ECFMG Certification --

Mindy Hung

July 11, 2001

The Boards -- USMLE Step 1 and Step 2

Submitting the first application for the USMLE Step 1 or Step 2 -- also known as the Boards -- marks the beginning of the certification process. The ECFMG is in charge of receiving and tracking all foreign applications (Form 104S [.pdf]), issuing each person an identification number that should be used in subsequent correspondence.

To qualify to take the USMLE, candidates must supply the aforementioned diplomas and pictures, and one's medical school must be listed in the current edition of the World Directory of Medical Schools . (Medical school libraries often carry the publication.)

Although the boards can be taken in any order, students must be within 12 months of completing the full didactic curriculum at their medical school in order to take Step 2 while those who have had 2 years of medical school may take Step 1.

After confirming eligibility, the National Board of Medical Examiners will then send a scheduling permit that will allow the applicant to make an appointment to take the test. Applicants must take the exam within 3 months of receiving the permit.

Step 1 and Step 2 are computer-based multiple-choice exams, which must be taken at Prometric exam centers located around the world. For 2001, each Step costs $615 US in addition to an international test delivery surcharge.

Step 1 tests applicants on the basic mechanisms and principles of medicine (for example, anatomy and biochemistry, identifying specimens). Composed of about 350 test items, the exam takes place during an 8-hour testing session, divided into 30- to 60-minute blocks with about 45 minutes break time. Step 2 is divided into 30- to 60-minute blocks, administered in a 9-hour testing session with a 45-minute break. It focuses on clinical diagnosis and disease pathogenesis (mental and physical disorders, applying principles of management). Examples of questions from USMLE Step 1 and 2 can be found in Medscape Med Student's Test Center. Candidates should answer 55% to 65% of items correctly to achieve a passing score.

Familiarity with the format of the exam and the subject matter is key. Visiting the USMLE Web site will give applicants a good overview of the depth and breadth of the test but CD-ROMs or prep books are necessary investments. The Boards are long and grueling, and these study-aids will help test-takers familiarize themselves with the format and subject matter.