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Medical Education

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 examinations, 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 requirements. 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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