Federation of State Medical Boards - USMLE Examination

USMLE Examination

The United States Medical Licensing Examination (USMLE) must be passed before a physician with an (Doctor of Medicine) (M.D.) degree can obtain a license to practice medicine in the United States. The USMLE assesses a physician's ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care. Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.

Students and graduates of U.S. or Canadian medical school programs accredited by the Liaison Committee on Medical Education (LCME), leading to the M.D. degree, or by the American Osteopathic Association (AOA), leading to the Doctor of Osteopathic Medicine (D.O.) degree, register for Step 1 and Step 2 of USMLE with the NBME. Students and graduates of medical schools outside the United States or Canada register for Step 1 and Step 2 with the Educational Commission for Foreign Medical Graduates (ECFMG). Graduates of medical schools in and outside the United States and Canada register for Step 3 with the FSMB or with a medical licensing authority in the United States. Each of the three steps of the USMLE examination complements the other; no step stands alone in the assessment of readiness for medical licensure. The USMLE program recommends that for Step 3 eligibility, licensure authorities require the completion, or near completion, of at least one postgraduate training year in a program of graduate medical education accredited by the Accreditation Council on Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA).

The USMLE was first designed in the late 1980s and introduced during the period 1992 to 1994. The program replaced the NBME Part Examination program and the FSMB's Federation Licensing Examination (FLEX) program, which were the widely accepted medical licensing examination programs at the time in the medical profession. In 2004, a clinical-skills examination was added to Step 2 of the USMLE, and beginning with the medical school graduating class of 2005, students have been required to pass it in order to be licensed. In 2005, a clinical-skills component was also added to the examination program of the Comprehensive Osteopathic Medical Licensing Examination of the National Board of Osteopathic Medical Examiners, which physicians with the D.O. degree take to achieve medical licensure in the United States.

In 2009, the FSMB's Board of Trustees adopted a board report on a comprehensive review of the USMLE program. Major recommendations from this strategic review included more explicitly orienting the USMLE examination to support the licensing decisions made by medical boards, transitioning the exam to a competencies schema and emphasizing the importance of scientific foundations of medicine throughout the examination sequence.