United States Medical Licensing Examination (USMLE)
What is the USMLE?
Before you can apply for a medical license, you must pass a three-step test called the United States Medical Licensing Examination (USMLE), also known as the board exam.
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 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 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 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.
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.