USMLE Information
The United States Medical Licensing Examination (USMLE) is a four-step process for licensure. Individual state medical boards grant medical licenses, but all require applicants to pass the USMLE test battery. The USMLE has contracted with Prometric Testing Centers to administer the written (computer) exams for Steps 1, 2 CK (Clinical Knowledge), and 3.
The UTHSC College of Medicine requires students to obtain a passing score on the USMLE Step 1 exam to be promoted to the M-3 year, and a passing score on USMLE Step 2CK to receive a diploma from the College. The Step 3 exam is usually taken near the end of the first year of residency. You must typically answer 60-70% of the items correctly to pass a USMLE exam.
You may take a step exam no more than three times within a twelve-month period. If you pass a step exam, you are not allowed to retake it unless you have exceeded the seven-year time limit for taking all Step exams.
USMLE Examination Fees 2014
The 2014 USMLE fee schedule for students in and graduates of medical schools in the United States and Canada accredited by the Liaison Committee on Medical Education or the Commission on Osteopathic College Accreditation is shown below:
| Examination | 2014 Fee | Effective Dates |
|---|---|---|
| USMLE Step 1* | $580 | Three month eligibility periods beginning November 1, 2013 - January 31, 2014 and ending October 1, 2014 - December 31, 2014. |
| USMLE Step 2 - Clinical Knowledge | $580 | |
| USMLE Step 3 | $800 | Three month eligibility periods beginning November 1, 2013 - January 31, 2014 and ending October 1, 2014 - December 31, 2014. |
USMLE Examination Fees 2015
The 2015 USMLE fee schedule for students in and graduates of medical schools in the United States and Canada accredited by the Liaison Committee on Medical Education or the Commission on Osteopathic College Accreditation is shown below:
| Examination | 2015 Fee | Effective Dates |
|---|---|---|
| USMLE Step 1* | $590 | Three month eligibility periods beginning November 1, 2014 - January 31, 2015 and ending October 1, 2015 - December 31, 2015. |
| USMLE Step 2 - Clinical Knowledge | $590 | |
| USMLE Step 3 | $815 | Three month eligibility periods beginning November 1, 2014 - January 31, 2015 and ending October 1, 2015 - December 31, 2015. |
USMLE Step 1 Exam
Step 1 is administered by computer through the Prometric Testing Centers.
The exam covers basic science content in the areas of: anatomy, behavioral science, biochemistry, microbiology, pathology, pharmacology, physiology, and interdisciplinary topics such as nutrition, genetics, and aging. Step 1 consists of 322 multiple-choice questions, is divided into seven 60-minute blocks, and is administered in one eight-hour session. Beginning January 1, 2014 the minimum passing score is 192, and the national mean averages around 220.
USMLE Step 2 CK (Clinical Knowledge) Exam
Step 2CK is administered by computer through the Prometric Testing Centers.
Step 2CK is more integrated, frequently requiring interpretation of tables, lab data, imaging studies, specimens, etc. Much of the content is organized around organ systems.
Step 2CK has approximately 346 multiple-choice questions and is divided into eight 60-minute blocks and administered in one nine-hour test session. The minimum passing score is 209 (As of July 2014).
The mean for UT College of Medicine students each year is generally at or near the national mean. The first time pass rate for COM students is normally 97% (national rate 96%) with a mean score of 233; and a 99% pass rate overall. Our students tended to perform their best in Diseases of Blood and Blood Forming Organs; Diseases of the Nervous System and Special senses; Disorders of Pregnancy, Childbirth and Puerperium; and Obstetrics & Gynecology. The lowest performance occurred in Immunologic Disorders; Cardiovascular Disorders; and Renal, Urinary and Male Reproductive Systems.
Subject Exams – Clerkships
The third-year clerkships in Family Medicine, Medicine, Obstetrics/Gynecology, Surgery, Pediatrics, and Psychiatry use the NBME web-based Subject Exam as a final written exam for the clerkship. Information about the subject exams can be found on the NBME web site.
Students generally will take the exam on the last day of a rotation and have two and a half hours to complete an exam. The exams provide a measurement of knowledge in the content area and a means for comparing student performance with national scores. The subject exams require students to solve clinical problems and concentrate heavily on application and integration of knowledge rather than recall of isolated facts. A useful description of the content covered in each exam can be found here.
Exams count for approximately 10-35 % of clerkship grades.
The following are recommendations from our students:
- Start early. Familiarize yourself with new terminology and major topics that are unique to the clerkship, then build on this with more in depth study. Try to read something new or review a topic each day instead of trying to cram hours of studying into the last week.
- Use your time in clinic and on wards as a way to study, but be aware that the test will often cover a broader range of topics than your clinical exposure. Read about the patients your team is taking care of, use that reading as a starting point, and fill in gaps with a review book. In general, an entire textbook is too much information to cover but may be of use as a resource for furthering understanding of a subset of topics/diseases of particular interest. Ask fourth year students or residents for suggestions about helpful review books or textbooks but keep in mind that everyone will have different preferences.
- Use your residents and attendings as resources. Ask them questions and ask to discuss topics with them, as they often know the “bread and butter” topics, “classic” questions, and key information for exams.
- Make sure to do practice questions throughout the clerkship, but don't focus 100% of your efforts on them at the exclusion of reading a text or review book. Use explanations of answers to guide your use of textbooks and other, more detailed, sources. Practice questions will also provide insight into the depth and detail of understanding that will be tested.
- Use what worked in preparing for Step I to maximize pacing and timing on the shelf exams. If doing practice Step I exams was valuable, do at least one or two full-length, practice exams two-four weeks before the shelf exams. These are available in the SASS.
- Make an effort to attend all student lectures, resident lectures, noon conferences, and grand rounds. These lectures often provide important information on many frequently-tested topics.
- Subject exams generally test:
- disease recognition and basic epidemiology/statistics.
- diagnostic tests (expect questions such as "What test would you order next for this patient?")
- "big picture" pathophysiology but not intricate basic science knowledge
- early management of acute diseases
- indications for referral to a specialist, surgery, invasive interventions etc.
- DO NOT expect resident level questions on topics such as how best to perform procedures, what type of sutures to use, drug dosages, etc. While searching out in depth journal articles during your clerkship may help you better understand your patients, and may occasionally be expected of you, shelf exam questions do not test this level of knowledge.