Grading & Testing
No numerical grades go on a student’s record. First year is pass/fail, and there are five permanent grades that first and second year students can receive: honors, pass, fail, condition/pass and condition/fail. The condition applies to students who have to complete additional remedial work. During the clinical years, there are six permanent grades for a course: honors, high pass, pass, fail, condition/pass and condition/fail. The final grade for an academic year may only be honors, pass or fail.
To be licensed to practice medicine, all states require medical students to pass a three-part test called the United States Medical Licensing Examinations (USMLE) – and commonly known as the Boards. The Boards consist of three “Steps” – generally, Step 1 is taken at the end of the second year, Step 2 is taken at the end of the third year and Step 3 is taken after one year of internship or residency (read below for more information about each examination). USMLE step examinations are administered by a computer at approved testing sites throughout the year. Time is built into the curriculum to enable students to study for the boards, and the UNC School of Medicine provides a number of resources to help students with review and test-taking strategies.
USMLE Step 1
Students typically take Step 1 of the USMLE Boards at the end of their second year. The exam is designed to test the knowledge gained during the basic science years of medical school and assess whether students can apply concepts of sciences that are fundamental to the practice of medicine. Subjects tested include anatomy, behavioral sciences, biochemistry, microbiology, pathology, pharmacology, and physiology, as well as to interdisciplinary areas including genetics, aging, immunology, nutrition, and molecular and cell biology. Epidemiology, medical ethics and questions on empathy are also emphasized. The computer-based exam is taken in a single day and is composed of seven 46-question sections, for a total of 322 questions.
USMLE Step 2
Students typically take Step 2 of the USMLE Boards at the end of their third year. The exam has two parts: the Clinical Knowledge (CK) exam and the Clinical Skills (CS) exam. Step 2-CK is the multiple choice portion of the exam that assesses the ability to apply medical knowledge, skills and understanding of clinical science to patient care. The computer-based exam is taken in a single day and is composed of nine 44-question sections, for a total of 352 questions. Most questions provide a clinical situation and ask the student to give a prognosis, diagnosis, understanding of the underlying causes of the disease, next steps in treatment or preventative measures. Step 2-CS consists of a series of patient encounters during which students must take a history, do a physical exam, determine diagnosis and write patient notes.
USMLE Step 3
Step 3 is the final of the USMLE Boards and is typically taken after the first year of residency or internship. The exam is comprised of multiple-choice questions and clinical case simulations. Most students find this the easiest of the three board exams.
Clinical Performance Examination (CPX)
After completing their third year, all students are required to take and pass the Clinical Performance Examination (CPX) before graduating from medical school. This evaluation is a practical test of the clinical skills and professional behaviors learned in the first three years. There are 12 cases based on problems presented by trained, standardized patients.