US medical students usually take Step 1 at the end of the second year of medical school. It is an eight-hour computer-based exam consisting of 336 multiple-choice questions (MCQs) divided into seven blocks each consisting of 48 questions. As of summer 2008, some questions include audio and video. Each block must be finished within an hour. The remaining hour is break time. An optional tutorial about how to use the computer program of the exam is offered at the beginning of the exam and takes 15 minutes. This time is deducted from the hour of allotted break time.
The scores are reported with a three digit score and a two digit score. As of January 1, 2007, the passing score has been raised to 185 from a previous score of 182. The average score is approximately 215. If the student passes the exam, he or she may not repeat the exam to achieve a higher score. Theoretically, the maximum score is 300 . However, scores above 280 are virtually unheard of.
While not recommended by the creators of the USMLE, the Step 1 score is frequently used in medical residency applications as a measure of a candidate's likelihood to succeed in that particular residency (and on that specialty's board exams). More competitive residency programs usually accept applications with higher Step 1 scores. The Step 1 exam is arguably the hardest and most important examination a medical student will take during his/her career.
The USMLE score is just one of many factors considered by residency programs in selecting applicants. The median USMLE Step 1 scores for graduates of U.S. Medical Schools for various residencies are available in Chart 10 on page 11 of "Charting Outcomes in the Match" available at http://www.aamc.org/programs/cim/chartingoutcomes.pdf
The examination is offered in five cities across the country:
Before 2004, a similar exam, the Clinical Skills Assessment (CSA) was used to assess the clinical skills of foreign medical graduates.
Step 3 is a two-day examination. Each day of testing must be completed within eight hours. The first day of testing includes 336 multiple-choice items divided into blocks, each consisting of 48 items. Examinees must complete each block within sixty minutes.
The second day of testing includes 144 multiple-choice items, divided into blocks of 36 items. Examinees are required to complete each block within forty-five minutes. Approximately 3 hours are allowed for these multiple-choice item blocks. Also on the second day are nine Clinical Case Simulations, where the examinees are required to 'manage' patients in real-time case simulations. Examinees enter orders for medications and/or investigations into the simulation software, and the condition of the patient changes accordingly. Each case must be managed in a maximum of 25 minutes of actual time.
Approximately forty-five minutes to one hour is available for break time on each of the two days of testing.
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