United States Medical Licensing Examination (USMLE)
The United States Medical Licensing Examination (USMLE) is a multi-part professional series of exams. USMLE consists of three steps, all of which must be passed before a medical school graduate is eligible to apply for a license to practice medicine. A chart of USMLE Step 1 scores for graduates and their frequency at various residencies are charted in Table 2 on page 5 of "Charting Outcomes in the Match".
Step ONE
Although the USMLE score is just one of many factors in the decision making process, competitive residency programs tend to look for a high Step 1 score when assessing applicants. The Step 1 exam is arguably the most difficult, and the most important, examination a medical student will ever undertake. Usually taken at the end of the second year of medical school, Step 1 is an assessment of the student's ability to understand, and apply, scientific concepts to the practice of medicine. This is an 8 hour computer based examination that consists 336 multiple choice questions. For theories, the maximum score is 300 marks. The mark for a normal pass out is 185. Themes are looked at both systemically (general and individual anatomical characteristics) and procedurally (functional, therapeutic, environmental, and abnormality) in the following areas: Anatomy, Interdisciplinary topics, such as nutrition, genetics, and aging, Behavioral sciences, Microbiology, Biochemistry, Pathology, Physiology and Pharmacology.
Step TWO
Typically taken during the fourth year of medical school, Step 2 assess whether students can apply medical knowledge, skills and understanding of clinical science which will be essential for providing patient care while under supervision. It comes in two parts: 2-CK and 2-CS.
Step 2-CK is designed to assess clinical knowledge through a 9-hour multiple-choice examination. Subjects included in this exam are clinical sciences: Internal Medicine, Surgery, Pediatrics, Psychiatry, Obstetrics & Gynecology.
Step 2-CS assesses clinical skills through simulated patient interactions. The student interacts with twelve actors who portray standardized symptoms. They have fifteen minutes to take history and conduct a clinical examination for each patient. Ten further minutes are provided in which to write a patient note which describes the findings, initial differential diagnosis list and a list of initial tests. The cost for this test is around $1200, plus added expenses related to travel, lodging, and food to and in the one of only five cities in which they offer the test: Philadelphia (PA), Chicago (IL), Atlanta (GA), Houston (TX), Los Angeles (CA).
Step THREE
Step 3 assesses whether a medical school graduate can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine. This exam is typically taken at the end of an internship/first year of residency. The examination takes place over the course of two days. The first day of testing includes 336 multiple-choice questions. The second requires another 144 multiple-choice questions to be answered. On the 2nd day there will nine Clinical Case Simulations. Examinees are expected to manage the patients in real-time. This includes entering orders for medication and/or investigations into the simulation software, and any changes in the patient's condition. Each case should be managed in a maximum provided time of 25 minutes. On successful completion of USMLE, the individual may apply for a license to practice medicine - the only route to working in an unsupervised capacity.