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PLIC CONSULTANTS

2002 USMLE Bulletin
OVERVIEW

Introduction
The United States Medical Licensing Examination (USMLE) is a three-step examination for medical licensure in the United States and is sponsored by the following organizations:
Federation of State Medical Boards (FSMB)
National Board of Medical Examiners (NBME)

The Composite Committee, appointed by the FSMB and NBME, governs the USMLE. The Composite Committee establishes rules for the USMLE program. Membership includes representatives from the following:
Changes in the USMLE program may occur after the release of this bulletin. If changes occur, information will be posted at the USMLE website. You must obtain the most recent information to ensure an accurate understanding of current USMLE rules.

Purpose of the USMLE
In the United States and its territories, the individual medical licensing authorities ("state medical boards") of the various jurisdictions grant a license to practice medicine. Each medical licensing authority sets its own rules and regulations and requires passing an examination that demonstrates qualification for licensure. Results of the USMLE are reported to these authorities for use in granting the initial license to practice medicine. The USMLE provides them with a common evaluation system for applicants for medical licensure.

The USMLE assesses a physician's ability to apply knowledge, concepts, and principles that are important in health and disease and that constitute the basis of safe and effective patient care. Each of the three Steps complements the others; no Step can stand alone in the assessment of readiness for medical licensure. Because individual medical licensing authorities make decisions regarding use of USMLE results, you should contact the jurisdiction where you intend to apply for licensure to obtain complete information. Also, the FSMB can provide general information on medical licensure.

The Three Steps of the USMLE
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 undergirding the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning.

Step 2 assesses whether you can apply medical knowledge 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 that undergird the safe and competent practice of medicine.

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.

Examination Committees
Examination committees composed of prominent medical educators and clinicians prepare the examination materials. Committee members broadly represent the teaching, practicing and licensing communities across the United States. At least two of these committees critically appraise each test item or problem. They revise or discard any materials that are in doubt.

The USMLE parent organizations, the FSMB and NBME, own the examination materials used in the USMLE. The examinations are copyrighted. If you reproduce and/or distribute any examination materials by any means, including memorizing and reconstructing them, without explicit written permission from the parent organizations, you violate the rights of the FSMB and NBME. In addition to actions described under Irregular Behavior, the FSMB and NBME will use every legal means available to protect USMLE copyrighted materials and impose penalties on those who violate copyright law.

Computer-Based Testing (CBT)
The USMLE is administered by computer. Prometric, Inc.®, a subsidiary of Thomson Learning™, provides scheduling and test centers for the USMLE. Step 1 and Step 2 are given around the world at Prometric Test Centers (PTCs). Step 3 is given at PTCs in the United States and its territories.

ELIGIBILITY
Step 1 and Step 2
To be eligible for Step 1 or Step 2, you must be in one of the following categories at the time of application and on the test day:
* A medical student officially enrolled in, or a graduate of, a US, Puerto Rican, or Canadian medical school program leading to the MD degree that is accredited by the Liaison Committee on Medical Education (LCME)
a medical student officially enrolled in, or a graduate of, a US medical school that is accredited by the American Osteopathic Association (AOA)
* A medical student officially enrolled in, or a graduate of, a medical school outside the United States, Puerto Rico, and Canada and eligible for examination by the ECFMG for its certificate

Step 3
To be eligible for Step 3, prior to submitting your application, you must meet the Step 3 requirements set by the medical licensing authority to which you are applying, obtain the MD degree (or its equivalent) or the DO degree, obtain passing scores on Step 1 and Step 2, and obtain certification by the ECFMG or successfully complete a "Fifth Pathway" program if you are a graduate of a medical school outside the United States, Puerto Rico, and Canada.
Note: A physician whose basic medical degree or qualification was conferred by a medical school outside the United States, Puerto Rico, and Canada may be eligible for certification by the ECFMG if the medical school is listed at the time of graduation in the World Directory of Medical Schools, published by the World Health Organization. Citizens of the United States who have completed their medical education in schools outside the United States, Puerto Rico, and Canada are included in this category, while foreign nationals who have graduated from medical schools in the United States, Puerto Rico, and Canada are not. Specific eligibility criteria for students and graduates of medical schools outside the United States, Puerto Rico, and Canada to take Step 1 and Step 2 are described in the Information Booklet provided by the ECFMG.

Note: A physician whose basic medical degree or qualification was conferred by a medical school outside the United States, Puerto Rico, and Canada may be eligible for certification by the ECFMG if the medical school is listed at the time of graduation in the World Directory of Medical Schools, published by the World Health Organization. Citizens of the United States who have completed their medical education in schools outside the United States, Puerto Rico, and Canada are included in this category, while foreign nationals who have graduated from medical schools in the United States, Puerto Rico, and Canada are not. Specific eligibility criteria for students and graduates of medical schools outside the United States, Puerto Rico, and Canada to take Step 1 and Step 2 are described in the Information Booklet provided by the ECFMG.

Note: The USMLE program recommends that for Step 3 eligibility, licensing authorities require the completion, or near completion, of at least one postgraduate training year in a program of graduate medical education accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the AOA. You should contact the FSMB or the individual licensing authority for complete information on Step 3 eligibility requirements in the state where you plan to be licensed.

A "Fifth Pathway" program* is an academic year of supervised clinical education provided by an LCME-accredited medical school, and is available to persons who meet all of the following conditions:
A. Have completed, in an accredited US college or university, undergraduate premedical work of the quality acceptable for matriculation in an LCME-accredited US medical school;
B. Have studied medicine in a medical school located outside the United States, Puerto Rico, and Canada that is listed in the World Directory of Medical Schools (published by the World Health Organization) and that requires an internship and/or social service after completing the school's academic requirements and before receiving the final medical credential;
C. Have completed all of the formal requirements of the non-US medical school except internship and/or social service. (Those who have completed all of these requirements for graduation are not eligible.)

Students who have completed the academic curriculum in residence at a non-US medical school and who meet the above conditions may be offered the opportunity to substitute, for an internship and/or social service required by a non-US medical school, an academic year of supervised clinical training in a medical school accredited by the LCME.

Any medical school accredited by the LCME can provide Fifth Pathway education. As of the release of this bulletin, the only medical school known to provide such education is New York Medical College in Valhalla, New York.

*Source: Graduate Medical Education Directory, 2001/2002, American Medical Association.
Graduates of Unaccredited Medical Schools in the United States and Canada


If you are eligible for licensure by a medical licensing authority but are not in one of the eligibility categories listed on page 3, you may take the USMLE only upon specific request by that licensing authority. A licensing authority may sponsor you to take Step 1 and Step 2, followed by Step 3 if Step 1 and Step 2 are passed, if all of the following conditions apply to you:
You are a graduate of an unaccredited medical school in the United States, Puerto Rico, or Canada.
You are an applicant for initial medical licensure in the jurisdiction of the sponsoring licensing authority.
The sponsoring licensing authority certifies that you have met all of the requirements for licensure in the jurisdiction except for the examination requirement.
If these conditions apply to you, the medical licensing authority should submit the request to sponsor you to the USMLE Secretariat in advance of your application for the Step.

Sequence of Steps
If you meet the eligibility requirements to take Step 1 and/or Step 2, you may take either Step first. You may apply for Step 3 only after passing both Step 1 and Step 2.

Time Limit and Number of Attempts Allowed to Complete All Steps Although there is no limit on the total number of times you can retake a Step you have not passed, the USMLE program recommends to medical licensing authorities that they require successful completion of Steps 1, 2, and 3 within a seven-year period, beginning when you first pass a Step; and allow no more than six attempts to pass each Step without demonstration of additional educational experience acceptable to the medical licensing authority.
If you pass a Step, you are not allowed to retake it, except to comply with the time limit of a medical licensing authority for the completion of all Steps or a requirement imposed by another authority recognized by the USMLE program. The medical licensing or other authority must provide information indicating that you are applying to retake the passed Step in order to comply with its requirement. If you are repeating a Step because of a time limit, you may apply to retake the Step only after the applicable time limit has expired.

The number of attempts allowed to pass each Step and the time allowed to complete all Steps vary among jurisdictions. To obtain specific information, you should contact the medical licensing authority in the jurisdiction where you intend to apply for medical licensure or the FSMB.

Formerly Administered Examinations
The NBME certifying examinations, Part I, Part II, and Part III, and the Federation Licensing Examination (FLEX) Components 1 and 2 are no longer administered. Use of the former NBME Parts or FLEX Components to fulfill eligibility requirements for Step 3 is no longer accepted. If you have passed all or a portion of these examinations, you may take the Step(s) corresponding to the passed examination(s) only to comply with a time limit or other requirement established by the USMLE program, a medical licensing authority, or other authority recognized by the USMLE program.

Retakes
If you fail or do not complete a Step and want to retake it, you must reapply by submitting a new application and fee. You may take the failed or incomplete Step no more than three times within a 12-month period.

For Step 1 and Step 2, you may retake the Step no earlier than the first day of the month 60 days after your previous test date. When you reapply to retake Step 3, the FSMB will assign an eligibility period to you that begins no earlier than 60 days after your previous test dates.

Change in Eligibility Status
If your eligibility for a Step changes after you submit your application but before your scheduled test date(s), you must notify your registration entity promptly. Failure to notify your registration entity that you may no longer be eligible to take the Step may result in a determination of irregular behavior. If you take a Step for which you are not eligible, scores for that Step will not be reported or, if previously reported, will be revoked.

For further information on USMLE,
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