USMLE – What’s it for?

In order to become a licensed physician in the United States, individuals must pass a series of examinations conducted by the National Board of Medical Examiners.  These examinations are the United States Medical Licensing Examinations, or USMLE.  Currently there are four separate exams which must be passed in order to eligible for medical licensure:   

 

• Step 1, usually taken after the completion of the second year of medical school; 
• Step 2 Clinical Knowledge (CK), usually taken during the fourth year; 
• Step 2 Clinical Skills (CS), usually taken during the fourth year; and 
• Step 3, typically taken during the first year of post graduate training.

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 2 Clinical Skills (CS)  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 began in June 2004. The clinical skills examination is a separately administered component of Step 2 and is referred to as Step 2 Clinical Skills, or Step 2 CS. The computer-based, multiple-choice component of Step 2 is referred to as Step 2 Clinical Knowledge, or Step 2 CK. 

USMLE Step 2 CS is administered at five regional test centers (CSEC Centers) in the United States.

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.

Requirements for licensure in each state are set by the state’s medical licensing boards.  Each state board may determine the maximum number of times that a person may take each Step exam and still remain eligible for licensure.

But what we’re really here for is to talk about preparing for Step 1.  Step 1 is your first BIG hurdle.  And make no mistake about it, this is a VERY important test.  A very good performance on Step 1 can definitely help you when it comes to securing a top-rate residency, and likewise a poor score can hurt you and limit your options.  And a failure on Step 1 can eliminate the possibility of some residencies altogether.  So it is definitely in your best interest to do all you can to maximize your chances of doing well, regardless of what type of residency you may choose to pursue.