Purpose
Many educators foster metacognitive habits among their students to encourage them to evaluate their study strategies and modify them accordingly before and after examinations. However, there is sparce mention of metacognition in real time during examinations. This abstract describes a novel piloted project in which postbaccalaureate students completed an exam autopsy at the time of examination.

Methods
Postbaccalaureate students were given the opportunity to conduct an exam autopsy immediately following their first exam in their gross anatomy course. The exam covered material on the back and upper limb, and it included 50 multiple-choice items. The exam was administered in Examsoft with a 75-minute time limit. After completing the exam, students were prompted to complete a 30-minute post-exam review and analyze their mistakes using an exam autopsy tool published by the University of Colorado Denver. The tool allowed for binary (yes/no) indications of missed exam item rationales according to categories: insufficient information, text anxiety, careless mistakes, lack of test wisdom, and other, and it allowed qualitative responses about exam preparation and future goals.

Results
Of the 81 students enrolled in the course, 69 students chose to complete the exam autopsy alongside their post-exam review immediately after their exam. The majority of these students indicated rationales across all categories for missed items. A substantial number of students indicated misunderstood vocabulary.

Conclusion
While many students made careless errors and lacked the ability to apply information to exam items, they also misunderstood general vocabulary words needed to make sense of the questions. Given that most words in test items are not content specific, educators might consider semantics of question verbiage and the advanced nature of general vocabulary used in item construction. Such considerations can have practically significant benefits for students’ exam scores.