Lento has years of experience helping students navigate these complex matters. You've worked so hard and spent so much money to get into medical school, you want to make sure your future is protected. Call the Lento Law Firm today.

What is a Shelf Exam?

Most medical students begin rotations in their third year of medical school. Depending on whether your rotation is a core or an elective, it will take between 4-12 weeks to complete. At the end of each rotation, you will be evaluated by clinical instructors and required to take a shelf exam.

The shelf exam is officially licensed by the National Board of Medical Examiners (NBME) and will cover that particular subject. So, if you are finishing an internal medicine rotation, that's what your shelf exam will cover.

While you don't need a shelf exam to gain your medical license, shelf exam scores do become part of your United States Medical Licensing Exam (USMLE) record and are used to calculate your final grade in the rotation. Every medical school is different, but your final grade could potentially be composed of 60% clinical performance and 40% shelf exam score, making them an important part of your medical school career.

Shelf Exam Rules

A shelf exam is made up of 110 multiple choice questions that are presented as hypothetical clinical scenarios. You will have 165 minutes to complete the exam. Shelf exams are old USMLE Step 1 and Step 2 questions that have been retired. As such, they require critical thinking, and the exam won't be about just eliminating all the wrong answers.

These shelf exams are intense and difficult. They cover a broad range of medical information you may or may not have come in contact with during your rotation. You will have to figure out how to balance a 12-hour clinical shift with studying for the shelf exam.

The passing score for a shelf exam will depend on your individual school, but the NBME does lay out specific percentile requirements for the following core rotations:

  • Internal medicine: 11th percentile to pass
  • Medicine: 11th percentile to pass
  • OB/GYN: 22nd percentile to pass
  • Pediatrics: 11th percentile to pass
  • Neurology: 11th percentile to pass
  • Family medicine: 4th percentile to pass

Grades for shelf exams can take about two weeks to receive, while the grades for your rotation overall will take about 4-6 weeks. This means you will be well into your next rotation before you find out if you've passed the rotation prior, making it all the more difficult to study and ace the prior subject.

Shelf Exam Issues

If you do not pass a shelf exam, how detrimental it is to your medical school career will depend on how much it adds to your final rotation grade. Some medical schools allow students to retake their shelf exams.

If you are allowed to retake the exam, you'll want to do so within 90 days of the original exam, as this is new score may be able to expunge your original score. Additionally, if you are unable to take the shelf exam a second time or fail it the second time, many schools with give you an F in the rotation and require you to redo the entire rotation before allowing you to retake the shelf exam. Check with your specific school to see their policy on retaking the shelf exam.

Consequences for Not Passing

The consequences for not passing a shelf exam can be life-altering. For instance, many schools will hold you back from graduating if your shelf exam score would negatively (and detrimentally) affect your overall rotation grade. If you are unable to retake the rotation or fail it a second time, you may be removed from the program altogether.

Most medical schools expect their students to graduate within six years, and that's only if you have a significant issue – like a death in the family or an illness – that affects your ability to continue. Each consideration for extra time would be reliant on the specific issue in question.

For students that fail a rotation and must make it up, if given a chance, this will push back your graduation date. Moreover, if you are forced to study for a shelf exam while simultaneously participating in another specialty rotation and studying for that rotation's shelf exam, it will become increasingly more difficult to pass both at once.

Unfortunately, medical students, like many graduate students, take out considerable student loans each year so they can focus on their studies. If you are required to leave medical school early, you will still have these loans to repay – which will be a lot harder without a doctor's income.

What Happens if You are Accused of Cheating on a Shelf Exam?

Because the shelf exams have so much riding on their passage, some students may be tempted to cheat, while others may be wrongfully accused of cheating – especially if they failed the first time and scored considerably higher the second time.

The NBME and USMLE make and monitor the standardized tests that physicians have to take while in medical school, during their internships, residencies, and throughout their medical careers. If either board notices “irregular behavior” on the exam, they will begin an investigation into the matter.

Irregular behavior is defined as any action that:

  • Violates the integrity of the exam
  • Attempts to gain an unfair advantage over other students
  • Violates the security of the test

If these misconduct violations are proven true, it could mean being expelled from medical school, being prevented from applying to the matching program for your internship or residency post-graduation or result in not receiving your medical degree at all.

Notice and a Chance to Respond

Before any of these negative consequences can come to fruition, your medical school, or the board overseeing the exam, will contact you with a letter stating that they believe irregular behaviors were present during your exam. They will give you an opportunity to defend yourself against the allegation and attend a hearing.

During the hearing, evidence may be submitted to the student, including their own testimony. The student will also be afforded the chance to present their own evidence and witness testimony. Students are allowed to have legal representation during these hearings. What happens after these hearings will depend on the case you present. They could result in your scores being validated or in your official ban from the medical profession.

Medical School Misconduct Hearings

The process for misconduct hearings will be different depending on the medical school you attend. But most tend to start with an investigation and end with a hearing. In certain circumstances, your medical school may have an informal resolution process.

Informal resolution processes are like mediation or alternative dispute resolution proceedings. The student will meet with their faculty advisor and/or the clinical instructor in charge of the specialty in question. You will be reminded of the allegations and then given a chance to explain yourself. If you take responsibility for the incident, the punishment may be less severe – like having to retake the rotation and shelf exam under stricter scrutiny. If you do not take responsibility, the issue will be moved back to the more formal hearing process.

Possible Punishments

In some instances, the hearing process may result in specific remedies for the student to make amends. These remedies will change depending on your school but may include:

  • Repeating the school year
  • Retaking a failed course at another medical school
  • The creation of an individualized special placement program

While remedies such as these can increase student debt and pressure to graduate within the state time limits, they can also act as salvation for students who would otherwise be facing dismissal.

Another possible punishment is expulsion. Dismissal from medical school is a horrifying prospect. Students who are dismissed will face difficulties re-enrolling in another medical school, and if they are allowed to re-enroll, they will have lost their academic progress, forcing them to start from year one.

Appeals Process

Fortunately, most every medical school in the country will provide for some type of appeals process once the hearing is completed. The notification of the hearing committee's determination will usually explain how you can appeal the decision.

These appeals are overseen by appeals committees comprised of individuals who were not involved in the original hearing deliberation. The idea is to prevent bias from taking over. At some schools, the appeals committee will only make a decision based on the hearing record and will not review any new information. But at other schools, you will be allowed to provide evidence and information not previously considered, as well as reference letters from faculty, staff, and other students.

For medical students, the appeals process may be your last chance to save your medical career dreams.

How a Medical Student Defense Attorney Can Help

You've spent so much time and money in striving for your medical license, it's scary to potentially lose it all because of a misconduct accusation. And unfortunately, many medical schools will only be worrying about their own reputations. For instance, they may fear that “going easy” on you may result in other students attempting to cheat. As a result, your due process rights could be neglected.

But don't worry, there are several things you can do to make sure your career is protected. Working with an experienced attorney will guarantee you the best possible outcome. Attorney Joseph D. Lento has the skill and unmatched prowess to create a strategic defense on your behalf. He and his team will work with you to understand the allegations, inform you of what's really at stake, and gather evidence and witnesses who will attest to the situation on your behalf.

Medical school accusations are complex at best, and with so much riding on the line, hiring an attorney is the only choice. Call Lento Law Firm today at 888-535-3686 today. We are here to help.

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If you, or your student, are facing any kind of disciplinary action, or other negative academic sanction, and are having feelings of uncertainty and anxiety for what the future may hold, contact the Lento Law Firm today, and let us help secure your academic career.

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