Chapter 20
The United States Medical Licensing Examination (www.usmle.org)
The USMLE is a three-step examination for medical licensure in the United States, sponsored by the
Federation of State Medical Boards and the National Board of Medical Examiners (NBME): Step 1, Step
2 CK, a computerized multiple choice clinical knowledge component, Step 2 CS, a clinical skills
examination, and Step 3. Passing all parts is required of physicians who plan to practice medicine in the
United States. Detailed information can be found at www.usmle.org.
It is likely that if you are reading this, you have recently passed the USMLE, Step 1. Passing the
USMLE, Steps 2 CK and CS are graduation requirements at RWJMS. The Student Affairs Deans
generally suggest that Step 2 CK and CS be taken early enough so that your scores can be reviewed by
residency programs during the application process. Because of the long lag time in reporting Step 2 CS
scores, this should be taken by early December of your M4 year. You should discuss with a Student
Affairs dean strategies regarding the reporting of Step 2 CK scores to residency programs. Your fourth
year schedule will offer the opportunity of up to 1 month of study time for the USMLE Step 2.
Step 3 of the USMLE is taken during your Residency training, and assesses clinical knowledge essential
for the unsupervised practice of medicine.
The USMLE, Step 2
1. USMLE, Step 2 CK: Check websites for details about this exam.
(www.usmle.org and www.nbme.org)
The USMLE Step 2 CK exam consists of approximately 370 multiple-choice test questions (single best
answer and matching sets), administered in eight 60-minute blocks. The subjects tested on the Step 2
exam are internal medicine, obstetrics and gynecology, pediatrics, preventive medicine, psychiatry and
surgery. The content description of the exam can be found on the USMLE website. The current passing
score is 184. The application instructions, similar to the USMLE, Step 1, can also be found at the NBME
website (http://www.nbme.org). Scores are generally reported within a 3-4 week turn around period, but
could take 6 weeks or more.
How to Prepare:
Clinical experiences with patients, time spent reading, and studying for clerkship examinations all help in
preparing for this comprehensive assessment of clinical knowledge. However, you are advised to spend
some time in focused study specifically for this exam. It is helpful to relate to your own clinical
experiences. Be certain to select study resources that broaden your knowledge base, i.e. that help you
“fill in the gaps.” Review materials that you have used before and are familiar with are often the most
useful, particularly the ones you used to prepare for Clerkship NBME Subject exams. You are advised to
do questions throughout your study period to become familiar with question formats and gain facility in
using the computer software. Questions should also be used for self-testing, to identify areas of strengths
and weaknesses to guide further study and to determine reasons for your errors.
Cognitive Skills Program: Third year students are able to schedule individual appointments with a
Cognitive Skills instructor for assistance in discussing resources and preparing study schedules. Scoring
poorly on or failing clerkship exams may predict difficulties on the USMLE Step 2; it is best to address
this early on. Call 732-235-4129 for an appointment.
2. Clinical Skills Examination:
The Step 2 CS is a one-day (approximately 8 hours) test administered at regional Clinical Skills
Evaluation Centers. (There is a site in Philadelphia). You will have 12 patient cases, 15 minutes for each
patient encounter, and 10 minutes to record the patient note. You will examine standardized patients and
be expected to take a history, perform focused physical examinations, answer questions and provide
counseling where appropriate. After each exam, you will be given time to record pertinent history and
physical findings, list diagnostic impressions, and outline plans for further evaluation, if necessary. The
website http://www.usmle.org indicates: “The cases cover common and important situations that a
physician is likely to encounter in common medical practice in clinics, doctors’ offices, emergency
departments, and hospital settings in the United States.”
How to Prepare:
http://www.usmle.org
It is likely that your day-to-day work in the clerkships will prepare you well for this exam. In addition,
every clerkship has a clinical skills assessment (OSCE) as part of the evaluation. You will also have
a Summative Clinical Skills Assessment in June, 2010. Be sure to watch the online videos available at
the USMLE website which will give you a good idea of what to expect the day of the exam.