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Annual Report on USMLE to Medical Licensing Authorities in the U.S. | 2017
Introduction and Program Overview
The United States Medical Licensing Examination® (USMLE®) is a jointly owned program of the
Federation of State Medical Boards of the United States, Inc., (FSMB) and the National Board of
Medical Examiners® (NBME®). USMLE is a three-step examination sequence for medical licensure
in the United States. The first administrations of the examination took place in 1992. Today, the
program administers approximately 140,000 Step examinations or Step components annually with
more than 2.7 million total test administrations since 1992. In fact, as of 2016 approximately 50% of
this nation’s 953,695 actively licensed physicians have taken all or a part of the USMLE sequence.
Mission:
The USMLE’s stated mission is to support US medical licensing authorities through the development,
delivery and continual improvement of high quality assessments across the continuum of physicians’
preparation for practice. The program’s goal is to provide medical licensing authorities with
meaningful information from assessments of physician characteristics—including medical knowledge,
skills, values, and attitudes—that are important to the provision of safe and effective patient care.
The results of the USMLE are reported to medical licensing authorities for their use in the decision
to grant a provisional license to practice in a post-graduate training program and the decision to grant
an initial license for the independent practice of medicine. The USMLE is recognized and utilized by
all state medical boards for licensing allopathic physicians and graduates of international medical
schools. Some licensing authorities also recognize USMLE for licensing osteopathic graduates.
Governance:
The FSMB and the NBME co-own the USMLE. However, much of the governance responsibility for
the program resides with the USMLE Composite Committee. The committee comprises
representatives from the FSMB, the NBME, the Educational Commission for Foreign Medical
Graduates (ECFMG) and the public. The Composite Committee is responsible for overseeing and
directing USMLE policies. Specific functions of the committee include establishing policies for
scoring and standard setting; approving Step examination blueprints and test formats; setting policies
for test administration, test security and program research. The membership of the Composite
Committee routinely includes current or former members of state medical boards. At this time, current
and former members of the Iowa, Minnesota, North Carolina, Vermont-Medical, and Virginia boards
serve on the USMLE Composite Committee.
The three USMLE Step examinations are overseen by a Management Committee composed of
physicians and scientists from the licensing, practice and medical education communities and
members of the public. At this time, current and former members of the Florida-Medical, Hawaii,
Iowa, Minnesota, North Carolina and Wisconsin medical boards serve on the USMLE Management
Committee.
Eligibility:
USMLE is intended to be taken by students and graduates of medical school programs leading to the
M.D., D.O., or equivalent degree. The USMLE requirements are as follows:
To be eligible for Step 1, Step 2 CK, and Step 2 CS, the examinee must be in one of the following
categories at the time of application and on test day:
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Annual Report on USMLE to Medical Licensing Authorities in the U.S. | 2017
• a medical student officially enrolled in, or a graduate of, a US or Canadian medical school
program leading to the MD degree that is accredited by the Liaison
Committee on Medical
Education (LCME), or
• a medical student officially enrolled in, or a graduate of, a US medical school leading to the
DO degree that is accredited by the American Osteopathic Association (AOA), or
• a medical student officially enrolled in, or a graduate of, a medical school outside the United
States and Canada listed in the
World Directory of Medical Schools as meeting ECFMG eligibility
requirements; and who meets other ECFMG criteria.
To be eligible for Step 3, prior to submitting an application, the examinee must meet the following
eligibility requirements prior to submitting an application:
• obtain the MD degree (or its equivalent) or the DO degree, and
• pass Step 1, Step 2 CK, and Step 2 CS, and
• obtain certification by the ECFMG if the examinee is a graduate of a medical school outside
the United States and Canada.
The USMLE program recommends that for Step 3 eligibility, examinees should have at least one
postgraduate training (PGT) year in a program of an accredited graduate medical education (e.g.,
accredited by the ACGME or the AOA) that would qualify for medical licensure in the United States.
A physician who received his or her basic medical degree or qualification from a medical school
outside the United States and Canada may be eligible for certification by the ECFMG if the medical
school and graduation year are listed in the
World Directory of Medical Schools. This applies to
citizens of
the United States who have completed their medical education in schools outside the United States
and Canada but not to foreign nationals who have graduated from medical schools in the United States
and Canada. Specific eligibility criteria for students and graduates of medical schools outside the
United States and Canada to take Step 1 and Step 2 are described in the
ECFMG Information Booklet.
Once an individual passes a USMLE Step, it may not be retaken. Rare exceptions to this policy can
be found at
http://www.usmle.org/bulletin/eligibility/
.
Content:
The USMLE is composed of three Steps: Step 1, Step 2, and Step 3. Step 2 has two separately
administered components, Clinical Knowledge (CK) and Clinical Skills (CS). Although the USMLE is
generally completed over the course of several years in the career of a prospective physician, it
constitutes a single examination. Each of the three Steps complements the others; no Step can stand
alone in the assessment of readiness for medical licensure.
Content for the USMLE is developed by committees of medical educators and clinicians. Committee
members broadly represent the teaching, practice and licensing communities across the United States.
At least two of these committees critically appraise each test item or case before it is used as live (i.e.,
scored) material on the USMLE. These committees may revise or discard materials for any of several
reasons, e.g., inadequate clinical relevance, outdated content, failure to meet acceptable statistical
performance criteria, etc. For a more detailed explanation of content development, contact FSMB for
a copy of the 2009
Journal of Medical Licensure and Discipline article, “Developing Test Content for the
USMLE”.