USE CAUTION IN SELECTING REVIEW COURSES: Orientation, Practice, and Self-Assessment Materials Available through USMLE, NBME, and Third Parties

The United States Medical Licensing Examination® (USMLE®) program recognizes the importance of providing all examinees the opportunity to learn about the design and content of its examinations and to have some exposure, before examination day, to samples of testing formats and materials. USMLE provides orientation and practice materials for all USMLE Steps and Step Components. These materials, which are available at no cost on the USMLE website, include:

  • Informational materials on the overall USMLE program and content descriptions for each of the USMLE examinations,
  • Tutorials that illustrate the USMLE Step 1, Step 2 Clinical Knowledge (CK), Step 3 multiple-choice question software and the Step 3 computer-based case simulation (CCS) Primum® software,
  • Sample multiple-choice test questions with answer keys for each Step,
  • Sample Step 3 CCS cases with feedback, and
  • Orientation materials for Step 2 Clinical Skills (CS).

In addition, the National Board of Medical Examiners® (NBME®) provides, for a fee, self-assessment services to help the examinee evaluate his or her readiness to take USMLE. These services help individuals become familiar with questions like those that have appeared on USMLE and provide performance feedback on the individual’s areas of relative strength and weakness. See to obtain additional information and to purchase self-assessment services.

Beyond these USMLE and NBME services, there are a variety of commercial test preparation materials and courses that claim to prepare examinees for USMLE examinations. Examinees who are considering using such services should fully understand the nature of these services, the sources of any content being used, and the basis for any claims being made. None of these third-party materials or courses are affiliated with or sanctioned by the USMLE program and information on such materials and courses is not available from the Educational Commission for Foreign Medical Graduates (ECFMG), the Federation of State Medical Boards (FSMB), NBME, USMLE Secretariat, or medical licensing authorities.

Please note that it is unlawful for any test preparation program or any individual to use, disclose, distribute, or provide access to questions or answers from actual USMLE exams. An examinee who is involved with any enterprise that disseminates USMLE content should be aware of the consequences, which include the possible cancellation of USMLE registration and/or testing, the withholding or cancellation of scores, and the imposition of additional sanctions.

Unified Content Outline To Be Adopted for All USMLE Exams

A unified content outline, which provides a common organization of content across all USMLE examinations, has been developed.

Examinations released in 2014 will be built using the new unified content outline. Test specifications using the unified outline will be published in early 2014. For Step 1, Step 2 CK, and Step 2 CS, the changes will be subtle, and the examinations will be similar in content to previous years. Step 3 examinations administered on or after November 1, 2014 will include more substantial changes in content; additional information about changes to Step 3 is available.

Examinees should read the full announcement and monitor the USMLE website for the latest information.

Transition of Test Content to DSM-5 Criteria and Terminology

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) was released at the American Psychiatric Association’s Annual Meeting in May 2013. USMLE test content will be impacted by changes in criteria and terminology.

Because USMLE content pools are large, the transition from DSM-IV to DSM-5 criteria and terminology will need to be gradual and will likely take place over several years. The following principles will guide this transition:

  1. The highest priority has been given to test content assessing diagnoses that do not appear in DSM-5. This content has already been removed from USMLE examinations.
  2. USMLE will begin to transition content to include both DSM-IV and DSM-5 terminology. This process will begin in 2014. Start and end dates for this transition will vary by exam.

Changes to the Step 3 Examination in 2014

As previously announced, changes to the Step 3 examination will occur in 2014.

The current Step 3 examination is administered in two 8-hour test sessions, which must be taken on consecutive days. The restructured examination will also be two test days; however, examinees will be able to schedule the two test days on non-consecutive days. The examination days will consist of the following:

Step 3 Foundations of Independent Practice (FIP): this test day will focus on assessment of knowledge of foundational medicine and science essential for effective health care. Content areas covered will include applying foundational sciences; biostatistics, epidemiology/population health, and interpretation of the medical literature; and social sciences, including communication and interpersonal skills, medical ethics, and systems-based practice/patient safety. The test day will also include some content assessing knowledge of diagnosis and management. This test day will consist solely of multiple-choice questions and will include some of the newer item formats, such as those based on scientific abstracts and pharmaceutical advertisements.

Step 3 Advanced Clinical Medicine (ACM): this test day will focus on assessment of applying comprehensive knowledge of health and disease in the context of patient management. Content areas covered will include assessment of knowledge of history and physical examination, diagnosis and use of diagnostic studies, prognosis/outcome, health maintenance/screening, therapeutics, and medical decision-making. This test day will include multiple-choice questions and computer-based case simulations.

A single score (with graphical performance profile information) and a single pass/fail outcome will be reported following completion of both examination days.

The restructured Step 3 examination will be administered beginning November, 2014. During an approximately one-month period (October, 2014), it is likely that no Step 3 examinations will be administered.

Practice materials for the restructured examinations will be posted to the USMLE website in mid-2014. Examinees should anticipate a score delay following the introduction of the restructured examinations. Additional information will be posted to the USMLE website as soon as it is available.

Changes to USMLE Procedures for Reporting Scores: Elimination of the 2-digit Score on or about April 1, 2013

As previously reported in 2011, the USMLE® program began the process of eliminating the reporting of results on the 2-digit score scale to parties other than the examinee and any state licensing authority to which the examinee sends results. This process began on July 1, 2011 with elimination of 2-digit scores from USMLE transcripts reported through the Electronic Residency Application Service (ERAS®).

The USMLE program will extend this change in reporting to include all score recipients (e.g., examinees, state medical boards). This means that scores on the 2-digit scale will no longer be calculated or reported. The USMLE Program expects to eliminate the 2-digit score on or about April 1, 2013. This change pertains to the Step 1, Step 2 Clinical Knowledge (CK), and Step 3 examinations only; Step 2 Clinical Skills (CS) will continue to be reported as pass or fail with no numeric score.

The full announcement is available on the USMLE website.

More about the 2-digit Score and Its Elimination

The following may be helpful in understanding the change in USMLE procedures for reporting scores, described above.

Why is the USMLE Program eliminating the 2-digit score?
The 2-digit score can be subject to misinterpretation. Some have interpreted it as a percentile (an indication of how an examinee’s performance compares to the performance of other examinees who took the same exam administration). Others have interpreted it as a percentage (an indication of how many questions an examinee answered correctly during an exam administration). The 2-digit score is neither of these things.

Additionally, unlike the 3-digit score, the 2-digit score does not allow reasonable comparisons over time. This may create challenges for score users that attempt to compare 2-digit scores that span several years. To eliminate the misuse of and confusion surrounding the 2-digit scale, the USMLE Composite Committee, the body that governs USMLE, decided that it should no longer be calculated or reported. Additional information about the relationship between the 2-digit and 3-digit score scales is available on the USMLE website.

Does this change apply to all USMLE examinations?
This change applies to Step 1, Step 2 CK and Step 3 only, since numeric scores are reported for these exams. It does not apply to Step 2 CS. Performance on Step 2 CS will continue to be reported as pass or fail with no numeric score.

Once this change takes effect, who will have access to 2-digit scores?
No one will have access to 2-digit scores. Beginning on the effective date of this change:

  • The USMLE Program will no longer report 2-digit scores to examinees on their exam score reports.
  • Two-digit scores will not be reported to any third parties via USMLE transcripts. This means that recipients of USMLE transcripts, including graduate medical education programs and state medical boards in the United States, will not receive 2-digit scores. This is true for all USMLE exam administrations, regardless of when the exam administration took place and regardless of whether a 2-digit score was reported previously.
  • Two-digit scores will no longer be calculated. As a result, the National Board of Medical Examiners® (NBME®), the entity responsible for scoring USMLE exams, will not be able to provide 2-digit scores. The entities responsible for registering examinees for USMLE and reporting their scores, including ECFMG and the Federation of State Medical Boards (FSMB), will not be able to provide 2-digit scores.

Why does the USMLE transcript I requested in April 2013 look different from the transcript I requested in December 2012, when it includes results for the same exam administration(s)?
Effective on or about April 1, 2013, the USMLE Program will stop calculating and reporting 2-digit scores. Two-digit scores reported before the effective date of this change will no longer be reported. As a result, a transcript issued prior to the effective date will include 2-digit scores for administrations of Step 1, Step 2 CK, and Step 3, while a transcript issued after the effective date will include only 3-digit scores for the same exam administrations.

Understanding the 3-digit Score

The elimination of the 2-digit score does not change the reporting or interpretation of results on the 3-digit scale. While the following information is not new, it may be helpful in understanding the 3-digit score.

What is the 3-digit score?
Since its beginning in the 1990s, the USMLE Program has reported scores for Step 1, Step 2 CK, and Step 3 on a 3-digit scale. When an examinee tests, the number of items the examinee answers correctly is converted to a score on the 3-digit scale. The 3-digit scale is considered the primary score reporting scale for USMLE exams.

What are the minimum passing scores for the exams?
The USMLE Program recommends a minimum passing level of proficiency for each exam. For Step 1, Step 2 CK, and Step 3, the USMLE Program sets a minimum passing score on the 3-digit scale. For the current minimum passing scores, visit Scores & Transcripts on the USMLE website.

The USMLE Program reviews the minimum passing level for each exam every three to four years. Since this process may result in changes, the minimum passing score for a given exam, expressed on the 3-digit scale, may change over time. The recommended minimum passing level in place on the day an examinee sits for an examination will be the level used for scoring purposes. Monitor the USMLE website for information on review of and changes to the minimum passing scores for USMLE exams.

How can I tell how well I did on the examination? How much better than passing did I do?
Your score report will include the 3-digit minimum passing score that applies to the exam administration.

On the 3-digit scale, most scores on Step 1, Step 2 CK, and Step 3 fall between 140 and 260. The mean score for first-time examinees from accredited medical school programs in the United States is in the range of 215 to 235, and the standard deviation is approximately 20. If your score is in the range of 215 to 235, your performance is on par with the average first-time examinee from an accredited medical school program in the United States. Your score report will include the mean and standard deviation for recent administrations of the examination.

Your score report will also include graphical performance profiles that summarize relative areas of strength and weakness to aid in self-assessment. The profiles are accompanied by further information on what they mean and how to interpret them.

More information on scores and score interpretation is available on the Scores FAQs page of the USMLE website at

How will U.S. GME programs be able to evaluate my 3-digit score?
The 3-digit score scale is the primary score reporting scale and has been used since the USMLE Program was established in the early 1990s. Unlike the 2-digit score, the 3-digit score is calculated using statistical procedures that ensure that scores from different years are on a common scale and have the same meaning. This means that GME programs can use the 3-digit score to make reasonable comparisons of examinees who tested at different times. Information on the meaning and interpretation of the three-digit score is included with USMLE transcripts, is available on the USMLE website, and is provided in the USMLE Bulletin of Information.

(posted December 28, 2012; updated March 22, 2013)

Delay in Score Reporting for Step 3 in 2013

Starting the week of February 11, 2013, a transition period will begin in which routine modifications to the items in the exam, including a minor decrease in the number of multiple-choice questions (MCQs) in current forms of the Step 3 examination, will occur.

Although the transition will occur quickly at many test centers, there may be some locations where the changes take slightly longer. The transition period will likely take approximately 4 weeks. Please note that:

  • The length of the examination day will remain unchanged.
  • Scores on new and old forms will be comparable.

Score reports for Step 3 are usually available within four weeks of testing. However, because of the changes described above, score reporting for most Step 3 examinations administered from the week of February 11, 2013 through early May 2013 will take longer.

The target date for reporting Step 3 scores for most examinees testing the week of February 11 through early May 2013 will be on Wednesday, June 5, 2013.

Examinees should monitor the USMLE website for the latest information.

Changes to Step 3 Examination in 2013

As previously announced, changes to the USMLE Step 3 examination are scheduled to take place no earlier than 2014. The redesigned examination will include assessment of “a comprehensive knowledge of both foundational science and clinical medicine,” as well as “a demonstration of evidence-based medicine and quantitative reasoning skills important to patient care and to life-long learning.”

Over the next few years, Step 3 examinees will see a gradual increase in test items that assess knowledge of foundational science.

Examinees should read the full announcement on the USMLE website.