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Licensure in the U.S.

Most hospitals select candidates for residency from applicants who participate in the “Match.” This system of matching candidates to residency training positions allows you to interview and rank preferences, while simultaneously allowing the hospitals to rank those they have interviewed.
The preference lists are merged by a computer at the National Resident Matching Program (NRMP, www.nrmp.org). Results are announced annually in March. Generally, program directors search for USMLE scores above 200/82, but it is clear that the higher score the better. They also take into account experience in U.S. hospitals supported by letters of recommendation from physicians with whom you have worked. It is also important to carefully prepare a personal statement, which outlines goals, reasons for entering the profession, special interests and extracuriculum achivements, if any. Plan well ahead to prepare the full application to ensure that you are able to meet the various deadlines for Matching and impressive curriculum.

Licensing Exams

The United States Medical Licensing Examination (USMLE) consists of three steps with four exams designed to assess a physician’s ability to apply a broad spectrum of knowledge, concepts, and principles to evaluate the physician’s basic patient-centered skills. Once the passing score for Step 1 or 2 CK is achieved, practically you cannot re-take the exam in order to achieve a higher score. Teoretically you need to wait 7 years for an option to retake the exam. Therefore, it is very important to be prepared to achieve the highes score possible.

STEP 1

The USMLE Step 1 is a one-day computer exam taken by most medical students at the end of their second year of a medical school (considering 4 year MD program) to test their knowledge in basic sciences. It is also taken by thousands of international medical graduates who want to practice medicine in the United States. This Step  includes 308 multiple-choice questions and spans 7.45 hours of testing, broken down into seven 1-hour blocks of 40 questions each.

The USMLE Step 1 emphasizes basic science principles, specifically anatomy, behavioral science, biochemistry, microbiology, pathology, pharmacology, and physiology. Interdisciplinary areas such as genetics, immunology, and nutrition are also tested.

  • One-day exam,
  • 308 multiple-choice items divided into 7 blocks of 44 items,
  • 60 minutes allotted for completion of each block of test items—on test day, examinees have a minimum of 45 minutes of break time and a 15- minute optional tutorial,
  • Tests the basic sciences and assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy,
  • Minimum passing score: 192.

STEP 2 – Clinical Knowledge (CK)

The USMLE Step 2 CK is a multiple-choice exam created to determine whether the examinee possesses the medical knowledge and understanding of clinical science considered essential for the provision of patient care under supervision. The Step 2 CK includes approximately 355 questions and spans 8.45 hours of testing, broken down into eight 1-hour blocks of about 45 questions each.

The USMLE Step 2 CK will include two multiple-choice formats: Single Best Answer and Single Answer Matching. The exam may also contain patient-centered vignettes with a series of associated questions. Topics are presented randomly.

  • One-day exam,
  • A multiple-choice test with up to 45 questions in each block,
  • Designed to assess students’ abilities to apply medical knowledge in a supervised setting with “emphasis on health promotion and disease prevention“,
  • Minimum passing score: 209.

STEP 2 – Clinical Skillls (CS)

The communication skills component of the exam are evaluated through the following areas:

  • Fostering the relationship
  • Gathering information
  • Information provision
  • Making decisions
  • Supporting emotions
  • Enabling patient behaviors

Over the longer term, more advanced functions will be incorporated.

Implementing this model will alter how standardized patients (SPs) are trained as well as broaden the range of behaviors on which examinees will be evaluated. This evaluation process eliminates the history checklist formerly used by SPs to evaluate whether certain examinee behaviors occurred. SPs are now trained on a particular personality profile, thus allowing them to respond in a more natural manner to examinee questions.

The CS exam is based on the ever-increasing awareness of the importance of communication skills and changes in the nature of the doctor-patient relationship. More patient-centered approaches, more patient involvement in decision-making and the need to support patients in making lifestyle changes are now commonplace and vital physician duties. Because residents are deeply involved in all of these types of activities, the assessment of their communication skills must reflect and be adapted to assess these activities as well.

  • One-day exam
  • A live test made up of twelve 15-minute patient encounters
  • Tests students’ abilities to be “patient centered, to address the diagnostic challenges posed, to prepare the patient for next steps, and to document the encounter appropriately”*
  • This exam is pass/fail

By completing Steps 1, 2 CK, and, 2 CS, you are ECFMG certified. That means you’re eligible for the National Resident Matching Program® (NRMP®). The NRMP is the service that matches eligible medical school graduates into residency programs.

STEP 3

This two-day, 16 hours exam assess the examinee’s ability to apply medical knowledge and the understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings.

  • Administered over two, non-consecutive days,
  • Assesses whether students can apply and understand biomedical and clinical science concepts, and focuses on patient management in ambulatory settings,
  • The final examination in the USMLE sequence, which leads to a license to practice medicine without supervision,
  • Minimum passing score: 190.

Recently, Step 3 has changed. It includes more questions about basic science essential for effective healthcare:

  • Biostatistics,
  • Epidemiology,
  • Population health management,
  • Medical literature interpretation,
  • Medical ethics,
  • Patient safety.