Doctors & Future Doctors From All Over The World!: USMLE

United States Medical Licensing Examination

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 a 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.)

The total cost to take all three portions of the process is $2900.

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 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 FRED^tm, was upgraded in 2008 to a new version, FRED^tm 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.