USMLE Coaching Center


USMLE Coaching center

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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). Physicians with an M.D. degree are required to pass this examination before being permitted to practice medicine in the United States; see below for requirements of physicians with a D.O. degree.

 

Purpose

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.

Overview

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 Doctor of Medicine (M.D.) degree, or by the American Osteopathic Association (AOA), leading to the Doctor of Osteopathic Medicine(D.O.) 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 USMLE Step 1 test takers in 2013-2014 are: 95% for U.S. M.D. medical school graduates (97% in first-time takers), 94% for U.S. D.O. osteopathic medical school graduates (94% in first-time takers), and 72% for international medical school graduates (79% for first-time takers). Overall USMLE Step 2 CK test taker pass rates in 2013-2014 are: 97% for U.S. M.D. medical school graduates (98% in first-time takers) and 96% for U.S. D.O. medical school graduates (96% in first-time takers). Overall USMLE Step 2 CS test taker pass rates in 2013-2014 are: 97% for U.S. M.D. medical school graduates (98% in first-time takers) and 89% for U.S. D.O. medical school graduates (89% in first-time takers), though this figure may be somewhat misleading since there were 19,757 M.D. first-time test takers and 63 D.O. first-time test takers.[5] Overall pass rates for USMLE Step 3 test takers in 2013-2014 are: 96% for U.S. M.D. medical school graduates (97% in first-time takers), 92% for U.S. D.O. medical school graduates (96% in first-time takers), and 83% for international medical school graduates (87% in first-time takers). These statistics may be somewhat misleading since there were 19,086 M.D. first-time test takers for Step 3 and 23 D.O. first-time test takers. (In these statistics, “U.S. M.D. medical school graduates” includes graduates of Canadian M.D. programs.)

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USMLE Step 1

The USMLE Step 1 (more commonly just Step 1 or colloquially, The Boards) 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, as well as Canadian medical students who wish to seek licensure in the US, typically take Step 1 at the end of the second year of medical school. Graduates of international medical schools (i.e., those outside the US or Canada) must also take Step 1 if they want to practice in the US. Graduates from international medical schools must apply through ECFMG, and the registration fee is $850. For 2016, the NBME registration fee for the test is $600, with additional charges for applicants who choose a testing region outside the United States or Canada.

Format

The exam is currently an eight-hour computer-based test taken in a single-day, composed of seven 44-question sections with a total of 308 multiple-choice questions. Beginning May 9, 2016, the NBME plans to shorten the test to seven 40-question sections. One hour is provided for each section, allotting an average of a minute and eighteen seconds to answer each question.[5] Between test sections, the test taker is allotted a cumulative 45 minutes (during the test day) for personal breaks. (There is a 15-minute tutorial at the beginning of the exam, which the test-taker can choose to skip and have that time added to break time.) If the taker finishes any section before the allotted one hour time limit, the unused time is added to the break time total. The test is administered at any of several Prometric computer testing sites.

Subjects

Step 1 is designed to test the knowledge learned during the basic science years of medical school. This includes anatomy, behavioral sciences, biochemistry, microbiology,pathology, pharmacology, and physiology, as well as to interdisciplinary areas including genetics, aging, immunology, nutrition, and molecular and cell biology. Epidemiology,medical ethics and questions on empathy are also emphasized. Each exam is dynamically generated for each test taker; while the general proportion of questions derived from a particular subject is the same, some test takers report that certain subjects are either emphasized or deemphasized.

Scoring

The USMLE phased out the use of a percentile based system in 1999. Examinees receive a three-digit score and a two-digit score; the latter of which is not a percentile. The three-digit score is a scaled score with a mean that fluctuates test year to test year, and a standard deviation of approximately 21. The three-digit score is calculated using a statistical percentile that ensures that scores from different years are read on a common scale, since the exam is known to get progressively more difficult as the years go on. However, the NBME does not disclose how this three-digit score is calculated. The two digit score is a scaled score that defines 75 as the minimum passing score, which is equivalent to a 192 on the three-digit scale. The three-digit score is more commonly used. As of October 3, 2011, USMLE began the process of eliminating the reporting of results on the two-digit score scale to any parties, including residency programs, other than the examinee and any state licensing authority to which the examinee sends results.
In 2014, the national mean score was 229 with a standard deviation of 20;[10] the minimum passing score was 192. This mean score represents an increase from the previous five years, as seen in the table below. Many top residency programs use a “cutoff” score for Step 1, below which applicants are unlikely to be considered. Most other residency programs follow a similar “cutoff,” but will allow consideration of applicants with significantly higher Step 2 scores.

National Step 1 means among US and Canadian first time test-takers by year
Year Mean Score Standard Deviation
2014 229 20
2013 228 21
2012 227 22
2011 225 22
2010 222 24
2009 221 24
2008 221 23

Effect on residency matching

The USMLE score is one of many factors considered by residency programs in selecting applicants. However, at present, this test is the only standardized measure of all applicants. The median USMLE Step 1 scores for graduates of U.S. Medical Schools for various residencies are charted in Chart 6 on page 9 of “Charting Outcomes in the Match” available through NRMP Website

 

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USMLE Step 2 Clinical Knowledge

The USMLE-Step 2-CK (“Clinical Knowledge”) is the nine-hour-long multiple-choice portion of the second part of the United States Medical Licensure Examination It assesses clinical knowledge through a traditional, multiple-choice examination. In contrast to the USMLE Step 1, the focus is much more on clinical application of medical knowledge. It assesses the ability to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision. The USMLE Step 2 is generally taken during the 4th year of medical school by medical students. From January 2010, to take the exam in North America the registration fee is $580 for students attending medical colleges in the United States and $850 for medical students from other countries. There are additional charges for applicants who choose a testing region outside the United States or Canada.

Format

The exam is a nine-hour single-day computer-based test composed of eight question sets with no more than 45 questions per set (340 to 355 multiple-choice questions in total). Each section is one hour long. The test taker is permitted 45 minutes, in total for the whole day, for the purpose of breaks that can only be taken between sections. There is a 15-minute tutorial at the beginning of the exam, which the test-taker can choose to skip, and have the time added to the break time. If the taker finishes any section before the allotted 1 hour time limit, the remainder of the time is added to break time. The test is administered at the PROMETRIC Training Center in India testing sites around the world.

Topics

Step 2 CK includes test items in the following content areas: internal medicine, obstetrics and gynecology, pediatrics, preventive medicine, psychiatry, surgery, other areas relevant to provision of care under supervision.
Most Step 2 CK test items describe clinical situations and require that you provide one or more of the following: diagnosis, a prognosis, an indication of underlying mechanisms of disease, the next step in medical care, including preventive measures.
Step 2 CK is a broadly based, integrated examination. It frequently requires interpretation of tables and laboratory data, imaging studies, photographs of gross and microscopic pathologic specimens, and results of other diagnostic studies. Step 2 CK classifies test items along two dimensions: disease category and physician task.

Scoring

Scoring is reported in 3 digit scores. Most scores fall between 140 and 260, with the mean score for first-time examinees from accredited medical schools in the United States in the range of 220 to 230, and the standard deviation approximately 25. The mean score for Step 2CK as of 4/2/2014 for first-time test takers in US and Canadian medical schools is a 238 with a standard deviation of 19. Every three to four years the Step Committees are asked to complete an in-depth review of standards, and they may schedule more frequent reviews. At its May 2014 meeting, the Step 2 Committee conducted a review for USMLE Step 2 Clinical Knowledge (CK). As a result of its review, the Step 2 Committee decided to raise the Step 2 recommended minimum passing score to 209 for students taking the test after July 1, 2014.

 

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USMLE Step 3

Step 3 is the final exam in the USMLE series of examinations. It is part of the licensing requirements for Doctors of Medicine (M.D.) and international medical graduates to practice medicine in the United States. The USMLE Step 3 exam is considered the final step in the series of medical licensure examinations. Generally, it is a pre-requisite of the majority of the state licensing boards.
USMLE Step 3 tests several concepts that are often required to provide general health care to a patient. USMLE Step 3 is a mandatory exam that must be passed in order to obtain license as a practicing physician. Some International Medical Graduates are required to pass USMLE Step 3 in order to obtain an H1 Visa.
Most of the USMLE Step 3 exam (75 percent) consists of multiple choice questions, while the remaining 25 percent are clinical case simulations. A full description of the content of the exam can be found on the USMLE website. USMLE Step 3 exams are delivered online and are available throughout the year to the examinees. The examinee needs to register via a state licensing board for this exam.
Starting from 2014 USMLE Step 3 can be taken on two non-consecutive days, instead of two consecutive days.

Examination content

USMLE Step 3 examination tests on general topics that are required to understand and practice concepts of general medicine/ family medicine.
The following components are tested:
Normal conditions and disease categories (normal growth and development, basic concepts, and general principles)
Clinical encounter frame (initial work up, continuing care, urgent intervention)
Physician task (applying scientific concepts, formulating a diagnosis based on history, physical exam, and lab findings, and managing the patient).
Clinical encounter frames are common clinical scenarios physicians may encounter. They range from nonemergency problems, to the continuity of care, to life-threatening emergency situations encountered in emergency departments, clinics, offices, care facilities, inpatient settings, and on the telephone. Each test item, in an encounter frame, represents one of the six physician tasks. For example, initial care encounters emphasize taking a history and performing a physical examination. In contrast, continued care encounters emphasize decisions regarding prognosis and management.

Eligibility for USMLE Step 3

To be eligible to take the USMLE Step 3 exam, the physician must hold an M.D. or D.O. degree, and successfully pass the USMLE Step 1 and Step 2 Clinical Knowledge exams. International medical graduates (IMGs) must obtain certification by the Educational Commission for Foreign Medical Graduates (ECFMG) or successfully complete a “Fifth Pathway” program. The Step 2 CS may also be required. Canadian M.D. graduates are not considered IMGs.
Starting November 2014, fulfillment of specific requirements from individual medical licensing authorities will not be needed.

Preparation strategies for USMLE Step 3

Typically, worldwide examinees require two to three months to prepare for this exam, although in the US, examinees who are American medical school graduates commonly prepare for only a few days to a few weeks.Physicians in post-graduate training that plan for fellowships or additional training often are advised to consider more detailed preparation. An examinee is tested on clinical skills, diagnostic acumen, decision making, treatment guidelines and follow up care. Most recently, some changes have been made to USMLE Step 3 multiple choice questions including increased emphasis placed on biostatistics, epidemiology, and population health, literature interpretation, medical ethics, and patient safety. “Archer review”, “USMLE World” and “Board Vitals” are some courses that offer test banks and review literature for purchase.

Pass rates

First-time USMLE pass rates for D.O. and M.D. students in 2011 were 94 percent and 96 percent, respectively. Pass rates for students from schools outside of the United States and Canada were 84 percent. Trainees in fields which encompass multiple specialties, such as emergency medicine or family practice, tend to perform well on step 3 regardless of when they take the exam; trainees in other fields tend to do better if they take the exam shortly after medical school.

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USMLE STEP 1

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USMLE STEP 2 CK

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USMLE STEP 3 Clinical Skills

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