作者：Dr. Suzanne M. Miller

nn

Harvard MD,nEmergency Physician，Best-Selling Author

nnnn

特別標註：Dr. Suzanne的分享是基於美國醫學教育體系下的分享，並不完全針對於中國醫學生，所有針對於國際醫學生的具體要求以ECFMG為準。

nn

Whatnis the USMLE? All the Basics to Know About the Test

nnnn

Students whonaspire to become doctors in the U.S. know that they will eventually need tontake the daunting USMLE. In this series, we lay out the different steps,nthe concepts they assess, and how each is scored. This first article offers anbroad overview of the exam and its component steps.

nn

Importance

nn

The USMLE,nformally the United States Medical Licensing Examination, is a famouslynchallenging, three-step exam series that is required for anyone who wants tonpractice medicine in the United States. The first two steps of the series arentypically taken while a student is still in medical school, while thenthird step takes place after graduation.

nn

The exams arensponsored by two organizations: the Federation of State Medical Boards (FSMB)nand the National Board of Medical Examiners (NBME). The USMLE exams,nparticularly Step 1, are often referred to colloquially as 「The Boards.」

nn

USMLE scoresnare used in three major ways:

nn

· nMostnU.S. medical schools require students to pass Step 1 to graduate — and somenalso require that they pass Step 2/Clinical Knowledge (CK) and Step 2/ClinicalnSkills (CS) to receive their degree.

nn

· nThenscores from the first two steps (Step 1, Step 2 CK, and Step 2 CS) play annimportant part in assessing medical students for residency training positionsnin the U.S.

nn

· nPassingnthe last step (Step 3) is required in order to be admitted into U.S.-basednspecialty boards, such as the American Board of Internal Medicine, but is alsonrequired by state medical boards that license doctors to practice in their specialty.n(Boards are governing bodies that certify doctors at the state level, as wellnas in more than 150 specialties.)

nn

Eligibility

nn

Step 1, Step 2nCK, and Step 2 CS may be taken by any student who is enrolled in or hasngraduated from a:

nn

· nU.S.nor Canadian allopathic medical school accredited by the Liaison Committeenon Medical Education (LCME), leading to an M.D. degree

nn

· nU.S.nor Canadian osteopathic medical school accredited by the AmericannOsteopathic Association (AOA), leading to a D.O. degree

nn

· nMedicalnschools outside the U.S. or Canada that are listed in the InternationalnMedical Education Directory (IMED) and that meet EducationalnCommission for Foreign Medical Graduates (ECFMG) criteria

nn

Step 3 may bentaken by:

nn

· nGraduatesnof an accredited U.S. or Canadian allopathic or osteopathic medical school whonhave passed Step 1, Step 2 CK, and Step 2 CS

nn

· nGraduatesnof a medical school outside the U.S. or Canada listed in IMED who have obtainedncertification by the ECFMG and passed Step 1, Step 2 CK, and Step 2 CS

nn

Components

nn

Although thenUSMLE is referred to as a three-step exam, it requires five days of testing.nMoreover, with the introduction of Step 2 CS and a second day of testing fornStep 3, preparation may actually need to be even more rigorous than in thenpast. Still, the consensus among medical professionals is that Step 1 is thenhardest of the exams, and each subsequent step gets easier from there.

nn

Below is anbrief overview of each USMLE step (each of which Ill be addressing in greaterndetail in upcoming articles).

nn

Step 1

nn

· nWhatnis tested?: Abilitynto apply basic science concepts to medical practice

nn

· nWhennis it taken?: Typicallyntaken after the basic science years — that is, after the first two years ofnmedical school

nn

· nHownlong is the exam?: Onenday, 8 hours

nn

· nHownmany questions are there?: 325nmultiple-choice questions

nn

· nWhatnis the format?: Computer-based

nnnn

Step 2 CKn(Clinical Knowledge)

nn

· nWhatnis tested?: Abilitynto apply clinical science knowledge in a supervised patient care setting

nn

· nWhennis it taken?: Typicallyntaken during the clinical years — that is, the third and fourth years ofnmedical school

nn

· nHownlong is the exam?: Onenday, 9 hours

nn

· nHownmany questions are there?: 350nmultiple-choice questions

nn

· nWhatnis the format?: Computer-based

nn

Step 2 CSn(Clinical Skills)

nn

· nWhatnis tested?: Clinicalnskills applied to 「 standardized patient」 scenarios (that is, actors presentingnsymptoms or problems a typical doctor may encounter)

nn

· nWhennis it taken?: Typicallyntaken in the fourth year of medical school

nn

· nHownlong is the exam?: Onenday, 8 hours

nn

· nWhatnare the length and format?: 12npatient cases, with 15 minutes for the patient encounter and 10 minutes tonrecord notes for each case

nn

· nWherencan you take it?: Fiventest centers (Atlanta, Chicago, Houston, Los Angeles, and Philadelphia)

nn

Step 3

nn

· nWhatnis tested?: Abilitynto apply clinical science to patients in an unsupervised patient care setting

nn

· nWhennis it taken?: Typicallynfollowing medical school graduation during residency training

nn

· nHownlong is the exam?: Twondays:

nn

o Day 1 - Foundations in Independent Practice (FIP)

nn

§ Concepts tested: Scientific principles required for effectivenmedical care

nn

§ Duration of Day 1: One day, 7 hours

nn

§ How many questions are there?: 260 multiple-choice questions

nn

o Day 2 - Advanced Clinical Medicine (ACM)

nn

§ Concepts tested: Applying medical knowledge to patient managementnand evolving disease processes

nn

§ Duration of Day 2: One day, 9 hours

nn

§ How many questions are there?: 200 multiple-choice questions, 13 computer-basednclinical simulations

nn

o Format of exam: Computer-based

nn

Scoring

nn

Step 1, Step 2nCK, and Step 3 are each scored on a 1–300 scale. Students can compare scoresnfor each step from year to year — that is, Step 1: 2013 scores to Step 1: 2014nscores — but not between the different steps.

nn

Score reportsnfor these three steps contain the following information:

nn

· nIfnthe student passed

nn

· nThenminimum score needed to pass

nn

· nThenstudent』s three-digit score (which is the number most often quoted whennstudents report their USMLE result)

nn

· nPerformancenprofile breakdowns for each testing category

nn

Scores for Stepn1, Step 2 CK, and Step 3 are generally available four weeks following the examnadministration.

nn

Minimum passingnscores for 2016 are:

nn

· nStepn1: 192

nn

· nStepn2 CK: 209

nn

· nStepn3: 196

nn

Step 2 CS isnonly scored as pass/fail, and results for this step can take up to three monthsnto be reported.

nn

Residencynadmissions committees, specialty boards, and state medical boards often ask fornall scores.

nn

Registration

nn

Registrationnfor each USMLE step varies according to the test and medical school location.nStep 1, Step 2 CK, and Step 3 (both days) are offered at Prometric test centersnon multiple testing days. Students can sign up for each step up to six monthsnin advance of the testing dates.

nn

As mentionednearlier, Step 2 CS is offered in only five cities in the U.S. Once a studentnhas applied for Step 2 CS, NBME/ECFMG assigns a 12-month eligibility periodnduring which a medical student may take the test. Since test sites fill upnquickly (usually four or more months in advance), students should schedule thentest date before May 31 of the year assigned for this step. Moreover, studentsndo not have their choice of location, but rather will be assigned to a testncenter in one of these five cities.

nn

Step 1, Step 2nCK, and Step 2 CS registration:

nn

· nU.S.nor Canadian M.D. or D.O. students/graduates can register at the NBMEnwebsite

nn

· nNon-U.S.nmedical school students/graduates can register at the ECFMG website

nn

Step 3nRegistration:

nn

· nAllngraduates of any medical school who have passed Step 1, Step 2 CK, and Step 2ncan register for Step 3 at the FSMB website

nn

2016nUSMLE Step Fees:

nn

· nStepn1: $845

nn

· nStep 2 CK: $845

nn

· nStep 2 CS: $1550

nn

· nStep 3: $845

nn

Note thatnPrometric charges an additional fee for any appointment change — which could bena date, site, or cancellation — if it is made less than 30 days before thenscheduled date of the exam. Moreover, there are also extra charges if a studentnrequests an eligibility period extension or to sit for the exam at anninternational center.

nn

Miscellaneous

nn

Here are a fewnodds and ends about the USMLE:

nn

· nStepn1, Step 2 CK, and Step 2 CS may be taken in any sequence.

nn

· nStepn3 can only be taken once a student has passed Step 1, Step 2 CK, and Step 2 CS.

nn

· nStudentsncan take the same exam up to six times.

nn

· nNonexam may be taken more than three times within a 12-month period.

nn

· nOncena student has passed a step, she cannot retake it unless this is required toncomply with the time limits of a medical licensing body.

nn

· nStudentsnwith disabilities may request accommodations, although the USMLE hasnhistorically been very strict in approving these. Be sure to plan ahead andnlearn about the requirements in advance of registering for the exam.

nn

微信公眾號搜索：「USMLECHINA」

推薦閱讀：