2006 USMLE Performance Data
As published in the 2006 NBME Annual Report,
Copyright 2007 by the National Board of Medical Examiners®

USMLE Administration, Minimum Passing Scores, and Performance

USMLE registration, test administration, and score reporting occur continuously throughout the year. For Step 1, Step 2 Clinical Knowledge (CK), and Step 3, which are the computer-based testing (CBT) components of the USMLE program, test scheduling and delivery are provided by Prometric, Inc.®, part of The Thomson Corporation™. These CBT examinations are currently administered at more than 350 US/Canadian Prometric test centers and more than 125 international Prometric test centers. Additional test centers are located at eight medical schools in the United States. The Step 1 and Step 2 CK examinations are administered worldwide; the Step 3 examination is administered only in the United States.

Step 2 Clinical Skills (CS) is a standardized patient (SP) examination. Scheduling and test delivery for Step 2 CS are provided by the Clinical Skills Evaluation Collaboration (CSEC). There are five test centers.

For each of the Step examinations, once the registration process is completed, applicants make their own appointment to take the examination at a location and time most convenient to their schedule. Examination records are processed continuously, and scores are reported weekly. Most Step 1 and Step 2 CK examinees receive their scores approximately three to four weeks after their test date and most Step 3 examinees, four to six weeks. For Step 2 CS, most examinees receive their results by approximately eight weeks after the test date but this length of time may vary for some individuals because of the scoring and quality assurance steps associated with this component of USMLE.

A pass or fail result is provided, as a USMLE recommendation, for each examinee. Passing results are based on achievement of specified levels of proficiency established prior to administration of examinations. Statistical procedures are employed to ensure that for each Step, the level of proficiency required to pass remains uniform across forms of the examination. As noted in the USMLE Bulletin of Information and at the USMLE website, the score required to meet the recommended level of proficiency is reviewed periodically and may be adjusted without prior notice. Announcements about such activity are posted on the USMLE website.

In reviewing standards for USMLE examinations, the USMLE Step Committees employ information gathered from a number of sources including standard setting surveys. These surveys, which seek opinions on the appropriateness of current USMLE pass/fail standards for each of the Steps, are sent to random samples of examinees, directors of basic and clinical science courses and clinical clerkships, associate deans for academic and student affairs, directors and chief residents from residency programs, members of USMLE test material development committees, executive directors and presidents of all state medical boards, and members of the NBME Board and the FSMB Board of Directors.

In addition to surveys, USMLE Step Committees consider the results of content review by standard setting panels. These panels are typically made of physicians who are not otherwise involved in the USMLE program. These panels review the content of the Step examinations and, through a series of exercises, provide data that reflect their opinions on minimally acceptable levels of performance.

Step 1

Details on the performance of examinees taking Step 1 in 2005 and 2006 are provided in Table 1. Data for 2006 are based upon examinees whose results were reported through February 7, 2007. Approximately 16,800 first-time takers from US and Canadian medical schools that grant the MD degree were tested in both 2005 and 2006. First-time takers from non-US/Canadian medical schools numbered 13,488 and 14,585 for the same years. The pass rates for first-time takers from MD-granting US and Canadian medical schools were 94% in 2005 and 95% in 2006. Because failing examinees generally retake Step 1, the ultimate passing rate across test administrations is expected to increase to approximately 99% for this same group.

Performance standards for Step 1 were reviewed in 2006. Data for consideration in the review included the results of an August 2006 survey regarding the appropriateness of current USMLE pass/fail standards for each of the Steps, described above.

In addition to the survey, standard setting exercises were conducted using three panels of physicians and basic scientists. The 29 panelists were selected to represent a range of medical schools and medical specialties. Panelists had a broad range of roles such as course and clerkship directors, program directors, department chairs, and practitioners; a range of gender and ethnic groups was also included. Each panel met for 1½ days, engaging in a modified version of the Angoff standard-setting procedure. Each panelist saw a subset of the items appearing on the Step 1 exam. As a result of that review, a recommended minimum passing performance level was identified, representing the opinion of the panelists on the required mastery of examination content for medical licensure purposes.

At its December 2006 meeting, the Step 1 Committee considered the results of the surveys and the standard setting exercises, as well as data on recent trends in examinee performance and on the relationship of score precision to the pass/fail decision. As a result of this review, the Step 1 Committee decided to raise the three-digit score required to pass Step 1 from 182 to 185. The new minimum passing score was applied to Step 1 examinations for which the first day of testing was on or after January 1, 2007.

TABLE 1 - 2005-2006 STEP 1 ADMINISTRATIONS Number Tested and Percent Passing
	2005		2006*
	#Tested	%Passing	#Tested	%Passing
Examinees from US/Canadian Schools that Grant
MD Degree	18,290	92%	18,167	93%
1st Takers	16,799	94%	16,818	95%
Repeaters**	1,491	65%	1,349	67%
DO Degree	1,331	73%	1,325	76%
1st Takers	1,265	73%	1,258	77%
Repeaters**	66	53%	67	52%
Total US/Canadian	19,621	90%	19,492	92%
Examinees from Non-US/Canadian Schools
1st Takers	13,488	68%	14,585	71%
Repeaters**	5,911	39%	6,017	39%
Total non-US/Canadian	19,399	59%	20,602	61%
* Represents data for examinees tested in 2005 and reported through February 7, 2007. ** 'Repeaters' represents examinations given, not number of different examinees.

Step 2 CK

Table 2A provides details on the performance of examinees taking Step 2 CK in the 2004-2005 and 2005-2006 academic years. First-time takers from US and Canadian medical schools granting the MD degree numbered 16,447 for 2004-2005 and 16,493 for 2005-2006. First-time takers from non-US/Canadian medical schools numbered 10,355 and 11,305, respectively. The pass rates for first-time takers from MD-granting US and Canadian medical schools were 94% and 95%, respectively. As noted with Step 1, given the opportunity for this same group to repeat the examination, the ultimate Step 2 CK passing rate across test administrations is expected to increase to approximately 99% for this same group.

TABLE 2A - 2004-2006 STEP 2 CK ADMINISTRATIONS Number Tested and Percent Passing
	2004-2005*		2005-2006*
	#Tested	%Passing	#Tested	%Passing
Examinees from US/Canadian Schools that Grant
MD Degree	17,803	93%	17,714	93%
1st Takers	16,447	94%	16,493	95%
Repeaters**	1,356	69%	1,221	72%
DO Degree	399	85%	453	80%
1st Takers	386	85%	439	80%
Repeaters**	13	62%	14	57%
Total US/Canadian	18,202	92%	18,167	93%
Examinees from Non-US/Canadian Schools
1st Takers	10,355	77%	11,305	77%
Repeaters**	3,470	50%	3,557	71%
Total non-US/Canadian	13,825	71%	14,862	71%
* Data for Step 2 CK are provided for examinees tested during the period of July 1 to June 30. ** 'Repeaters' represents examinations given, not number of different examinees.

Step 2 CS

Table 2B provides details on the performance of examinees taking Step 2 CS in the 2004-2005 and 2005-2006 academic years. First-time takers from US and Canadian medical schools granting the MD degree numbered 15,814 for 2004-2005 and 16,611 for 2005-2006. First-time takers from non-US/Canadian medical schools numbered 12,708 and 13,235, respectively.

Examinees taking Step 2 CS must pass three separate subcomponents in order to record an overall pass on Step 2 CS. The three subcomponents are: Integrated Clinical Encounter (ICE), Communication and Interpersonal Skills (CIS), and Spoken English Proficiency (SEP). The overall Step 2 CS pass rate for first-time takers from US and Canadian medical schools that grant the MD degree was 96% for 2004-2005 and 98% for 2005-2006. The pass rate for first-time takers from non-US/Canadian medical schools was 83% and 85%, respectively.

The USMLE Step 2 Committee is responsible for setting and monitoring pass/fail standards for the Clinical Knowledge (CK) and the Clinical Skills (CS) examinations. Initial standards for the CS examination were set by the Committee in November 2004. Because this process was completed with less than a full year's cohort of examinees, the Committee decided to closely monitor cumulative data on CS during the following year and to undertake a review of the CS standards in the spring of 2006.

Based upon the review, the Step 2 Committee decided to raise the performance levels required to receive a passing outcome on two of the three Step 2 CS subcomponents: ICE and CIS. No change was made to minimum passing requirements for the third subcomponent of Step 2 CS, SEP. The new passing requirements were applied to Step 2 CS examinations taken on and after July 16, 2006.

TABLE 2B - 2004-2006 STEP 2 CS ADMINISTRATIONS Number Tested and Percent Passing
	2004-2005*		2005-2006**
	#Tested	%Passing	#Tested	%Passing
Examinees from US/Canadian Schools that Grant
MD Degree	16,124	96%	16,936	98%
1st Takers	15,814	96%	16,611	98%
Repeaters†	310	96%	325	97%
DO Degree	31	87%	28	89%
1st Takers	31	87%	27	89%
Repeaters†	0	N/A	1	***
Total US/Canadian	16,155	96%	16,964	98%
Examinees from Non-US/Canadian Schools
1st Takers	12,708	83%	13,235	85%
Repeaters†	973	83%	1,875	81%
Total non-US/Canadian	13,681	83%	15,110	84%
* Data for 2004-2005 are provided for examinees tested during the period of June 14, 2004 to June 30, 2005. Data for 2005-2006 are provided for examinees tested during the period of July 1 to June 30. † 'Repeaters' represents examinations given, not number of different examinees. * Performance data not reported for categories containing fewer than 5 examinees. N/A not applicable.

Step 3

Table 3 provides details on the performance of examinees taking Step 3 in 2005 and 2006. Data for 2006 are based upon examinees whose results were reported through February 7, 2007. First-time takers who were graduates of MD-granting schools in the US and Canada numbered 15,868 in 2005 and 16,395 in 2006. First-time takers who were graduates of non-US/Canadian medical schools numbered 8,307 and 9,003, respectively for the same years. For both 2005 and 2006, the pass rate for first-time takers who were graduates of MD-granting US and Canadian medical schools was 96%. Like Step 1 and Step 2 CK, the ultimate Step 3 passing rate, accounting for repeat attempts, is expected to increase to approximately 99% for this same group.