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Date Updated: April 18, 2013

Urban Legends

A topic or statement is considered to be an "urban legend" if it circulates widely, is told and re-told with differing details (or exists in multiple versions), and is said to be true*. In the realm of the medical student or resident, many of these are related to the NBME or the USMLE exam. In this section, we'll be happy to let you know whether something is fact or fiction.

Debunking The Rumors

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I heard from various sources that next year Step 1 and Step 2 will be pass/fail.

Reality Check: Fiction

Explanation:
A multi-year project to review and revise the USMLE sequence is called the Comprehensive Review of USMLE (CRU). Accurate information regarding CRU can be found here: http://www.usmle.org/cru/

I have heard that the NBME self assessments have differing levels of difficulty.

Explanation:
The scores reported for the NBME self-assessment examinations are statistically equated so that they are on the same scale and are directly comparable regardless of which form you take.  The forms may differ slightly in difficulty, but equating adjusts for differences in difficulty and ensures that the score you receive will be comparable regardless of whether you took an easier form or a more difficult form.

I have heard that different questions are graded differently on USMLE steps.

Reality Check: Fiction

Explanation:
USMLE weights all multiple choice questions equally within each Step exam. Thus, answering relatively easy questions or relatively difficult questions correctly provides equal progress toward meeting the minimum passing score. This urban myth may derive from a misunderstanding about the statistical methods called equating that ensure that the 3-digit score is comparable regardless of what test form or what time of year a candidate tests. The statistical processes make small adjustments to scores achieved on test forms that contain relatively more or less difficult items. Scores on tests with relatively difficult items are adjusted up and those achieved on relatively easy items are adjusted down. These adjustments ensure that the scores that are awarded are comparable regardless of the particular combination of items on any examinee's test form and ensures fairness for all test takers.

I have heard that if you take Step 1 in May through July, you will get a lower score or fail because a lot of candidates test during this period and competition is high.

Reality Check: Fiction

Explanation:
The USMLE uses statistical techniques called equating to ensure that the 3-digit score is comparable regardless of what test form or what time of year a candidate tests. There are, however, natural ebbs and flows to the preparation, readiness, and demographic composition that may be associated with the success of candidates who take or retake Step 1 at particular times of the year, which can lead to modest variations in pass rates. For example, specific, highly selective US medical schools whose students typically have very high pass rates tend to test within specific time bands associated with their curriculum, resulting in somewhat higher pass rates during this period. In contrast, students who were unsuccessful on their first attempt tend to retake at other times of the year, resulting in somewhat higher fail rates at that time of year. The statistical techniques used ensure that the same standard is applied to all students regardless of what time of year they test or what test form they are administered.

Step 1 is easier in places with fewer medical students or in more isolated areas.

Reality Check: Fiction

Explanation:
While it may be easier to schedule your USMLE exams according to your preferred dates in certain areas, the exam itself is not easier or harder depending on where it is administered.

The USMLE Clinical Skills exam (Step 2 CS) is 'going away'.

Reality Check: Fiction

Explanation:
The NBME, along with its collaborators in USMLE (the Federation of State Medical Boards and the Educational Commission for Foreign Medical Graduates), is committed to the assessment of clinical skills as part of the licensing examination sequence. In fact, a major recommendation from the Committee to Evaluate the USMLE program (CEUP) states: "CEUP recommends that the assessment of clinical skills remain a component of USMLE, but that USMLE con­sider ways to further enhance the testing methods current­ly used, in order to address additional skills important to medical practice. It is also recommended that the admin­istrative challenges and costs to examinees associated with related testing formats be given substantial weight in the consideration of future changes."

This recommendation, among others, was approved by all three organizations that govern the USMLE program. The clinical skills examination is here to stay!

Step 1 is 'going away' or Step 1 and Step 2 CK are being combined into one exam.

Reality Check: Fiction

Explanation:
This urban legend seems to spring from some misperceptions about the recommendations made by the Committee to Evaluate the USMLE Program (CEUP) with respect to the assessment of basic science. Early feedback from the wide variety of stakeholders surveyed to inform CEUP’s work told us that from both a licensing and an educational perspective, the separate design and administration of an examination of the basic sciences seems to create an artificial separation of basic and clinical sciences.  This sentiment was frequently expressed by stakeholders, including faculty members from both the basic sciences and clinical sciences.  The weight of opinion favored the integration of basic science and clinical science concepts throughout all examination components rather than the current segregation of basic science content in Step 1. This does not mean, however, that Step 1 will be eliminated from the USMLE sequence or that Step 1 and Step 2 CK will be combined.

Steps 1 and 2 CK will exist as separate, discrete examinations for at least the next several years. During this time, evolution in content coverage is likely. At some point as USMLE evolves, the current Step structure could shift. If this occurs, stakeholders will be advised of changes well in advance of any change. Plans for transitioning to a new structure will be provided well in advance so that the phase-in will be smooth and equitable, to minimize potential disruptions for examinees, schools, licensing boards, or other constituencies. Additionally, the NBME will be attentive to other uses of USMLE performance data and strive to meet educationally sound secondary uses.

There are plans to add the Assessment of Professional Behaviors to the USMLE sequence as Step 4.

Reality Check: Fiction

Explanation:
There are no plans to add a test of professionalism to the USMLE sequence. Consistent with the recommendations from CEUP, USMLE will, to the extent possible, measure core competencies, including professionalism; however there are no plans for a "Step 4".

Questions from the NBME’s self-assessments are also used in live USMLE examinations.

Reality Check: Fiction

Explanation:
While the questions used in the of the NBME self-assessments may look quite similar to live questions students see on their USMLE Steps, no live USMLE items are used for the NBME’s self-assessments.


Have you heard something about the NBME or the USMLE exam
that may be fact or fiction? Tell us about it.

*As defined by www.Snopes.com 

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