Medical Education

expertise. Only a sound scientific basis for critical evaluation will enable the physician

to incorporate or reject various items in the large volume of data obtained during the

course of a patient's "workup" and thereby arrive at an appropriate diagnosis.

A better relationship may be facilitated if one has a view of what the patient seeks in

a physician. A survey has shown that priority is given to: (1) being knowledgeable, (2)

being competent, (3) answering questions honestly and completely, (4) providing clear

explanations to medical problems, (5) making sure that patients understand what they

have been told, (6) spending adequate time with them, and (7) demonstrating a genuine

interest in the patient's health and welfare.

UNITED STATES MEDICAL LICENSING EXAMINATION

There is no national medical licensing body in the United States. It is the function of the

individual states to determine who shall practice within their borders and to maintain

high standards of medical practice in accordance with their own rules and regulations.

In recognition of the thoroughness and widely accepted standards of the USML exami-

nations, its certificate is accepted by the medical licensing authorities of the District of

Columbia, Puerto Rico, and all states except Louisiana and Texas.

The National Board of Medical Examiners (NBME) has established three qualifying

examinations which are referred to as Steps 1, 2, and 3 of the United States Medical

Licensing Examination (USMLE). Step 1 is given all year round, over an eight-hour

day, and is a multiple-choice test. It seeks to assess the ability to apply knowledge and

understanding of key concepts of basic biomedical science, with an emphasis on the

principles and mechanisms of disease and modes of therapy. Step 2 is given in March

and September and has a similar format to Step 1. It seeks to assess the ability to apply

the medical knowledge and understanding of clinical science considered essential for

the provision of patient care under supervision, including emphasis on health care and

disease prevention. A clinical skills component has been incorporated in Step 2 of the

USMLE; a fee of around $1,000 has been set for it. There is also a charge for exam

review questions, which can serve as a self-assessment exam program. Step 3 seeks to

assess the ability to apply the medical knowledge and understanding of biomedical and

clinical science considered essential for the supervised practice of medicine with

emphasis on patient management in ambulatory settings. To be eligible to take Step 3,

the individual must (a) have obtained the MD degree (or its equivalent) or the DO

degree, (b) have successfully completed both Steps 1 and 2, (c) if a foreign medical

school graduate, have successfully completed a Fifth Pathway Program, and (d) have

met the requirements for taking Step 3 imposed by the medical licensing authority that

is administering the examination, such as the completion of any postgraduate require-

ments. The latter generally is the near completion or completion of one full postgraduate

training year in an accredited graduate program.

All three steps of the USMLE are offered in a computerized format and need to be

taken at Sylvan Technology Centers, which are responsible for scheduling. Registration

information is provided by the Office of Student Affairs at each of the medical schools

and from the National Board of Medical Examiners (NBME), Department of Licensing

Examination Services, 3750 Market Street, Philadelphia, PA 19104. This organization's

web site address is www.nbme.org.

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