Table 1.

Current and future USMLE

Current USMLE
Step 1Step 2 Clinical KnowledgeStep 2 Clinical SkillsStep 3A: Foundations of Independent Practice (FIP)Step 3B: Advanced Clinical Management (ACM)
Primary focus of contentFoundational scienceClinical science; emphasis on competencies leading to diagnosis; some managementClinical skillsFoundational science; diagnosis (history, physical exam, laboratory and diagnostic tests); communication skills; evidence-based medicine; patient safety; professionalismClinical science: emphasis on competencies in management; diagnosis (prognosis/outcomes)
FormatsMCQsMCQsStandardized patientsMCQsMCQs, computerized case simulations
Timing*End of second-year medical schoolFourth-year medical schoolFourth-year medical schoolMid first-year to third-year residencyMid first-year to third-year residency
Recent key changesAll MCQs use a clinical or experimental vignette; interpretation of heart sounds; reduce number of medical “buzzwords”Interpretation of heart sounds; introduction of scientific abstracts; item sets that unfold over timeNew communication and interpersonal skills scale; notes require integration of case findings; history checklist eliminatedContent organized by competency (see above); interpretation of heart sounds; item sets that unfold over time; introduction of scientific abstracts and faux pharmaceutical advertisementsContent organized by competency (see above); interpretation of heart sounds; item sets that unfold over time
Future USMLE
Step 1Step 2 Clinical KnowledgeStep 2 Clinical Skills
ContentFoundational science, clinical science: diagnosis; communication skills; evidence-based medicineClinical science: diagnosis, management; evidence-based medicine; patient safety; professionalismClinical skills: includes assessment of more advanced communication skills
FormatsMCQsMCQsStandardized patients
Timing*UnknownUnknownLikely fourth-year medical school

USMLE, United States Medical Licensing Examinations; MCQs, multiple-choice questions.

  • * Time during the United States medical education process when most students/graduates sit for the examinations.

  • Step 1 and Step 2 changes will not occur before 2018, and these changes are tentative.