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December 4, 2013

The Evolution of the United States Medical Licensing Examination (USMLE): Enhancing Assessment of Practice-Related Competencies

Author Affiliations
  • 1National Board of Medical Examiners, Philadelphia, Pennsylvania
JAMA. 2013;310(21):2245-2246. doi:10.1001/jama.2013.282328

The United States Medical Licensing Examination (USMLE) is the only route to medical licensure for graduates of the Liaison Committee on Medical Education (LCME)–accredited medical schools in the United States and for all graduates of international medical schools. It currently consists of 4 examinations: Step 1, assessing application of foundational science; Step 2 Clinical Skills, assessing communication, physical examination, and data interpretation skills; Step 2 Clinical Knowledge, assessing knowledge of clinical medicine; and Step 3, assessing application of clinical knowledge and patient management. In the early 1990s, the USMLE replaced the National Board of Medical Examiners (NBME) certification examinations and the Federation Licensing Examination (FLEX) program. Since its inception, the USMLE has undergone gradual evolution in design and format, with some major changes that include computerized examination delivery and the use of computerized patient simulations in 1999, and standardized patients introduced in 2004 to assess clinical skills.