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Date Updated: August 8, 2011

Expressing Breast Milk During the USMLE

Updated November 8 , 2007

Recent inquiries prompt us to update this Q&A about policies and circumstances that may affect women who wish to express milk during the United States Medical Licensing Examination (USMLE).   We have also included information about the lawsuit filed by Sophie C. Currier. If you have any additional questions, please contact the National Board of Medical Examiners at (215) 590-9700.

What is USMLE?

USMLE is a standardized examination designed to assess a physician’s ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.  USMLE is accepted by virtually all licensing boards in the US as evidence of competence to practice medicine in the US.  Because of the test’s importance to the public’s safety and to examinees, maintaining its fairness and integrity is our priority.

Who sponsors the USMLE?

The National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB) cosponsor the US Medical Licensing Examination.  Policies governing its administration are established by the USMLE Composite Committee comprising representatives of the cosponsors, NBME and FSMB, the public, and the Educational Commission for Foreign Medical Graduates, which assesses the readiness of international medical graduates for medical residencies and fellowships.

Is it possible to express milk during the testing day for the computer-based portions (Step 1, Step 2 CK and Step 3) of USMLE?

Yes.  Women may express milk during the 45 minutes of standard break time.  If examinees complete the tutorial or examination blocks in less than the allotted time, they can add that time to their break time.  Examinees may use their break time throughout the day as they choose (e.g., take multiple short breaks between blocks of the test or fewer breaks of longer duration).

Is it possible to express milk during the Step 2 Clinical Skills Examination?

Yes.  Women may express milk during the 45 minutes of standard break.  For Step 2 CS, the entire testing center is a secure testing area.  Therefore, women wishing to bring a breast pump into the CS testing center must submit a request for a Personal Item Exception (PIE) in advance of their examination date.  Information and instructions regarding Personal Item Exception requests may be found in the USMLE Bulletin of Information at www.usmle.org

Have applicants successfully used their break time to express milk?

Yes.  To our knowledge, many women have expressed milk during the standard allotted break time for each Step examination. 

What is the impact of the Order by a single justice of the Massachusetts Court of Appeals in Sophie C. Currier v. National Board of Medical Examiners on other women who request additional break time to express milk?

The single justice’s order issued a preliminary injunction to give Ms. Currier additional break time during her Step 2 CK examination administered on October 10 and 11.   The order applies only to Ms. Currier. The lawsuit filed by Ms. Currier is currently pending.

Under what conditions is additional break time available as a test accommodation?

Test-takers who are covered under the Americans with Disabilities Act (ADA) may be legally entitled to receive additional break time or other accommodations, such as a separate testing room.  The Guidelines to Request Test Accommodations can be accessed at www.usmle.org. Lactation is one of many temporary conditions not covered by the ADA.

How often is USMLE given?

The exam is offered at testing centers in the United States and abroad, five to six days a week year-round, except for a limited period in January. 

Is there any chance the policies about break time will change?

The governing body of the USMLE is reviewing the amount of break time for everyone. The importance of fair, consistent standards means we cannot make ad hoc individual exceptions to policy. 


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