The USMLE (United States Medical Licensing Examination) assesses a physician's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care. Each of the three Steps of the USMLE complements the others; no Step can stand alone in the assessment of readiness for medical licensure. Because individual medical licensing authorities make decisions regarding use of USMLE results, physicians seeking licensure should contact the jurisdiction where they intend to apply for licensure to obtain complete information.

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

Sections focusing on individual organ systems are subdivided according to normal and abnormal processes, principles of therapy, and psychosocial, cultural, and environmental considerations. Each examination covers content related to the traditionally 8 defined disciplines

1. Anatomy
2. Behavioral sciences
3. Biochemistry
4. Microbiology
5. Pathology
6. Pharmacology
7. Physiology
8. Interdisciplinary areas including genetics, aging, immunology, nutrition, and molecular and cell biology.

While not all topics listed in the content outline are included in every examination, overall content coverage is comparable in the various examination forms that will be taken by different examinees.

The Step 1 content outline describes the scope of the examination in detail but is not intended as a curriculum development or study guide. It provides a flexible structure for test construction that can readily accommodate new topics, emerging content domains, and shifts in emphasis. The categorizations and content coverage are subject to change. Broadly based learning that establishes a strong general understanding of concepts and principles in the basic sciences is the best preparation for the examination.

Clinical Knowledge

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 Knowledge (Step 2 CK) consists of multiple-choice questions prepared by examination committees composed of faculty members, teachers, investigators, and clinicians with recognized prominence in their respective fields. Committee members are selected to provide broad representation from the academic, practice, and licensing communities across the United States and Canada. Test questions focus on the principles of clinical science that are deemed important for the practice of medicine under supervision in postgraduate training. The examination is constructed from an integrated content outline that organizes clinical science material along two dimensions.

Clinical Skills

Step 2 CS assesses whether you can demonstrate the fundamental clinical skills essential for safe and effective patient care under supervision. There are three subcomponents of Step 2 CS: Integrated Clinical Encounter (ICE), Communication and Interpersonal Skills (CIS), and Spoken English Proficiency (SEP).

Step 2 CS uses standardized patients to test medical students and graduates on their ability to gather information from patients, perform physical examinations, and communicate their findings to patients and colleagues.

Step 3 is organized along two principal dimensions: clinical encounter frame and physician task. Step 3 content reflects a data-based model of generalist medical practice in the United States.
Encounter frames capture the essential features of circumstances surrounding physicians' clinical activity with patients. They range from encounters with patients seen for the first time for nonemergency problems, to encounters with regular patients seen in the context of continued care, to patient encounters in (life-threatening) emergency situations. Encounters occur in clinics, offices, skilled nursing care facilities, hospitals, emergency departments, and on the telephone. Each test item in an encounter frame also represents one of the six physician tasks. For example, initial care encounters emphasize taking a history and performing a physical examination. In contrast, continued care encounters emphasize decisions regarding prognosis and management.
Vietnamese doctors will take Step 3 during residency in the US.

When you take Step 1, Step 2 CK, or Step 3, 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, 2 CK, or 3 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.

As of December 2016, the minimum passing score for step 1 is 192, step 2 CK is 209, and step 3 is 196. This corresponds to answering about 60% questions correctly. Since Step 1 score is scaled score, it is difficult to give the exact percentage of correct answer for minimum score. For VMGUS Division, we encourage you to score at least 200 (3 digits score) or 85 (2 digit score) on step 1. Score 85 USMLE will make you become a competitive applicant.

References:

1. The United Stated Medical Licensing Exams

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