What is USMLE United States Medical Licensing Exam

The United States Medical Licensing Examination(USMLE) is a multi-part professional exam sponsored by theFederation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). Medical doctors are required to pass  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 medical schools outside the United States or Canada register for Step 1 and Step 2 with theEducational Commission for Foreign Medical Graduates (ECFMG)  

To find out if your desired center has available seats for the upcoming step 1 please visit www.prometric.com

The EXAM Format: The USMLE first started out as a paper examination, converting in 2004 to a computer based multiple choice examination. The test can be taken at Thomson Prometric test centers worldwide. However, the Step 2 CS and the Step 3 can only be taken in the USA.
The Exam consists of three parts or the famous “STEPS” . Step 1, step 2 and step 3.

USMLE Step 1: Assesses whether medical school students or graduates understand and can apply important concepts of the sciences basic 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:

  • Anatomy,
  • Physiology,
  • Biochemistry,
  • Pharmacology,
  • Pathology,
  • Microbiology,
  • Behavioral sciences,
  • Interdisciplinary topics, such as nutrition, genetics, and aging

Step 1 is an eight-hour computer-based exam consisting of 336 multiple-choice questions (MCQs) divided into seven blocks each consisting of 48 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 tutor 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 studentpasses the exam, he or she may not repeat the exam to achieve a higher score.

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, and Dermatology usually only accept applicants with high

Step 1 scores 

The USMLE score is just one of many factors considered by residency programs in selecting applicants.

Overall pass rates for first time USMLE Step 1 test takers is 73% forinternational medical graduates.

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. 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
  • 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 cost for this test is approx. $1200, plus added expenses related to travel, lodging, and food to and in the one of only five cities in which the test is offered. The examination is offered in five cities across the country:

  • Philadelphia
  • Chicago
  • Atlanta
  • Houston
  • Los Angeles

Before 2004, a similar exam, the Clinical Skills Assessment (CSA) was used to assess the clinical skills of foreign medical graduates.

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. Foreign medical graduates can take Step 3 before starting residency in about ten U.S. states.

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.

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