Copyright © 1997 by the National Board of Medical Examiners® (NBME ®). All rights reserved.
PERFORMANCE ON 1996 USMLE EXAMINATIONS

USMLE Step 1

The USMLE Step 1 examination assesses whether an examinee can apply the knowledge and understanding of key concepts of basic biomedical sciences, with an emphasis on principles and mechanisms of health, disease, and modes of therapy. The inclusion of Step 1 in the USMLE sequence is intended to ensure mastery of not only the basic medical sciences undergirding the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning. Content coverage is dictated by a single, integrated content outline that is organized by organ system and process. The exam includes approximately 720 items divided into four books administered over two days. A booklet containing the detailed content outline and sample items is published annually and distributed to examinees and to interested medical school faculty, licensing authorities, and other interested individuals.

A three-digit score of 176 is required to pass USMLE Step 1. For recent administrations, the mean and standard deviation for first-time takers from US and Canadian medical schools were approximately 205 and 20, respectively, with most scores falling between 165 and 245. The overall pass rate of 88% for NBME-registered examinees is equal to that of 1995. For ECFMG®-registered examinees in 1996, the overall pass rate (44%) is slightly lower than in 1995 (45%).

The number of examinees tested and the percent passing Step1 in 1996 are shown in Table 1; the NBME figures include examinees from accredited osteopathic schools in the United States. For the first time in several years, there was a decline in the total number of examinees tested due to smaller numbers of foreign medical graduates. Compared with 1995, pass rates were increased for both NBME-registered and ECFMG-registered examinees.

USMLE Step 2

The Step 2 examination assesses whether an examinee can apply the medical knowledge and understanding of clinical science considered essential for provision of patient care under supervision, including emphasis on health promotion and disease prevention. The inclusion of Step 2 in the USMLE sequence of licensing examinations ensures that due attention is devoted to principles of clinical science that undergird the safe and competent practice of medicine. Content coverage for this exam is dictated by a single, integrated content outline that is organized by physician task and disease classification. Step 2 includes approximately 680 items divided into four books administered over two days. A booklet containing the detailed content outline and sample items is published annually and distributed to examinees and to interested medical school faculty, licensing authorities, and other interested individuals.

A three-digit score of 167 was required to pass USMLE Step 2 for administrations between September 1991 and March 1996. An in-depth review of the Step 2 standard was completed in May 1996. This review resulted in a decision to raise the minimum passing score from 167 to 170, beginning with the August 1996 examination. For recent administrations, the mean and standard deviation for first-time takers from US and Canadian medical schools were 200 and 23, respectively, with most scores falling between 140 and 260.

Table 2 shows the number of examinees tested and the percent passing Step 2 for the August 1995 and March 1996 administrations; this corresponds to the medical school class cohort graduating in 1996. The NBME figures include examinees from accredited osteopathic medical schools in the United States. The pass rates for NBME-registered examinees were slightly higher in 1995-96 when compared with the pass rates for the 1994-95 cohort. Pass rates for the ECFMG-registered examinees also increased slightly in 1995-96.

USMLE Step 3

Step 3 assesses whether an examine can apply the medical knowledge and understanding of biomedical and clinical science considered essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. The inclusion of Step 3 in the USMLE sequence of licensing examinations reflects the importance of adequately assessing the level of such knowledge and understanding in physicians before they assume independent responsibility for the delivery of general medical care to patients. The content of this examination is organized along two principal dimensions: physician tasks and clinical encounter category, and the test material is presented to examinees organized by clinical setting. Step 3 includes approximately 730 items divided into four books administered over two days. A booklet containing a detailed description of Step 3 content and sample items is published annually and is available to examinees by state medical licensing authorities or the Federation of State Medical Boards.

A three-digit score of 176 is recommended as the passing score for USMLE Step 3. For the most recent administration, the mean and standard deviation for first-time takers from US and Canadian medical schools were 204 and 18, respectively, with most scores falling between 150 and 260.

The number of examinees tested and the percent passing Step 3 for the 1996 administrations are shown in Table 3. Despite relatively small numbers of examinees taking Step 3 in its inaugural year of 1994, the number of Step 3 examinees has grown steadily over the subsequent administrations. It should be noted that eligibility requirements for Step 3 include graduation from medical school and the successful completion of Step 1 and Step 2. In addition, some state licensing authorities impose their own requirements for postgraduate training and those requirements vary by state. Therefore, the amount of time between medical school graduation and sitting Step 3 is not standard across examinees.