USMLE

The United States Medical Licensing Examination is a three-step examination for medical licensure in the United States and is sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners.

The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care. Each of the three Steps of the USMLE complements the others; no Step can stand alone in the assessment of readiness for medical licensure.

The USMLE, formally the United States Medical Licensing Examination, is a famously challenging, three-step exam series that is required for anyone who wants to practice medicine in the United States.

This test is unusual for two reasons. First, you take each part at a different stage of your medical education. Second, unlike many standardized tests, the USMLE actually assesses your mastery of the material, not how well you take a test.  Some test-taking strategies will improve your performance, but you won't pass without comprehensive knowledge of the sciences, as well as an ability to apply that knowledge in a clinical setting.

Who Takes the USMLE?

The USMLE is designed for students of  allopathic medicine, who are on the path to an MD. Students of osteopathic medicine can take either the USMLE or a similar test called the Comprehensive Osteopathic Medical Licensing Examination (COMEX).

Overview of the Tests

The USMLE is divided into three steps.

• Step 1  Step 1 is a one-day test, usually taken at the end of the second year of med school. It emphasizes knowledge of basic sciences, including anatomy, biochemistry, behavioral sciences, microbiology, immunology, pathology, pharmacology and physiology. Topics such as nutrition, genetics and aging are also covered. All questions are multiple-choice.

• Step 2  Step 2 is a two-day test, usually taken in the fourth year of med school. It has two components. The first (called Clinical Knowledge, or CK), requires you to answer multiple–choice questions on clinical sciences like surgery, internal medicine, pediatrics and obstetrics and gynecology. The second (called Clinical Skills, or CS) requires you to examine and diagnose actors posing as patients. For the Step 2 CS, students must travel to one of five testing centers around the country.

• Step 3 Step 3 is a two-day test, usually taken after the first year of residency. This is the final assessment of whether or not you're prepared to practice general medicine in an unsupervised setting. Like Step 2, Step 3 focuses on the diagnosis and treatment of patients. It includes both multiple choice questions and computer simulations of patient care.

What is tested ?   Ability to apply clinical science to patients in an unsupervised patient care setting

When is it taken ?  Typically following medical school graduation during residency training

How long is the exam? Two days:

Day 1 – Foundations in Independent Practice (FIP)

Concepts tested: Scientific principles required for effective medical care
Duration of Day 1: One day, 7 hours
How many questions are there?: 260 multiple-choice questions

Day 2 – Advanced Clinical Medicine (ACM)

Concepts tested: Applying medical knowledge to patient management and evolving disease processes
Duration of Day 2: One day, 9 hours
How many questions are there?: 200 multiple-choice questions, 13 computer-based clinical simulations
Format of exam: Computer-based
Where can you take it?: Administered at Prometric test sites in U.S. and U.S. territories

1) Step 1 (Preclinical MCQ) – 8 hours

2) Step 2 CK (Clinical MCQ) – 9 hours

USMLE Scores

The Step 2 CS has no numerical score. You earn a "pass" or a "fail" based on your ability to gather data, communicate with the patient and write an effective report.

On all other parts of the test, the number of correct answers you earn is converted into two numerical scores, one on a three–digit scale and the other on a two–digit scale. These are simply two ways of reporting the same result to schools. You must earn a 75 on the two–digit scale to pass.

While your medical school education will give you many of the skills and much of the knowledge necessary to pass the USMLE, you are still likely to log a substantial amount of time reviewing and preparing for each stage of the test.

USMLE Governing Body

USMLE is governed by a number of committees that include members from the ECFMG, FSMB, NBME, and the public. This committee is responsible for the overall direction of the program, identifying and approving procedures for scoring and determining the pass/fail standard, and all significant policies and procedures.

USMLE Questions Source

Members of USMLE test committees include scientists, educators, and clinicians from every region of the United States. Virtually all LCME-accredited medical schools in the United States have been represented on USMLE test committees. USMLE test committee members represent a “national faculty of medicine” drawn from medical schools, state medical boards, and clinical practice settings across the United States.

Why USMLE was created?

USMLE was created in response to the need for one path to medical license for allopathic physicians in the United States. It was desirable to create one examination system accepted in every state, to ensure that all licensed MD’s had passed the same assessment standards – no matter in which school or which country they had trained. Today all state medical boards utilize a national examination – USMLE for allopathic physicians, COMLEX-USA for osteopathic physicians.

Some important things to note:

Here are a few odds and ends about the USMLE:

Step 1, Step 2 CK, and Step 2 CS may be taken in any sequence.

Step 3 can only be taken once a student has passed Step 1, Step 2 CK,

Students can take the same exam up to six times.

No exam may be taken more than three times within a 12-month period.

Once a student has passed a step, she cannot retake it unless this is required to comply with the time limits of a medical licensing body.

Students with disabilities may request accommodations, although the USMLE has historically been very strict in approving these. Be sure to plan ahead and learn about the requirements in advance of registering for the exam.