United States Medical Licensure Examination
Encyclopedia
The United States Medical Licensing Examination (USMLE) is a multi-part professional exam sponsored by the Federation of State Medical Boards
(FSMB) and the National Board of Medical Examiners
(NBME). Medical doctors with an M.D. degree are required to pass this examination before being permitted to practice medicine in the United States of America.
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.
Students and graduates of U.S. or Canadian medical school programs accredited by either the Liaison Committee on Medical Education
(LCME) or Committee on Accreditation of Canadian Medical Schools, leading to the M.D. (Doctor of Medicine) degree, or by the American Osteopathic Association
(AOA), leading to the D.O. (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
(ECFMG). 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 (ACGME) or the American Osteopathic Association (AOA).
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
(COMLEX) 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 first time USMLE Step 1 test takers are: 92% for U.S. M.D. medical school graduates, 81% for U.S. D.O. osteopathic medical school graduates, and 73% for international medical school graduates. Overall pass rates for first time USMLE Step 3 test takers are: 95% for U.S. M.D. medical school graduates, 95% for U.S. D.O. medical school graduates, and 78% for international medical school graduates. (In these statistics, "U.S. M.D. medical school graduates" includes graduates of Canadian M.D. programs.)
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 (general and individual anatomical characteristics) and procedural (functional, therapeutic, environmental, and abnormality) themes:
US medical students usually take Step 1 at the end of the second year of medical school
. It is an eight-hour computer-based exam consisting of 322 multiple-choice questions (MCQs) divided into seven blocks each consisting of 46 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.
The scores are reported with a three digit score and a two digit score. As of January 1, 2010, the passing score has been raised to 188 from a previous score of 185. The average score is approximately 221 and the standard deviation is 23. If the student passes the exam, he or she may not repeat the exam to achieve a higher score.
While not recommended by the creators of the USMLE, 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 on that specialty's board exams). More competitive residency programs such as Radiology
, Ophthalmology
, Plastic Surgery
, Orthopedic Surgery
and Dermatology
usually only accept applicants with high Step 1 scores. The Step 1 exam is arguably the hardest and most important examination a medical student will take during his/her career.u also can join in an institute who provides you detailed coaching for usmle step 1. http://www.gims-org.com,http://www.usmletutor.org.
The USMLE score is among the most important of several factors considered by residency programs in selecting applicants. The median USMLE Step 1 scores for graduates of U.S. Medical Schools for various residencies are available in Chart 6 on page 9 of "Charting Outcomes in the Match" available at http://www.aamc.org/programs/cim/chartingoutcomes.pdf
Before 2004, a similar exam, the Clinical Skills Assessment (CSA) was used to assess the clinical skills of foreign medical graduates.
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.
Step 3 is 16 hour examination divided over two-days. Each day of testing must be completed within eight hours. The first day of testing includes 336 multiple-choice items divided into 7 blocks, each consisting of 48 items. Examinees must complete each block within sixty minutes.
The second day of testing includes 144 multiple-choice items, divided into 4 blocks of 36 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 nine 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 accordingly. Each case must be managed in a maximum of 25 minutes of actual time.
Approximately forty-five minutes to one hour is available for break time on each of the two days of testing.
Federation of State Medical Boards
The Federation of State Medical Boards of the United States is a national non-profit organization that represents the 70 state medical and osteopathic boards of the United States and its territories and co-sponsors the United States Medical Licensing Examination...
(FSMB) and the National Board of Medical Examiners
National Board of Medical Examiners
The National Board of Medical Examiners , founded in 1915, is a United States examination board which sets state recognised examinations for medical students. The NBME is an independent, not-for-profit organization and is headquartered on and adjacent to the University City Science Center research...
(NBME). Medical doctors with an M.D. degree are required to pass this examination before being permitted to practice medicine in the United States of America.
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.
Students and graduates of U.S. or Canadian medical school programs accredited by either the Liaison Committee on Medical Education
Liaison Committee on Medical Education
The Liaison Committee on Medical Education is an accrediting body for educational programs at schools of medicine in the United States and Canada. The LCME accredits only the schools that grant a doctor of medicine degree; osteopathic medical schools are accredited by the Commission on...
(LCME) or Committee on Accreditation of Canadian Medical Schools, leading to the M.D. (Doctor of Medicine) degree, or by the American Osteopathic Association
American Osteopathic Association
The American Osteopathic Association is the representative member organization for the over 78,000 osteopathic medical physicians in the United States...
(AOA), leading to the D.O. (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
Educational Commission for Foreign Medical Graduates
Through its program of certification, the Educational Commission for Foreign Medical Graduates assesses the readiness of international medical graduates to enter residency or fellowship programs in the United States that are accredited by the Accreditation Council for Graduate Medical Education...
(ECFMG). 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 (ACGME) or the American Osteopathic Association (AOA).
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
COMLEX-USA
COMLEX-USA or The Comprehensive Osteopathic Medical Licensing Examination of the United States is a series of three osteopathic medical licensing examinations administered by the National Board of Osteopathic Medical Examiners similar to the United States Medical Licensing Examination...
(COMLEX) 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 first time USMLE Step 1 test takers are: 92% for U.S. M.D. medical school graduates, 81% for U.S. D.O. osteopathic medical school graduates, and 73% for international medical school graduates. Overall pass rates for first time USMLE Step 3 test takers are: 95% for U.S. M.D. medical school graduates, 95% for U.S. D.O. medical school graduates, and 78% for international medical school graduates. (In these statistics, "U.S. M.D. medical school graduates" includes graduates of Canadian M.D. programs.)
Step 1
USMLE Step 1USMLE Step 1
The USMLE Step 1 is the first part of the United States Medical Licensing Examination. It assesses whether medical school students or graduates can apply important concepts of the sciences fundamental to the practice of medicine. US medical students typically take Step 1 at the end of the second...
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 (general and individual anatomical characteristics) and procedural (functional, therapeutic, environmental, and abnormality) themes:
- AnatomyHuman anatomyHuman anatomy is primarily the scientific study of the morphology of the human body. Anatomy is subdivided into gross anatomy and microscopic anatomy. Gross anatomy is the study of anatomical structures that can be seen by the naked eye...
, - PhysiologyPhysiologyPhysiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...
, - BiochemistryBiochemistryBiochemistry, sometimes called biological chemistry, is the study of chemical processes in living organisms, including, but not limited to, living matter. Biochemistry governs all living organisms and living processes...
, - PharmacologyPharmacologyPharmacology is the branch of medicine and biology concerned with the study of drug action. More specifically, it is the study of the interactions that occur between a living organism and chemicals that affect normal or abnormal biochemical function...
, - PathologyPathologyPathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
, - MicrobiologyMicrobiologyMicrobiology is the study of microorganisms, which are defined as any microscopic organism that comprises either a single cell , cell clusters or no cell at all . This includes eukaryotes, such as fungi and protists, and prokaryotes...
, - Behavioral sciences,
- Interdisciplinary topics, such as nutritionNutritionNutrition is the provision, to cells and organisms, of the materials necessary to support life. Many common health problems can be prevented or alleviated with a healthy diet....
, geneticsGeneticsGenetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....
, and aging.
US medical students usually take Step 1 at the end of the second year of medical school
Medical school
A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. Degree programs offered at medical schools often include Doctor of Osteopathic Medicine, Bachelor/Doctor of Medicine, Doctor of Philosophy, master's degree, or other post-secondary...
. It is an eight-hour computer-based exam consisting of 322 multiple-choice questions (MCQs) divided into seven blocks each consisting of 46 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.
The scores are reported with a three digit score and a two digit score. As of January 1, 2010, the passing score has been raised to 188 from a previous score of 185. The average score is approximately 221 and the standard deviation is 23. If the student passes the exam, he or she may not repeat the exam to achieve a higher score.
While not recommended by the creators of the USMLE, the Step 1 score is frequently used in medical residency
Residency (medicine)
Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a medical degree , Podiatric degree , Dental Degree and who practices...
applications as a measure of a candidate's likelihood to succeed in that particular residency (and on that specialty's board exams). More competitive residency programs such as Radiology
Radiology
Radiology is a medical specialty that employs the use of imaging to both diagnose and treat disease visualized within the human body. Radiologists use an array of imaging technologies to diagnose or treat diseases...
, Ophthalmology
Ophthalmology
Ophthalmology is the branch of medicine that deals with the anatomy, physiology and diseases of the eye. An ophthalmologist is a specialist in medical and surgical eye problems...
, Plastic Surgery
Plastic surgery
Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand...
, Orthopedic Surgery
Orthopedic surgery
Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system...
and Dermatology
Dermatology
Dermatology is the branch of medicine dealing with the skin and its diseases, a unique specialty with both medical and surgical aspects. A dermatologist takes care of diseases, in the widest sense, and some cosmetic problems of the skin, scalp, hair, and nails....
usually only accept applicants with high Step 1 scores. The Step 1 exam is arguably the hardest and most important examination a medical student will take during his/her career.u also can join in an institute who provides you detailed coaching for usmle step 1. http://www.gims-org.com,http://www.usmletutor.org.
The USMLE score is among the most important of several factors considered by residency programs in selecting applicants. The median USMLE Step 1 scores for graduates of U.S. Medical Schools for various residencies are available in Chart 6 on page 9 of "Charting Outcomes in the Match" available at http://www.aamc.org/programs/cim/chartingoutcomes.pdf
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 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 (SPs) 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, PennsylvaniaPhiladelphia, PennsylvaniaPhiladelphia is the largest city in the Commonwealth of Pennsylvania and the county seat of Philadelphia County, with which it is coterminous. The city is located in the Northeastern United States along the Delaware and Schuylkill rivers. It is the fifth-most-populous city in the United States,...
- Chicago, Illinois
- Atlanta, GeorgiaAtlanta, GeorgiaAtlanta is the capital and most populous city in the U.S. state of Georgia. According to the 2010 census, Atlanta's population is 420,003. Atlanta is the cultural and economic center of the Atlanta metropolitan area, which is home to 5,268,860 people and is the ninth largest metropolitan area in...
- Houston, TexasHouston, TexasHouston is the fourth-largest city in the United States, and the largest city in the state of Texas. According to the 2010 U.S. Census, the city had a population of 2.1 million people within an area of . Houston is the seat of Harris County and the economic center of , which is the ...
- Los Angeles, CaliforniaLos Angeles, CaliforniaLos Angeles , with a population at the 2010 United States Census of 3,792,621, is the most populous city in California, USA and the second most populous in the United States, after New York City. It has an area of , and is located in Southern California...
Before 2004, a similar exam, the Clinical Skills Assessment (CSA) was used to assess the clinical skills of foreign medical graduates.
Step 3
USMLE Step 3USMLE Step 3
Step 3 is the final exam in the USMLE series of examinations. It is part of the licensing requirements for M.D.s, D.O.s, and FMGs to practice medicine in the United States.It is considered as the final step in the series of medical licensure examinations...
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
Connecticut
Connecticut is a state in the New England region of the northeastern United States. It is bordered by Rhode Island to the east, Massachusetts to the north, and the state of New York to the west and the south .Connecticut is named for the Connecticut River, the major U.S. river that approximately...
is frequently chosen for such purpose because it does not require simultaneous application for licensure, unlike New York.
Step 3 is 16 hour examination divided over two-days. Each day of testing must be completed within eight hours. The first day of testing includes 336 multiple-choice items divided into 7 blocks, each consisting of 48 items. Examinees must complete each block within sixty minutes.
The second day of testing includes 144 multiple-choice items, divided into 4 blocks of 36 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 nine 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 accordingly. Each case must be managed in a maximum of 25 minutes of actual time.
Approximately forty-five minutes to one hour is available for break time on each of the two days of testing.
Exam 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" (COMLEX-USACOMLEX-USACOMLEX-USA or The Comprehensive Osteopathic Medical Licensing Examination of the United States is a series of three osteopathic medical licensing examinations administered by the National Board of Osteopathic Medical Examiners similar to the United States Medical Licensing Examination...
) is required for osteopathic physicians in the United StatesUnited StatesThe United States of America is a federal constitutional republic comprising fifty states and a federal district...
In other countries
- Medical Council of Canada Qualifying ExaminationMedical Council of Canada Qualifying ExaminationThe Medical Council of Canada Qualifying Examination is a two part professional exam sponsored by the Medical Council of Canada. It is an essential part of becoming a Licentiate of the Medical Council of Canada ....
, in Canada - Professional and Linguistic Assessment Board testProfessional and Linguistic Assessment Board testThe Professional and Linguistic Assessment Board test is the assessment procedure conducted by the General Medical Council of the United Kingdom that is required for overseas doctors outside the European Union before they can practice medicine in the UK....
(similar exam used in United KingdomUnited KingdomThe United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
) - Australian Medical CouncilAustralian Medical CouncilThe Australian Medical Council is the Australian national standards advisory body for medical education and training.Its mission statement is:Within Australia, it:* Accredits Australian and New Zealand medical schools and medical courses...
(AMC) in Australia. - Examen Nacional de Aspirantes a Residencias Medicas (ENARM) in Mexico
- Saudi Licensing Examination (SLE) in Saudi Arabia