A Resource for
USMLE Step 1
Preparation
Compiled by the TTUHSC
School of Medicine
Office of Student Affairs
Dr. JoAnn Larsen
Assistant Dean for Student Affairs
USMLE – What’s it for?
In order to become a licensed physician in the United States, individuals must pass a series
of examinations conducted by the National Board of Medical Examiners. These examinations
are the United States Medical Licensing Examinations, or USMLE. Currently there are four
separate exams which must be passed in order to eligible for medical licensure:
• Step 1, usually taken after the completion of the second year of medical school;
• Step 2 Clinical Knowledge (CK), usually taken during the fourth year;
• Step 2 Clinical Skills (CS), usually taken during the fourth year; and
• Step 3, typically taken during the first year of post graduate training.
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 that provide a foundation for 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, skills, 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 and basic patient-centered skills that provide the
foundation for the safe and competent practice of medicine.
Step 2 Clinical Skills (CS) A clinical skills examination was part of the original design of
USMLE. The NBME was charged with including a test of clinical skills using standardized patients
when such an examination was shown to be valid, reliable, and practical. NBME research and the
work of other organizations administering clinical skills examinations demonstrate that clinical
skills examinations measure skill sets different from those measured by traditional multiple-
choice questions. Mastery of clinical and communication skills, as well as cognitive skills, by
individuals seeking medical licensure is important to the protection of the public.
Implementation of the clinical skills examination began in June 2004. The clinical skills
examination is a separately administered component of Step 2 and is referred to as Step 2
Clinical Skills, or Step 2 CS. The computer-based, multiple-choice component of Step 2 is
referred to as Step 2 Clinical Knowledge, or Step 2 CK.
USMLE Step 2 CS is administered at five regional test centers (CSEC Centers) in the United States.
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.
Requirements for licensure in each state are set by the state’s medical licensing boards. Each
state board may determine the maximum number of times that a person may take each Step
exam and still remain eligible for licensure. In Texas, individuals are limited to three
attempts at each Step exam.
But what we’re really here for is to talk about preparing for Step 1. Step 1 is your first BIG
hurdle. And make no mistake about it, this is a VERY important test. A very good
performance on Step 1 can definitely help you when it comes to securing a top-rate
residency, and likewise a poor score can hurt you and limit your options. And a failure on
Step 1 can eliminate the possibility of some residencies altogether. So it is definitely in your
best interest to do all you can to maximize your chances of doing well, regardless of what
type of residency you may choose to pursue.
How is Step 1 scored?
When you take Step 1, the computer records your responses. After your test ends, your
responses are transmitted to the NBME for scoring. The number of test items you answer
correctly is converted to two equivalent scores, one on a three-digit score scale and one on a
two-digit score scale. Both scales are used for score-reporting purposes.
On the three-digit scale, most Step 1 scores fall between 140 and 260. The mean score for
first-time examinees from accredited medical school programs in the United States is in the
range of 200 to 220, and the standard deviation is approximately 20. Your score report will
include the mean and standard deviation for recent administrations of the examination. The
two-digit score is derived from the three-digit score. It is used in score reporting because
some medical licensing authorities have requirements that include language describing a
"passing score of 75." The two-digit score is derived in such a way that a score of 75 always
corresponds to the minimum passing score.
1
,Blocks of items are constructed to meet specific content specifications. As a result, the
combination of blocks of items creates a form of the examination that is comparable in
content to all other forms. The percentage of correctly answered items required to pass
varies from form to form. However, examinees typically must answer 60 to 70 percent of
items correctly to achieve a passing score.
What is the minimum passing score?
In December 2006, the Step 1 Committee decided to raise the three-digit score recommended to
pass Step 1 from 182 to 185. The new minimum passing score will be applied to Step 1
examinations for which the first day of testing is on or after January 1, 2007.
What is Texas Tech’s policy on USMLE exams?
Step 1 Exam
• All students will be required to take the United States Medical Licensing
Examination (USMLE) Step 1 at the end of Year Two and no later than June 30.
Excepted from this requirement are students who must remediate a Basic Science
course immediately following Year Two. Such students will complete any
remediation work /exam by June 15 following Year Two and take USMLE Step 1 by
July 31 of Year Three.
• All students who take the USMLE Step 1 no later than June 30 following
completion of Year Two will be eligible to start the Year Three clerkship
rotations in July of that year.
• Passage of USMLE Step 1 is required for promotion to Year Four.
• For students who must repeat USMLE Step 1, leave from the third year curriculum
to prepare for the exam is not required but is strongly recommended and
encouraged. Any request for such leave must be approved by the Associate
Dean for Educational Programs or the Assistant Dean for Student Affairs.
• Students who reach the end of the Year Three curriculum and have not yet passed
Step 1 will be placed on administrative leave of absence for up to one year,
consistent with Section 4.1 of this policy which allows no more than six (6) years
to complete the curriculum for the Doctor of Medicine degree, inclusive of all
leaves, repetition, or decompression of an academic year. Passage of the exam
during this time frame will result in return to the curriculum.
• Inability to pass Step 1 within the one-year leave of absence will result in
withdrawal from the curriculum as stated in the SOM Student Affairs Student
Handbook under Student Leaves of Absence. Appeals regarding this issue will be
handled as outlined in Sections 6, 7, and 8 of the Grading and Promotions policy.
Step 2 Exam
• For students who begin the curriculum in August of 2005 or later, passage of Step
2 Clinical Knowledge and Step 2 Clinical Skills will be required for graduation.
Passing scores must be documented no later than May 1 of the year graduating.
How do I apply for Step 1?
The initial application for Step 1 is done on the Internet. Go to www.nbme.org. Click on
“NBME Licensing Exam Services”, then “National Licensing Examination Services
Website”. In the yellow LOG IN box, please note you do not have a USMLE ID number yet.
Instead, click on “First time user” and follow the instructions. As part of the application,
2
, you will indicate a 90-day eligibility period during which you plan to take the exam. Payment
is also required at this time ($480).
• Print out the application form which will require your signature and a picture.
Bring the form to the Student Affairs Office for signature – Dr. McMahon, Dr.
Larsen, Tamara Lane, and Karen Nelson are authorized to sign the form.
• Then take the form to the Registrar’s Office (2C400 – across from the Synergistic
Center) and have the school seal put on it.
• After that, you’re ready to mail it in.
Where do I take the test?
Thomson Prometric, a part of The Thomson Corporation, provides scheduling and test centers
for the computer-based components of USMLE. Step 1 and Step 2 CK are given around the
world at Prometric Test Centers (PTCs).
Prometric test centers are located throughout the U.S. In Texas there are centers in:
• Abilene
• Amarillo
• Austin (2)
• Beaumont
• Bedford (2)
• Corpus Christi
• Dallas (2)
• El Paso
• Houston (3)
• Lubbock
• McAllen
• Midland
• San Antonio (2)
• Tyler
• Waco
• Wichita Falls
How do I schedule my test?
Once your application has been processed, you will receive an email from NBME notifying you
that your application is complete. About a week later, you will receive a second email from
them notifying you that your scheduling permit is available; this message will include
instructions for accessing the electronic scheduling permit using the registration entity's
interactive website.
PRINT OUT YOUR SCHEDULING PERMIT and keep it in a safe place. You MUST bring it
with you to the test center on the day of your test. You will not be allowed to take the exam
without your scheduling permit.
Once you’ve gotten your permit, you may schedule your test online at www.prometric.com
for any available test date that is within your approved 90-day eligibility period. Not all
Prometric centers are open on weekends, and USMLE exams are not necessarily offered every
day the centers are open. Please note that May through July are one of the busiest
periods for these testing centers because of the large USMLE demand during that
time – PLAN AHEAD!
3
USMLE Step 1
Preparation
Compiled by the TTUHSC
School of Medicine
Office of Student Affairs
Dr. JoAnn Larsen
Assistant Dean for Student Affairs
USMLE – What’s it for?
In order to become a licensed physician in the United States, individuals must pass a series
of examinations conducted by the National Board of Medical Examiners. These examinations
are the United States Medical Licensing Examinations, or USMLE. Currently there are four
separate exams which must be passed in order to eligible for medical licensure:
• Step 1, usually taken after the completion of the second year of medical school;
• Step 2 Clinical Knowledge (CK), usually taken during the fourth year;
• Step 2 Clinical Skills (CS), usually taken during the fourth year; and
• Step 3, typically taken during the first year of post graduate training.
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 that provide a foundation for 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, skills, 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 and basic patient-centered skills that provide the
foundation for the safe and competent practice of medicine.
Step 2 Clinical Skills (CS) A clinical skills examination was part of the original design of
USMLE. The NBME was charged with including a test of clinical skills using standardized patients
when such an examination was shown to be valid, reliable, and practical. NBME research and the
work of other organizations administering clinical skills examinations demonstrate that clinical
skills examinations measure skill sets different from those measured by traditional multiple-
choice questions. Mastery of clinical and communication skills, as well as cognitive skills, by
individuals seeking medical licensure is important to the protection of the public.
Implementation of the clinical skills examination began in June 2004. The clinical skills
examination is a separately administered component of Step 2 and is referred to as Step 2
Clinical Skills, or Step 2 CS. The computer-based, multiple-choice component of Step 2 is
referred to as Step 2 Clinical Knowledge, or Step 2 CK.
USMLE Step 2 CS is administered at five regional test centers (CSEC Centers) in the United States.
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.
Requirements for licensure in each state are set by the state’s medical licensing boards. Each
state board may determine the maximum number of times that a person may take each Step
exam and still remain eligible for licensure. In Texas, individuals are limited to three
attempts at each Step exam.
But what we’re really here for is to talk about preparing for Step 1. Step 1 is your first BIG
hurdle. And make no mistake about it, this is a VERY important test. A very good
performance on Step 1 can definitely help you when it comes to securing a top-rate
residency, and likewise a poor score can hurt you and limit your options. And a failure on
Step 1 can eliminate the possibility of some residencies altogether. So it is definitely in your
best interest to do all you can to maximize your chances of doing well, regardless of what
type of residency you may choose to pursue.
How is Step 1 scored?
When you take Step 1, the computer records your responses. After your test ends, your
responses are transmitted to the NBME for scoring. The number of test items you answer
correctly is converted to two equivalent scores, one on a three-digit score scale and one on a
two-digit score scale. Both scales are used for score-reporting purposes.
On the three-digit scale, most Step 1 scores fall between 140 and 260. The mean score for
first-time examinees from accredited medical school programs in the United States is in the
range of 200 to 220, and the standard deviation is approximately 20. Your score report will
include the mean and standard deviation for recent administrations of the examination. The
two-digit score is derived from the three-digit score. It is used in score reporting because
some medical licensing authorities have requirements that include language describing a
"passing score of 75." The two-digit score is derived in such a way that a score of 75 always
corresponds to the minimum passing score.
1
,Blocks of items are constructed to meet specific content specifications. As a result, the
combination of blocks of items creates a form of the examination that is comparable in
content to all other forms. The percentage of correctly answered items required to pass
varies from form to form. However, examinees typically must answer 60 to 70 percent of
items correctly to achieve a passing score.
What is the minimum passing score?
In December 2006, the Step 1 Committee decided to raise the three-digit score recommended to
pass Step 1 from 182 to 185. The new minimum passing score will be applied to Step 1
examinations for which the first day of testing is on or after January 1, 2007.
What is Texas Tech’s policy on USMLE exams?
Step 1 Exam
• All students will be required to take the United States Medical Licensing
Examination (USMLE) Step 1 at the end of Year Two and no later than June 30.
Excepted from this requirement are students who must remediate a Basic Science
course immediately following Year Two. Such students will complete any
remediation work /exam by June 15 following Year Two and take USMLE Step 1 by
July 31 of Year Three.
• All students who take the USMLE Step 1 no later than June 30 following
completion of Year Two will be eligible to start the Year Three clerkship
rotations in July of that year.
• Passage of USMLE Step 1 is required for promotion to Year Four.
• For students who must repeat USMLE Step 1, leave from the third year curriculum
to prepare for the exam is not required but is strongly recommended and
encouraged. Any request for such leave must be approved by the Associate
Dean for Educational Programs or the Assistant Dean for Student Affairs.
• Students who reach the end of the Year Three curriculum and have not yet passed
Step 1 will be placed on administrative leave of absence for up to one year,
consistent with Section 4.1 of this policy which allows no more than six (6) years
to complete the curriculum for the Doctor of Medicine degree, inclusive of all
leaves, repetition, or decompression of an academic year. Passage of the exam
during this time frame will result in return to the curriculum.
• Inability to pass Step 1 within the one-year leave of absence will result in
withdrawal from the curriculum as stated in the SOM Student Affairs Student
Handbook under Student Leaves of Absence. Appeals regarding this issue will be
handled as outlined in Sections 6, 7, and 8 of the Grading and Promotions policy.
Step 2 Exam
• For students who begin the curriculum in August of 2005 or later, passage of Step
2 Clinical Knowledge and Step 2 Clinical Skills will be required for graduation.
Passing scores must be documented no later than May 1 of the year graduating.
How do I apply for Step 1?
The initial application for Step 1 is done on the Internet. Go to www.nbme.org. Click on
“NBME Licensing Exam Services”, then “National Licensing Examination Services
Website”. In the yellow LOG IN box, please note you do not have a USMLE ID number yet.
Instead, click on “First time user” and follow the instructions. As part of the application,
2
, you will indicate a 90-day eligibility period during which you plan to take the exam. Payment
is also required at this time ($480).
• Print out the application form which will require your signature and a picture.
Bring the form to the Student Affairs Office for signature – Dr. McMahon, Dr.
Larsen, Tamara Lane, and Karen Nelson are authorized to sign the form.
• Then take the form to the Registrar’s Office (2C400 – across from the Synergistic
Center) and have the school seal put on it.
• After that, you’re ready to mail it in.
Where do I take the test?
Thomson Prometric, a part of The Thomson Corporation, provides scheduling and test centers
for the computer-based components of USMLE. Step 1 and Step 2 CK are given around the
world at Prometric Test Centers (PTCs).
Prometric test centers are located throughout the U.S. In Texas there are centers in:
• Abilene
• Amarillo
• Austin (2)
• Beaumont
• Bedford (2)
• Corpus Christi
• Dallas (2)
• El Paso
• Houston (3)
• Lubbock
• McAllen
• Midland
• San Antonio (2)
• Tyler
• Waco
• Wichita Falls
How do I schedule my test?
Once your application has been processed, you will receive an email from NBME notifying you
that your application is complete. About a week later, you will receive a second email from
them notifying you that your scheduling permit is available; this message will include
instructions for accessing the electronic scheduling permit using the registration entity's
interactive website.
PRINT OUT YOUR SCHEDULING PERMIT and keep it in a safe place. You MUST bring it
with you to the test center on the day of your test. You will not be allowed to take the exam
without your scheduling permit.
Once you’ve gotten your permit, you may schedule your test online at www.prometric.com
for any available test date that is within your approved 90-day eligibility period. Not all
Prometric centers are open on weekends, and USMLE exams are not necessarily offered every
day the centers are open. Please note that May through July are one of the busiest
periods for these testing centers because of the large USMLE demand during that
time – PLAN AHEAD!
3
