School Requirement
Students are required to pass Step 1 and both components of Step 2, Clinical Knowledge (CK) and Clinical Skills (CS), of the United States Medical Licensing Examination (USMLE) prior to graduation [formerly, National Board of Medical Examiners (NBME) Parts I and II]. Performance on these examinations provides one method of comparing our students to those at other medical schools and thereby assessing performance relative to a national peer group. The successful completion of all three steps of the USMLE is necessary for obtaining a license to practice medicine.
Cost and Timing of Examinations
STEP 1
Students are expected to take Step 1 in the June-July timeframe after the completion of the second year and prior to entering the clinical curriculum. The current fee for Step 1 is $470. Past performance of our students suggests that those, who have received a Fail grade in either Biochemistry, Anatomy, or Microbiology or two or more Fail grades in any of the first or second year courses, are at a higher risk of having difficulty on the examination. Students whose records fall within one of these categories should consider the option of scheduling the examination to permit a six- to eight-week study period to prepare for Step 1.
Information regarding registration and preparation for Step 1 will be discussed at the USMLE Step 1 Orientation, which is typically held during the 2nd Year Class Meeting in Winter Quarter. In 2009, this will be on Thursday, February 12, 4:00-5:00 PM.
STEP 2-CK
STEP 2-CS
Students are required to take Step 2-CK and Step 2-CS in July/September timeframe of the senior year. The current fee for the Step 2 Clinical Knowledge exam is $470. The Clinical Skills exam component of Step 2 was implemented in mid-2004; the fee is $1005. Additional funds will be needed for travel and hotel costs when taking this exam at one of five sites in the United States. Requests for delays beyond these timeframes are approved by Dr. Eveland, and granted only under exceptional circumstances.
STEP 3
Graduates take the exam during the first year of residency training, and the current fee for Step 3 is $655.
Implications If Examination Is Failed
Students who have difficulty with the USMLE examinations are reviewed by the Student Progress Committee. Students must take time to restudy and retake Step 1 before continuing in the clinical curriculum. Reexaminations may be taken after a 60-day waiting period for restudy from the date of the previous attempt. Generally, if a student is not having academic difficulty in the curriculum, she or he is permitted to attempt the examination again. If a student has had difficulty in the basic science curriculum, the Student Program Committee may recommend dismissal if Step 1 is failed twice. If Step 2 is failed in the summer of the senior year, this information is included in the Dean's MSPE. If Step 2 is failed a second time and if the student has had difficulty in the curriculum, the Student Progress Committee may recommend dismissal.
If a student fails Step 1, s/he should contact the Dr. Eveland to discuss the timing of retaking the examination in relation to his/her clinical schedule. With the Step 1 examination being given essentially year-round, the student is usually permitted to complete the clerkship in which s/he is currently enrolled. Most students find that having completed one or more clerkships helps in preparing for the retake of Step 1.
For students who are having difficulty both in the curriculum and with the USMLE examinations, the Student Progress Committee will take a more active role in the determination of the student's academic program. In instances in which a student is having serious academic difficulty, the Student Progress Committee may require the student to develop an independent study program of three to six months in duration.
If either Step 1 or Step 2 is failed three times, the Student Progress Committee will consider a dismissal recommendation. In rare cases, the Committee may allow a fourth test administration upon petition by the student and with assurances that the student will spend adequate time in preparation.
Registration for USMLE
The USMLE certification registration, application, and instructions for completing them are available on the web at http://www.nbme.org/. The certification registration form, which is valid for five years, requires a current picture of a specific size, the School's seal, and Registrar's signature. It is important that you meet the specified deadline for registration for the examination. This will enable you to receive from the National Boards certification of the three-month timeframe in which you can schedule a testing date with Prometrics Testing Center for taking the one-day computerized examination. If you do not secure a Step 1 testing date in a timely manner, your entry into the clinical curriculum will be delayed. Similarly, if you do not secure a testing date in a timely manner for Step 2 CK or CS, your continuance in the curriculum will be delayed. If you are unable to take the examination in the timeframe required by the School, your progress in the curriculum may be interrupted.
If you wish to request any special accommodations during the test administration, you must provide additional information required by the NBME Office that includes specific, current documentation related to the requested accommodation. If you have any questions about this, please refer to USMLE information bulletin or contact Dr. Eveland. All accommodations must be approved by the NBME Office prior to the testing date.
USMLE Test Administrations and Test Statistics
Step 1
The Step 1 examination is given throughout the year, but is usually taken the first time in June-July after completion of the HuBio curriculum and must be taken prior to entering the clinical curriculum. The minimum passing score is currently 185. Nationally, about 10% of the first-time examinees fail this examination. The national test mean is 215 with a standard deviation of 20.
Step 2-CK and CS
The Step 2-CK examination is given throughout the year, but must be taken the first time in the July/September timeframe of the fourth year of medical school. The minimum passing score is currently 182. Nationally, about 6% of first-time examinees fail this examination. The national test mean is 215 with a standard deviation of 20.
The Step 2-CS must also be taken in the July-September timeframe of the fourth year of medical school, even if approved to expand the fourth year. This is a Pass/Fail examination.
Step 3
The Step 3 examination is taken during the first year of residency training.
UW Performance
In the past several years, the total mean score on Step 1 of our students has been at about the National mean score. Our failure rate has ranged from 1 - 5% as compared to the National average of 6 - 10%. For Step 2-CK, our students' performance has also been at about the National mean score; the failure rates are similar to the National average of 6%. For Step 3, our graduates have consistently performed well.
Score Report
The results of your performance on Step 1 and Step 2-CK will be reported as a total numeric score and a pass/fail designation. In addition, you will receive a graph showing how you scored in the major content areas. You will receive more specific information on the scoring of the examination with your USMLE application materials. Step 2-CS is reported as a pass/fail designation only.
The USMLE transcript is released to residency directors by the student as part of the Electronic Residency Application Service (ERAS), which was implemented in 1995-96. Thus, the USMLE transcripts are a routine part of the residency application process, and the USMLE score may be used to screen candidates for interviews.
USMLE Certified Transcript of Scores (Prepared by the NBME)
If a student needs to request an official copy (transcript) of performance on either Step 1 or Step 2, this will be provided through the NBME Office in accordance with USMLE policies for reporting scores to third parties, such as a residency program, but not to a medical licensing authority. This transcript will be provided only through ERAS or a written request by the examinee who has taken Step 1 and/or Step 2, has not yet taken Step 3, and who may have also taken but not passed an NBME Part examination. The transcript includes the entire examination history (pass and fail scores for all Steps taken to date). The additional related information which is also noted includes an indicator of special circumstances (such as "did not complete", "irregular behavior", "special testing accommodations") and an indicator of prior history in taking NBME or FLEX examinations. The examinee cannot choose which Step score will be shown on the transcript. For example, if both Steps 1 and 2 were taken, both will be reported, even if the request was for Step 1 only. (This information was taken from the October 1992 memo from the NBME Secretary for Certification. For additional information, see Bulletin provided with your USMLE application.)
Importance of the National Board Scores
To the School
The School requires students to pass Step 1 and both components of Step 2 for graduation. The USMLE scores are not used in the Dean's MSPE prepared for students' applications to residency programs. The Dean's MSPE does include a statement related to the student's status in meeting this graduation requirement, i.e. Step 1 has been passed; Step 2 will be retaken in December, etc. If either of the Step 2 exams has not been scheduled within the timeframe required, this will be noted in the Dean's MSPE since the residency directors expect our students to have completed these licensure applications prior to interviewing.
For Licensure
Passage of the USMLE Steps 1, 2, and 3 is now the single pathway for licensure. States may set a score level that needs to be met to be considered for a license. There is a seven (7) year limit between the date Step 1 was taken to when Step 3 is completed. If the timeframe exceeds seven years, you may be required to retake Step 1.
To Residency Program Directors
Many residency program applications ask for information about licensure examinations. In most cases, program directors are interested in whether the student has "passed". It is important to the residency director that the student accepted into the program is capable of meeting licensure requirements. If a resident is not successful in fulfilling the licensure examination requirement by the end of the first year of residency, the resident may not be able to continue in the program. In addition, the residency director may believe that successful performance on the USMLE is predictive of performance on specialty boards, which may be important to the evaluation of the residency program.
As some residency programs are becoming more competitive because of either the reduction in the number of positions or the increase in the number of applicants, the USMLE scores are being used in various ways in making decisions on whom to select for interviews. The following programs consistently use the scores in the screening process: Emergency Medicine, Neurosurgery, Obstetrics & Gynecology, Ophthalmology, Orthopaedic Surgery, Otolaryngology, Radiology, Surgery, and Urology. Other specialties may request and use the scores, but this appears to be more dependent on the residency program than the specialty. With the implementation of ERAS, submission of USMLE official transcripts has become a routine part of the residency application process for all specialties. Some programs also request MCAT scores and college transcripts.
To the Student
The importance that you place on the level of the score you wish to achieve is your decision. The amount of study time may be important to your overall strategy. You must also be aware that, if you take either Step 1, Step 2-CK or Step 2-CS and receive a passing score, you cannot retake the examination to improve your score. The issue of the use of the USMLE scores, particularly Step 1, in the residency selection process is one about which you need to be aware so that you can make a decision on how you wish to approach this examination. Many programs want to also see the Step 2-CK scores as part of the residency application process. With the implementation of the ERAS noted earlier, it is expected that residency programs now expect to receive official transcripts for both Step 1 and Step 2-CK.
IMPORTANT NOTE
Please retain your score reports, as you may need them for residency applications. In addition, you will need the information contained in these reports when you apply for licensure for the first-year of residency and Step 3.
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Questions regarding the USMLE application process/scheduling permit should be directed to Trudy Furberry, our USMLE coordinator.