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USMLE : United Sates Medical Licensing Examination

In the United States of America (USA)and all its territories, the authorities of medical licensing /state medical boards of the various jurisdictions grant a license to practice medicine. Each medical licensing authority/medical boards sets its own rules and regulations and requires passing an examination that can demonstrate qualification for the license. Results of the USMLE are reported to these medical licensing authorities for use in granting the initial license to practice medicine in USA. The USMLE provides them with a common evaluation system for applicants for initial medical licensure

Who is USMLE?

The USMLE®, or the United States Medical Licensing Examination® program, is owned by two entities: the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners® (NBME®).

The FSMB is a non-profit organization that represents the 70 state medical and osteopathic boards of the United States Of America and its territories. The individual medical boards are responsible for licensing physicians, investigating patient complaints, and disciplining physicians who violate the law. The FSMB acts on behalf of its state board members in providing a national assessment program, sponsoring a national data base for tracking disciplinary actions, providing tools that facilitate the documentation and distribution of credentials and acting as a national voice for the individual boards on issues that are important to licensing and practice.

The NBME is also a non-profit organization that serves the public through assessments of health professionals. It has approximately 80-member board which includes representation from national experts who contribute to the design of its examinations, at-large members who bring a variety of perspectives including the public, and representatives from organizations such as the Association of American Medical Colleges (AAMC), the American Board of Medical Specialties (ABMS), the American Medical Association (AMA), the Resident and Fellows Section of the AMA, the American Medical Student Association (AMSA), the Council of Medical Specialty Societies (CMSS), the Educational Commission for Foreign Medical Graduates (ECFMG), FSMB, the Student National Medical Association (SNMA), the uniformed services, and the Department of Veterans Affairs.

The NBME develops a number of assessments used in medical education, licensure, and certification, domestically and internationally, and is involved in research and development intended to advance medical education and the science of assessment.

Who Governs USMLE?

USMLE is governed by a committee that includes members from the FSMB, ECFMG, NBME, and the public. This committee is responsible for the overall direction of the program which also includes identifying and approving procedures for scoring and determining the pass/fail standard, and all significant policies and procedures.

Who Develops the Content for the Exams?

USMLE test committees’ members include educators, biomedical scientists and clinicians from every region of the United States. Virtually all LCME-accredited medical schools in the United States have been represented on USMLE test committees. USMLE test committee members represent a “national faculty of medicine” drawn from medical schools, state medical boards, and clinical practice settings across the United States.

Why One National Examination?

USMLE was created as one path to medical licensure for allopathic physicians in the United States of America. Before USMLE, multiple examinations (the NBME Parts examination and the Federation Licensing Examination [FLEX]) offered paths to medical licensure. It was desirable to create one examination system accepted in every state, to ensure that all licensed MDs had passed the same assessment standards – no matter in which school or which country they had trained. Today all state medical boards utilize a national examination – USMLE for allopathic physicians, COMLEX-USA for osteopathic physicians.

USMLE Mission Statement
  • To provide to licensing authorities 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.
  • To engage medical educators and their institutions, licensing authority members, and practicing clinicians in the design and development of these assessments.
  • To assure fairness and equity to physicians through the highest professional testing standards.
  • To continue to develop and improve assessments for licensure with the intent of assessing physicians more accurately and comprehensively.
  • USMLE exam consists of three steps with four exams to assist physicians ability to apply aboard spectrum of knowledge concepts, and principles to evaluate the physician’s basic patient-centered skill. The three USMLE steps are steps 1, steps 2 CK, step 2 CS and STEP 3. Step 1 & Step 2 CK are online examination can be given in majorities of countries globally. Where in step 2 cs is practical exam and step 3 again online, both of them are given in USA.
STEP 1 :

Step 1 assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine. 

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 1 is constructed according to an integrated content outline that organizes basic science material along two dimensions: system and process.

Step 1 is a one-day examination. It is divided into seven 60-minute blocks and administered in one 8-hour testing session. The number of questions per block on a given examination form may vary, but will not exceed 40. The total number of items on the overall examination form will not exceed 280.

STEP 2 CK :

Step 2 CK assesses an examinee’s ability to 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 CK ensures that due attention is devoted to principles of clinical sciences and basic patient-centred skills that provide the foundation for the safe and competent practice of medicine under supervision.

Step 2 CK is a one-day examination. It is divided into eight 60-minute blocks and administered in one 9-hour testing session. The number of questions per block on a given examination will vary but will not exceed 40. The total number of items on the overall examination will not exceed 318.

The examination also includes a minimum allotment of 45 minutes of break time and a 15-minute optional tutorial. The amount of time available for breaks may be increased by finishing a block of test items or the optional tutorial before the allotted time expires.

STEP 2 CS :

Step 2 of the USMLE assesses the ability of examinees to 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 the principles of clinical sciences and basic patient-centred skills that provide the foundation for the safe and effective practice of medicine.

Step 2 CS uses standardized patients to test medical students and graduates on their ability to gather information from patients, perform physical examinations, and communicate their findings to patients and colleagues.

STEP 3 CS :

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.  It is the final examination in the USMLE sequence leading to a license to practice medicine without supervision.

Step 3 content reflects a data-based model of generalist medical practice in the United States. The test items and cases reflect the clinical situations that a general, as-yet undifferentiated, physician might encounter within the context of a specific setting.

Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care.

The Step 3 examination devotes attention to the importance of assessing the knowledge and skills of physicians who are assuming independent responsibility for providing general medical care to patients. The first day of the Step 3 examination is referred to as Foundations of Independent Practice (FIP), and the second day is referred to as Advanced Clinical Medicine (ACM).

Exam Format Step 3 is a two-day examination.

The first day of testing includes 232 multiple-choice items divided into 6 blocks of 38-39 items; 60 minutes are allotted for completion of each block of test items. There are approximately 7 hours in the test session on the first day, including 45 minutes of break time and a 5-minute optional tutorial. Note that the amount of time available for breaks may be increased by finishing a block of test items or the optional tutorial before the allotted time expires.

on the second day There are approximately 9 hours in the test session. This day of testing includes a 5-minute optional tutorial followed by 180 multiple-choice items, divided into 6 blocks of 30 items; 45 minutes are allotted for completion of each block of test items. The second day also includes a 7-minute CCS tutorial. This is followed by 13 case simulations, each of which is allotted a maximum of 10 or 20 minutes of real time. A minimum of 45 minutes is available for break time. There is an optional survey at the end of the second day, which can be completed if time allows.

Day 1
Step 3 Foundations of Independent Practice (FIP)
This test day focuses on assessment of knowledge of basic medical and scientific principles essential for effective health care. Content areas covered include application of foundational sciences; understanding of biostatistics and epidemiology/population health, and interpretation of the medical literature; and application of social sciences, including communication and interpersonal skills, medical ethics, systems-based practice, and patient safety.

The test day also includes content assessing knowledge of diagnosis and management, particularly focused on knowledge of history and physical examination, diagnosis, and use of diagnostic studies. This test day consists solely of multiple-choice questions and includes some of the newer item formats, such as those based on scientific abstracts and pharmaceutical advertisements.

Day 2
Step 3 Advanced Clinical Medicine (ACM)

This test day focuses on assessment of the ability to apply comprehensive knowledge of health and disease in the context of patient management and the evolving manifestation of disease over time. Content areas covered include assessment of knowledge of diagnosis and management, particularly focused on prognosis and outcome, health maintenance and screening, therapeutics, and medical decision making. Knowledge of history and physical examination, diagnosis, and use of diagnostic studies also is assessed. This test day includes multiple-choice questions and computer-based case simulations.

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