2008 USMLE Performance Data
As published in the 2008 NBME Annual Report,
Copyright 2009 by the National Board of Medical Examiners®
USMLE Administration, Minimum Passing Scores, and Performance
Continuous test administration of the USMLE is available to all examinees. 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. These CBT examinations are currently administered at more than 350 US/Canadian Prometric test centers and more than 110 international Prometric test centers. Additional test centers are located at seven 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 is provided by the Clinical Skills Evaluation Collaboration (CSEC). There are five CSEC 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 results are processed continuously, and scores are reported weekly. Most examinees taking the computer-based Step examinations receive their scores approximately three to four weeks after their test date. For Step 2 CS, examinees receive their results by approximately eight weeks but this length of time may vary for some individuals because of the scoring and quality assurance steps associated with this component of USMLE. The schedule for reporting Step 2 CS results is published on the USMLE website. Individual score reports are made available to examinees via a secure website.
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. Notice of adjustments is 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 typically consist 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 2007 and 2008 are provided in Table 1. Data for 2008 are based upon examinees whose results were reported through February 4, 2009. Approximately 17,000 and 17,500 first-time takers from US and Canadian medical schools that grant the MD degree were tested in 2007 and 2008, respectively. First-time takers from non-US/Canadian medical schools numbered 15,762 and 14,889 for the same years. The pass rates for first-time takers from MD-granting US and Canadian medical schools were 95% in 2007 and 94% in 2008. 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.
| TABLE 1 - 2007-2008 STEP 1 ADMINISTRATIONS Number Tested and Percent Passing |
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|---|---|---|---|---|
2007 |
2008* |
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| #Tested | %Passing | #Tested | %Passing | |
| Examinees from US/Canadian Schools that Grant | ||||
| MD Degree | 18,218 | 93% | 18,855 | 92% |
| 1st Takers | 17,028 | 95% | 17,494 | 94% |
| Repeaters** | 1,190 | 65% | 1,361 | 61% |
| DO Degree | 1,470 | 81% | 1,661 | 80% |
| 1st Takers | 1,411 | 82% | 1,605 | 81% |
| Repeaters** | 59 | 49% | 56 | 46% |
| Total US/Canadian | 19,688 | 92% | 20,516 | 91% |
| Examinees from Non-US/Canadian Schools | ||||
| 1st Takers | 15,762 | 70% | 14,889 | 73% |
| Repeaters** | 6,126 | 37% | 5,534 | 37% |
| Total non-US/Canadian | 21,888 | 61% | 20,423 | 63% |
| * Represents data for examinees tested in 2008 and reported through February 4, 2009. ** 'Repeaters' represents examinations given, not number of different examinees. |
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Step 2 CK
Details on the performance of examinees taking Step 2 CK in the 2006-2007 and 2007-2008 academic years are provided in Table 2A. First-time takers from US and Canadian medical schools granting the MD degree numbered approximately 16,500 in both the 2006-2007 and 2007-2008 academic years. First-time takers from non-US/Canadian medical schools numbered 12,584 and 12,847, respectively. The pass rates for first-time takers from MD-granting US and Canadian medical schools were 96% for both academic years. 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 - 2006-2008 STEP 2 CK ADMINISTRATIONS Number Tested and Percent Passing |
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|---|---|---|---|---|
2006-2007* |
2007-2008* |
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| #Tested | %Passing | #Tested | %Passing | |
| Examinees from US/Canadian Schools that Grant | ||||
| MD Degree | 17,571 | 94% | 17,440 | 94% |
| 1st Takers | 16,512 | 96% | 16,499 | 96% |
| Repeaters** | 1,059 | 72% | 941 | 69% |
| DO Degree | 567 | 87% | 701 | 87% |
| 1st Takers | 546 | 87% | 672 | 87% |
| Repeaters** | 21 | 71% | 29 | 72% |
| Total US/Canadian | 18,138 | 94% | 18,141 | 94% |
| Examinees from Non-US/Canadian Schools | ||||
| 1st Takers | 12,584 | 79% | 12,847 | 81% |
| Repeaters** | 3,653 | 52% | 3,320 | 51% |
| Total non-US/Canadian | 16,237 | 73% | 16,167 | 74% |
| * 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. |
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Step 2 CS
Details on the numbers and overall performance of examinees taking Step 2 CS in the 2006-2007 and 2007-2008 academic years are provided in Table 2B. First-time takers from US and Canadian medical schools granting the MD degree numbered 16,769 for 2006-2007 and 16,715 for 2007-2008, with passing rates of 97% for both years. First-time takers from non-US/Canadian medical schools numbered 14,439 and 13,787 during these two periods. The respective, passing rates for this group were 77% and 72%.
Examinees taking Step 2 CS must pass three separate sub-components in order to record an overall pass on Step 2 CS. The three sub-components are: Integrated Clinical Encounter (ICE), Communication and Interpersonal Skills (CIS), and Spoken English Proficiency (SEP). For the total US/Canadian and the total non-US/Canadian medical school groups separately, Table 2C provides first-taker passing rates on each of the CS sub-components.
| TABLE 2B - 2006-2008 STEP 2 CS ADMINISTRATIONS Number Tested and Percent Passing |
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|---|---|---|---|---|
2006-2007* |
2007-2008* |
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| #Tested | %Passing | #Tested | %Passing | |
| Examinees from US/Canadian Schools that Grant | ||||
| MD Degree | 17,256 | 97% | 17,302 | 97% |
| 1st Takers | 16,769 | 97% | 16,715 | 97% |
| Repeaters** | 487 | 93% | 587 | 92% |
| DO Degree | 28 | 93% | 48 | 88% |
| 1st Takers | 28 | 93% | 47 | 87% |
| Repeaters** | 0 | N/A | 1 | † |
| Total US/Canadian | 17,284 | 97% | 17,350 | 97% |
| Examinees from Non-US/Canadian Schools | ||||
| 1st Takers | 14,439 | 77% | 13,787 | 72% |
| Repeaters** | 2,379 | 68% | 3,436 | 64% |
| Total non-US/Canadian | 16,818 | 76% | 17,223 | 70% |
| * Data for Step 2 CS 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. |
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| TABLE 2C - 2006-2008 STEP 2 CS ADMINISTRATIONS* First Taker Passing Rates** for Subcomponents: Integrated Clinical Encounter (ICE), Communication and Interpersonal Skills (CIS), Spoken English Proficiency (SEP) |
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|---|---|---|---|---|---|---|
| 2005-2006 | 2006-2007 | |||||
| ICE | CIS | SEP | ICE | CIS | SEP | |
| All US/Canadian Schools | 97 | 99 | 100 | 98 | 99 | >99 |
| All Non-US/Canadian Schools | 85 | 87 | 99 | 86 | 81 | 92 | * Data for Step 2 CS are provided for examinees tested during the period of July 1 to June 30. **‘>99’ is used to signify those passing rates that would otherwise round up to 100%. |
Step 3
Details on the performance of examinees taking Step 3 in 2007 and 2008 are provided in Table 3. Data for 2008 are based upon examinees whose results were reported through February 4, 2009. First-time takers who were graduates of MD-granting schools in the US and Canada numbered 16,633 in 2007 and 17,245 in 2008. First-time takers who were graduates of non-US/Canadian medical schools numbered 9,384 and 9,376, respectively for the same years. The passing rates for first-time takers who were graduates of MD-granting US and Canadian medical schools were 96% in 2007 and 95% in 2008. 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.
Step 3 Standard Setting
Performance standards for Step 3 were reviewed in 2008. In addition to the survey described on page 45, standard setting exercises were conducted using three panels of physicians. The 35 panelists were selected to represent a range of medical schools and medical specialties. In addition, panelists had a broad range of roles, such as course and clerkship directors, program directors, department chairs, practitioners, and state board members; a range of gender and ethnic groups were also included. Each panel met for 3 days. Panelists saw a subset of items appearing on the multiple-choice question (MCQ) component of the Step 3 exam, engaging in a modified version of the Angoff standard-setting procedure. In addition, panelists reviewed examinee performance on a subset of cases in the computer-based case simulation (CCS) component of the Step 3 exam. As a result of their 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. The results were provided to the Step 3 Committee for consideration.
At its April 2008 meeting, the Step 3 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 its review, the Committee decided to raise the three-digit score recommended to pass Step 3 from 184 to 187. The new minimum passing score was applied to Step 3 examinations for which the first day of testing was on or after May 1, 2008.
| TABLE 3 - 2007-2008 STEP 3 ADMINISTRATIONS Number Tested and Percent Passing |
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|---|---|---|---|---|
2007 |
2008* |
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| #Tested | %Passing | #Tested | %Passing | |
| Examinees from US/Canadian Schools that Grant | ||||
| MD Degree | 17,570 | 95% | 18,241 | 94% |
| 1st Takers | 16,633 | 96% | 17,245 | 95% |
| Repeaters** | 937 | 72% | 996 | 67% |
| DO Degree | 21 | 86% | 21 | 90% |
| 1st Takers | 20 | 85% | 19 | 95% |
| Repeaters** | 1 | † | 2 | † |
| Total US/Canadian | 17,591 | 95% | 18,262 | 94% |
| Examinees from Non-US/Canadian Schools | ||||
| 1st Takers | 9,384 | 79% | 9,376 | 78% |
| Repeaters** | 3,537 | 60% | 3,293 | 54% |
| Total non-US/Canadian | 12,921 | 73% | 12,669 | 71% |
| * Represents data for examinees tested in 2008 and reported through February 4, 2009. ** 'Repeaters' represents examinations given, not number of different examinees. † Performance data not reported for categories containing fewer than 5 examinees. |
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