Guide to the United States Medical Licensing Examination

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The United States Medical Licensing Examination (USMLE) must be passed by anyone wishing to practice medicine in the United States, whether they have undertaken their training there or abroad. The exam is in three stages and all must be passed to obtain a license. Steps 1 and 2 are usually taken during the undergraduate years and Step 3 in the first year of postgraduate training. Until January 2012 there is no limit on how many times a student can take the examination but after that date, there will be a maximum number of attempts, currently set at six.

The USMLE is delivered by Prometric, a computer examining body with centers all over the USA. The eligibility for being able to take the test and all of the administration is completed by the Licensing Board, and the booking for the examination is forwarded to the prospective licensed medical student or practitioner. The exam is then taken and the results are ready in around a month. The results are expressed as a number, except in the Step 2 CS which is pass or fail, and depending on which scoring system is used the pass level is either expressed as 45 or 188. It is made very clear whether the exam has been passed or failed. It is not possible to take a Step again to improve the score, although obviously it can be taken again in the case of a fail, up to the new limit of six times.

Everyone who wishes to practise medicine in the United States must be in possession of a valid USML and stringent steps are taken to make sure that this is the case. Qualified physicians from out of the country are not allowed to practise until they have passed the USMLE. There are tutorials and review material easily available online to help with taking the exam and of course if it is taken in the course of studying for a medical degree, teaching staff are on hand to help. The questions are based on the basic medical training and are not designed to trick or trip up the examinee – the examination is designed with the sole aim in mind of improving the standard of medical care in the United States to the same level no matter whereabouts in the country the doctor is practising. In such a large country there is an obvious necessity to ensure that there are no areas where quality might fall below acceptable standards and the use of the USMLE across the board is the best way of ensuring this.

The Steps are easy to study for and are split into areas as follows. Step 1 takes the examinee back to the first principles of the sciences which underpin medicine and measure the depth of the knowledge obtained in these during training. Step 2, Clinical Knowledge, covers the application of these facts in patient care and Step 2 Clinical Skills is patient based and measures the examinee’s ability to obtain knowledge from the patient by questioning and physical examination. Step 3, which is taken at postgraduate level, measures all these skills again, but this time in an unsupervised environment. Good Luck!

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