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Date Updated: January 30, 2017

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, and Portuguese. 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

IFOM CSE Self-Assessment
The NBME offers the International Foundations of Medicine (IFOM) Clinical Science Self-Assessment. Built to the same content specifications as the IFOM Clinical Science Examination, this web-based examination provides a self-assessment for international medical students who want to assess their knowledge of the clinical sciences in advance of taking the IFOM Clinical Science Examination, or for any other purpose.

The self-assessment is currently available in English and Spanish, and will be available in Portuguese in Fall 2016.

For more information and to order the self-assessment for yourself or your students, visit the IFOM CSE Self-Assessment webpage.

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.
  • Becoming familiar with the types of questions that are used on examinations such as the United States Medical Licensing Examination® (USMLE®).

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

A full description of this program is available in the International Foundations of Medicine program guide.

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 BSE Score Interpretation Guide:
www.nbme.org/ifombse2017

IFOM CSE Score Interpretation Guide:
www.nbme.org/ifomcse2017

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.

Individual Testing

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 2017 are as follows:

Test Window Registration Period
March 27 - May 5 January 1 – February 10
October 2 – November 10 July 10 - August 18

Note: Enrollment will only be active during the “registration periods” listed above.

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 complete information about IFOM individual administration, 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

Institutional Testing

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.

International Oversight Committee

The International Oversight Committee comprises clinicians and medical school faculty from six countries, along with NBME staff. The Committee governs all of NBME’s international work and advises staff on issues relating to program policies, examination design, score reporting, standard setting, and the assessment needs of medical students and faculty around the world.

Ricardo Correa Marquez, MD
The Warren Alpert Medical School
Brown University
Warren, RI, USA

Donna D. Elliott, MD, EdD
Keck School of Medicine
University of Southern California
Los Angeles, CA, USA

Peter J. Katsufrakis, MD, MBA
National Board of Medical Examiners
Philadelphia, PA, USA

Enrique Mendoza, MD, MSc
Universidad de Panama
Panama City, Panama

Melchor Sánchez-Mendiola, MD, MHPE, PhD
Facultad de Medicina
Universidad Nacional Autónoma de México
Mexico City, Mexico

Nuno J. C. Sousa, MD, PhD (Chair)
University of Minho
Braga, Portugal

Dame Lesley J. Southgate, DBE, DSc
European Board of Medical Assessors
Broxbourne, Herts, United Kingdom

Danny M. Takanishi, Jr., MD
John A. Burns School of Medicine
University of Hawaii at Manoa
Honolulu HI, USA

Michael Wan, MBChB, FRCP, GCUT
University of Notre Dame, Australia
Darlinghurst, New South Wales, Australia

W. T. Williams, Jr., MD
University of North Carolina School of Medicine
The Williams Group
Davidson, NC, USA

Suzanne T. Anderson (Ex Officio)
Chair, National Board of Medical Examiners
Virginia Mason Medical Center
Seattle, WA, USA


IFOM Committee

Along with the International Oversight Committee, the International Foundations of Medicine (IFOM) Committee oversees the content and performance of IFOM. However, its primary function is to write new items for the IFOM item banks, review new and used items for inclusion in the item banks, and review all new IFOM exam forms. Additionally, a subset of committee members reviews items for accuracy of translation and key validation.

Joseph Amoah Adu, MBChB
University of Cape Coast
College of Health & Allied Sciences
Cape Coast, Ghana

Angel Centeno, MD, PhD
Universidad Austral
Facultad de Ciencas Biomédicas
Buenos Aires, Argentina

Ricardo Correa Marquez, MD
The Warren Alpert Medical School
Brown University
Warren, RI, USA

Stephen R. Daniels, MD, PhD
University of Colorado School of Medicine
Children’s Hospital Colorado
Aurora, CO, USA

Christopher A. Feddock, MD, MS
University of Kentucky
College of Medicine
Lexington, KY, USA

Hossam Hamdy, MBChB, DS, MCh, PhD
Qatar University
College of Medicine
Doha, Qatar

Maya M. Hammoud, MD (Chair)
University of Michigan Medical School
Ann Arbor, MI, USA

Zeina A. Kanafani, MD, MS
American University of Beirut Medical Center
Beirut, Lebanon

Ricardo Komatsu, MD, MSc, PhD
Faculdade de Medicina de Marília
São Paulo, Brazil

Janelle A. Rhyne, MD, MA
New Hanover Regional Medical Center
Kayenta, AZ, USA

Derek Soon, MBBChir, PhD
National University of Singapore
Singapore

Michael Wan, MBChB, FRCP, GCUT
University of Notre Dame, Australia
Darlinghurst, New South Wales, Australia

Alison J. Whelan, MD
Association of American Medical Colleges
Washington, D.C. , USA


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

Who can use IFOM exams?

NBME wishes to work with any medical school or other organization around the world (for example, ministries of health, residency programs and hospitals, and other healthcare agencies) whose programs and goals could benefit from using high-quality comprehensive assessments. Generally, medical school users should have already been found eligible to apply for ECFMG certification—see the ECFMG Information Booklet for more information.

We require that all institutional users be able to comply with our test administration standards, including security protocols.

Individuals may apply to take the International Foundations of Medicine (IFOM) exams if they are currently enrolled in or have graduated from medical school. For more information about taking an IFOM exam as an individual, see the “Applying for IFOM” tab on this webpage.

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 does an IFOM BSE score mean, and how do I interpret performance relative to other IFOM examinees?
The 2017 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 and are limited to a range of 200 to 800. This scaling group included all examinees who took the 2011 IFOM BSE. Scores can be interpreted relative to this group, which had examinees from Asia including the Middle East, Europe and Oceania. 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.

IFOM Clinical Science Examination

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 example, a school may wish to identify areas of strength and weakness in its curriculum by looking at student performance on the IFOM exams.  When schools or other oganizations do wish to establish a pass/fail standard, the NBME can work with them to do so.

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 and are limited to a range of 200 to 800, which included a sample of examinees from the Americas, Asia including the Middle East and Europe 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.

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 or other organization, you need to obtain your score report from officials at your organization.

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 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 want to improve my performance 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 institutional administrations online within two to three weeks of testing.

Do organizations need permission from students to receive their scores?

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

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

Students need to obtain their score reports from organization 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 organizations use IFOM to measure their students' base level of medical knowledge, in which case preparation may defeat the purpose. It is up to each medical school or other sponsoring organization 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

Are the IFOM exams 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). Some organizations also use IFOM BSE for high-stakes purposes.

Security & Integrity of NBME Examinations

The examination materials used in the NBME examinations are the confidential, copyrighted property of the NBME. If you reproduce and/or distribute examination materials, by any means, including reconstruction through memorization without the express written consent of the NBME, you are in violation of the rights of the owners. Every legal means available to protect NBME examination materials and secure redress against those who violate copyright law may be pursued.

  • The confidentiality of examination content must be maintained at all times. You are prohibited from communicating, publishing, reproducing, or transmitting any part of your exam, in any form, or by any means, verbal or written, for any purpose.
  • If you become aware of any suspicious activity related to an NBME exam administration, notify the proctor or submit a report.
  • The NBME reserves the right to discontinue examination services to an institution at any time in order to maintain the security and integrity of the NBME’s examination programs.

Test Day Rules and Procedures

  • Do not bring any personal/unauthorized items into the secure testing area. Such items include but are not limited to, outerwear, hats, food, drinks, purses, briefcases, notebooks, notes, pagers, watches, cell phones, recording devices, and photographic equipment.
  • You are not permitted to access any unauthorized items during the exam administration.
  • Do not make notes on your note board prior to entering your CIN or start up code. Once your exam begins, you are permitted to make calculations or notes ONLY on the erasable note board provided.
  • You must adhere to the instructions provided by proctors administering the examination.
  • Carefully review and agree to abide by any instructions provided or that appear at the start of the examination session.
  • Test proctors are not authorized to answer questions from examinees regarding examination content, testing software or scoring.
  • Do not leave the testing site at any time during your administration unless you inform and obtain permission from the testing proctor or are instructed to so do by test administration staff.
  • Failure to follow test day rules and procedures may result in the withholding or cancellation of your scores, and/or a bar from future exams administered by the NBME.

Test Administration at Prometric

If you are testing at a Prometric test center, please review the instructions on your scheduling permit and familiarize yourself with Prometric’s testing center regulations

Contacting NBME about a Security Concern

NBME encourages you to provide information concerning any activity of which you are aware that may compromise the security and integrity of the NBME’s examinations. Please contact NBME using our contact form to report such information.



 

 

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