Test Preparation USMLE
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). Physicians with an MD degree are required to pass this examination before being permitted to practice medicine in the United States; see below for requirements of physicians with a DO degree.
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 create the examination materials each year. At least two committees critically appraise each test item or case, revising or discarding any materials that are in doubt
All three steps of the USMLE exam must be passed before a physician with an M.D. degree is eligible to apply for an unrestricted license to practice medicine in the United States. U.S. osteopathic medical school graduates are permitted to take either the USMLE or the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) exam for medical licensure. Students who have graduated from medical schools outside the US and Canada must pass all three steps of the USMLE to be licensed to practice in the US, regardless of the title of their degree.
USMLE Step 1 assesses whether medical school students or graduates understand and can apply important concepts of the basic sciences to the practice of medicine. 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 1 is constructed according to an integrated content outline that organizes basic science material along two dimensions: system and process. It includes the following subjects: Anatomy, Behavioral sciences, Biochemistry, Microbiology, Pathology, Pharmacology, Physiology, Interdisciplinary topics, such as nutrition, genetics, and aging.
Step 1 is a one-day examination. It is divided into seven 60-minute blocks and administered in one 8-hour testing session The number of questions per block on a given examination form will vary, but will not exceed 40. The total number of items on the overall examination form will not exceed 280.
US medical students take Step 1 at the end of the Basic Sciences portion of the curriculum, usually after the second year of medical school. The Step 1 score is frequently used in medical residency applications as a measure of a candidate’s likelihood to succeed in that particular residency (and on that specialty’s board exams), and it has been cited by residency program directors as their most important criterion in selecting graduating medical students for their residency program. Average USMLE Step 1 scores for various residencies are available in Charting Outcomes in the Match.
If the student passes the exam, he or she may not repeat it to achieve a higher score, and any failed attempt is permanently recorded. This “one-time deal” situation is the reason the Step 1 is unanimously viewed as the most arduous and paramount examination a medical student will ever sit during his or her entire career. It has substantial bearing on the specialties and location a residency applicant is competitive for.
USMLE Step 2 is designed to assess whether medical school students or graduates can apply medical knowledge, skills and understanding of clinical science essential for provision of patient care under supervision. US medical students typically take Step 2 during the fourth year of medical school. Step 2 is further divided into two separate exams:
Step 2- Clinical Knowledge (CK)
USMLE Step 2 Clinical Knowledge assesses whether medical school students or graduates can apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision 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.
Step 2 CK is a one-day examination. It is divided into eight 60-minute blocks, administered in one 9-hour testing session. Test item formats may vary within each block. It is constructed according to an integrated content outline that organizes clinical science material along two dimensions: physician task and disease category. It includes the following subjects:  internal medicine, obstetrics and gynecology, pediatrics, preventive medicine, psychiatry, surgery, other areas relevant to provision of care under supervision.
Step 2 CS
USMLE Step 2 Clinical Skills assesses the ability of medical school students or graduates to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision, and includes emphasis on health promotion and disease prevention. Step 2 ensures that due attention is devoted to the principles of clinical sciences and basic patient- centered skills that provide the foundation for the safe and effective practice of medicine. The exam contains the following subjects: Integrated Clinical Encounter (ICE), Communication and Interpersonal Skills (CIS), and Spoken English Proficiency (SEP).
Step 2 CS uses standardized patients to test medical students and graduates on their ability to gather information from patients, perform physical examinations, and communicate their findings to patients and colleagues. The examination is offered in five cities across the country:
Philadelphia, Chicago, Atlanta, Houston, Los Angeles
Administration of the Step 2-CS began in 2004. Prior to 2004, a similar exam, the Clinical Skills Assessment (CSA) was used to assess the clinical skills of foreign medical graduates.
USMLE Step 3 is the final exam in the USMLE sequence and assesses whether you can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. Graduates of US medical schools typically take this exam at the end of the first year of residency. Examinee are tested on the following subjects: central nervous system, eye/ ear/ nose/ mouth/ throat, respiratory system, circulatory system, digestive system, behavioral/ emotional disorders, musculoskeletal system, skin/subcutaneous tissue, endocrine/ nutrition/ metabolic disorders, kidneys/ urinary tract, reproductive system, pregnancy/ childbirth, neonate/ childhood illnesses, blood and blood-forming organs, infectious/ parasitic diseases, injuries/ wound/ toxic effects/ burns, and health maintenance issues.
Step 3 is a two-day examination. The first day of testing includes 233 multiple-choice items divided into 6 blocks of 38-40 items; 60 minutes are allotted for completion of each block of test items. Items with an associated pharmaceutical advertisement or scientific abstract are included in each of these multiple-choice blocks. There are approximately 7 hours in the test session on the first day.
There are approximately 9 hours in the test session on the second day. This day of testing includes 180 multiple-choice items, divided into 6 blocks of 30 items; 45 minutes are allotted for completion of each block of test items. This is followed by 13 case simulations, each of which is allotted a maximum of 10 or 20 minutes of real time.
The USMLE Step 1 and Step 2 CK exams can be taken at prometric test centers worldwide. The Step 2 CS and the Step 3 can only be taken in the USA.
The Professional and Linguistic Assessments Board (PLAB) test provides the main route for International Medical Graduates (IMGs) to demonstrate that they have the necessary skills and knowledge to practice medicine in the United Kingdom (UK). PLAB is a two part assessment that overseas doctors (or international medical graduates), from outside the European Economic Area and Switzerland, usually need to pass before they can legally practice medicine in the UK. It is conducted by the General Medical Council of the United Kingdom. The test is designed to assess the depth of knowledge and level of medical and communication skills possessed by the international medical graduates. The PLAB blueprint sets out what candidates are expected to demonstrate in the test and beyond.
The PLAB test has 2 parts:
Part 1 : Consists of a multiple choice format examination paper with 200 SBA’s (Two Hundred Single Best Answer questions) lasting 3 hours, This part is conducted in a number of countries including Bangladesh, Egypt, India, Pakistan, Nigeria and Sri Lanka.
Part 2: Consists of an objective structured clinical examination (OSCE). This Part is available only in the city of Manchester, United Kingdom. It consists of 18 clinical stations. All the stations are eight minutes long, plus two minutes reading time. The standard of both parts of the PLAB exam is set at the level of competence of a doctor at the start of Foundation Year 2 (F2) in the Foundation Programme.
Membership of the Royal Colleges of Physicians of the United Kingdom (MRCP)
Membership of the Royal Colleges of Physicians of the United Kingdom (MRCP-UK) is a postgraduate medical diploma in the United Kingdom (UK). The examinations are run by the Federation of the Medical Royal Colleges – the Royal College of Physicians of London, the Royal College of Physicians of Edinburgh, and the Royal College of Physicians and Surgeons of Glasgow. The three Royal Colleges of Physicians share this common three part assessment in general medicine which consists of two written parts and one clinical examination. Examinations are held throughout the UK and in overseas centers.
Holders of the MRCP (UK) can subscribe as “collegiate members” to any or all of the three UK Royal Colleges of Physicians. Thus the MRCP (UK) qualification has replaced the former MRCP (Lon), MRCP (E), and MRCP (G) qualifications. (Similarly, the MRCS is also now intercollegiate.)
There is a separate MRCPI qualification, run by the Royal College of Physicians of Ireland, based in Dublin in the Republic of Ireland.
Aims and content
The exam incorporates both examination of the candidate’s knowledge of basic medical sciences as well as testing the clinical skills required for the diagnosis and management of disease. Changes to the exam in recent years have put more emphasis on communication skills and professionalism. Obtaining the “MRCP (UK)” is a prerequisite to anyone wishing to go on to a specialist training post as a Physician in the United Kingdom. Various companies, including the Royal Colleges themselves, have developed preparatory courses that focus on the nature of the questions and the required background knowledge.
In partnership with the relevant specialist societies, the three UK Royal Colleges have set up the MRCP Specialist Examinations Unit responsible for the organization of new knowledge based assessments. The ultimate objective is to ensure that NHS consultants have demonstrated their acquisition of sufficient knowledge in their chosen specialty to practice safely and competently. This will bring the assessment of physicians in training in the UK into line with those training in North America, where most specialist trainees sit a specialist examination as a further test of excellence, usually after having acquired certification in Internal Medicine.
The MRCP exam has three parts: MRCP Part 1 (written paper); MRCP Part 2 (written paper); and MRCP Part 2 Clinical Examination (PACES).
The MRCP part 1 examination consists of multiple choice questions in the best of five formats.
The MRCP part 2 examination consists of multiple choice questions in the best of five formats.
The MRCP PACES examination consists of a carousel with 5 stations. Station one tests the candidate’s ability to examine the respiratory system and abdomen. Station 2 tests the candidate’s history taking ability. Station 3 tests the candidate’s ability to examine the cardiovascular system and perform a neurological examination. Station 4 tests the candidate’s communication skills and the ability to deal with issues of medical ethics. Station 5 comprises two 8-minute “integrated clinical assessments” requiring the candidate to take a focused history and examination, formulate a differential diagnosis and management plan, and communicate the plan to the patient.
Countries hosting PACES
The MRCP PACES examination is held not only in the United Kingdom, but also in many other parts of the world. Hosting sites include Brunei, Dubai, Al Ain, Egypt, Kuwait, Oman, Qatar, India, Singapore, Malaysia, Malta, Hong Kong, Myanmar, Sri Lanka, and Sudan. Examination fees at centers outside the UK are significantly higher than at UK centers. In Singapore, the MRCP (UK) and MMed are often taken together. In Hong Kong, MRCP (UK) is taken with MHKCP intermediate examination.
At present, the examination cost is £1495 from start to finish if all parts are taken in the UK and £2390 if are taken overseas – assuming each examination is passed in a single attempt without attending any courses. Candidates may elect to participate in any of a number of training courses, online revision websites or use mobile applications as revision aids to improve their chances of passing.