Urban Legends

This is not true. USMLE is NOT an adaptive test and content does not change based on performance.

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) {insert link} 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!

This urban legend seems to spring from some misperceptions about the recommendations made by the Committee to Evaluate the USMLE Program (CEUP) {link} 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 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".

The NBME does offer the Assessment of Professional Behaviors (APB) program, a multi-source, multi-competency program that brings a standardized approach to the support of professionalism and related skills. The APB is designed as a formative assessment, leading to individual insight and improvement. The APB can also strengthen efforts at promoting professionalism at the departmental or institutional level. For more information on APB, please click here.

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.