Information for Current Students

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.  Step 2 CS (Clinical Skills) is conducted at five NBME testing centers.

The UT 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 and Step 2CS 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.

The 2010 USMLE fee schedule is:

USMLE Step 1	$505
USMLE Step 2CK - Clinical Knowledge	$505
USMLE Step 2CS - Clinical Skills	$1,075
USMLE Step 3	$705

The USMLE provides for “reasonable accommodations” for examinees with disabilities who are covered under the Americans with Disabilities Act (ADA). Please check the web site (http://www.usmle.org/ ) for information.

The USMLE provides regular updates on testing information on its web site at http://www.usmle.org. 

USMLE Step 1 Exam

Step 1 is administered by computer through the Prometric Testing Centers.  Information about the local testing center in Memphis can be found here.  

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 approximately 330 multiple-choice questions, is divided into seven 60-minute blocks, and is administered in one eight-hour session.   The minimum passing score is 185, and the national mean averages around 220. 

More specific details about test content can be found at http://www.usmle.org.

The mean for UT College of Medicine students each year is generally at or near the national mean, as is the first time pass rate (approx. 94%), and an overall pass rate of 98.7%.  Over the past three years, our students have tended to perform their best in Biochemistry, Genetics and Pharmacology. Areas with lower performance over this time period were Anatomy/Embryology, Respiratory Systems, Cardiovascular Systems, and Epidemiology.

USMLE Step 2 CK (Clinical Knowledge) Exam

Step 2CK is administered by computer through the Prometric Testing Centers.  Information about the local testing center in Memphis can be found here.

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 370 multiple-choice questions and is divided into eight 60-minute blocks and administered in one nine-hour test session. The minimum passing score is 184.

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 in 2008 was 93% (national rate 95%) with a mean score of 229; 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.

More specific details about test content can be found at http://www.usmle.org. 

USMLE Step 2CS (Clinical Skills) Examination

Registration is available at http://www.nbme.org/

The USMLE Board has added a clinical skills exam to the USMLE licensing process.

Cost to students is $1,075, plus whatever travel and lodging expenses are incurred. The NBME has five testing centers -  Philadelphia, Atlanta, Los Angeles, Chicago, and Houston.

The exam consists of 11-12 encounters with standardized patients (SP).  The cases are developed around common situations typical of an ambulatory clinic setting.  Students will have 15 minutes to interview the SP and 10 minutes to record pertinent history and physical findings, diagnostic impressions, and follow-up if necessary. 

The NBME has been working for over 15 years to develop an objective, fair, and reliable exam process, and has field tested the exam with a number of medical schools and the Education Commission for Foreign Medical Graduates (USFMG).  All foreign medical graduates seeking US licensure have been required to complete a clinical skills exam since 1998.

Why a clinical skills exam?  There is considerable concern that as many as 25% of medical school graduates report never having been observed by a faculty member while interviewing a patient.  Also, while a multiple-choice exam can adequately test medical knowledge, it does not measure well skills such as interviewing and physical exams.  One study found that foreign medical graduates that pass the ECFMG Clinical Exam demonstrated better physical exam skills than US graduates.  The NBME believes that the entire battery of tests will help identify physicians who may pose risks to patients.

The UT College of Medicine requires that all students pass the Step 1, Step 2CK, and Step 2CS exams prior to graduation.  The College introduced a clinical skills assessment in the Doctoring: Recognizing Signs and Symptons (DRS) course in 2000.  Currently, all DRS students complete a 5-station assessment at the end of years one and two.   Standardized patient encounters have been integrated into the weekly clinical skills sessions in the M-2 DRS  curriculum. 

Subject Exams – Clerkships

The third-year clerkships in Family Medicine, Medicine, Obstetrics/Gynecology, Surgery, Pediatrics, and Psychiatry use the NBME Subject Exam as a final written exam for the clerkship. Information about the subject exams can be found on the NBME web site http://www.nbme.org/. 

Students generally will take the exam on the last day of a rotation and have two-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 at http://www.nbme.org/programs-services/medical-schools/subject-examinations/clinical-science-disciplines.html.

Exams count for approximately 10-35 % of clerkship grades.

Study tips for NBME subject exams (recommendations from our students):

1. Start early. Generally, reading 30 minutes every day will be adequate for most students and is easier than trying to cram hours of studying into the last week. 

2. Be aware that the test will often cover a broader range of topics than your clinical exposure.  Try to read through most of a review book or textbook to make sure you cover all high yield material.

3. Make sure to do some practice questions, but don't focus 100% of your efforts on them at the exclusion of reading a text or review book.

4. Subject exams generally test:

    i) disease recognition and basic epidemiology

    ii) diagnostic tests (expect questions such as "What test would you order next for this patient?")

    iii) "big picture" pathophysiology but not intricate basic science knowledge 

    iv) early management of acute diseases

    v) indications for referral to a specialist, surgery, invasive interventions etc.

    vi) DO NOT expect resident level questions on topics such as how best to perform procedures, what type of sutures to use, drug dosages, etc.