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Medical physiology faculty overpredict assessment question complexity and alignment with national board expectations
Alex C S Shefflette1, Irving Joshua2, Michael J Metz1
1Department of Physiology, School of Medicine, University of Louisville, Louisville, Kentucky, United States.
Advances in Physiology Education
|July 2, 2026
Summary
Physiology faculty overestimated their exam questions
Area of Science:
- Medical Education
- Physiology
- Assessment
Background:
- Medical licensing exams assess foundational science application.
- Board-style patient presentations are key.
- Allopathic and osteopathic programs require this knowledge.
Purpose of the Study:
- Assess alignment of Medical Physiology course questions with NBME Item-Writing Guide.
- Evaluate faculty's perception versus reality of question style.
Main Methods:
- Analyzed 316 practice and 187 course exam questions from five faculty.
- Coded questions into basic science, clinical scenario, or NBME-style.
- Compared course questions to NBME Step-1 practice exam questions.
- Surveyed faculty on familiarity and estimation of NBME-style questions.
Main Results:
- Faculty predicted 14% (practice) and 23% (exam) NBME-style questions.
- Actual NBME-style questions: 3% (practice) and 7% (exam).
- NBME Step-1 practice exam: 92% NBME-style questions.
- Course exams had significantly lower word counts than Step-1 questions.
Conclusions:
- Faculty significantly overpredict the NBME-style nature of their questions.
- This discrepancy may impact student preparedness for Step-1 licensure exams.
- Training on the NBME Item-Writing Guide is recommended for faculty.
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