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Information Booklet 2005 from ww.USMLE
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TM
2005
[bleep] of Information
A Joint Program of the Federation of State
Medical Boards of the United States, Inc., and
the National Board of Medical Examiners®
TABLE OF CONTENTS
OVERVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Purpose of the USMLE
. . . . . . . . . . . . . . . . . . . . . . . . 1
The Three Steps of the USMLE
. . . . . . . . . . . . . . . . . 1
Examination Committees . . . . . . . . . . . . . . . . . . . . . . 2
Ownership and Copyright of
Examination Materials . . . . . . . . . . . . . . . . . . . . . . 2
USMLE
Step 2 Clinical Skills (CS) Examination . . . 2
Computer-Based Testing (CBT) . . . . . . . . . . . . . . . . . 3
ELIGIBILITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Step 1, Step 2 CK, and Step 2 CS . . . . . . . . . . . . . . . . 4
Step 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Graduates of Unaccredited Medical Schools
in the United States and Canada
. . . . . . . . . . . . . . 5
Sequence of Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Time Limit and Number of Attempts Allowed
to Complete All Steps . . . . . . . . . . . . . . . . . . . . . . . 6
Retakes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Official Performance of Record for Examinees
Retaking a Previously Passed Step . . . . . . . . . . . . 6
Formerly Administered Examinations . . . . . . . . . . . . 7
Change in Eligibility Status. . . . . . . . . . . . . . . . . . . . . 7
EXAMINATION CONTENT . . . . . . . . . . . . . . . . . . . 8
Step 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Step 2 Clinical Knowledge (CK) . . . . . . . . . . . . . . . . . 9
Step 2 Clinical Skills (CS) . . . . . . . . . . . . . . . . . . . . . 10
Step 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
PREPARING FOR THE TEST. . . . . . . . . . . . . . . . . 12
Sample Test Materials . . . . . . . . . . . . . . . . . . . . . . . . 12
Test Lengths and Formats . . . . . . . . . . . . . . . . . . . . . 12
Multiple-Choice Test Items . . . . . . . . . . . . . . . . . . . . 12
Primum® Computer-Based Case Simulations (CCS) . 13
Practice at Prometric Test Centers . . . . . . . . . . . . . . 13
APPLYING FOR THE TEST AND SCHEDULING
YOUR TEST DATE . . . . . . . . . . . . . . . . . . . . . . . 14
Application Materials . . . . . . . . . . . . . . . . . . . . . . . . 14
Applying for Step 1, Step 2 CK, and Step 2 CS . . . . 14
Applying for Step 3 . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Examinees with Disabilities . . . . . . . . . . . . . . . . . . . . 14
Obtaining an Eligibility Period
for Step 1 and Step 2 CK . . . . . . . . . . . . . . . . . . . 14
Testing Regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Obtaining an Eligibility Period for Step 2 CS . . . . . 15
Obtaining an Eligibility Period for Step 3 . . . . . . . . 15
Scheduling Step 1, Step 2 CK, and Step 3 . . . . . . . . . 16
Your Scheduling Permit . . . . . . . . . . . . . . . . . . . . . 16
Scheduling Test Dates . . . . . . . . . . . . . . . . . . . . . . . 16
Rescheduling Test Dates . . . . . . . . . . . . . . . . . . . . . 17
Scheduling Step 2 CS. . . . . . . . . . . . . . . . . . . . . . . . . 17
Your Scheduling Permit . . . . . . . . . . . . . . . . . . . . . 17
Scheduling Test Dates . . . . . . . . . . . . . . . . . . . . . . . 17
Rescheduling Test Dates . . . . . . . . . . . . . . . . . . . . . 18
Summary of Process . . . . . . . . . . . . . . . . . . . . . . . . . 20
TESTING. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Testing Regulations and Rules of Conduct . . . . . . . . 21
Admission to the Test. . . . . . . . . . . . . . . . . . . . . . . . . 23
Step 1, Step 2 CK, and Step 3 . . . . . . . . . . . . . . . . . . 23
Test Centers and Testing Conditions . . . . . . . . . . . . 23
Completing the Test . . . . . . . . . . . . . . . . . . . . . . . . 24
How Break Time Works . . . . . . . . . . . . . . . . . . . . . 24
Step 2 CS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
SCORING AND SCORE REPORTING. . . . . . . . . . 26
Examination Results and Scoring . . . . . . . . . . . . . . . 26
Scoring for Multiple-Choice Items . . . . . . . . . . . . . . 26
Scoring for Primum CCS. . . . . . . . . . . . . . . . . . . . . . 27
Scoring for Step 2 CS. . . . . . . . . . . . . . . . . . . . . . . . . 27
Minimum Passing Scores. . . . . . . . . . . . . . . . . . . . . . 27
Official Examinee Score Reports . . . . . . . . . . . . . . . 27
Score Rechecks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Score Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Official USMLE
Transcripts and Providing
Scores to Third Parties . . . . . . . . . . . . . . . . . . . . . 28
Electronic Residency Application Service
(ERAS®) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
INDETERMINATE SCORES AND
IRREGULAR BEHAVIOR. . . . . . . . . . . . . . . . . . 30
Validity of Scores . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Irregular Behavior. . . . . . . . . . . . . . . . . . . . . . . . . . . 30
COMMUNICATING ABOUT USMLE
. . . . . . . . . . 32
Application and Registration Inquiries. . . . . . . . . . . 32
Scheduling and Test Center Inquiries . . . . . . . . . . . . 33
Test Administration Problems/Inquiries . . . . . . . . . . 33
General Inquiries. . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Step 3 and Medical Licensure Inquiries . . . . . . . . . . 33
Copyright © 2004 by the Federation of State Medical Boards of the United States, Inc., and the National Board of Medical
Examiners® (NBME®). The USMLE
is a joint program of the Federation of State Medical Boards of the United States, Inc.,
and the National Board of Medical Examiners.
OVERVIEW
INTRODUCTION
The United States Medical Licensing Examination™
(USMLE
™) is a three-step examination for medical
licensure in the United States and is sponsored by the
Federation of State Medical Boards (FSMB) and the
National Board of Medical Examiners® (NBME®).
The Composite Committee, appointed by the FSMB
and NBME, establishes rules for the USMLE
pro-
gram. Membership includes representatives from the
following:
! FSMB,
! NBME,
! Educational Commission for Foreign
Medical Graduates (ECFMG®),
! American public.
Changes in the USMLE
program may occur after the
release of this [bleep]. If changes occur, information
will be posted at the USMLE
website. You must
obtain the most recent information to ensure an accu-
rate understanding of current USMLE
rules.
PURPOSE OF THE USMLE
In the United States and its territories ("United States"
or "US"), the individual medical licensing authorities
("state medical boards") of the various jurisdictions
grant a license to practice medicine. Each medical
licensing authority sets its own rules and regulations
and requires passing an examination that demonstrates
qualification for licensure. Results of the USMLE
are
reported to these authorities for use in granting the ini-
tial license to practice medicine. The USMLE
provides
them with a common evaluation system for applicants
for medical licensure.
The USMLE
assesses a physician's ability to apply
knowledge, concepts, and principles, and to demonstrate
fundamental patient-centered skills that are important in
health and disease and that constitute the basis of safe
and effective patient care. Each of the three Steps com-
plements the others; no Step can stand alone in the
assessment of readiness for medical licensure. Because
individual medical licensing authorities make decisions
regarding use of USMLE
results, you should contact the
jurisdiction where you intend to apply for licensure to
obtain complete information. Also, the FSMB can pro-
vide general information on medical licensure.
THE THREE STEPS OF THE USMLE
Step 1 assesses whether you understand and can apply
important concepts of the sciences basic to the prac-
tice of medicine, with special emphasis on principles
and mechanisms underlying health, disease, and
modes of therapy. 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 2 assesses whether you can apply medical knowl-
edge, skills, and understanding of clinical science
essential for the provision of patient care under super-
vision and includes emphasis on health promotion and
disease prevention. Step 2 ensures that due attention is
devoted to principles of clinical sciences and basic
patient-centered skills that provide the foundation for
the safe and competent practice of medicine.
1
Note: You must become familiar with the
information in this [bleep] if you are an
applicant with an eligibility period in 2005. If
your eligibility period extends into 2006 and
you test in 2006, you must become familiar
with and will be subject to the policies and
procedures detailed in the 2006 [bleep] of
Information. Eligibility periods are explained on
pages 14–16. To apply for the USMLE
, you must
contact the appropriate registration entity (see
page 32).
Visit the USMLE
website for
up-to-date information.
See pages 32–38 for information on how
to contact the FSMB and medical licensing
authorities.
OVERVIEW
Step 3 assesses whether you can apply medical
knowledge and understanding of biomedical and clin-
ical science essential for the unsupervised practice of
medicine, with emphasis on patient management in
ambulatory settings. Step 3 provides a final assess-
ment of physicians assuming independent responsi-
bility for delivering general medical care.
EXAMINATION COMMITTEES
Examination committees composed of medical edu-
cators and clinicians prepare the examination materi-
als. Committee members broadly represent the teach-
ing, practicing, and licensing communities across the
United States. At least two of these committees criti-
cally appraise each test item or case. They revise or
discard any materials that are in doubt.
OWNERSHIPAND COPYRIGHT OF
EXAMINATION MATERIALS
The examination materials used in the USMLE
are
copyrighted. If you reproduce and/or distribute any
examination materials, by any means, including
memorizing and reconstructing them, without explic-
it written permission, you are in violation of the
rights of the owners. In addition to actions described
on pages 30–31, every legal means available to pro-
tect USMLE
copyrighted materials and secure
redress against those who violate copyright law may
be pursued.
USMLE
STEP 2 CLINICAL SKILLS (CS)
EXAMINATION
A clinical skills examination was part of the original
design of USMLE
. The NBME was charged with
including a test of clinical skills using standardized
patients when such an examination was shown to be
valid, reliable, and practical. NBME research and the
work of other organizations administering clinical
skills examinations demonstrate that clinical skills
examinations measure skill sets different from those
measured by traditional multiple-choice questions.
Mastery of clinical and communication skills, as well
as cognitive skills, by individuals seeking medical
licensure is important to the protection of the public.
Implementation of the clinical skills examination
began in June 2004. The clinical skills examination is
a separately administered component of Step 2 and is
referred to as Step 2 Clinical Skills, or Step 2 CS.
The computer-based, multiple-choice component of
Step 2 is referred to as the Clinical Knowledge com-
ponent, or Step 2 CK.
In order to be eligible to Register for USMLE
Step 3,
the examination requirements for students and gradu-
ates of Liaison Committee on Medical Education
(LCME)-accredited medical school programs or
American Osteopathic Association (AOA)-accredited
medical schools include passing Step 1 and Step 2.
Such individuals must pass Step 2 CS as part of the
examination requirements for Step 3 if they: (a) have
graduation dates in 2005 or later, or (b) have gradua-
tion dates prior to 2005 and have not passed the CK
component of Step 2 taken on or before June 30, 2005.
Step 2 CS replaced the Clinical Skills Assessment
(CSA®) formerly administered by the ECFMG.
Effective June 14, 2004, Step 2 CS is a requirement
for ECFMG Certification of international medical
graduates who have not passed the CSA.
ECFMG-certified physicians who have not taken and
passed either the CSA or Step 2 CS may Register for
Step 3 through June 30, 2005. After that point,
ECFMG certificate holders will have to have taken
and passed either the CSA or the Step 2 CS in order
to Register for Step 3.
Physicians who have successfully completed Fifth
Pathway programs and who have not taken and
passed either the USMLE
Step 2 CS or the ECFMG
CSA will be allowed to Register for Step 3 through
June 30, 2005. After that point, Fifth Pathway gradu-
ates will have to have taken and passed either the
CSA or the Step 2 CS in order to Register for Step 3.
Individuals who have passed Step 2 prior to the
implementation of Step 2 CS are not permitted to
take Step 2 CK, except under the specific exceptions
to the retake policy approved by the Composite
Committee (see page 6), but are permitted to take
Step 2 CS provided they meet all other eligibility
requirements.
2
OVERVIEW
Individuals who are not required to pass Step 2 CS
for Step 3 eligibility but elect to do so and fail are not
eligible for Step 3 until such time as the individual’s
Step 2 CS performance of record is a pass and the
individual meets all other Step 3 requirements.
USMLE
Step 2 CS is administered at five regional
Clinical Skills Evaluation Centers (CSECs) in the
United States.
COMPUTER-BASED TESTING (CBT)
Parts of the USMLE
are administered by computer.
Prometric, a division of Thomson Learning, Inc., pro-
vides scheduling and test centers for the computer-
based components of USMLE
. Step 1 and Step 2 CK
are given around the world at Prometric Test Centers
(PTCs). Step 3 is given at PTCs in the United States
and its territories.
3
ELIGIBILITY
STEP 1, STEP 2 CK, AND STEP 2 CS
To be eligible, you must be in one of the following
categories at the time of application and on the test
day:
! 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 LCME,
! a medical student officially enrolled in, or a
graduate of, a US medical school program
leading to the DO degree that is accredited by
the AOA,
! a medical student officially enrolled in, or a
graduate of, a medical school outside the United
States and Canada
and eligible for examination
by the ECFMG for its certificate.
STEP 3
To be eligible for Step 3, prior to submitting your
application, you must:
! meet the Step 3 requirements set by the medical
licensing authority to which you are applying,
! obtain the MD degree (or its equivalent) or the
DO degree,
! pass Step 1, Step 2 CK, and, if required based
upon the rules referenced on page 2, Step 2 CS,
and
! obtain certification by the ECFMG or
successfully complete a "Fifth Pathway" program
if you are a graduate of a medical school outside
the United States and Canada
.
4
Note: A physician whose basic medical degree or
qualification was conferred by a medical school
program 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 International Medical Education Directory
(IMED) of the Foundation for Advancement of
International Medical Education and Research
(FAIMER®). This applies to citizens of the
United States who have completed their medical
education in programs outside the United States
and Canada
but not to foreign nationals who have
graduated from medical school programs in the
United States and Canada
. Specific eligibility cri-
teria for students and graduates of medical school
programs outside the United States and Canada
to
take Step 1 and Step 2 are described in the
Information Booklet provided by the ECFMG.
Application and other requests for services will
not be processed if it is determined that doing so
would be violative of any applicable federal laws
or regulations.
Note: The USMLE
program recommends that for
Step 3 eligibility, licensing authorities require the
completion, or near completion, of at least one
postgraduate training year in a program of gradu-
ate medical education accredited by the
Accreditation Council for Graduate Medical
Education (ACGME) or the AOA. You should
contact the FSMB or the individual licensing
authority (see pages 32–38) for complete infor-
mation on Step 3 eligibility requirements in the
state where you plan to seek licensure.
ELIGIBILITY
GRADUATES OF UNACCREDITED MEDICAL
SCHOOLS IN THE UNITED STATES AND
Canada
If you are eligible for licensure by a medical licens-
ing authority but are not in one of the eligibility
categories listed on page 4, you may take the
USMLE
only upon specific request by that medical
licensing authority. A licensing authority may sponsor
you to take Step 1 and Step 2, followed by Step 3 if
Step 1 and Step 2 are passed, if all the following con-
ditions apply to you:
! You are a graduate of an unaccredited medical
school in the United States or Canada
;
! You are an applicant for initial medical licensure
in the jurisdiction of the sponsoring licensing
authority;
! The sponsoring licensing authority certifies
that you have met all of the requirements for
licensure in the jurisdiction except for the
examination requirement.
If these conditions apply to you, the medical licensing
authority should submit the request to sponsor you to the
USMLE
Secretariat at the address shown on page 33 in
advance of your application for the Step.
SEQUENCE OF STEPS
Once eligibility requirements are met (see page 4),
you may take Step 1, Step 2 CK, and Step 2 CS in
any sequence.
5
Note: A "Fifth Pathway" program* is an academ-
ic year of supervised clinical education provided
by an LCME-accredited medical school program
and is available to persons who meet all the fol-
lowing conditions:
A. Have completed, in an accredited US college
or university, undergraduate premedical work of
the quality acceptable for matriculation in an
LCME-accredited US medical school program;
B. Have studied medicine in a medical school
located outside the United States and Canada
that
is listed in the International Medical Education
Directory (IMED) of the Foundation for
Advancement of International Medical Education
and Research (FAIMER®), and that requires an
internship and/or social service after completing
the school's academic requirements and before
receiving the final medical credential;
C. Have completed all of the formal requirements
of the non-US medical school except internship
and/or social service. (Those who have completed
all of these requirements for graduation are not
eligible.)
Students who have completed the academic cur-
riculum in residence at a non-US medical school
and who meet the above conditions may be
offered the opportunity to substitute, for an
internship and/or social service required by a
non-US medical school, an academic year of
supervised clinical training in a medical school
program accredited by the LCME.
Any medical school program accredited by the
LCME can provide Fifth Pathway education. As
of the release of this [bleep], the only medical
schools known to provide such education are
New York Medical College in Valhalla, New
York, and Ponce School of Medicine in Ponce,
Puerto Rico.
*Source: GMED Companion: An Insider’s Guide
to Selecting a Residency Program, 2004/2005,
American Medical Association.
ELIGIBILITY
TIME LIMIT AND NUMBER OF ATTEMPTS
ALLOWED TO COMPLETE ALL STEPS
Although there is no limit on the total number of
times you can retake a Step or Step Component you
have not passed, the USMLE
program recommends
to medical licensing authorities that they:
! require the dates of passing the Step 1, Step 2,
and Step 3 examinations to occur within a
seven-year period; and
! allow no more than six attempts to pass each
Step or Step Component without demonstration
of additional educational experience acceptable
to the medical licensing authority.
RETAKES
If you fail or do not complete a Step or Step
Component and want to retake it, you must reapply by
submitting a new application and fee. You may take the
failed or incomplete Step or Step Component no more
than three times within a 12-month period. For Step 2
CS, attempts at the CSA count toward this limit.
No Step or Step Component may be taken sooner than
60 days after your previous test date. For Step 1 and
Step 2 CK, you may retake the examination no earlier
than the first day of the month that begins at least 60
days after your previous test date. For Step 2 CS, you
may retake the examination no sooner than 60 days after
your last attempt. For Step 2 CS and Step 3, your eligi-
bility period for the retake will begin no earlier than 60
days after the date of your prior attempt.
If you pass a Step or Step Component, you are not
allowed to retake it, except to comply with the time
limit of a medical licensing authority for the comple-
tion of all Steps or a requirement imposed by another
authority recognized by the USMLE
program for this
purpose. The medical licensing or other authority
must provide information indicating that you are
applying to retake the passed Step or Step Component
in order to comply with its requirement. If you are
repeating a Step or Step Component because of a time
limit, you may apply to retake the examination only
after the applicable time limit has expired.
An exception to the policy of requiring the time limit
to expire before applying to retake a previously
passed Step or Step Component can be granted if, at
the time of application and testing:
! you are currently enrolled in an LCME- or AOA-
accredited medical school program leading to the
MD or DO degree;
! you have previously passed Step 1 and/or Step 2
but have not passed Step 3;
! you will graduate from the medical school
program seven or more years after the date you
first passed Step 1 and/or Step 2; and
! you are otherwise eligible to retake the
examination.
The number of attempts allowed to pass each Step
and the time allowed to complete all Steps vary
among jurisdictions. To obtain specific information,
you should contact the medical licensing authority in
the jurisdiction where you intend to apply for med-
ical licensure or the FSMB.
OFFICIAL PERFORMANCE OF RECORD FOR
EXAMINEES RETAKINGAPREVIOUSLY
PASSED STEP
In order for an individual to meet the examination
requirements for Step 3 eligibility, a passing
performance must be achieved on the most recent
administration of the examinations intended to
meet those requirements.
Individuals who have not yet passed Step 3 and who
wish to retake a previously passed Step 1 or Step 2
examination in order to meet a time limit imposed by
6
See pages 32–38 for information on how to
contact the FSMB and medical licensing authorities.
Note: Eligibility periods are explained on pages
14–16. To apply for the USMLE
, you must contact
the appropriate registration entity (see page 32).
ELIGIBILITY
a medical licensing authority should understand the
implications for Step 3 eligibility of a failing
performance on a retake. Specifically, if a failing
performance on a retake is the most recent
administration of that Step examination, that
failing score will preclude Step 3 eligibility.
FORMERLYADMINISTERED EXAMINATIONS
The NBME certifying examinations, Part I, Part II,
and Part III, and the Federation Licensing
Examination (FLEX) Components 1 and 2 are no
longer administered. Use of the former NBME Parts
or FLEX Components to fulfill eligibility require-
ments for Step 3 is no longer accepted. If you have
passed all or a portion of these examinations and
have never been granted a medical license by a US
medical licensing authority, you may take any Step(s)
for which you are otherwise eligible.
CHANGE IN ELIGIBILITY STATUS
If your eligibility for a Step or Step Component changes
after you submit your application but before your sched-
uled test date(s), you must notify your registration entity
promptly. Failure to notify your registration entity that you
may no longer be eligible to take the examination may
result in a determination of irregular behavior (see page
30). If you take a Step or Step Component for which you
are not eligible, scores for that examination will not be
reported or, if previously reported, will be revoked.
7
EXAMINATION CONTENT
STEP 1
Step 1 includes test items in the following content
areas:
! Anatomy
,
! behavioral sciences,
! Biochemistry
,
! Microbiology
,
! Pathology
,
! Pharmacology
,
! Physiology
,
! interdisciplinary topics, such as nutrition,
genetics, and aging.
Step 1 is a broadly based, integrated examination.
Test items commonly require you to perform one or
more of the following tasks:
! Interpret graphic and tabular material.
! Identify gross and microscopic pathologic and
normal specimens.
! Apply basic science knowledge to clinical
problems.
Step 1 classifies test items along two dimensions,
system and process, as shown in Table 1.
8
Sample Step 1 test materials and further
information on Step 1 test content are
available from your registration entity
and at the USMLE
website.
Table 1: USMLE
Step 1 Specifications*
System**
40%–50% General principles
50%–60% Individual organ systems
• hematopoietic/lymphoreticular
• nervous/special senses
• skin/connective tissue
• musculoskeletal
• respiratory
• cardiovascular
• gastrointestinal
• renal/urinary
• reproductive
• endocrine
Process
30%–50% Normal structure and function
30%–50% Abnormal processes
15%–25% Principles of therapeutics
10%–20% Psychosocial, cultural,
occupational and environmental
considerations
* Percentages are subject to change at any time.
See the USMLE
website for the most up-to-date
information.
** The general principles category includes test
items concerning those normal and abnormal
processes that are not limited to specific organ
systems. Categories for individual organ systems
include test items concerning those normal and
abnormal processes that are system specific.
EXAMINATION CONTENT
STEP 2 CLINICAL KNOWLEDGE (CK)
Step 2 CK includes test items in the following
content areas:
! internal medicine,
! obstetrics and Gynecology
,
! pediatrics,
! preventive medicine,
! Psychiatry
,
! surgery,
! other areas relevant to provision of care under
supervision.
Most Step 2 CK test items describe clinical situations
and require that you provide one or more of the
following:
! a diagnosis,
! a prognosis,
! an indication of underlying mechanisms
of disease,
! the next step in medical care, including
preventive measures.
Step 2 CK is a broadly based, integrated examina-
tion. It frequently requires interpretation of tables and
laboratory data, imaging studies, photographs of
gross and microscopic pathologic specimens, and
results of other diagnostic studies. Step 2 CK classi-
fies test items along two dimensions: disease catego-
ry and physician task, as shown in Table 2.
Please note that much of the content that addresses
normal growth and development and general princi-
ples of care is also related to the individual organ
systems categories, so that the number of questions
that deal solely with normal growth and development
and general principles of care is relatively small.
9
Sample Step 2 CK test materials and further
information on Step 2 CK test content are
available from your registration entity
and at the USMLE
website.
Table 2: USMLE
Step 2 CK Specifications*
Normal Conditions and Disease Categories
! Normal growth and development and general
principles of care
! Individual organ systems or types of
disorders
• immunologic disorders
• diseases of the blood and blood-forming
organs
• mental disorders
• diseases of the nervous system and
special senses
• cardiovascular disorders
• diseases of the respiratory system
• nutritional and digestive disorders
• gynecologic disorders
• renal, urinary, and male reproductive
systems
• disorders of pregnancy, childbirth, and
the puerperium
• disorders of the skin and subcutaneous
tissue
• diseases of the musculoskeletal system
and connective tissue
• endocrine and metabolic disorders
Physician Task
15%–20% Promoting preventive medicine
and health maintenance
20%–35% Understanding mechanisms
of disease
25%–40% Establishing a diagnosis
15%–25% Applying principles of management
* Percentages are subject to change at any time.
See the USMLE
website for the most up-to-date
information.
EXAMINATION CONTENT
STEP 2 CLINICAL SKILLS (CS)
Step 2 CS assesses whether an examinee can demon-
strate the fundamental clinical skills essential for safe
and effective patient care under supervision. There
are three subcomponents of Step 2 CS: Integrated
Clinical Encounter (ICE), Communication and
Interpersonal Skills (CIS), and Spoken English
Proficiency (SEP).
Step 2 CS uses standardized patients, i.e., people
trained to portray real patients. Examinees are
expected to establish rapport with the patients, elicit
pertinent historical information from them, perform
focused physical examinations, answer questions, and
provide counseling when appropriate. After each
interaction with a patient, examinees record pertinent
history and physical examination findings, list diag-
nostic impressions, and outline plans for further eval-
uation, if necessary. The cases cover common and
important situations that a physician is likely to
encounter in common medical practice in clinics,
doctors’ offices, emergency departments, and hospital
settings in the United States.
The cases that make up each administration of the
Step 2 CS examination are based upon an examina-
tion blueprint. An examination blueprint defines the
requirements for each examination, regardless of
where and when it is administered. The sample of
cases selected for each examination reflects a balance
of cases that is fair and equitable across all exami-
nees. On any examination day, the set of cases will
differ from the combination presented the day before
or the following day, but each set of cases has a com-
parable degree of difficulty.
The intent is to ensure that examinees encounter a
broad spectrum of cases reflecting common and
important symptoms and diagnoses. The criteria that
are used to define the blueprint and create individual
examinations focus primarily on presenting com-
plaints and conditions. Presentation categories
include, but are not limited to, cardiovascular, consti-
tutional, gastrointestinal, genitourinary, musculo-
skeletal, neurological, psychiatric, respiratory, and
women's health. Examinees will see cases from
some, but not all, of these categories. The selection
of cases is also guided by specifications relating to
acuity, age, gender, and type of physical findings pre-
sented in each case.
10
Table 3: The Subcomponents of Step 2 CS
Integrated Clinical Encounter (ICE)
Subcomponent
• Data gathering – patient information
collected by history taking and physical
examination
• Documentation – completion of a patient
note summarizing the findings of the patient
encounter, diagnostic impression, and initial
patient work-up
Communication and Interpersonal Skills (CIS)
Subcomponent
• Questioning skills (e.g., use of open-ended
questions, transitional statements, not
interrupting the patient)
• Information-sharing skills (e.g., avoidance
of jargon, responsiveness to patient
questions or concerns, provision of
counseling when appropriate)
• Professional manner and rapport (e.g.,
concern for patient's comfort and modesty,
examinee's attention to personal hygiene,
expression of interest in the impact of the
illness)
Spoken English Proficiency (SEP)
Subcomponent
• Clarity of spoken English communication
within the context of the doctor-patient
encounter (e.g., pronunciation, word choice,
and minimizing the need to repeat questions
or statements)
Further information on Step 2 CS
is available from your registration entity
and at the USMLE
website.
EXAMINATION CONTENT
STEP 3
Step 3 is organized along two principal dimensions:
clinical encounter frame and physician task (see
Table 4). Step 3 content reflects a data-based model
of generalist medical practice in the United States.
Encounter frames capture the essential features of
circumstances surrounding physicians' clinical activi-
ty with patients. They range from encounters with
patients seen for the first time for nonemergency
problems, to encounters with regular patients seen in
the context of continued care, to patient encounters in
(life-threatening) emergency situations. Encounters
occur in clinics, offices, skilled nursing care facili-
ties, hospitals, emergency departments, and on the
telephone. Each test item in an encounter frame also
represents one of the six physician tasks. For exam-
ple, initial care encounters emphasize taking a history
and performing a physical examination. In contrast,
continued care encounters emphasize decisions
regarding prognosis and management.
High-frequency, high-impact diseases also organize
the content of Step 3. Clinician experts assign clinical
problems related to these diseases to individual clini-
cal encounter frames to represent their occurrence in
generalist practice.
11
Sample Step 3 test materials and further
information on Step 3 test content
are available from your registration entity
and at the USMLE
website.
Table 4: USMLE
Step 3 Specifications*
Clinical Encounter Frame
20%–30% Initial care
50%–60% Continued care
15%–25% Emergency care
Physician Task
8%–12% Obtaining history and performing
physical examination
8%–12% Using laboratory and diagnostic
studies
8%–12% Formulating most likely diagnosis
8%–12% Evaluating severity of patient's
problems
8%–12% Applying scientific concepts and
mechanisms of disease
45%–55% Managing the patient
• health maintenance
• clinical intervention
• clinical therapeutics
• legal and ethical issues
* Percentages are subject to change at any time.
See the USMLE
website for the most up-to-date
information.
PREPARING FOR THE TEST
SAMPLE TEST MATERIALS
The best preparation for the USMLE
is a general,
thorough review of the content reflected in the exami-
nation descriptions on pages 8–11. You should also
review further information on the examination content
and test formats available on the USMLE
website or
from your registration entity and run the sample test
materials available on the USMLE
website or on the
2005 USMLE
compact disc (CD). The 2005 USMLE
CD is available through your registration entity.
There are no test preparation courses affiliated with
or sanctioned by the USMLE
program. Information
on such courses is not available from the ECFMG,
FSMB, NBME, USMLE
Secretariat, or medical
licensing authorities.
TEST LENGTHS AND FORMATS
! Step 1 has approximately 350 multiple-choice
test items, divided into seven 60-minute blocks,
administered in one eight-hour testing session.
! Step 2 CK has approximately 370 multiple-choice
test items, divided into eight 60-minute blocks,
administered in one nine-hour testing session.
! Step 2 CS has 11 or 12 patient cases. You will
have 15 minutes for each patient encounter and
10 minutes to record the patient note. If you do
not use the entire 15 minutes for the patient
encounter, the remaining time will be added to
the time you have to record the patient note. The
testing session is approximately eight hours.
! Step 3 has approximately 480 multiple-choice
test items, divided into blocks of 35 to 50 items.
You will have 45 to 60 minutes to complete each
of these blocks. There are approximately nine
computer-based case simulations (see page 13),
with one case in each block. You will have a
maximum of 25 minutes to complete each of
these blocks. Step 3 is administered in two eight-
hour testing sessions.
For Step 1, Step 2 CK, and Step 3 multiple choice
sections, during the defined time to complete the
items in each block, you may answer the items in any
order, review your responses, and change answers.
After you exit the block, or when time expires, you
can no longer review test items or change answers.
Step 2 CS cases and Step 3 case simulations must be
taken in the order presented. After you exit the case
or session, or when time expires, you can no longer
review test items or cases, change answers, or collect
additional information.
MULTIPLE-CHOICE TEST ITEMS
You should acquaint yourself with the test software
well before your test date(s). Practice time is not
available on the test day. A brief tutorial on the test
day provides a review of the test software, including
navigation tools and examination format, prior to
beginning the test. It does not provide an opportunity
to practice.
Sample test materials to practice with the software
are available to eligible applicants from their registra-
tion entity and at the USMLE
website.
12
Note: The test descriptions, including test length
and number of test items or cases, provided here
may be changed at any time. Notice of any
changes will be posted at the USMLE
website.
PREPARING FOR THE TEST
PRIMUM® COMPUTER-BASED CASE
SIMULATIONS (CCS)
Primum CCS allows you to provide care for a simu-
lated patient. You decide which diagnostic informa-
tion to obtain and how to treat and monitor the
patient's progress. The computer records each step
you take in caring for the patient and scores your
overall performance. This format permits assessment
of clinical decision-making skills in a more realistic
and integrated manner than other available formats.
In Primum CCS, you may request information from
the history and physical examination; order laborato-
ry studies, procedures, and consultants; and start
medications and other therapies. Any of the thou-
sands of possible entries that you type on the "order
sheet" are processed and verified by the "clerk."
When you have confirmed that there is nothing fur-
ther you wish to do, you decide when to reevaluate
the patient by advancing simulated time. As time
passes, the patient's condition changes based on the
underlying problem and your interventions; results of
tests are reported, and results of interventions must
be monitored. You suspend the movement of simulat-
ed time as you consider next steps. While you cannot
go back in time, you can change your orders to
reflect your updated management plan.
The patient's chart contains, in addition to the order
sheet, the reports resulting from your orders. By
selecting the appropriate chart tabs, you can review
vital signs, progress notes, patient updates, and test
results. You may care for and move the patient
among the office, home, emergency department,
intensive care unit, and hospital ward.
Practice time with the Primum software is not avail-
able on the test day. Therefore, you must review the
Primum CCS orientation materials and practice with
all the sample cases well in advance of your testing
day to have a thorough understanding of how the
CCS system works. CCS sample cases are provided
to Step 3 applicants on the 2005 USMLE
CD and are
available at the USMLE
website.
PRACTICE AT PROMETRIC TEST CENTERS
If you wish to experience some of the conditions of
test administration for Step 1, Step 2 CK, or Step 3,
you may schedule time to review sample test materi-
als at a Prometric Test Center for a fee. Although
shorter than an actual USMLE
examination and con-
taining the same sample test materials provided by
the USMLE
registration entities and at the USMLE
website, this option allows you to experience
USMLE
sample test materials in the same environ-
ment as your actual test. After your registration for a
Step or Step Component is complete and you have
received your Scheduling Permit, you may Register
for a practice session for that examination by follow-
ing the instructions at the USMLE
website or by con-
tacting your registration entity.
13
Note: If you Register for the practice session, you
will receive a separate Scheduling Permit specifi-
cally for the practice session. You must have this
Permit before you can contact Prometric to
schedule the practice session.
APPLYING FOR THE TEST AND SCHEDULING YOUR TEST DATE
APPLICATION MATERIALS
If you meet the eligibility requirements on page 4,
you can apply for the Step 1, Step 2 CK and CS, or
Step 3 at any time. Applications are available from
the appropriate registration entity. You must use cur-
rent application materials to apply.
APPLYING FOR STEP 1, STEP 2 CK, AND
STEP 2 CS
Students and graduates of LCME-accredited pro-
grams and AOA-accredited medical schools should
apply for Step 1, Step 2 CK, and Step 2 CS by fol-
lowing the instructions at the NBME website
(http://www.nbme.org). Review and follow the appli-
cation instructions, complete your application, and
submit it to the NBME.
Students and graduates of medical school programs
outside the United States and Canada
should apply
for Step 1, Step 2 CK, and Step 2 CS by following
the instructions at the ECFMG website
(http://www.ecfmg.org). Review and follow the
application instructions, complete your application,
and submit it to the ECFMG.
APPLYING FOR STEP 3
To request information on Step 3 eligibility require-
ments and application procedures, follow the instruc-
tions at the FSMB website (http://www.fsmb.org), or
contact the FSMB or the medical licensing authority
to which you wish to apply.
Application procedures for Step 3 vary among juris-
dictions. You should begin inquiries at least three
months in advance of the dates on which you expect
to take the test.
After you obtain application materials, review and
follow the application instructions to complete your
application and submit it to the medical licensing
authority or the FSMB as directed in the instructions.
EXAMINEES WITH DISABILITIES
The USMLE
program provides reasonable accommo-
dations for examinees with disabilities who are cov-
ered under the Americans with Disabilities Act
(ADA). If you are a disabled individual covered
under the ADA and require test accommodations, the
following guidelines apply to you:
! You must obtain information regarding
procedures and documentation requirements in
advance of applying for each Step or Step
Component. This information is available from
the USMLE
website, from your registration
entity if you are applying for Step 1, Step 2 CK
or Step 2 CS, or from the FSMB if you are
applying for Step 3.
! Your application and your request for
accommodations and accompanying
documentation must be submitted at the same
time to the appropriate mailing addresses. If you
are applying for Step 2 CS, review the
informational materials available on the USMLE
website before requesting test accommodations.
Some policies and procedures described in this
[bleep] may not apply to examinees who are
granted test accommodations.
! When USMLE
examinations are taken with test
accommodations, score reports and transcripts
may include an annotation that an
accommodation was provided.
OBTAINING AN ELIGIBILITY PERIOD FOR
STEP 1 AND STEP 2 CK
When applying for Step 1 or Step 2 CK, you must
select a three-month period, such as January-
February-March or February-March-April, during
which you prefer to take the examination. A
Scheduling Permit with instructions for making an
appointment at a Prometric Test Center will be sent to
you after your registration entity processes your appli-
14
Note: See page 32 for information on how to
contact your registration entity to apply for a Step
or Step Component.
Note: See pages 33–38 for information on how to
contact medical licensing authorities.
APPLYING FOR THE TEST AND SCHEDULING YOUR TEST DATE
cation and determines your eligibility. The Scheduling
Permit specifies the three-month eligibility period
during which you must complete the examination.
During peak periods, allow up to approximately four
weeks for processing of your application. On receipt
of your Scheduling Permit, you are able to contact
Prometric immediately to schedule a test date.
Prometric schedules testing appointments for
Steps 1 and 2 CK up to six months in advance of the
assigned eligibility period. If your application is
submitted more than six months in advance of your
requested eligibility period, it will be processed, but
your Scheduling Permit will be sent no more than six
months before your assigned eligibility period begins.
If you are unable to take the test within your eligibili-
ty period, contact your registration entity to inquire
about a contiguous three-month eligibility period
extension. A fee is charged for this service. Visit
your registration entity’s website (see page 32) for
more information. If you do not take the test within
your original or extended eligibility period and wish
to take it in the future, you must reapply by submit-
ting a new application and fee(s).
TESTING REGIONS
Step 1 and Step 2 CK are administered in the United
States and Canada
and in more than 50 other coun-
tries. International testing locations are distributed
among defined international testing regions. There is
an additional international test delivery surcharge.
OBTAINING AN ELIGIBILITY PERIOD FOR
STEP 2 CS
Step 2 CS is offered regularly throughout the year;
however, there may be occasional, brief periods when
all centers are closed. There is no deadline for sub-
mitting your application to Register for Step 2 CS.
However, in planning the timing of your application,
see below for information on how Step 2 CS eligibil-
ity periods are assigned. You should be aware that
demand for test dates/centers at certain times during
the year may exceed the number of testing spaces
available.
Applicants registered for Step 2 CS are assigned a
12-month eligibility period that begins when process-
ing of their application is completed.
Your eligibility period will be listed on your Step 2
CS Scheduling Permit. You must take the exam dur-
ing your eligibility period. You can schedule a testing
appointment for any available date in your eligibility
period. Once your eligibility period is assigned, it
cannot be changed. If you do not take the exam with-
in your eligibility period, you must reapply to take
the exam, including payment of the examination fee.
Although you cannot change your assigned eligibility
period, you can reschedule a scheduled testing
appointment within your eligibility period (see
Rescheduling). A fee is charged for this service.
OBTAINING AN ELIGIBILITY PERIOD FOR
STEP 3
Step 3 eligibility periods are assigned immediately
once your application has been processed and
approved. Time for processing will vary depending
on the particular medical licensing authority and the
volume of applications. Check the FSMB website
for more detailed information on processing times.
Upon complete processing of your Step 3 applica-
tion and confirmation of eligibility, a Scheduling
Permit will be sent to you with instructions for mak-
ing an appointment at a Prometric Test Center. On
receipt of your Scheduling Permit, you should con-
tact Prometric immediately to schedule the test
dates. The Scheduling Permit specifies the eligibili-
ty period (beginning immediately and extending for
approximately 90 calendar days) during which you
must complete the examination. If you are unable to
take the test within your eligibility period, contact
the FSMB to inquire about a contiguous three-
month eligibility period extension. A fee is charged
for this service, and some restrictions may apply.
Visit the FSMB website (http://www.fsmb.org) for
more detailed information. If you do not take the
15
Use the Prometric website for
up-to-date information on the locations
of Prometric Test Centers and to schedule
an appointment.
APPLYING FOR THE TEST AND SCHEDULING YOUR TEST DATE
test within your original or extended eligibility peri-
od and wish to take it in the future, you must reap-
ply by submitting a new application and fee(s).
SCHEDULING STEP 1, STEP 2 CK, AND STEP 3
Your Scheduling Permit
Your Scheduling Permit will be sent to you when the
processing of your application is complete. You
should verify the information on your Scheduling
Permit before scheduling your appointment. Your
Scheduling Permit includes the following:
! your name (see Important Note page 23) and
mailing address,
! the examination for which you registered,
! your eligibility period,
! your testing region,
! your Scheduling Number,
! your Candidate Identification Number (CIN).
Scheduling Test Dates
When applying for the USMLE
Steps 1, 2 CK, and 3
or scheduling test dates, please keep the following in
mind:
! You must have your Scheduling Permit before you
contact Prometric to schedule a testing appointment.
Appointments are assigned on a "first-come,
first-served" basis; therefore, you should contact
Prometric to schedule as soon as possible after
you have received your Scheduling Permit.
! You may take the test on any day that it is
offered during your assigned eligibility period,
provided that there is space at the Prometric Test
Center you choose.
! Prometric Test Centers are closed on major
local holidays.
! USMLE
Steps 1, 2 CK, and 3 are not available
during the first two weeks of January.
! The busiest testing times in the Prometric testing
network in the United States and Canada
are May
through July and November through December.
! Some, but not all, Prometric Test Centers are
open on weekend days. When you schedule your
Step 3 test dates, the two days on which you take
the test must be consecutive days unless the
center is closed on the day that follows your first
day of testing. In that event, Prometric will
assign you to the next day the center is open for
your second day of testing. In all other cases, you
must take Step 3 on two consecutive days at the
same test center.
Your Scheduling Permit includes specific information
for contacting Prometric to schedule your test date(s)
at the test center of your choice.
You will be required to provide information found
only on your Scheduling Permit. When you schedule
your appointment, you will receive the following
specific information:
16
Note: You will not be able to take the test if
you do not bring your Scheduling Permit to
the test center. Please keep it in a secure
location. If you lose your permit, contact your
registration entity immediately. A fee may be
charged to issue a replacement, and you may be
required to reschedule your appointment.
Note: Your Scheduling Number is needed when
you contact Prometric to schedule test dates. It
differs from your Candidate Identification
Number (CIN), which is your private key, and is
needed to test. Prometric does not have access to
your CIN.
Use the Prometric Test Center Locator for
up-to-date information on the locations
of Prometric Test Centers.
APPLYING FOR THE TEST AND SCHEDULING YOUR TEST DATE
! the confirmed test day(s), date(s), and time;
! the address and telephone number of the
Prometric Test Center where you will test; and
! your Prometric Confirmation Number.
After you schedule your testing appointment, you can
print a confirmation of your appointment from the
Prometric website. Scheduling a testing appointment
for a specific date at a Prometric Test Center is not a
guarantee that the scheduled test time or location will
remain available. The Prometric Test Center at which
you are scheduled may become unavailable after you
have scheduled your appointment. In that event,
Prometric will attempt to notify you in advance of
your scheduled testing appointment and to schedule
you for a different time and/or center. However, on
rare occasions, rescheduling your appointment for a
different time or center may occur at the last minute.
To avoid losses you would incur as a result, you
should try to maintain flexibility in your travel
arrangements. You are encouraged to confirm your
testing appointment a week prior to your test date.
Rescheduling Test Dates
If you are unable to keep your testing appointment on
the scheduled date(s) or at the scheduled location,
you may change your date(s) or center by contacting
Prometric. You will need to provide your Prometric
Confirmation Number when you reschedule.
To avoid a rescheduling fee, you must request to
reschedule your appointment at least five business
days before your appointment. If you are testing in
the United States or Canada
, you must make your
request by noon eastern time at least five business
days before your appointment. If you are testing out-
side the United States or Canada
, you must make
your request by noon local time of the Regional
Registration Center for your testing region at least
five business days before your appointment.
When calling Prometric, you must speak with a rep-
resentative. Leaving a voice mail message does not
satisfy the requirement to provide advance notice. If
you provide less than five business days' notice,
Prometric will charge you a fee to reschedule your
test date(s). Your rescheduled test date(s) must fall
within your assigned eligibility period.
SCHEDULING STEP 2 CS
Step 2 CS is administered at five Clinical Skills
Evaluation Centers (CSECs): Atlanta, Georgia;
Chicago, Illinois; Houston, Texas; Los Angeles,
California; and Philadelphia, Pennsylvania.
Your Scheduling Permit
After your registration for Step 2 CS is complete,
your registration entity will issue you a Scheduling
Permit. The Scheduling Permit contains your eligibil-
ity period, instructions on how to schedule your test-
ing appointment, a description of the kind of identifi-
cation you must bring to the testing center, and other
important information.
Scheduling Test Dates
Follow the instructions on your Scheduling Permit to
schedule your test date(s) at the test center of choice.
To browse available test dates in your eligibility peri-
od at each of the five test centers, you can use on-line
Step 2 CS Scheduling. Before accessing Step 2 CS
Scheduling, you should review the important infor-
mation in How Test Dates Become Available (see
page 18).
After you confirm your testing appointment, you will
be able to print a confirmation notice from the sched-
uling system. The confirmation notice includes your
scheduled test date, arrival time, test center, and other
important information. If you lose the confirmation
notice, you can reprint it by accessing Step 2 CS
Scheduling on the website of your registration entity.
17
Use the USMLE
website and click on the
Step 2 CS Information Page for the
up-to-date calendar.
APPLYING FOR THE TEST AND SCHEDULING YOUR TEST DATE
How Test Dates Become Available
! Test dates are opened so that dates will be
available throughout your 12-month eligibility
period.
! Additional test dates are opened, depending on
demand. These dates are opened in ways that
maximize operational efficiency at al | |
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