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Date Updated: November 12, 2013

International Foundations of Medicine (IFOM)

The IFOM examinations measure the core knowledge expected internationally of students at critical points in their undergraduate medical education. The IFOM exams carry out the NBME mission to protect the health of the public through state-of-the-art assessments worldwide.

The IFOM program comprises two separate exams: the Clinical Science Examination (CSE) and the Basic Science Examination (BSE).

The CSE

The IFOM CSE tests clinical knowledge that international students should have at a time just prior to receiving the Doctor of Medicine (or equivalent) degree. The CSE is currently available in International English, Spanish, Portuguese and Italian. Through 160 multiple-choice questions, each with one best answer accepted as correct, the CSE covers:

  • Family Medicine
  • Medicine
  • Obstetrics and Gynecology
  • Pediatrics
  • Psychiatry
  • Surgery

Individuals can familiarize themselves with the exam format through the online practice exam of 20 items at no charge, using either timed or untimed test administration conditions. The IFOM CSE practice exam is available in multiple languages.

IFOM CSE
http://ifomclinical.startpractice.com

The BSE

The IFOM BSE tests basic science knowledge that international students should have prior to the start of clinical training. The BSE is currently available only in International English. Through 160 multiple-choice questions, each with one best answer accepted as correct, the BSE covers:

  • Anatomy
  • Biochemistry
  • Histology and Cell Biology
  • Microbiology
  • Organ Systems
  • Pathology
  • Pharmacology
  • Physiology

Individuals can familiarize themselves with the exam format through the online practice exam of 20 items at no charge, using either timed or untimed test administration conditions. The IFOM BSE practice exam is available only in International English.

IFOM BSE
http://ifombasic.startpractice.com

Who Uses IFOM?

Individuals may find the IFOM useful for:

  • Participation in exchange programs.
  • Applications for post-graduate training programs and professional positions.
  • Self-assessment against international standards.
  • Practice for taking the United States Medical Licensing Examination® (USMLE®), which has similar types of questions.

Medical schools, post-graduate programs, and ministries of health/education may find IFOM useful for:

  • Selection of graduates for training.
  • Curriculum evaluation.
  • International benchmarking
  • Part of assessment for regional certification

International Foundations of Medicine Clinical Science Exam Blueprint

General Principles: 5%-7%

Infancy and Childhood (normal growth and development)

Adolescence (sexuality, separation from parents/autonomy, physical changes of puberty)

Senescence (normal physical and mental changes associated with aging)

Medical Ethics and Jurisprudence

  • consent to treatment and research issues
  • physician-patient relationship
  • death and dying and palliative care
  • professional conduct/integrity

Applied Biostatistics and Clinical Epidemiology

  • fundamental concepts of study design and interpretation
  • fundamental concepts of data analysis, data interpretation, hypothesis testing, and statistical inference
  • fundamental concepts for drawing conclusions from data (eg, causation, efficacy, effectiveness, subgroup analysis, and safety)
  • clinical applications of decision sciences (eg, sensitivity, specificity, and predictive value)

Public/Population Health

  • communicable disease transmission
  • community approaches to primary health care
  • disease surveillance and outbreak investigation
  • epidemics following natural disasters
  • maternal/child health and breast feeding
  • points of intervention
  • sanitation and water supply/waste water management
  • population pyramids and impact of demographic changes
  • measures of health status
  • measures of disease frequency

Organ Systems: 93%-95%

Immunologic Disorders: 4%-5%

Health and Health Maintenance

  • anaphylaxis and other allergic reactions
  • HIV infection/AIDS
  • immunization against infectious agents

Mechanisms of Disease

  • abnormalities of cell-mediated immunity
  • abnormalities of humoral immunity

Diagnosis

  • anaphylactic reactions and shock
  • connective tissue disorders
  • HIV infection/AIDS and deficiencies of cell-mediated immunity
  • deficiencies of humoral immunity and combined immune deficiency

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Diseases of the Blood and Blood-forming Organs: 4%-5%

Health and Health Maintenance

  • anemia
  • systemic infection

Mechanisms of Disease

  • red cell disorders
  • coagulation disorders
  • white cell disorders

Diagnosis

  • anemia; disorders of red cells, hemoglobin, and iron metabolism
  • bleeding disorders, coagulopathies, and thrombocytopenia
  • neoplastic disorders
  • eosinophilia and reactions to transfusion of blood components, including complications; leukopenic disorders; and agranulocytosis
  • infection

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Mental Disorders: 4%–5%

Health and Health Maintenance

  • early identification and intervention (eg, suicide potential, depression, and alcohol/substance abuse)

Mechanisms of Disease

  • biologic markers of mental disorders and mental retardation syndromes
  • intended/unintended effects of therapeutic interventions, including effects of drugs on neurotransmitters

Diagnosis

  • mental disorders usually first diagnosed in infancy, childhood, or adolescence
  • substance-related disorders
  • schizophrenia and other psychotic disorders
  • mood disorders
  • anxiety disorders
  • child, spouse, and elder abuse
  • adjustment disorder
  • psychological factors affecting medical conditions

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Diseases of the Nervous System and Special Senses: 8%–10%

Health and Health Maintenance

  • cerebrovascular disease and cerebral infarction
  • nutritional deficiencies, toxic injuries, and occupational disorders
  • infection involving the nervous system, eyes, or ears
  • degenerative and demyelinating disorders

Mechanisms of Disease

  • localizing anatomy (brain and special senses, brain stem, spinal cord, and neuromuscular system)
  • anatomy of cerebral circulation
  • increased intracranial pressure and altered state of consciousness
  • infection
  • degenerative/developmental and metabolic disorders

Diagnosis

  • disorders of the eye
  • disorders of the ear, olfaction, and taste
  • disorders of the nervous system
    • headache
    • seizure disorders
    • syncope
    • cerebrovascular disease
    • traumatic and toxic injury
    • infections
    • neoplasms
    • metabolic disorders
    • degenerative/developmental disorders
    • neuromuscular disorders, gait abnormalities, and disorders relating to the spine and spinal nerve roots
    • sleep disorders

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Cardiovascular Disorders: 10%–12%

Health and Health Maintenance

  • arterial hypertension
  • atherosclerosis and coronary artery disease, hyperlipidemia
  • prevention of rheumatic heart disease, thromboembolic disease, pulmonary emboli, and bacterial endocarditis

Mechanisms of Disease

  • cardiac output, resistance, and central venous pressure
  • valvular stenosis and incompetence
  • congenital heart disease
  • regulation of blood pressure
  • disorders of the arteries and veins

Diagnosis

  • dysrhythmias, palpitations, and syncope
  • heart failure, dyspnea, fatigue, and peripheral edema of cardiac origin
  • ischemic heart disease and chest pain of cardiac origin
  • diseases of the myocardium
  • diseases of the pericardium
  • valvular heart disease
  • congenital cardiovascular disease
  • systemic hypotension, hypovolemia, cardiogenic shock, and cyanosis
  • arterial hypertension
  • atherosclerosis - lipoproteins
  • disorders of the great vessels
  • peripheral arterial vascular diseases and vasculitis
  • diseases of the veins, peripheral edema
  • traumatic injury

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Diseases of the Respiratory System: 9%–11%

Health and Health Maintenance

  • bronchitis, asthma, emphysema, carcinoma of the larynx, carcinoma of the lung, pulmonary aspiration, atelectasis, and tuberculosis

Mechanisms of Disease

  • ventilatory dysfunction
  • respiratory failure, acute and chronic, including oxygenation failure
  • circulatory dysfunction
  • neoplastic disorders

Diagnosis

  • disorders of the nose, paranasal sinuses, pharynx, larynx, and trachea
  • infections of the lung
  • obstructive airways disease
  • atelectasis and pulmonary aspiration
  • pneumothorax, hemothorax, traumatic injury to the lungs, and disorders involving the pleura
  • pneumoconiosis and fibrosing or restrictive pulmonary disorders
  • respiratory failure, hypoxia, hypercapnia, and dyspnea
  • pulmonary vascular disorders
  • neoplastic disorders of the lungs and pleura

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Nutritional and Digestive Disorders: 8%–10%

Health and Health Maintenance

  • screening
  • viral hepatitis and alcohol-related hepatopathy

Mechanisms of Disease

  • malabsorption/malnutrition
  • jaundice
  • infections/parasites
  • obstruction/mechanical

Diagnosis

  • disorders of the mouth, salivary glands, oropharynx, and esophagus
  • disorders of the stomach, small intestine, colon, and rectum/anus
  • disorders of the pancreas
  • disorders of the liver and biliary system
  • traumatic injury

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Gynecologic Disorders: 7%–9%

Health and Health Maintenance

  • postmenarchal/reproductive
  • peri/postmenopausal

Mechanisms of Disease

  • infections
  • urinary incontinence and obstruction
  • menstrual and endocrinologic disorders, infertility

Diagnosis

  • pelvic relaxation and urinary incontinence
  • neoplasms
  • benign conditions of the breast
  • menstrual and endocrinologic disorders

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Renal, Urinary, and Male Reproductive Systems: 7%–9%

Health and Health Maintenance

  • infection
  • acute and chronic renal failure, including risk factors, prevention, and methods of limiting progression
  • male health maintenance examination

Mechanisms of Disease

  • disorders of the male reproductive system
  • urinary incontinence and obstruction and enuresis
  • renal insufficiency/failure
  • electrolyte and water metabolism and acid‑base balance

Diagnosis

  • disorders of the male reproductive system
  • disorders of the urinary bladder and urinary collecting system
  • disorders of the kidneys
  • traumatic injury

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Disorders of Pregnancy, Childbirth, and the Puerperium: 4%–5%

Health and Health Maintenance

  • prenatal care (eg, nutrition and prenatal diagnosis/prevention)
  • assessment of the at‑risk pregnancy and risk of preterm labor
  • intrapartum care and signs of fetal compromise
  • contraception, sterilization, and prevention of pregnancy after rape

Mechanisms of Disease

  • placenta and placental dysfunction
  • pregnancy and labor, including infection
  • postpartum disorders, including infection
  • fetus and newborn

Diagnosis

  • pregnancy and labor, including obstetric complications
  • nonobstetric complications of pregnancy
  • complications of the puerperium

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Disorders of the Skin and Subcutaneous Tissues: 4%–5%

Mechanisms of Disease

  • skin disorders, including cancer, infections, and inflammatory disorders

Diagnosis

  • infections
  • neoplasms
  • other skin disorders, including occupational and inflammatory

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Diseases of the Musculoskeletal System and Connective Tissue: 7%–9%

Health and Health Maintenance

  • epidemiology, impact, and prevention of degenerative joint and disc disease
  • prevention of disability due to musculoskeletal disorders or infection

Mechanisms of Disease

  • infections
  • nerve compressions and degenerative, metabolic, and nutritional disorders
  • inherited, congenital, and developmental disorders
  • inflammatory and immunologic disorders

Diagnosis

  • infections
  • degenerative, metabolic and nutritional disorders
  • inherited, congenital, and developmental disorders
  • inflammatory, immunologic, and other disorders
  • neoplasms
  • traumatic injury and nerve compression and injury

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Endocrine and Metabolic Disorders: 8%–10%

Health and Health Maintenance

  • diabetes mellitus, including prevention of morbidity and mortality due to complications
  • screening

Mechanisms of Disease

  • thyroid function
  • diabetes mellitus and carbohydrate metabolism
  • parathyroid and calcium metabolism
  • pituitary and hypothalamic function
  • adrenal function

Diagnosis

  • thyroid disorders
  • diabetes mellitus
  • parathyroid and calcium disorders
  • pituitary and hypothalamic disorders
  • adrenal disorders
  • heat-related illness

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Physician Tasks

Promoting Health and Health Maintenance: 8%-10%

Understanding Mechanisms of Disease: 20%-25%

Establishing a Diagnosis: 32%-36%

Applying Principles of Management: 25%-28%

Content Description

The International Foundations of Medicine Clinical Science Examination (IFOM CSE) focuses on the application of clinical knowledge considered essential for provision of safe and effective patient care. It consists of multiple-choice questions prepared by examination committees composed of faculty members, teachers, investigators, and clinicians with recognized prominence in their respective fields. The examination is constructed from an integrated content outline that organizes clinical science material along two dimensions: Normal Conditions and Disease categories and Physician Task.

Normal Conditions and Disease categories (Dimension 1) form the main axis for organizing the outline. The first section, General Principles, deals with normal growth and development, senescence, medical ethics and jurisprudence, applied biostatistics and epidemiology, and public/population health. The remaining sections deal with individual disorders.

Sections focusing on individual disorders are subdivided according to Physician Task (Dimension 2). The first set of physician tasks, Promoting Preventive Medicine and Health Maintenance, encompasses the assessment of risk factors, appreciation of epidemiologic data, and the application of primary and secondary preventive measures.

The second set of tasks, Understanding Mechanisms of Disease, encompasses etiology, pathophysiology, and effects of treatment modalities in the broadest sense.

The third set of tasks, Establishing a Diagnosis, pertains to interpretation of history and physical findings and the results of laboratory, imaging, and other studies to determine the most likely diagnosis or the most appropriate next step in diagnosis.

The fourth set of tasks, Applying Principles of Management, concerns the approach to care of patients with chronic and acute conditions in ambulatory and inpatient settings. Questions in this category will focus on the same topics covered in the diagnosis sections.

The topics and diseases detailed in the IFOM Clinical Sciences content outline do not represent an all-inclusive list of the disorders about which questions may be asked, and not all listed topics may be covered on every test form. The examination focuses on internationally important "high-Impact diseases," including both common problems and less common problems where early detection or treatability are important. Noteworthy exemplars of pathophysiology considered important internationally are also included.

The IFOM CSE content outline is not intended as a curriculum development or study guide. It provides a flexible structure for test construction that can readily accommodate new topics, emerging content domains, and shifts in emphases. The categorizations and content coverage are subject to change. Broadly based learning that establishes a strong general foundation of understanding of concepts and principles in the clinical sciences is the best preparation for the examination.

For individuals
For medical schools
Score Rechecks

For individuals

Examinees receive a detailed profile comparing their performance with that of other examinees on groups of questions about disciplines, physician tasks, and organ systems.

The standards of competence noted on these reports approximate passing scores on the USMLE.

However, the IFOM exams are intended to determine an examinee's relative areas of strength and weakness in general areas of basic and clinical science, not to predict performance on the USMLE, and the content covered by the IFOM exams and the USMLE is somewhat different. Furthermore, a school or agency may choose to use different standards for high-stakes testing. Thus, the standards of competence are guidelines only.

More information on interpreting your IFOM score and the relationship to the USMLE score scale is available online.

IFOM CSE Score Interpretation Guide:
www.nbme.org/ifomcse2013

IFOM BSE Score Interpretation Guide:
www.nbme.org/ifombse2013

For medical schools

Medical schools with participating students may elect to receive detailed performance reports comparing the performance of their students with the international comparison group and other groups of interest.*

By showing how their students are performing, these reports can help schools identify areas of strength and weakness in their curriculum.

*Note that there must be at least 20 students in a group to permit comparisons.

Score Rechecks

If you have recently taken an IFOM examination, you may request a score recheck by completing the Score Recheck Request Form For IFOM BSE and CSE. There is a $35 service fee for each score recheck. Payment must accompany the request. Your request must be received by the NBME no more than 4 months after your test date.

For all IFOM Examinations, standard procedures ensure that the scores reported for you accurately reflect your performance. A change in score based on a recheck is an extremely remote possibility. However, a recheck will be done if you submit the request form and fee to the NBME.

Change to the IFOM CSE Standard of Competence

At its June 2013 meeting, the USMLE Step 2 Committee conducted a review for USMLE Step 2 Clinical Knowledge (CK). As a result of its review, the Step 2 Committee decided to raise the Step 2 recommended minimum passing score. Therefore, the IFOM standard of competence will also be raised. The new standard will be applied to IFOM CSE examinations for which the first day of testing is on or after January 1, 2014.

At its December 2013 meeting, the USMLE Step 1 Committee will conduct a review for USMLE Step 1 . As a result of its review, the Step 1 Committee may decide to change the Step 1 recommended minimum passing score. Therefore, the IFOM standard of competence will also be changed if the Step 1 recommended minimum passing score is changed. If the recommended Step 1 minimum passing score is changed, the new standard will be applied to IFOM BSE examinations for which the first day of testing is on or after January 1, 2014.

photo of a globe

The International English versions of the IFOM CSE and BSE are available to individuals for testing at participating Prometric test centers. Once you register here, you will need to visit the Prometric website to choose a test site and time.

Test administration dates and registration periods for 2014 are as follows:

Test Window Registration Period
March 31 - May 9 January 1 – February 14
October 6 – November 14 July 14 - August 22

Register

Total testing time for the exam is four hours.

To be eligible, you must be a current medical student or medical school graduate.

Upon receipt of payment, you will be presented with a Status Verification Form for officials at your medical school to send to the Educational Commission for Foreign Medical Graduates (ECFMG®). Your medical school must submit the required paperwork to ECFMG no later than two weeks prior to the start of the test window or you will not be permitted to test.

For more information, please see the candidate brochure at www.nbme.org/PDF/IFOM/CandidateBrochure.pdf.

Examinees taking the test at a Prometric test center can pay with major credit cards or money orders. Personal checks are not accepted. The cost at a Prometric test center includes the exam fee, the cost to verify an examinee's status as a currently enrolled medical school student or graduate, and seat time at a Prometric test center.

Administration Fee at Prometric Test Center
(Per Examinee)
IFOM Exams
IFOM Basic Science Exam $200
IFOM Clinical Science Exam $300

Administer IFOM (for Medical Schools)

Over 50 medical schools worldwide administer IFOM exams annually to their students. If you wish to organize an IFOM administration at your school, please have an administrator email us at IFOM@nbme.org.

Medical School Administration Fee1 (Per Examinee)
IFOM Exams
IFOM Basic Science Exam $50
IFOM Clinical Science Exam $75
Other Fees
School Reports $3,500
International School Shipping Fee2 School is responsible for all FedEx Shipping Fees
  1. Pricing is the same for paper-based and Web-based administrations.
  2. Fee applies to paper-based medical school administrations only.

IFOM Oversight Committee

The Oversight Committee brings together clinicians and medical school faculty from five countries, with NBME staff. By combining varied perspectives, the Committee is better able to ensure IFOM's integrity and to guide program policies, examination design, score reporting and standard setting.

IFOM Oversight Committee photo

IFOM Oversight Committee members: Front row: Adrian Freeman, MD (UK), Paul M. Wallach, MD (Chair, USA), Fuad N. Ziyadeh, MD (Lebanon); Back row:  W. T. Williams, Jr., MD (USA), Nuno J. Sousa, MD, PhD (Portugal), Peter V. Scoles, MD (USA); Not pictured: Raffaele Landolfi, MD (Italy)

IFOM Integrated Examination Committee

The Integrated Examination Committee brings together medical school faculty from eight countries to approve forms for the CSE and BSE and to approve changes to examination blueprints and content outlines.  This committee also identifies item-writing needs and oversees new item development.

IFOM Integrated Examination Committee photo

IFOM Integrated Examination Committee members: Front row: Thurayya Arayssi, MD, FACP, FACR (Qatar), William V. Raszka, MD (USA), Nuno J. Sousa, MD, PhD (Chair, Portugal), Ralph F. Jozefowicz, MD (USA), Lorenzo Dagna, MD (Italy); Back row: Francisco Lamus, MD (Colombia), Paul M. Wallach, MD (USA), Maya M. Hammoud, MD (USA), Cyril M. Grum, MD (USA), Bernard J. Himpens, MD (Belgium); Not pictured: Richard R. Doherty, MD (Australia), Enrique Mendoza, MD (Panama)

Collaborating Organizations

NBME also works with other organizations with expertise in international medical issues.

Educational Commission for Foreign Medical Graduates (ECFMG)

Global Health Learning Opportunities (GHLO)

photo of doctors

NBME staff members frequently collaborate with medical school faculty members and individuals to evaluate the validity and reliability of assessment products. Below are summaries of several research projects designed to strengthen the IFOM program.

Gathering evidence of external validity for the International Foundations of Medicine (IFOM) examination: A collaboration between the National Board of Medical Examiners and the University of Minho

Winward, Marcia L.; De Champlain, Andre F.; Grabovsky, Irina; Scoles, Peter V.; Swanson, David B.; Holtzman, Kathleen Z.; Pannizzo, Lorena; Sousa, Nuno; Costa, Manuel J. (2009) “Gathering evidence of external validity for the Foundations of Medicine Examination: a collaboration between the National Board of Medical Examiners and the University of Minho.” Academic Medicine 84(10), S116–S119.

In this study, NBME staff members and medical faculty of the University of Minho in Braga, Portugal, gathered evidence of external validity for the IFOM examination by assessing the relationship between its subscores and local grades for a sample of Portuguese medical students. Correlations were computed between six IFOM subscores and nine University of Minho grades for a sample of 90 medical students.

Results indicate that the IFOM examination seems to supplement local assessments by targeting constructs not currently measured. Therefore, the IFOM examination may contribute to a more comprehensive assessment of basic and clinical sciences knowledge.

Collecting evidence of content validity for the International Foundations of Medicine Examination: An expert-based judgmental approach

De Champlain A.F., Grabovsky I., Scoles P.V., Pannizzo L., Winward M., Dermine A. and Himpens B. (2011) “Collecting evidence of content validity for the International Foundations of Medicine Examination: an expert-based judgmental approach.” Teaching and Learning in Medicine 23(2):144–147.

Through this collaborative investigation, NBME staff and medical faculty of the Katholieke Universiteit Leuven, Belgium, gathered evidence about the content validity of the IFOM CSE.  To assess the relevance of items to the IFOM exam’s stated objectives, the research team asked a panel of KU Leuven content experts to assess the extent to which a large random sample of IFOM items were relevant to core medical knowledge domains specified by the examination committee.

Correspondence analysis was used to map the dimensions along which items could be classified and to identify those that were deemed to be irrelevant to the aims of IFOM.  Results suggest that the vast majority of items are appropriately included in the IFOM and target core medical knowledge domains specified by the IFOM examination committee.

photo of students taking exam

For all

How are IFOM and USMLE related?

NBME designs the IFOM examinations and the USMLE for different purposes, and the content covered by the two exams is somewhat different.  However, there is substantial overlap in content coverage and many IFOM items were previously used on the USMLE.  Because of the overlap, it is possible to roughly project IFOM performance onto the USMLE score scale.  Please see the IFOM Basic Science and Clinical Science [Link to www.nbme.org/ifomcse2013] Score Interpretation Guides for more information.

How long are the IFOM Examinations?

Both the BSE and CSE have 160 multiple-choice questions, each with a single best answer accepted as correct.  Examinees have four hours to complete the exam.

In what languages are the IFOM exams offered?

The IFOM CSE is offered in International English, Spanish, Portuguese and Italian.  The IFOM BSE is offered in International English only. Additional languages will be added based on demand.

Who can use IFOM exams?

Medical schools listed in the Foundation for the Advancement of International Medical Education and Research's (FAIMER) International Medical Education Directory (IMED; https://imed.faimer.org/) as well as approved government organizations, ministries, and healthcare organizations.  All institutions or organizations using these exams must comply with test administration standards, including security protocols.

How is IFOM delivered?

IFOM can be delivered in one of two ways:

  1. On the computer at a participating Prometric test center
  2. At a medical school, if it participates in the program.  Within a school, IFOM can be delivered on a computer or as a paper and pencil exam.

What are the validity and reliability/psychometric properties of the IFOM examination?

Reliability analysis of the IFOM scores indicates an internal consistency value of greater than 0.90, which meets standards for high-stakes examinations using multiple-choice questions.  Comparison of exam results with other measures of performance used by participating universities shows good correspondence.

How are the post-test survey items selected?

NBME and affiliated organizations select survey items to support research initiatives and program development.

Scoring FAQs

IFOM Basic Science Examination

What is the IFOM BSE standard of competence?
The IFOM BSE standard of competence is currently a score of 582, which corresponds approximately to the minimum passing score for USMLE Step 1 as of January 1, 2013.  Specific information on USMLE Step 1 and the current minimum passing score is available on the USMLE website at www.usmle.org.  The IFOM BSE standard of competence allows comparison of an individual's performance on the BSE with the level of performance required to pass Step 1.

The IFOM BSE Score Interpretation Guide provides more information about the scaling group, composition and performance of the international comparison group, the IFOM BSE score scale and the relationship to the USMLE Step 1 score scale.

What does an IFOM BSE score mean, and how do I interpret performance relative to other IFOM examinees?
The 2013 IFOM BSE scores were scaled to have a mean of 500 and a standard deviation of 100 based on the 2011 IFOM BSE scaling group.  This scaling group included all examinees who took the 2011 IFOM BSE.  Scores can be interpreted relative to this group, which had examinees from Australia, Belgium, Lebanon and Portugal.  For example, a score of 450 means that an examinee has scored half a standard deviation below the mean of the IFOM BSE scaling group.

In addition, the norm table in the Score Interpretation Guide allows an individual to determine the percentage of examinees in the IFOM BSE international comparison group who obtained scores lower than their score.

How do I interpret an IFOM BSE score relative to the USMLE Step 1?
The IFOM BSE and the USMLE Step 1 are designed for different purposes and cover somewhat different content.  For these reasons, NBME cannot provide an exact corresponding Step 1 score for a given IFOM BSE score.  However, because there is substantial overlap in the content coverage and many IFOM items were previously used on Step 1, it is possible to roughly project performance onto the Step 1 score scale.  In addition, the IFOM BSE standard of competence is based on the projected pass/fail standard for Step 1.  A table in the Score Interpretation Guide shows the approximate correspondence between IFOM BSE scores and Step 1 scores.

How can I interpret the performance profile on the back of the performance report?
NBME created the performance profile on the back of the performance report to help examinees identify their own areas of strength and weakness.  We intend the report for self-assessment purposes and do not share it with programs, schools, and agencies. Individuals can use their profiles to see how they performed in various content areas relative to the average performance of the IFOM BSE international comparison group.  The performance profile bands for the various content areas offer an indication of the range in which an individual performance falls.  The width of the profile bands varies depending on how precisely the score was measured in that area; narrower bands reflect greater precision and wider bands reflect less precision.  An asterisk indicates that a portion of the profile band extends beyond the range of scores that are displayed.  Small differences in the location of bands should not be over interpreted. If two bands overlap, performance in the associated areas should be interpreted as similar.  Because the IFOM BSE is designed to be integrative, many items contribute to more than one content area.  As a consequence, caution should be used when interpreting differences in performance across content areas and in relation to the average performance of the IFOM BSE international comparison group.

If an IFOM BSE score is within a standard error of measurement (SEM) of the BSE standard of competence, does that mean that performance meets the standard of competence?
The SEM provides and index of the precision of the IFOM scores. No score is perfectly precise and the SEM allows us to quantify the degree of imprecision. NBME constructs an interval that contains approximately two thirds of scores observed on repeated testing by adding and subtracting the SEM from the reported score. However, the reported score used to determine whether an individual's performance meets the standard of competence because it is based on actual performance. It is impossible to say whether scores on repeated attempts of the IFOM BSE would fall above or below the current score and above or below the standard of competence.

IFOM Clinical Science Examination

What is the 2013 IFOM CSE standard of competence?
The performance report shows the current recommended international standard of competence, which is based on the projected minimum passing score for the USMLE Step 2 CK as of January 1, 2013.  Specific information on USMLE Step 2 CK and the current minimum passing score are available on the USMLE website at www.usmle.org.

The IFOM CSE Score Interpretation Guide provides more information about the IFOM CSE scaling group, composition and performance of the international comparison group, the IFOM CSE score scale, and the relationship to the USMLE Step 2 CK score scale.

How do I know whether an individual passed or failed the IFOM CSE?
Schools, programs and agencies can use the IFOM exams for purposes that do not require establishing a pass/fail mark.  For examples, a school may wish to identify areas of strength and weakness in its curriculum by looking at student performance on the IFOM exams.  When score-users do wish to establish a pass/fail status, the IFOM Oversight Committee recommends they base it on the international standard of competence.  However, score users may decide to apply a different minimum passing score.

Why is the 2013 recommended international standard of competence higher than the 2012 international standard of competence?
The projected minimum passing score for Step 2 CK of the USMLE changed on July 1, 2012.  That score serves as the basis for the IFOM CSE international standard of competence, which therefore changed as well.

What does an IFOM CSE score mean, and how do I interpret performance relative to other IFOM examinees?
The IFOM CSE scores were scaled to have a mean of 500 and a standard deviation of 100 based on the 2010 IFOM CSE scaling group, which included a sample of examinees from Europe, the Middle East, North America and South America in the final year of medical school.  You can interpret scores relative to this group.  For example, a score of 450 means that an individual scored half a standard deviation below the mean of the IFOM CSE scaling group.

The norm table in the Score Interpretation Guide allows individuals to determine the percentage of examinees in the IFOM CSE international comparison group who obtained scores lower than their score.

How do I interpret an IFOM CSE score relative to the USMLE Step 2 CK?
The IFOM CSE and the USMLE Step 2 CK are designed for different purposes and cover somewhat different content.  For these reasons, NBME cannot provide an exact corresponding Step 2 CK score for a given IFOM CSE score.  However, because there is substantial overlap in the content coverage and many IFOM items were previously used on Step 2 CK, it is possible to roughly project performance onto the Step 2 CK score scale.  In addition, the recommended passing score for IFOM CSE is based on the projected pass/fail standard for Step 2 CK.  A table in the Score Interpretation Guide shows the approximate correspondence between IFOM CSE scores and Step 2 CK scores.

How can I interpret the performance profile on the back of the performance report?
NBME created the performance profile on the back of the performance report to help individuals identify their own areas of strength and weakness.  We intend the report for self-assessment and do not share it with programs and schools using IFOM.  Individuals can use the performance profile to see how they performed in various content areas relative to the average performance of the IFOM CSE international comparison group.  The performance profile bands for the various content areas give examinees an indication of the range in which their performance falls.  The width of the profile bands varies depending on how precisely the score was measured in that area; narrower bands reflect greater precision and wider bands reflect less precision.  An asterisk indicates that a portion of the profile band extends beyond the range of scores that are displayed.  Small differences in the location of bands should not be over interpreted.  If two bands overlap, performance in the associated areas should be interpreted as similar.  Because the IFOM CSE is designed to be integrative, many items contribute to more than one content area.  As a consequence, you should be cautious when interpreting differences in performance across content areas and in relation to the average performance of the IFOM CSE international comparison group.

If an IFOM CSE score is within a standard error of measurement (SEM) of the recommended international standard of competence, does that mean that performance is passing?
The SEM provides an index of the precision of the IFOM scores.  No score is perfectly precise and the SEM allows us to quantify the degree of imprecision.  NBME constructs an interval that contains approximately two thirds of scores observed on repeated testing by adding and subtracting the SEM from the reported score.  However, the reported score is used to determine whether an individual's performance is passing based on the international standard of competence because it is based on actual performance.  It is impossible to say whether scores on repeated attempts of the IFOM CSE would fall above or below the current score and above or below the IFOM international standard of competence.

For individuals

Who is eligible to take an IFOM exam?

You need to be a currently enrolled medical student or medical school graduate.

How often can I take it?

You can take the IFOM CSE three times in a year and the BSE once per year.

How long does it take to get exam results? How will I know my score?

IFOM results are typically reported within three weeks after your test date. However, delays are possible for various reasons. Please allow at least six weeks after your test date to receive your score report.

If you are testing at a participating medical school, you need to obtain your score report from school officials otherwise you will be notified by email with instructions on how to retrieve your score report.

Will my school know my score?

If your school is sponsoring the exam administration, the school must gain permission from you to receive your score.  In cases where IFOM is used as part of the curriculum, your participation may be mandatory.  If you register to take the exam at a Prometric test center, only you will know your score.

What training materials do you recommend to prepare for the exam?

This depends on your purpose in taking the exam.  Many schools that use IFOM wish to measure their students' base level of medical knowledge, in which case preparation would defeat the purpose.  The school wants to test your knowledge in order to design its curriculum effectively.  Please check with your medical school before beginning preparation.

If you are taking the exam under higher-stakes conditions (e.g., residency selection), we offer online self-assessment examinations to help you prepare for IFOM exams.  For more information, please follow the link below:

NBME Self-Assessment Services

If I fall below the standard of competence on an IFOM exam, can I take it again? Will my performance on both attempts show?

You can take the IFOM CSE exam up to three times per calendar year and the IFOM BSE exam only once per calendar year.  NBME issues a score report each time you take the exam.  The report reflects your performance only on that administration.

For programs, schools, and agencies

How long does it take to get exam results?

NBME posts results for exams administered through schools online within two to three weeks of testing.

Do schools need permission from students to receive their scores?

Yes.  Since student scores are delivered to school administrators, the school must obtain permission from each student.  NBME relies on a school's representation that it has received such permissions.

How will students who take IFOM through their schools know their scores?

Students need to obtain their score reports from school officials, who receive the results electronically via the secure NBME services portal.

How can we advise students to prepare for IFOM exams?

This depends on your purpose for using the exam.  Many schools use IFOM to measure their students' base level of medical knowledge, in which case preparation would defeat the purpose.  It is up to each medical school to advise its students on how to prepare for the exam.

If you wish to advise students to prepare for an IFOM exam, NBME offers online self-assessment examinations.  For more information, please follow the link below:

NBME Self-Assessment Services

Is the instrument appropriate for making high-stakes decisions?

Yes.  Medical schools, post-graduate programs, and ministries of health/education have all used the IFOM CSE results to make high-stakes decisions (such as residency selection).

 

 

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