Overview and Scoring

Learn about the process of constructing and scoring the exam.  


Question Preparation

Preparation of the multiple choice examinations is by the IBHRE Committees in conjunction with the National Board of Medical Examiners (NBME).

  • Each member drafts a group of questions (items) which are submitted to the NBME staff. These are edited and, during a multiday meeting of the entire committee and the NBME staff, each item is then individually discussed and evaluated.
  • Some are accepted for the examination and others are rejected as being vague, or inadequately written.
  • Other items in specific topics may be needed and these are written after the initial meeting.
  • Additional meetings are then undertaken to prepare and evaluate additional items, in a manner similar to the first evaluation.
  • Construction of the examinations consists of 175-200 items, for a four-and-a-half-hour examination, and is performed during a second meeting at the NBME.
  • The item balance (the number concerning pacing, ICDs, Electrophysiology, those x-ray based and others ECG based) is determined.

Question Selection

Previously used items, responses to which have correlated well with an examinee’s overall score, and which have been deemed clear and unambiguous, are incorporated as one quarter of a current examination so that the examinee (and group performance for an examination year) can be compared to others from previous groups. While these items have a statistical examination history, each will have been reassessed to ascertain that it remains a valid question. Items are selected not to be product specific unless a field is defined by a single device. Only items which are commercially available (passed clinical investigation) in the United States may be the basis of an examination item. This may force product specific question items.


Content Overview

Exam content is developed from the examination blueprint (content outline).

  • Pacing questions are broadly in the realm of device management of arrhythmias, the relevant electrophysiology and, to a lesser extent, arrhythmia management by medications and other techniques. Questions about the implantable cardioverter defibrillator (ICD) and cardiac pacing are included. Understand comprehension of the electrophysiology of cardiac conduction and impulse formation is important to recognizing the indications and results to be derived from cardiac pacing and defibrillation. Surgical procedures, such as hardware, complications, infection and its management, and drug and device interactions are tested in addition to the electrophysiology of device sensing and cardiac stimulation. Device (e.g., pulse generator and lead) operation, such as timing cycles of single and dual chamber pacemakers and the ICD, and device longevity, are included.
  • Cardiac electrophysiology questions are in relation to all of these technologies and the understanding of devices and their management of arrhythmias. Electrical theory and Ohm’s law, as it relates to devices, is also analyzed. Additional evaluation is by interpretation of x-rays, ECGs and electrograms, device ECG interpretation channels, and other visual and diagrammatic interpretation of electrophysiologic phenomena. For the electrophysiology examinations cardiac electrophysiology, with a lesser emphasis on pacing and implantable defibrillation, will be tested.

Statistical Evaluation

The final construction of the examinations is still another process in which those items for the Physician examinations and those for the AP examinations are selected.

  • Following administration of each examination, each item is statistically evaluated. A number of characteristics are sought, including whether an item correlated well or badly with examinee performance or whether one (or more) of the “incorrect” multiple choice options seemed attractive to a substantial group of examinees.
  • Such items are reevaluated individually and if the examination committee is convinced that an item is inappropriate, it is deleted from examination scoring for all examinees.
  • The final scoring of the examination will then be based on the reduced number of items, e.g. 198 instead of 200, and the number of correct answers which have been accepted as suitable.
  • Incorrect answers do not penalize the examinee.
  • At the time of preparing each question item “key words” are assigned which explain the content of the item.
  • The final scores are provided to the examinees and a report is given based on key words which the examinee did not provide a satisfactory response.


Because the overall difficulty of the test varies slightly from year to year, total scores are equated so that a score "500" on one exam represents the same level of proficiency as a score of "500" on a previous test form. Percent correct scores are not reported because they vary slightly from year to year (and from each exam form to the other).


Pass/Fail Standard

Content experts review a variety of statistical analyses before setting a pass/fail standard. The equating procedure allows IBHRE to require the same level of proficiency across years therefore the pass/failure rates vary somewhat across years.