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Step 1: 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. 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.

Step 1 Content Description
Step 1 Test Question Formats (Step 1 includes only single questions with one best answer)

Step 2 : assesses whether you 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 Clinical Knowledge (CK): Step 2 CK is constructed according to an integrated content outline that organizes clinical science material along two dimensions: physician task and disease category.
Step 2 Clinical Skills (CS): Step 2 CS uses standardized patients, i.e., people trained to portray real patients. The cases cover common and important situations that a physician is likely to encounter in clinics, doctors' offices, emergency departments, and hospital settings in the United States.

Step 3 : 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. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care. A principal organizing dimension for Step 3 design is normal conditions and disease categories. Second and third organizing dimensions are the clinical encounter frame and physician tasks. Step 3 content reflects a data-based model of generalist medical practice in the United States.

Step 3 Content Description
Step 3 Test Formats: Step 3 has multiple-choice test items and computer-based case simulations.

USMLE scores in steps are made available to you by your USMLE registration entity - for Step 1 and Step 2, either NBME or ECFMG; for Step 3, FSMB. You must contact your USMLE registration entity if you have questions about obtaining your USMLE scores.


USMLE scores ready for release are released on a weekly basis on Wednesdays. Generally these will include examinees tested three to four weeks before the release date. However, there are many factors that may delay an individual USMLE score release. Usually these will be quickly resolved and the score released in the next weekly cycle. If you have not received your USMLE score within eight weeks of your USMLE test date, please contact your USMLE registration entity to determine the status of your score report. Please note that during 2009, no new scores for computer-delivered Step examinations will be released during the week of July 1 and during the week of December 27.

In order to assure that both the processing and scoring of USMLE examinations are done in a secure and accurate fashion, it is necessary to follow a number of quality assurance steps. These steps include monitoring reports from test centers about test delivery problems and about possible security violations. These processes are completed for a majority of examinees in three to four weeks.

On the 3-digit scale, most scores fall between 140 and 260. The mean score for first-time examinees from accredited medical schools in the United States is in the range of 200 to 220, and the standard deviation is approximately 20. Your score report includes the mean and standard deviation for recent administrations of the Step.


USMLE score information for each Step, including performance data by group, is posted each year for the previous year's examinees. Under current procedures, the scores for each administration of a USMLE Step are equated so that a given three-digit score represents essentially the same level of examinee performance for that Step, and this holds true across years. In other words, a score of 200 on one administration of a Step indicates a comparable level of examinee performance as a score of 200 on any other administration of the same Step. This equivalence holds even if the pass-fail standard is changed, which permits comparing performance across time.

It is important also to remember that the two-digit score, also reported for USMLE, is not a percentile and is not fully equated like the three-digit score. The two-digit score is a total test score that is designed to meet the requirements of some state licensing authorities. The two-digit score scale is one on which a 75 is always the minimum passing score. A given two-digit score may represent a different level of performance if the two administrations were subject to different pass/fail standards.

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