You’ve seen it before. A student who performed well on your in-house exams sits down for their first NBME subject exam and freezes. The vignette is three paragraphs long. There are lab values they’ve seen before but never had to interpret under pressure. The question isn’t asking them to recall a fact; it’s asking them to reason through a clinical scenario using that fact as one piece of a larger puzzle. 

The student knows the material. They proved that on your exam. But something about the format, the complexity, and the sheer cognitive load of an NBME-style question overwhelmed them. 

This isn’t a knowledge problem. It’s a translation problem. And as a course director, you’re in a unique position to solve it, and to do it earlier than most schools currently do. 

The gap is real, and students feel it 

When M1 and M2 students describe the jump from in-house assessments to NBME exams, a few themes come up repeatedly. Your exam questions tend to be shorter, more direct, and more closely tied to what was covered in lecture. That’s not a criticism; it reflects a reasonable approach to assessing whether students learned what you taught. 

But NBME-style questions operate differently. They embed the relevant concept inside a clinical narrative. They require students to filter signal from noise across a long stem. They test whether a student can apply a piece of knowledge, not just access it. 

The result is that students who feel confident in your course can feel blindsided by their first board-style assessment. And that experience, the disconnect between “I know this” and “I can’t answer this” — erodes confidence in ways that ripple forward into Step prep and clerkships. 

Why it’s hard to close this gap (and why it’s not your fault) 

If the solution were simply “write better questions,” every course would already have a bank of 200 board-quality vignettes. The reality is more complicated. 

Vignette-style item writing is a specialized skill. Crafting a good NBME-style question requires clinical context that many basic science faculty don’t routinely work with. As the NBME’s own Item-Writing Guide emphasizes, without a clinical or experimental vignette as stimulus, items will generally assess only knowledge recall, making it difficult to test higher-order application. But writing those vignettes requires a different kind of expertise than teaching the underlying science. A biochemistry professor may deeply understand metabolic pathways but lack the clinical framing to write a realistic patient presentation that tests that knowledge in the way NBME does. Research on faculty item-writing consistently shows that untrained faculty produce questions with significantly more structural flaws. And these flaws that can affect student scores and undermine the validity of the assessment itself. 

The time investment is substantial. A well-constructed clinical vignette with plausible distractors takes significantly longer to write than a standard recall question. Estimates put the cost of a single high-quality item at over $100 when accounting for faculty time, review, and revision. Multiply that across an entire course’s worth of assessable content, and you’re looking at a major faculty time commitment with no clear institutional support. 

Curriculum committees have competing priorities. Your course has defined learning objectives, and your assessments need to align with them. Board-style questions that integrate across disciplines or require clinical reasoning can feel like they’re testing something outside your course’s scope, even when they’re testing exactly the concept you taught. 

There’s a philosophical tension. Some faculty believe that foundational courses should assess foundational knowledge, period. The clinical application, in this view, comes later. It’s a defensible position, but it leaves students to bridge that gap on their own during a compressed and high-stress study period. 

What actually works: scaffolding board-style reasoning into your existing course 

The good news is that closing this gap doesn’t require replacing your assessments or rewriting your course. It requires supplementing what you already do with deliberate, scaffolded exposure to board-style question formats. Here’s what that looks like in practice. 

Start with low-stakes formative exposure 

The single most impactful thing you can do is give students regular, no-grade-pressure encounters with board-style questions tied to the content you’re actively teaching. This isn’t about replacing your quizzes; it’s about adding a layer. 

The evidence supports this approach. A 2018 study at the University of Alabama School of Medicine gave 185 preclinical students 18-month access to a commercial Step 1 question bank throughout their organ-based modules. Greater use of the question bank was associated with stronger performance across instructor-designed exams, NBME Customized Assessments, module final grades, and USMLE Step 1 scores. The found the benefit most pronounced for students with lower MCAT scores, precisely the population most at risk for the translation gap described above. This aligns with a broader body of cognitive science research on the “testing effect”: active retrieval in a test-question format doesn’t just assess learning, it enhances it Particularly when exposure is spaced over time rather than massed during a dedicated prep period. 

A USMLE-style question bank can serve this purpose well. Rather than treating it as a dedicated Step prep tool (the way students typically encounter it), you can assign targeted question sets that map to your weekly or unit-level content. Students get practice with the format and the reasoning style while the material is fresh, and they start building pattern recognition for how board questions are constructed. 

Teach question interpretation as a skill 

Students often struggle with NBME questions not because they don’t know the answer, but because they don’t know how to read the question. They get lost in the vignette, anchor on irrelevant details, or misidentify what’s actually being asked. 

This is a teachable skill, and it can be broken down into a simple framework that students practice repeatedly: 

1. Identify the core clinical pivot point in the vignette. What single finding or combination of findings narrows the diagnosis or mechanism? Everything else is context or noise. 

1. Translate that pivot back to a foundational mechanism. This is the bridge connecting the clinical presentation to the biochemistry, physiology, or pathology concept being tested. 

1. Eliminate distractors by testing them against that mechanism. If a distractor doesn’t explain the pivot point, it’s out. 

Consider building short “question dissection” exercises into your course. These could be brief modules where students work through a board-style question using this framework, mapping the question back to the foundational concept being tested. These exercises work best when students encounter them in context alongside the relevant course material, rather than as a separate study task. 

Add clinical anchors to foundational content 

You don’t need to turn your biochemistry course into a clinical rotation. But even brief clinical correlations — a two-sentence patient scenario that illustrates why a metabolic pathway matters clinically — can help students start building the mental bridges they’ll need for board-style questions. 

The key is that these anchors live inside your existing course materials, not in a separate resource students have to seek out. A mini-vignette embedded in a foundational learning module — one that mirrors the way NBME frames questions around your specific content area — does more work than a standalone “clinical correlations” supplement that students may or may not engage with. The NBME Item-Writing Guide makes the same point from the assessment side: the clinical vignette is the mechanism that elevates a question from recall to application. Giving students practice reading that format is as important as teaching the content it tests. 

Use assessment data to identify the translation gap 

If you have access to performance analytics from both your in-house assessments and board-style question banks, you can identify something valuable: students who score well on your exams but poorly on board-style questions covering the same content. 

When 80% of a cohort answers a recall-style enzymology question correctly but only 45% answer a clinically framed version of the same concept, that discrepancy is diagnostic. It points to a translation problem, not a knowledge problem, telling you exactly where to focus your bridging efforts. 

Performance analytics that span both in-house and board-style assessments can surface these patterns at both the individual and cohort level, giving you actionable data rather than anecdotal impressions. 

Leverage secure, externally developed item banks for summative checkpoints 

If you want to build board-style questions into your graded assessments but don’t have the faculty bandwidth to write them, secure item banks developed by subject-matter experts and aligned to board standards can provide a ready-made source of high-quality questions. This lets you incorporate board-style summative checkpoints without the item-writing burden falling entirely on your faculty. 

The compounding benefit 

Here’s what makes early exposure so valuable: board-style reasoning isn’t a separate skill that students learn during dedicated prep. It’s the application of the knowledge you’re already teaching. When students practice that application alongside learning the content — rather than months later — the two reinforce each other. Students understand the material more deeply because they’ve had to use it, and they approach board-style questions with more confidence because the format is familiar. 

This matters more now than it did five years ago. Since the USMLE’s transition to Pass/Fail for Step 1 in 2022, first-time pass rates have declined across all student populations, due in part to reduced study intensity when a three-digit score is no longer at stake. If students are preparing less aggressively during dedicated study periods, the scaffolding they receive during preclinical coursework becomes the primary mechanism for building board-style reasoning. The curriculum has to do more of the work that students previously did on their own. 

You’re not necessarily adding to their workload.  You’re reshaping part of it so that learning and application happen in parallel rather than in sequence. 

Where to start 

The goal isn’t to turn foundational courses into board prep. It’s to prevent board-style reasoning from feeling foreign when students first encounter it. 

You don’t need to overhaul your course. Pick one unit — ideally one where you know students historically struggle with the board-style application — and try one or two of these strategies. Assign a targeted question bank set as a formative exercise. Build a short question-dissection module into your existing materials. Look at performance data to see where the translation gap is widest. 

Small, targeted changes compound. And your students will notice the difference the first time they sit for an NBME exam and recognize what’s being asked of them. 

References 

1. Baños JH, Pepin ME, Van Wagoner N. Class-wide access to a commercial Step 1 question bank during preclinical organ-based modules: a pilot project. Academic Medicine. 2018;93(3):486-490. doi:10.1097/ACM.0000000000001861 

1. Akhtar S, et al. Assessing the impact of USMLE Step 1 going pass-fail: a brief review of the performance data. Journal of Graduate Medical Education. 2024. PMC11896725. 

1. Feddock C, et al. Formative assessment and feedback in medical education: a practical guide. AMEE Guide No. 189. Medical Teacher. 2025. doi:10.1080/0142159X.2025.2569623 

ScholarRx builds the tools that make these strategies practical to implement. Qmax provides the USMLE-style question bank for formative exposure. RxBricks and Bricks Create let faculty embed clinical anchors and question-dissection exercises directly into foundational content. The RxBricks Assessment Bank offers secure, board-aligned items for summative checkpoints. And integrated analytics surface the translation gaps that tell you where to focus.

The post Why Your Students Hit a Wall on Their First NBME Exam…and What You Can Do About It appeared first on ScholarRx.

Cloning is Easier than Ever

The Brick Exchange is a first-of-its-kind, open-access curriculum exchange that brings our vision of advancing medical education by enabling educators and students to create and disseminate creative content to life. Cloning a Brick you’ve found on the Brick Exchange has just gotten easier.

As you enjoy an excellent, informative Brick, you can now click to clone it from the Brick Exchange or within a Brick itself. When you clone a Brick from the Exchange, it automatically takes you to Bricks Create.

This new feature allows you to customize, localize, and expand upon bricks shared within the Brick Exchange, creating a community of practice where educators can collaborate and contribute to the world’s first health professions curriculum exchange.

Listing Multiple Authors

Education may feel like a lonely island, but you often collaborate with peers, colleagues, and friends to create your curriculum. With that in mind, we’ve released another new feature – the option to list multiple authors, editors, and contributors in each Brick.

It’s easy to add your collaborators to a Brick! Just hover your mouse over “Author” and click when the pencil (edit) icon appears.

From there, you can search for authors with an existing ScholarRx account and select them when they appear.

If you cannot find who you’re looking for, select ‘Can’t find who you’re looking for?’. You will be asked to add their first and last name and email.

When you add an author or collaborator to a Brick, they will be notified via email. If they want to be removed from your Brick, they will be told to reach out to you (the person who added them) to be removed.

Increased Accessibility

With our latest product update, your Brick privacy is manageable every time you go to publish a Brick. The first step is choosing whether or not your Brick is listed.

• Listed Bricks can appear on your school and author pages and within search results. Your Brick can be shared via a link and appear within reading lists.
• Unlisted Bricks will not appear on your school or author pages or within search results. Your Brick can be shared via a link and will appear when added to reading lists.

Listing a Brick increases visibility for your institution. The Brick Exchange allows medical educators to share learning materials, collaborate, and innovate. When you publish a listed Brick, it will appear on the Brick Exchange and be accessible to anyone looking for medical education resources. Not only does this exposure help your content reach more students, but it also amplifies recognition of your work and expertise.

A Variety of Licensing Options

Once you decide whether your brick is Listed or Unlisted, you’ll see two new licensing choices.

CC-BY-SA (Creative Commons License)

With the CC-BY-SA license, anyone can clone and adapt your Brick, and you will receive the credit within those adapted Bricks. The same license will be carried forward when the Brick is cloned or adapted, so long as they credit you and license their creations under identical terms. Your Brick:

• Will appear on the Brick Exchange
• Can be cloned
• Can be adapted

Edits to your Brick will maintain the CC-BY-SA license – it cannot be changed after you’ve set it.

Standard License

With the Standard License, your Brick can only be cloned by members of your same institution. The same license will be moved forward when they clone, edit, or adapt your Brick. Your Brick:

• Will appear on the Brick Exchange
• Can only be cloned by members of your institution
• Can only be adapted by members of your institution

Edits to your Brick can be re-published under CC-BY-SA or a Standard license.

Ready to Share?

Publishing a Brick brings a powerful relief – the work is done! Additionally, it encourages collaboration and sharing with colleagues, promotes visibility, and provides repurposing opportunities to faculty and students worldwide. 

With ScholarRx, publishing a Brick is easy, providing a secure mechanism for preparing, publishing, and sharing your educational materials. Free up valuable time by sharing your content, discovering the joy of collaboration, and watching your content make a difference!

Want to learn more about third-party cloning, licensing, and listing multiple authors? You can access our new release Zendesk articles here.

The post ScholarRx Announcement: Brick Licensing and More appeared first on ScholarRx.

ScholarRx is proud to announce the release of its newest health sciences innovation, the Rx Brick Exchange, a first-of-its-kind curriculum exchange that empowers educators to share and access Bricks with a global community. This digital ecosystem builds upon Rx Bricks and Bricks Create – with limitless potential.

At ScholarRx, we aim to build a healthier world through accessible, sustainable medical education. The Rx Brick Exchange is designed to expand opportunities for students and educators from every corner of the globe to learn from and collaborate with other passionate brick builders. We’re working to create a space to build the next generation of global health professionals.

Using our revolutionary digital learning platform, Rx Bricks, the Rx Brick Exchange enables educators and learners to share free, open-access educational modules that address topics important to you and your students. We aim for the Rx Brick Exchange to become a community where ideas and expertise are shared to develop engaging and open-access health science content.

About ScholarRx: ScholarRx is a mission-driven organization serving over 150,000 medical students and physician learners annually. ScholarRx has developed a revolutionary componentized, multi-competency curricular platform that empowers medical schools and medical student organizations to rapidly produce high-quality digital learning experiences, even in resource-constrained environments.

The post ScholarRx Announces the Rx Brick Exchange appeared first on ScholarRx.

If so, we have a special reason for you to visit us at Booth 226 for the AAMC’s annual meeting: an opportunity to see the groundbreaking Rx Brick Exchange and a chance to win a new Apple Watch Series 8!

We invite all med educators to stop by Booth 226 and learn about the world’s first health professions curriculum exchange and how it will help advance the cause of building a healthier world through accessible and sustainable medical education.

Imagine having a consistent repository of curricular materials and learning frameworks that can be rapidly deployed and customized to suit your unique curriculum needs and goals. That’s Rx Bricks.

When you connect this with our suite of assessment tools, including our sequestered Rx Bricks Assessment Banks (powered by ExamSoft), you’ll see why so many schools are turning to ScholarRx to help them bolster their curriculum with high-quality digital learning experiences and premium assessment solutions to generate positive education outcomes.

We hope to see you this weekend at Learn Serve Lead!

The post Meet ScholarRx at Learn Serve Lead 2022! appeared first on ScholarRx.

On November 2nd, we’re hosting a free webinar to tackle this topic: An Introduction to Diversity, Equity, and Inclusion in Curriculum. You can register here: https://bit.ly/3FopMtj

During this session, Catarina Pais Rodrigues, MD, the Assistant Director of Student Affairs at ScholarRx, will:

· Introduce different approaches to incorporating DEI into your medical education program
· Reflect on challenges and opportunities for promoting DEI in the medical curriculum
· Share the DEI framework developed in Rx Bricks

We hope you’ll join us!

The post An Introduction to Diversity, Equity, and Inclusion in Curriculum appeared first on ScholarRx.

ScholarRx is a mission-based organization of passionate medical educators, designers, and technologists dedicated to building a healthier world through accessible, sustainable medical education. ScholarRx offers a revolutionary, low-cost, multi-competency curriculum system featuring interconnectable “learning bricks,” powered by the groundbreaking Rx Bricks Create authoring tool, helping make this the world’s first sharable health science curriculum platform.

Come meet us and learn more about our curricular solutions!

We look forward to seeing you at PAEA!

The post Meet ScholarRx at PAEA 2022! appeared first on ScholarRx.

https://scholarrx.com/amee-webinar/

Over the past year, the COVID-19 pandemic has pushed global medical educators top reflect on the status of online medical education. While digital platforms now allow us to reach large, even international audiences at little or no cost, we often find ourselves developing and maintaining custom curricular content in silos despite having limited resources at our own institutions. Thus, there is an opportunity for the global community to improve sharing, outreach, and collaboration, especially during these extraordinary times.

On June 23, 2021, AMEE and ScholarRx will hold a special interactive webinar. We will encourage educators globally to become more engaged in shared online curriculum development. We’ll also be introducing a planned series of workshops that will provide educators to further develop skills and competencies in developing shared curriculum development.

Date & Time:

Wednesday, June 23, 2021 11am EST

Access to the webinars is completely free and open to non-AMEE members.

Following this interactive webinar, participants will be able to:

• Identify benefits and challenges to developing open, sharable digital curriculum
• Describe case examples of shared curriculum
• Discuss digital tools and practical strategies for shared curriculum development

Our panelists include:

Daniel Salcedo, MD, MHPE

Dr. Salcedo is a medical doctor and clinical educator at Taipei Municipal Wanfang Hospital in Taiwan. His field of study is Technology Enhanced Learning for Health Professions Education, and he works in integrating new technologies to improve the way we train health professionals at the point-of-care.

Tao Le, MD, MHS

Dr. Le is an Associate Professor and Section Chief of the Allergy and Immunology division at the University of Louisville. He is the Founder and Chief Education Officer of ScholarRx

Ronald Harden

Professor Ronald Harden is the editor of Medical Teacher and General Secretary and Treasurer of the Association for Medical Education in Europe (AMEE). He was formerly Professor of Medical Education, Teaching Dean and Director of the Centre for Medical Education at the University of Dundee.

Yun Weisholtz, MD, PhD

Dr. Weisholtzhas a passion for seeking and implementing strategies to make medical education accessible and affordable for students. She is spearheading curriculum initiative projects nationwide for ScholarRx, and serves as the Associate Director of Faculty Management at ScholarRx.

This webinar is for educators with an interest in developing open digital curricular materials that can be shared with the global education community.

The post Free AMEE Webinar on “Creating Shared Online Medical Education for the World” appeared first on ScholarRx.

Prof. Hossam Hamdy, Chancellor, Gulf Medical University states, “Gulf Medical University’s partnership with ScholarRx ensures that the content of the medical curriculum is benchmarked with similar top U.S. medical colleges using the same program. The Rx Bricks of ScholarRx provide our students with up-to-date medical knowledge through educationally sound courses delivered by expert faculty. As a leading medical university in the Middle East, Gulf Medical University will contribute to the continuous development of ScholarRx by integrating its Virtual Patient Learning (VPL) technology in the Rx Bricks, conducting research, and evaluating the educational impact of ScholarRx.  I am sure our students and faculty will appreciate the value of ScholarRx.”

GMU uses the innovative Rx Bricks digital learning platform from ScholarRx to better engage and align medical students with the curriculum. This has become especially important as more learning is taking place online. With this new set of resources, faculty teaching GMU students can:

• Assign specific Rx Bricks through their learning management system
• Use question banks accompanying the Rx Bricks for both formative and summative assessments, and
• Provide foundational support to their virtual patient learning sessions.

“Collaboration with ScholarRx has enriched and added value to our existing online learning resources, as the College of Medicine has been able to seamlessly integrate the Rx Bricks in the medical curriculum. Faculty and students alike have embraced it with ease due to the user-friendly nature of the resource,” said Prof. Manda Venkatramana, Vice-Chancellor Academics and Dean, College of Medicine at Gulf Medical University.

“GMU has developed into a leading institution for medical education in the Middle East under the visionary leadership of Chancellor Hamdy and Vice-Chancellor Manda,” said Dr. Tao Le, Founder and CEO of ScholarRx. “We are pleased to support their remarkable work in digital curricular innovation.”

About Gulf Medical University College of Medicine
The vision of the university is to be a leading international academic healthcare institution through the integration of quality health professions education, research, healthcare, and social accountability for sustainable community development. The College of Medicine, in existence since 1998, has managed to not only impart quality medical education, but has also created a network of healthcare services, a conducive research milieu, and developed unique related avenues for professional development, policy, and leadership to meet the healthcare needs of the nation and the region.

About ScholarRx
ScholarRx is a mission-driven education organization currently serving over 150,000 medical students and physician learners annually.  ScholarRx has developed a revolutionary componentized, multi-competency curricular platform that empowers medical schools and their faculty to rapidly develop high-quality education experiences, even in resource-poor environments.

The post Gulf Medical University College of Medicine and ScholarRx Announce Medical Education Partnership appeared first on ScholarRx.

The Rx Brick Assessment Banks are appropriate for use in all pre-clinical, medical and health science programs. These ready-to-use banks of high-quality questions are reserved for faculty use in summative and secure examinations in preclinical courses and can be pre-loaded into the ExamSoft platform for immediate use.

ExamSoft’s unique exam software enables over 1,900 academic institutions and professional licensure and certification programs to deliver exams within the most secure type of digital environment. Using a team of experienced educators and professional medical editors, ScholarRx has developed secure question banks covering the breadth of the typical foundational course material that is taught in the preclinical curriculum, comparable to the range of subjects covered on certification exams. This combination of content and educational technology provides ExamSoft users with easy and immediate access to assessment items from ScholarRx.

Dr. Tao Le, founder and chief education officer of ScholarRx, states, “We’re pleased to partner with ExamSoft to help address the need for high-quality assessment items. The combination of ExamSoft’s secure and reliable test-creation platform with ScholarRx’s comprehensive and professionally developed assessment items provides medical and health science educators with a powerful, time-saving tool to produce and deliver summative exams.”

“Medical schools have long trusted ExamSoft as a leading partner in bringing the highest level of security and visibility to their faculty and students,” said Sebastian Vos, CEO of ExamSoft. “Partnering with ScholarRx in this way enables the direct delivery of quality exam questions to our clients through the ExamSoft platform. We believe this partnership supports our goals of increasing faculty efficiency and improving learning outcomes students.”

About ExamSoft
ExamSoft, a Turnitin company, is an education technology company based in Dallas, Texas, that builds scalable software solutions that provide the highest level of exam security and integrity to education and certification institutions across a variety of verticals, settings and modalities. ExamSoft software gives educators and test-takers actionable data to improve performance and create meaningful efficiencies in grading, exam-building, psychometrics and overall assessment. The ExamSoft mission is to deliver superior assessment solutions to increase learning performance for every student, instructor and institution. ExamSoft currently serves more than 1,900 prominent academic, certification and licensing programs and has successfully administered over 63 million exams.

About ScholarRx
ScholarRx is a mission-driven organization currently serving over 150,000 medical students and physician learners around the world each year. ScholarRx has been trusted by hundreds of thousands of medical students to prepare for the boards through its comprehensive USMLE-Rx digital learning environment. ScholarRx has recently launched a revolutionary componentized, multi-competency curricular platform that empowers faculty and medical schools to rapidly develop high-quality education experiences, even in resource-constrained environments.

The post ScholarRx and ExamSoft announce partnership to provide Rx Brick Assessment Banks, high-quality, secure assessments for medical and other health science education programs appeared first on ScholarRx.

This pragmatic discussion will explore applications of the innovative Rx Bricks platform, which is a comprehensive curriculum support service featuring student-centered, customizable multimedia modules. Rx Bricks are built around standardized learning objectives and continuous formative feedback.

During this session, actual case studies will highlight schools that have successfully integrated Rx Bricks to:

• Enable a move to the flipped-classroom model
• Support online learning with asynchronous content prior to live lectures
• Support longitudinal, integrated teaching and learning
• Reduce faculty prep time and improve assessment quality
• Efficiently increase the number of formative exams aligned and linked to the curriculum

You can preview the Rx Bricks by completing the request form: Free ScholarRx Bricks For Your Institution. Or, for more details about Rx Bricks, Click here.

You can also visit the ScholarRx Virtual Exhibition Booth in Exhibition Hall 1.

We are looking forward to meeting you and your avatar at the AMEE 2020 Virtual Conference.

The post AMEE Session: Teaching Online Using ScholarRx appeared first on ScholarRx.