The United States Medical Licensing Examination is a multi-part professional
exam sponsored by the Federation of State Medical Boards and the National
Board of Medical Examiners. Physicians with an M.D. degree are required to pass
this examination before being permitted to practice medicine in the United
States; see below for requirements of physicians with a D.O. degree.
Purpose The USMLE assesses a physician's ability
to apply knowledge, concepts, and principles, and to determine fundamental
patient-centered skills that are important in health and disease and that
constitute the basis of safe and effective patient care. Examination
committees composed of medical educators and clinicians from across the United
States and its territories prepare the examination materials each year.
Overview Students and graduates of U.S. or
Canadian medical school programs accredited by either the Liaison
Committee on Medical Education or Committee on Accreditation of Canadian
Medical Schools, leading to the Doctor of Medicine degree, or by the American
Osteopathic Association, leading to the Doctor of Osteopathic Medicine degree,
register for Step 1 and Step 2 of the USMLE with the NBME. Students and
graduates of medical schools outside the United States or Canada register for
Step 1 and Step 2 with the Educational Commission for Foreign Medical
Graduates. Graduates of medical schools in and outside the United States and
Canada register for Step 3 with the FSMB or with a medical licensing authority in
the United States. Each of the three steps of the USMLE examination
complements the other; no step stands alone in the assessment of readiness for
medical licensure. The USMLE program recommends that for Step 3 eligibility,
licensure authorities require the completion, or near completion, of at
least one postgraduate training year in a program of graduate medical education
accredited by the Accreditation Council on Graduate Medical Education or the
American Osteopathic Association. All three steps of the USMLE exam must
be passed before a physician with an M.D. degree is eligible to apply for an
unrestricted license to practice medicine in the United States. U.S.
osteopathic medical school graduates are permitted to take the USMLE for medical
licensure, which they can also obtain by passing the multi-part Comprehensive
Osteopathic Medical Licensing Examination professional exam. Students
who have graduated from medical schools outside the US and Canada must pass all
three steps of the USMLE to be licensed to practice in the US, regardless of the
title of their degree. Overall pass rates for USMLE Step 1 test takers in
2013-2014 are: 95% for U.S. M.D. medical school graduates, 94% for U.S. D.O.
osteopathic medical school graduates, and 72% for international medical school
graduates. Overall USMLE Step 2 CK test taker pass rates in 2013-2014 are: 97%
for U.S. M.D. medical school graduates and 96% for U.S. D.O. medical school
graduates. Overall USMLE Step 2 CS test taker pass rates in 2013-2014 are: 97%
for U.S. M.D. medical school graduates and 89% for U.S. D.O. medical school
graduates, though this figure may be somewhat misleading since there were
19,757 M.D. first-time test takers and 63 D.O. first-time test takers. Overall
pass rates for USMLE Step 3 test takers in 2013-2014 are: 96% for U.S. M.D.
medical school graduates, 92% for U.S. D.O. medical school graduates, and 83%
for international medical school graduates. These statistics may be
somewhat misleading since there were 19,086 M.D. first-time test takers for
Step 3 and 23 D.O. first-time test takers.
Step 1 USMLE Step 1 assesses whether medical
school students or graduates understand and can apply important concepts of the
basic sciences to the practice of medicine. As of 2007, it covers the
following subjects, in both systemic and procedural themes:
Pathology, Pharmacology,
Physiology, Microbiology,
Biochemistry, Anatomy,
Behavioral sciences, Interdisciplinary topics, such as
nutrition, genetics, and aging. US medical students take Step 1 at the
end of the Basic Sciences portion of the curriculum, usually after the second
year of medical school. The two most renowned resources for Step 1 prep are
the UWorld question bank and "First Aid for the USMLE Step 1." Step 1 is an
eight-hour computer-based exam consisting of 308 multiple-choice
questions divided into seven blocks each consisting of 44 questions. As of summer
2008, some questions include audio and video. Each block must be finished
within an hour. The remaining hour is break time. An optional tutorial about
how to use the computer program of the exam is offered at the beginning of the
exam and takes 15 minutes. This time is deducted from the hour of allotted break
time. A quality assurance survey is presented at the end, provided some of
the original eight hours is left over. Scores are reported as both a
three-digit score and two-digit score. However as of July 1, 2011 only the
3-digit score is reported on USMLE transcripts. The two-digit score is not
a percentile, as many test-takers have been known to erroneously report, but is
instead an obsolete scale still used internally by some state medical
licensing authorities. On January 1, 2014, the passing score was raised from
188 to 192. The mean and standard deviation for first-time examinees from
US and Canadian medical schools, as of July 2014, are 228 and 21, respectively,
with most scores falling between 140 and 260; this is up from 224 and 22,
respectively, from December 2012. The Step 1 score is frequently used in
medical residency applications as a measure of a candidate's likelihood to
succeed in that particular residency, and it has been cited by residency
program directors as their most important criterion in selecting
graduating medical students for their residency program. Average USMLE Step 1
scores for various residencies are available in Charting Outcomes in the
Match. Averages for graduates of U.S. medical schools who matched into
residency range from 213 for a Family Medicine to 249 for Plastic Surgery.
If the student passes the exam, he or she may not repeat it to achieve a
higher score, and any failed attempt is permanently recorded. This "one-time
deal" situation is the reason the Step 1 is unanimously viewed as the most
arduous and paramount examination a medical student will ever sit during his
or her entire career. It has substantial bearing on the specialties and location
a residency applicant is competitive for.
Step 2 USMLE Step 2 is designed to assess
whether medical school students or graduates can apply medical knowledge,
skills and understanding of clinical science essential for provision of
patient care under supervision. US medical students typically take Step 2
during the fourth year of medical school. Step 2 is further divided into
two separate exams: = Step 2 CK =
USMLE Step 2 CK is designed to assess clinical knowledge through a
traditional, multiple-choice examination. It is a 9-hour exam
consisting of 8 blocks of approximately 44 questions each. One hour is given for
each block of questions. The subjects included in this exam are clinical
sciences like Medicine, Surgery, Pediatrics, Psychiatry and Obstetrics &
Gynecology. = Step 2 CS =
USMLE Step 2 CS is designed to assess clinical skills through simulated
patient interactions, in which the examinee interacts with standardized
patients portrayed by actors. Each examinee faces 12 Standardized Patients
and has 15 minutes to complete history taking and clinical examination for each
patient, and then 10 more minutes to write a patient note describing the
findings, initial differential diagnosis list and a list of initial tests.
Administration of the Step 2-CS began in 2004. The examination is only offered in
five cities across the country: Philadelphia
Chicago Atlanta
Houston Los Angeles
Before 2004, a similar exam, the Clinical Skills Assessment was used to
assess the clinical skills of foreign medical graduates.
Step 3 USMLE Step 3 is the final exam in the
USMLE series designed to assess whether a medical school graduate can apply
medical knowledge and understanding of biomedical and clinical science
essential for the unsupervised practice of medicine. Graduates of US medical
schools typically take this exam at the end of the first year of residency.
Foreign medical graduates can take Step 3 before starting residency in about ten
U.S. states. Connecticut is frequently chosen for such purpose because it does
not require simultaneous application for licensure, unlike New York. Starting
from 2014 USMLE Step 3 will be divided into two separate parts.
Step 3 is a 16-hour examination divided over two days. Each day of testing must
be completed within eight hours. The first day of testing includes 256
multiple-choice items divided into 6 blocks, each consisting of 42-43 items.
Examinees must complete each block within sixty minutes.
The second day of testing includes 198 multiple-choice items, divided into 6
blocks of 33 items. Examinees are required to complete each block within
forty-five minutes. Approximately 3 hours are allowed for these
multiple-choice item blocks. Also on the second day are 13 Clinical Case
Simulations, where the examinees are required to 'manage' patients in
real-time case simulations. Examinees enter orders for medications and/or
investigations into the simulation software, and the condition of the
patient changes. Cases are of 10 or 20 minutes.
Approximately forty-five minutes to one hour is available for break time on each
of the two days of testing. Format
The USMLE first started out as a paper examination, converting to a computer
based multiple choice examination. The test can be taken at Prometric test
centers worldwide. However, the Step 2 CS and the Step 3 can only be taken in
the USA. The software used to administer the test, the NBME FREDtm, was upgraded
in 2008 to a new version, FREDtm V2. The implementation of this changeover
continues. Performance
Grade point average in undergraduate science courses and performance on the
MCAT, particularly the biological sciences and physical sciences sections,
are strong predictors of performance on the USMLE step 1 and step 2 exams,
though it is unclear whether the verbal reasoning portion of the MCAT has any
predictive value. The selectivity of undergraduate institution is also a
predictor of step 1 and step 2 performance, even when controlling for
undergraduate GPA and MCAT score. Similar exams
The "Comprehensive Osteopathic Medical Licensing Examination" is required for
osteopathic physicians in the United States
= In other countries = Medical Council of Canada Qualifying
Examination, in Canada Professional and Linguistic Assessment
Board test Australian Medical Council in Australia.
Medical Council of India Examen Nacional de Aspirantes a
Residencias Medicas in Mexico Saudi Licensing Examination in Saudi
Arabia Ärztliche Prüfungen, overseen by the
IMPP, in Germany References
External links USMLE official website
For International medical graduates USMLE Forum
USMLE MCQs