The United States Medical Licensing Examination (USMLE®) is a series of tests given to people training to become medical doctors. The examination is broken down into three parts, or Steps, taken at different points in the medical training process. Passing Steps 1-3 of the USMLE® is required to independently practice medicine in the US and obtain a medical license. The USMLE® tests are produced as a joint effort of the National Board of Medical Examiners (NBME®) and the Federation of State Medical Boards (FSMB).
Step 1 of the USMLE® tests assesses basic knowledge about anatomy, pathology, biochemistry, physiology, behavioral sciences, pharmacology, and microbiology. Questions on the test reflect knowledge gained during the first two years of medical school, in which students traditionally learn in a classroom-based format. Most students take the Step 1 test in the summer between the second and third years of medical school. The test itself consists of 350 multiple-choice questions and is given as a computer-based examination.
Like the Step 1 test, Step 2 of the USMLE® tests is typically taken during medical school. Its objective is to evaluate whether a student can care for patients under the supervision of a licensed practitioner. This examination has two parts, Step 2 Clinical Knowledge (CK) and Step 2 Clinical Skills (CS). Both tests are usually taken during the fourth year of medical school.
The Step 2 CK test has a similar format to the Step 1 test in that it is computer-based and consists of multiple-choice questions. It tests knowledge that should have been acquired during a medical student's third-year clinical rotations. Questions focusing on the fields of internal medicine, surgery, pediatrics, psychiatry, obstetrics, gynecology, family medicine, and neurology are included.
Unlike the Step 2 CK test, the Step 2 CS test uses standardized patients, who are actors hired to pretend to be patients with different illnesses. The purpose of the test is to evaluate how well a student can obtain histories of patients' diseases, perform physical exams, discuss treatment options with patients, and write summaries of encounters with patients. It also assesses the student's ability to speak English and interact with patients in a professional way.
The objective of Step 3 of the USMLE® tests is to see if the student has learned enough to practice medicine independently. It is traditionally taken after the first year of residency training, although some doctors in training postpone taking the test until later. The Step 3 test contains some multiple-choice questions. Additionally, it includes computer simulations of patient cases that require the test-taker to make real-time decisions about what should be done to best treat the patient. The scope of the test includes assessing whether the student knows what questions to ask patients, what laboratory tests to order, how to diagnose diseases, and how to treat a variety of conditions.