2007 USMLE Bulletin - Testing

The USMLE program has established rules to govern administration of the examinations to ensure that no examinee or group of examinees receives unfair advantage on the examination, inadvertently or otherwise. The rules include standard test administration conditions consistent with the principles on which the examinations are developed and scored. For example, examinations are designed to sample knowledge across specified content domains and unauthorized access to examination content prior to testing violates that principle.

If there is a reason to believe that the integrity of the examination process is jeopardized, the USMLE parent organizations may invalidate all or any part of an examination. If information indicates that continued testing would jeopardize the security of examination materials or the integrity of scores, the USMLE parent organizations reserve the right to suspend or cancel test administration.

Testing Regulations and Rules of Conduct

Test center staff monitor all testing sessions for USMLE Steps. You must follow instructions of test center staff throughout the examination. Failure to do so may result in a determination of irregular behavior and permanent annotation of your USMLE transcript.

Test center staff are not authorized to answer questions from examinees regarding examination content, testing software, or scoring.

If staff observe you violating test administration rules or engaging in other forms of irregular behavior during an examination, the center staff will not necessarily tell you of the observation at the time of the examination. Test center staff are required to report such incidents to the USMLE program; each report is fully investigated.

Personal Items

Unauthorized possession of personal items while in the secure areas of the testing centers may lead to a finding of irregular behavior and permanent annotation of your USMLE transcript. It is important that you read and understand the rules regarding personal possessions; the rules for Steps 1, 2 CK, and 3 differ from those for Step 2 CS. Also, for Step 2 CS, you should understand that the entire testing session from orientation until the evaluation is completed, including all breaks, is considered a closed and secure testing session, and that the entire test center, including the orientation room and the restrooms, is a secure testing area. Therefore the rules regarding unauthorized possession during Step 2 CS extend to the orientation room and to all breaks.

For Step 1, Step 2 CK, and Step 3, unauthorized items include, but are not limited to:

• mechanical or electronic devices, such as cellular telephones, personal digital assistants (PDAs), calculators, watches of any type, electronic paging devices, recording or filming devices, radios;
• outerwear, such as coats, jackets, head wear, gloves;
• book bags, backpacks, handbags, briefcases, wallets;
• books, notes, study materials, or scratch paper;
• food, candy, gum, or beverages.

For Step 2 CS, unauthorized items include, but are not limited to:

• mechanical or electronic devices, such as cellular telephones, personal digital assistants (PDAs), calculators, digital watches, analog watches with computer communication and/or memory capability, electronic paging devices, recording or filming devices, radios;
• book bags, backpacks, briefcases;
• books, notes, study materials, or scratch paper;
• medical equipment of any kind other than a standard stethoscope.

If you bring personal items to the test center, you must store them in a designated locker outside the secure testing area or in the designated storage area for Step 2 CS. You should keep in mind that the storage facilities are small and that all stored mechanical or electronic devices must be turned off. Personal items and their contents may be subject to inspection. Any materials that reasonably appear to be reproductions of any USMLE examination materials will be confiscated. Making notes of any kind during an examination, except on the materials provided by the test center for this purpose, is not permitted.

Admission to the Test

When you arrive at the test center, you must present your Scheduling Permit and the required identification described on your Scheduling Permit. Acceptable forms of identification include the following forms of unexpired identification:

• passport,
• driver's license with photograph,
• national identity card,
• other form of unexpired, government-issued identification,
• ECFMG-issued identification card.

Your identification must contain both your signature and recent (no more than 10 years earlier) photograph. If it contains your photograph but not your signature, you can use another form of unexpired identification that contains your signature, such as a student/employee identification card or a credit card, to supplement your photo-bearing, government-issued identification.

If you do not bring your Scheduling Permit and acceptable identification, you will not be admitted to the test. In that event, you must pay a fee to reschedule your test. Your rescheduled test date(s) must fall within your eligibility period.

Step 1, Step 2 CK, and Step 3

Test Centers and Testing Conditions

Prometric provides computer-based testing services for academic assessment, professional licensure, and certification. USMLE Step 1 and Step 2 CK are given at Prometric Test Centers around the world. Step 3 is given at Prometric Test Centers in the United States and its territories. These centers provide the resources necessary for secure administration of the USMLE, including video and audio monitoring and recording, and use of digital cameras to record the identity of examinees.

Individual examinations are drawn from large pools of content-parallel test forms, which are in turn created from very large banks of test materials. Individual examinations vary within and across test centers, and within and across test days. Electronic encryption is employed to protect the security of item banks, test forms, and test responses. Physical security at test centers is maintained by proctoring and video surveillance and recording.

You should arrive at the Prometric Test Center 30 minutes before your scheduled testing appointment on your testing day(s). If you arrive after your appointment time, you may not be admitted. If you arrive more than 30 minutes after your scheduled testing appointment, you will not be admitted. In that event, you must pay a fee to Prometric to reschedule your test. Your rescheduled test date(s) must fall within your assigned eligibility period.

There are no waiting facilities for family and friends at the center; plan to meet them elsewhere after the examination ends.

Upon arrival at the test center, you must present the required identification, sign a test center log, be photographed, and store your personal belongings in your assigned locker. Test center staff will collect your Scheduling Permit. You will be instructed to write your name and Candidate Identification Number (CIN) on one of the laminated writing surfaces provided. Your Scheduling Permit will be retained at the Test Center Administrator's station. You may request access to the permit during the examination if it becomes necessary for you to rewrite the CIN on the laminated writing surface. In addition to the laminated writing surfaces, you will be provided with dry-erase markers and an eraser. Test center staff will escort you to your assigned testing station and provide brief instructions on use of the computer equipment. You must enter your CIN to start the examination. You may then take a brief tutorial prior to starting the first test block.

Completing the Test

Once you begin a block of the test, no authorized breaks are provided during the block. Each block lasts approximately 30 to 60 minutes. During blocks, the block and daytime clocks continue to run even if you leave the testing room, (e.g., for a personal emergency). If you leave during a block, the test center staff will report that fact as an irregular incident. In addition, the "unauthorized break" screen, described in the examination tutorial, may appear on the monitor at your workstation during a testing block. As explained in the tutorial, the unauthorized break screen will appear after a defined period of inactivity (no mouse click or key entry). Thirty seconds prior to the unauthorized break, an "inactivity timeout" warning will appear. If you do not click as instructed on the warning screen, the unauthorized break screen will appear after 30 seconds. You will then have to enter your CIN in order to continue with the examination. Each time you leave the testing room, you are required to sign out and sign in when you return. You must present your identification each time you sign in. Each block ends when its time expires or when you exit from it.

The test session ends when you have started and exited all sections or the total time for the test expires. You will sign out as you leave the test center, hand in the laminated writing surfaces, and receive a notice that you appeared for the test. If your test is scheduled for multiple days, your Scheduling Permit will be returned to you for use at check-in on the following day(s).

After you start taking an examination, you cannot cancel or reschedule that examination unless a technical problem prevents you from completing your examination. If you experience a computer problem during the test, notify test center staff immediately. The testing software is designed to allow the test to restart at the point it was interrupted. In most cases, your test can be restarted at the point of interruption with no loss of testing time. However, it is possible that a technical problem may occur that does not permit you to complete your examination. In the rare event that this occurs, please send a written description of the incident to Test Administration Services at the NBME (refer to Test Administration Problems/Inquiries for details). Your problem will be thoroughly investigated, and if necessary, arrangements will be made to allow you to test at a later date at no additional charge.

If you start to test and elect not to complete the examination, the attempt may appear as an "incomplete examination" on your USMLE transcript (see Examination Results and Scoring for further details).

How Break Time Works

Your entire testing session is scheduled for a fixed amount of time. The computer keeps track of your overall time and the time allocated for each block of the test. At the start of the testing session, you have a total of 45 minutes of break time. This allotment of time is used for authorized breaks between blocks and is also used to make transitions between items and blocks. Authorized breaks include any time taken between test blocks whether you take a brief break at your seat or you leave the testing room. If you complete the tutorial or other blocks of the test early, the remaining time will be available as break time. It will not be available to complete other blocks of the test.

As you progress through the blocks of the test, you should monitor how many blocks are remaining and how much break time is remaining. If you take too much break time and exceed the allocated or accumulated break time, your time to complete the last block(s) in the testing session will be reduced. You should keep track of the number of blocks completed and the number remaining.

When section time runs out, you will not be able to move to any new screens within that section. The computer will close the section. After you complete or run out of time for each block during the test, you must respond when the computer asks you to indicate whether you want to take a break or continue. After the test blocks, you may be asked to complete an additional block that contains survey questions about your testing experience.

Step 2 CS

The time you should arrive at the testing center is listed on the confirmation notice you will print after scheduling your appointment. If you arrive during the on-site orientation, you may be allowed to test; however, you will be required to sign a Late Admission Form. If you arrive after the on-site orientation, you will not be allowed to test. You will have to reschedule your testing appointment and will be required to pay the rescheduling fee. If you start to test and elect not to complete the examination, the attempt may appear as an "incomplete examination" on your USMLE transcript.

At the time of check-in, you will be required to present your Scheduling Permit and unexpired identification (see Admission to the Test). You will be given a small storage cubicle in which you must place personal belongings. These cubicles are not secure, so do not bring valuables. In addition, please note the following:

• You should bring your own stethoscope and white laboratory coat; all other equipment is provided at the center. (Information on use of non-standard personal items.)
• You should wear comfortable, professional clothing.
• There are no waiting facilities for family and friends at the center; plan to meet them elsewhere after the examination ends.
• Test center staff (wearing name tags) will direct you throughout the day, and their instructions should be followed at all times.
• There will be an on-site orientation to demonstrate the equipment available for you to use in the examination rooms, as well as to acquaint you with procedures and regulations.
• Once you enter the secure area of the test center (beginning with the orientation), you may not leave that area until the examination has been completed. The examination lasts about 8 hours. Two breaks are provided (one 30-minute break and one 15-minute break). A light meal is provided during the first break; however, you may bring your own food (provided that no refrigeration or preparation is required).
• You may not discuss the cases with your fellow examinees at any time, and conversation among examinees in any language other than English is prohibited at all times. Proctors will monitor all examinee activity.
• Should you wish to file a concern regarding your Step 2 CS testing experience, you may do so at the test center on your test day. If you do not file a report at the test center, you must notify NBME Test Administration in writing within three weeks of your testing date(s).
• The USMLE program retains the right to remove any examinee from the examination who appears to represent a health or safety risk to the standardized patients or test center staff. This includes, but is not limited to, examinees who appear ill, are persistently coughing or sneezing, have open skin lesions, or have evidence of active bleeding. Examinees who are not feeling well are encouraged to seek medical advice prior to arrival at the center and, if consistent with medical advice, should consider requesting a change in the date of their examination.