Introduction

The United States Medical Licensing Examination™ (USMLE™) 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® (NBME®).

The Composite Committee, appointed by the FSMB and NBME, establishes rules for the USMLE program. Membership includes representatives from the following:

Purpose of the USMLE

In the United States and its territories, the individual medical licensing authorities ("state medical boards") of the various jurisdictions grant a license to practice medicine. Each medical licensing authority sets its own rules and regulations and requires passing an examination that demonstrates qualification for licensure. Results of the USMLE are reported to these authorities for use in granting the initial license to practice medicine. The USMLE provides them with a common evaluation system for applicants for medical licensure.

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 complements the others; no Step can stand alone in the assessment of readiness for medical licensure.

The Three Steps of the USMLE

Step 1 assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Step 1 ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning.

Step 2 assesses whether you can apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision and includes emphasis on health promotion and disease prevention. Step 2 ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills that provide the foundation for the safe and competent practice of medicine.

Step 3 assesses whether you can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. Step 3 provides a final
assessment of physicians assuming independent responsibility for delivering general medical care.

Examination Committees

Examination committees composed of medical educators and clinicians prepare the examination materials. Committee members broadly represent the teaching, practicing, and licensing communities across the United States. At least two of these committees critically appraise each test item or case. They revise or discard any materials that are in doubt.

Ownership and Copyright of Examination Materials

The USMLE parent organizations, the FSMB and NBME, own the examination materials used in the USMLE. The examinations are copyrighted. If you reproduce and/or distribute any examination materials, by any means, including memorizing and reconstructing them, without explicit written permission from the parent organizations, you violate the rights of the FSMB and NBME. In addition to actions described under Irregular Behavior, the FSMB and the NBME will use every legal means available to protect USMLE copyrighted materials and secure redress against those who violate copyright law.

USMLE Step 2 Clinical Skills (CS) Examination

A clinical skills examination was part of the original design of USMLE. The NBME was charged with including a test of clinical skills using standardized patients when such an examination was shown to be valid, reliable, and practical. NBME research and the work of other organizations administering clinical skills examinations demonstrate that clinical skills examinations measure skill sets different from those measured by traditional multiple-choice questions. Mastery of clinical and communication skills, as well as cognitive skills, by individuals seeking medical licensure is important to the protection of the public.

Implementation of the clinical skills examination will occur in the second or third quarter of 2004. The clinical skills examination will be a separate component of Step 2, and will be referred to as Step 2 Clinical Skills, or Step 2 CS. The current Step 2 will be referred to as the Clinical Knowledge Component, or Step 2 CK.

In order to be eligible to register for USMLE Step 3, students and graduates of LCME- or AOA-accredited medical schools will be required to not only meet current examination requirements (i.e., passing Step 1 and passing Step 2 CK) but also to pass Step 2 CS if they: (a) have graduation dates in 2005 or later, or (b) have graduation dates prior to 2005 and have not passed the CK component of Step 2 taken on or before June 30, 2005.

When Step 2 CS is implemented, it will replace the Clinical Skills Assessment (CSA®) administered by the ECFMG and required for ECFMG certification of international medical graduates.

In order to be eligible to register for USMLE Step 3, international medical graduates will be required to not only meet current requirements (i.e., passing Step 1 and Step 2 CK and being certified by ECFMG), but also to pass Step 2 CS. However, international medical graduates who have passed the ECFMG CSA will not be required to pass Step 2 CS to register for USMLE Step 3.

To be eligible to register for Step 3, ECFMG-certified international medical graduates who have not passed the ECFMG CSA, as well as individuals who successfully complete a “Fifth Pathway” program, may also be required to pass Step 2 CS. These individuals should monitor the USMLE website for the effective date of this requirement.

You are responsible for determining whether this requirement applies to you, based on the rules stated in the paragraphs above.

This bulletin is written to include information available at the time of publication regarding the CS component of Step 2. As additional information about the implementation of Step 2 CS becomes available, details will be provided at the USMLE and your registration entity’s websites.

Computer-Based Testing (CBT)

Parts of the USMLE are administered by computer. Prometric®, part of The Thomson Corporation, provides scheduling and test centers for the USMLE. Step 1 and Step 2 Clinical Knowledge Component are given around the world at Prometric Test Centers (PTCs). Step 3 is given at PTCs in the United States and its territories.