USMLE / COMLEX: Getting Your Medical License

As you work through your medical school training and your residency experience, you will be required to complete a series of exams to demonstrate your competency to practice as a physician and to obtain your medical license. In the United States, physicians are required to prove themselves repeatedly to demonstrate that they have the knowledge and skills necessary to be entrusted with the health and well-being of another individual.

USMLE Step 1

Students in the United States generally take the first step of the USMLE after their second year of medical school. Thousands of international medical graduates who want to practice medicine in the United States also take the exam annually. The test helps gauge whether a prospective physician can understand and apply basic science principles, and specifically addresses issues related to disease, health, and therapy options. The USMLE Step 1 has a heavy emphasis in basic science principles, covering subjects such as anatomy, biochemistry, pathology, pharmacology, microbiology, and physiology. More interdisciplinary areas, including genetics, immunology, and nutrition, are also covered on the exam.

Format of the USMLE Step 1

The USMLE Step 1 focuses on principles of systems and processes. For example, the systems sections cover individual organ systems and their general principles. In the processes portion, the test addresses matters like principles of therapeutics; normal structure and function; and psychosocial, cultural, occupational, and environmental considerations. The test items in the general principles category cover normal and abnormal processes that are not limited to specific organ systems.

The questions on the test generally require the ability to interpret material presented in graphs and tables, and to identify specimens of both gross and microscopic, and pathologic and normal, varieties. Test takers have to choose the best response out of three to eleven possible answers. Examinees will not be able to return to a specific section of the test once the allotted time for that section has expired or after they have answered all of the questions.

To prepare for the USMLE Step 1, the USMLE website recommends reviewing the examination descriptions. Using this information, medical school students can perform a self-assessment to gauge their readiness in the subject matter. Examinees who wish to experience test conditions similar to what they will encounter on testing day may pay a fee and schedule an appointment at a Prometric testing center to try sample tests. Note, however, that these practice materials are based on older exam material and software.

The USMLE Step 1 is offered year-round, by appointment. Identification and a Scheduling Permit are required for admission to the test. A computer-based exam, the test generally lasts one day and is broken into seven one-hour sessions. Plan to arrive at your testing center 30 minutes early to take care of necessary procedures such as signing in and going through other checks to prove you do not have any unauthorized items. A late arrival for your testing appointment could result in your failure to be admitted to the exam.

USMLE Step 2

Getting Your Medical License

The USMLE Step 2 tests a medical student’s abilities to apply medical knowledge and skills and understanding of clinical science to quality patient care with supervision. The test emphasizes health promotion and disease prevention, specifically the basic abilities to keep a patient safe and to follow effective medical practices.

The second stage of the USMLE is divided into two categories: Clinical Knowledge (CK) and Clinical Skills (CS). In the CK portion of the test, examinees answer multiple-choice questions. The CS portion of the test uses real people trained to act as medical patients. The symptoms the patients share come from situations a doctor commonly encounters in clinics, offices, hospitals, and emergency-room settings. This section tests an individual on his or her ability to obtain information from patients, perform a physical exam, and share the findings with others.

Just five regional testing centers, known as Clinical Skills Evaluation Collaboration (CSEC) Centers, administer the CS portion of the USMLE. The test may be taken in Atlanta, Houston, Chicago, Los Angeles, or Philadelphia. The CK section of the test is administered at Prometric test centers around the world. The USMLE website encourages examinees to study test-day rules carefully, as the rules for participating in the Step 1 portion of the exam series and the Step 2 CK section are different from Step 2 CS testing. It can be helpful to gain familiarity with the format of USMLE Step 2 test questions before your actual testing day. Visit the USMLE website to review practice test items and other orientation materials.

Scheduling the USMLE Step 2

When scheduling a testing appointment for either the Step 1 or Step 2 portion of the exam, remember that they are offered on a “first-come, first-served” basis. Your first choice of testing time may not be available. However, because students reschedule appointments frequently, it may be possible to later secure the date you desire. Once your test day is set, remember that timing is crucial. Plan to arrive early to your testing appointment, and know that arriving late could preclude you from taking the exam at all on your scheduled day. Follow the instructions of test-center staff to the letter to avoid having any conduct violations that may affect your exam.

The Step 1 and Step 2 portions of the USMLE may be taken in any order. Traditionally, the Step 1 exam is completed after a student’s second year of medical school, and the Step 2 is taken during the fourth year.

USMLE Step 3

The USMLE Step 3 assesses how well a physician in training can apply his or her medical knowledge and understanding of biomedical and clinical science to practicing medicine in an unsupervised setting. In this test, examinees will find an emphasis on patient management under ambulatory conditions. As the final step in the USMLE series, the Step 3 exam tests an individual’s ability to take full responsibility for providing general medical care. The test items and cases are patient-centered, with multiple-choice questions as well as simulations. Additionally, the principles and basic concepts covered in the Step 1 and Step 2 examinations will also be included here.

USMLE Step 3 Format

The Step 3 exam is divided into three parts, or “dimensions.” The first dimension is “normal conditions and disease categories.” Here, the test deals with normal growth and development, basic concepts, and general principles. The second portion of the test considers clinical encounters and a doctor’s ability to ascertain whether a patient’s problems are new or ongoing, as well as what type of intervention, urgent or otherwise, may be necessary. The clinical problems “involve mainstream, high-impact diseases,” according to the USMLE website. Some less-common, but still important, issues are also covered. The third dimension of the USMLE Step 3 tests a medical student’s ability to perform essential physician tasks, such as taking a patient’s history, conducting a physical exam, formulating a diagnosis, and providing a prognosis. Patient management, including health maintenance, communication, and therapeutics, is also addressed.

Typically, students take the USMLE Step 3 once they have completed medical school and are in their first or second year of postgraduate training. The exam cannot be taken without first successfully passing the USMLE Step 1 and Step 2. Many state licensing boards mandate that physicians pass the USMLE Step 1, Step 2, and Step 3 within a seven-year period, which begins once the examinee has passed the Step 1 test. Check with an authority such as the Federation of State Medical Boards to obtain more specific information about the state in which you want to practice medicine.

While some parts of the comprehensive USMLE exam may be taken at multiple locations around the world, the USMLE Step 3 is only offered at Prometric test centers in the United States and its territories. The test is not conducted on federal or state holidays, or during the first two weeks of January.

To prepare for the exam, you can review practice tests and orientation material available at the USMLE website. Be certain you understand the rules of conduct and other important procedures that must be followed to the letter on your testing day. For example, certain items are prohibited in testing areas, and procedures regarding testing breaks are strictly enforced. Additionally, the failure to bring proper forms of identification and other necessary documents can preclude you from being able to test on your scheduled day. The rules are stringent, but with the right preparation and planning, you can have a successful testing day.

Understanding the USMLE & the COMLEX

The USMLE, or United States Medical Licensing Examination, is a multipart test. Students working to become more traditional, or allopathic, doctors must pass the USMLE to practice medicine. This exam is taken in the early part of a student’s career and is the initial medical license.

Those looking to become osteopathic doctors must pass the COMLEX, or Comprehensive Osteopathic Medical Licensing Examination. Like the USMLE, the COMLEX is also a multi-part examination. Osteopathic generalist physicians who pass the various portions of this test are considered to have the skills necessary to practice medicine without supervision.

Both the COMLEX and the USMLE are progressive examinations and are divided into three parts. Each part is related directly to the experience level a physician is expected to have at the time that he or she takes that particular phase of the test. The levels of the exams complement each other. Taken comprehensively, these tests help provide licensing boards with a well-rounded look at a doctor’s abilities.

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