Medical Student Clerkship Exam Failure

Policy Manual

  • Effective Date: 05/05/2007
  • Last Revised: 11/10/2021


All medical students enrolled in clinical clerkships at the University of Nevada, Reno School of Medicine (UNR Med).


Students in the UNR Med Medical Degree (MD) Program, UNR Med faculty (including community faculty), and staff.


The University of Nevada, Reno School of Medicine uses the National Board of Medical Examiners (NBME) Medical Subject Exams for assessment throughout the clerkships. The exams are designed to be effective evaluation tools and provide useful examinee performance data. This policy established guidelines for clerkship exams including procedures in the event that a student fails an NBME Subject Exam.


  1. All medical students must take and pass exams required for each clerkship, including NBME Subject Exams, other written exams and/or oral exams.
  2. Any student who fails any clerkship exam on the first attempt will receive a grade of "Incomplete" until they have passed the exam.
  3. If the failed exam is not an NBME Subject Exam, the remediation process is at the discretion of the clerkship director.
  4. The following items relate to a failure on the first attempt of the NBME Subject Exam: 

a. A repeat exam must be taken before the next semester begins.

b. The student, clerkship director, Office of Medical Education and the director(s) of any other affected clerkship will determine an appropriate date for the retake. The final decision for the retake exam rests with the clerkship director and is subject to staff availability. Clerkship coordinators will coordinate scheduling of the exam in consultation with the clerkship director.

c. Once the date of the retake exam has been finalized, any request by the student to reschedule the exam must be made, in writing, to that clerkship director and associate dean for medical education no fewer than 14 calendar days prior to the scheduled retake. Approval of the request is at the descretion of the clerkship director. 

d. Students should initiate a study collaboratively with the clerkship director and the learning specialist at the Learning and Wellness Resource Center (LWRC). 

5. The following items relate to a failure on the second attempt of the same NBME Subject Exam: 

a. Any student who fails the retake exam will receive a grade of "Fail" for the clerkship and must repeat the clerkship.

b. The student must appear before the Student Promotion and Conduct Committee (SPCC).

c. The student must follow a prescribed plan of study during the repeat clerkship, designed in collaboration with the clerkship director and the learning specialist at the LWRC.

d. The need for a student to repeat a clerkship may affect their graduation date. 

6. Students may not repeat more than one clerkship. Students who fail an NBME Subject Exam twice in a second clerkship (e.g., failing Family Medicine Subject Exam twice and needing to repeat Family Medicine, and then failing the Psychiatry Subject Exam twice) will be required to appear before the SPCC and will be subject to dismissal. The SPCC may approve continued active student status, however, the student will be required to repeat all of the clerkships in their entirety.

7. Any student who who fails the NBME Subject Exam on their third try (after repeating a clerkship due to two NBME Subject Exam failures), will be subject to dismissal.

8. If a student fails an NBME Subject Exam in a third clerkship on the first attempt during the clerkship year, they will be subject to dismissal. The SPCC may approve continued active student status, however the student may be required to repeat the clerkships in their entirety. 

9. Students may not exceed the six-year maximum time allotment for the completion of the M.D. degree. 

10. All dismissals by the SPCC related to this policy will be subject to the Student Due Process Policy


Clerkships: Family medicine, internal medicine, neurology, obstetrics and gynecology, pediatrics, psychiatry, and surgery clerkships.

NBME Shelf Exam: Nationally administered and standardized multiple choice exam, which assesses students' clerkship-specific medical knowledge.

NBME Shelf Exam failure: Overall exam score below the 5th percentile nationally, based on student performance on the exam from the two previous academic years (AY) prior. 


Director of evaluation and assessments notifies the student, clerkship director and the associate dean for admissions and student affairs of the examination failure within 48 hours of release of exam scores.