From my personal experience they do. Our class at the end of med-surg 1 was approximately 60 students, give or take a few. Well the comprehensive final comes around, let's just say it was extremely challenging. Rumor has it that it was constructed by the dean himself, not the instructor. Well that final cut our class in half when it was time to go into med-surg 2. Approximately 30 students passed the class, half of what we started with and jus about the size of a typical grauating class. Interesting.....