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USMLE - United States Medical Licensing Examination - Dump Information

Vendor : USMLE
Exam Code : USMLE
Exam Name : United States Medical Licensing Examination
Questions and Answers : 400 Q & A
Updated On : December 7, 2018
PDF Download Mirror : Pass4sure USMLE Dump
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USMLE Questions and Answers

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USMLE United States Medical Licensing Examination

Study Guide Prepared by Killexams.com USMLE Dumps Experts


Killexams.com USMLE Dumps and Real Questions

100% Real Questions - Exam Pass Guarantee with High Marks - Just Memorize the Answers



USMLE exam Dumps Source : United States Medical Licensing Examination

Test Code : USMLE
Test Name : United States Medical Licensing Examination
Vendor Name : USMLE
Q&A : 400 Real Questions

It is Awesome! I got dumps of USMLE exam.
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Passed the USMLE examination the alternative day. I would have by no means accomplished it without your examination prep substances. A few months ago I failed that exam the primary time I took it. Your questions are very much like real one. I handed the examination very without difficulty this time. Thank you very a lot on your assist.


How an awful lot modern day for USMLE certified?
Killexams.com was very refreshing entry in my life, mainly because the material that I used through this killexams.coms help was the one that got me to clear my USMLE exam. Passing USMLE exam is not easy but it was for me because I had access to the best studying material and I am immensely grateful for that.


can i discover dumps questions state-of-the-art USMLE examination?
I am one among the high achiever in the USMLE exam. What a fantastic Q&A material they provided. Within a short time I grasped everything on all the relevant topics. It was simply superb! I suffered a lot while preparing for my previous attempt, but this time I cleared my exam very easily without tension and worries. It is truly admirable learning journey for me. Thanks a lot killexams.com for the real support.


Believe it or not, Just try once!
I clearly required telling you that ive crowned in USMLE exam. All of the questions on exam desk have been from killexams. Its miles stated to be the real helper for me on the USMLE exam bench. All praise of my achievement is going to this manual. That is the real motive at the back of my success. It guided me in the right way for trying USMLE exam questions. With the assist of this have a look at stuff i used to be proficient to effort to all the questions in USMLE examination. This examine stuff publications a person within the proper way and guarantees you one hundred% accomplishment in exam.


it's far genuinely first rate experience to have USMLE state-statemodern dumps.
I used this dump to pass the USMLE exam in Romania and got 98%, so this is a very good way to prepare for the exam. All questions I got on the exam were exactly what killexams.com had provided in this brain dump, which is incredible I highly recommend this to everyone if you are going to take USMLE exam.


USMLE actual question bank is actual look at, genuine result.
I practically lost trust in me in the wake of falling flat the USMLE exam.I scored 87% and cleared this exam. Much obliged killexams.com for recovering my certainty. Subjects in USMLE were truly troublesome for me to get it. I practically surrendered the plan to take this exam once more. Anyway because of my companion who prescribed me to use killexams.com Questions & Answers. Inside a compass of simple four weeks I was completely ready for this exam.


can i discover dumps questions state-of-the-art USMLE examination?
I just bought this USMLE braindump, as soon as I heard that killexams.com has the updates. Its genuine, theyve covered all new areas, and the exam appears very fresh. Given the current update, their turn round time and help is top notch.


observed those most USMLE Questions in real take a look at that I passed.
Candidates spend months trying to get themselves prepared for their USMLE tests but for me it was all just a days work. You would wonder how someone would be able to complete such a great task in just a day Let me tell you, all I had to do was register myself on this killexams.com and everything was good after that. My USMLE test seemed like a very simple task since I was so well prepared for it. I thank this site for lending me a helping hand.


what's simplest way to put together and pass USMLE exam?
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USMLE USMLE United States Medical

Becker knowledgeable education Expands beyond u.s. scientific Licensing Examination® (USMLE®) With New Collaborations and choices | killexams.com Real Questions and Pass4sure dumps

DOWNERS GROVE, ill.--(enterprise WIRE)--Becker professional training, a worldwide chief in professional schooling and part of Adtalem global education, announced two fundamental new initiatives to expand beyond the latest USMLE preparation path. Becker is participating with 4MedPlus to make certain that its students have effortless entry by means of a single tool to key certifications essential previous to the delivery of their clinical classes. furthermore, Becker is additionally adding a GuideRN Self analyze to prep nursing students for the NCLEX-RN - the standardized exam required to become a board certified nurse.

New 4MedPlus Compliance iBookPlus+ providing

The 4MedPlus Compliance iBookPlus+ is an online path tool which allows practitioners, employers, educators and organizations to deliver entry to required and advised compliance getting to know for personnel, students and participants with a single click on. compatible with computing device, MAC/iPad and Android on all browsers, the iBookPlus+ aspects a web interactive educational hub where students can promptly set up talent in regulatory, compliance and protection subject matters in healthcare suddenly.

The six certificates of proficiency accessed by using Becker college students within the compliance iBookPlus+ consist of:

  • realizing HIPAA for the team of workers expert
  • NYS Mandated an infection handle and Barrier coverage
  • Bloodborne Pathogens protection
  • Needlesticks and Sharps safeguard
  • OSHA/PPE basics for Healthcare people (OSHA/PPE)
  • comprehensive Tuberculosis Prevention (TB)
  • Completion of every path in the bundle achieves a 4MedApproved certificate of proficiency with Nursing CEU's, general practitioner CME and college credit score purchasable. The iBookPlus+ device additionally provides access to lots of of particular person modules and numerous further classes for customized compliance. All PDF certificates are dispatched upon iBookPlus+ completion to college students in addition to to the administrator or distribution checklist linked to the account and a comprehensive admin panel is blanketed which allows for for monitoring and management of pupil development.

    Becker Launches New GuideRN, Self-Paced discovering program, to Prep Nursing students for NCLEX-RN

    Becker knowledgeable schooling is launching a new GuideRN Self analyze software to assist nursing college students put together for his or her NCLEX look at various required to turn into a board licensed nurse. featuring 21 core discipline topics, the GuideRN self look at contains a full curriculum of nursing subjects to aid students prepare for the NCLEX, together with Nursing Sciences, simple abilities, knowledgeable specifications, and Examination preparation.

    moreover, the GuideRN device offers greater than 30 hours of modular on-line content grounded in the fundamentals of drugs, as well as full-colour illustrations, photographs and embedded animations to assist carry medical issues to lifestyles and illustrate the procedures of the human body. also, the end of each chapter includes follow inquiries to boost the realizing of selected nursing subjects and the user has the option to add greater than 2,000 UWorld query financial institution questions providing designated explanations that are written to simulate the NCLEX examination.

    “through our partnership with 4MedsPlus and our new GuideRN Self analyze application, we are reworking the typical getting to know procedure inside key areas of scientific examine to provide interactive, superior examination prep options that are conveniently purchasable throughout gadgets,” brought up David Bartholomew, vice president, Healthcare at Becker knowledgeable training. “Becker’s focused increase plan will proceed to deliver our students with resources tailor-made for finished realizing and access to the important thing information essential to succeed in quite a lot of areas of medical examination and certification prep.”

    Becker expert education has helped basically half a million americans put together to prevail on expert checks together with the USMLE and now in each scientific certifications and NCLEX. To gain knowledge of extra about Becker skilled schooling, talk over with www.becker.com.

    About Becker professional schooling

    Becker expert schooling is a member of Adtalem world education (NYSE: ATGE), a world schooling provider headquartered in the united states. The firm's goal is to empower students to achieve their desires, locate success and make inspiring contributions to our world community. Becker is international chief in professional schooling serving the accounting, undertaking management and healthcare professions. well-nigh half a million authorities have organized to strengthen their careers through its CPA exam evaluation, ACCA® courses, CMA examination evaluate, PMP® exam overview, USMLE® assessment and carrying on with expert schooling courses. all through its more than 60-yr historical past, Becker has earned a robust tune checklist of pupil success via world-class educating, curriculum and learning equipment that enable its college students to develop the skills and efficiency talents vital to stay ahead in an ever-altering business world. For extra information about Becker knowledgeable education, discuss with www.becker.com.

    About Adtalem world education

    The purpose of Adtalem global education is to empower students to achieve their goals, find success and make inspiring contributions to our global community. Adtalem global schooling Inc. (NYSE: ATGE; member S&P MidCap four hundred Index) is a leading world schooling provider, and the mum or dad firm of Adtalem Educacional do Brasil, American tuition of the Caribbean school of medicine, affiliation of licensed Anti-funds Laundering specialists, Becker knowledgeable training, Carrington school, Chamberlain university, DeVry university and its Keller Graduate faculty of administration, Ross college school of medication and Ross college school of Veterinary medication. For greater advice, please consult with adtalem.com.

    concerning the 4MedPlus business enterprise

    4MedPlus business enterprise is the main company of authorized carrying on with education CME/CEU on subject matters regarding fitness IT, compliance, security, regulatory necessities, government incentives, fitness and security, and extra. Healthcare professionals are in a position to meet their ongoing working towards needs wholly online on their personal schedule, which encourages more productive delivery of medical functions and constructive time management for more desirable patient care. 4Med can provide their classes via an intensive network of educational catalog partnerships and by way of their personal on-line training catalog equipment.

    USMLE® is a joint application of the Federation of State clinical Boards (FSMB) and the national Board of scientific Examiners (NBME). verify names and different trademarks are the property of the respective trademark holders. none of the trademark holders are counseled, sponsor or support Becker knowledgeable education in any method.

    NCLEX-RN® is a registered trademark of the country wide Council of State Boards of Nursing and this trademark owner does not sponsor, endorse or assist Becker knowledgeable schooling in any manner.


    three.22: united states clinical Licensing Examinations (USMLE) requirements: Step 1, Step 2 CK and Step 2 CS | killexams.com Real Questions and Pass4sure dumps

    To graduate, college students should move USMLE Step 1 and Step 2 CK (medical competencies), and must have taken the Step 2 CS (medical abilities). The national Board of scientific Examiners (NBME) sets the level for passing the steps of the USMLE.

    students ought to receive an overall flow on Step 1 of the USMLE within one year of the beginning of scientific clerkships. students performing on the agenda of the Committee on efficiency, Professionalism and promoting (CP3) because of educational deficiencies in pre-clerkship courses may be required to sit down for the USMLE Step 1 ahead of starting clerkships. Exemptions to this policy should be permitted by the CP3.

    college students must receive an typical flow on Step 2 CK (medical competencies). students should still practice for Step 2 with the aid of November 1 of their ultimate yr and need to take a seat for the examination no later than March 30 in order to be sure that look at various rankings are acquired by the school of medicine Registrar in time to clear college students for commencement.

    Failure to fulfill these necessities will result in evaluate by way of the CP3. Passing an institutionally administered USMLE equivalency examination may also, below definite situations and within the discretion of the CP3, serve to satisfy Step 2 CK requirements for the MD degree. Such institutionally administered USMLE equivalency assessments do not, although, meet necessities for licensure to observe medicine.

    students have to take the USMLE Step 2 CS (medical talents) examination prior to graduation. A passing score isn't required for commencement but is required to take a seat for Step three; passing Step 3 is required for licensure in California and pretty much every different state. be aware: college students not desiring to enter the residency match might also qualify for an exemption. A letter co-signed via the scholar and marketing consultant have to be submitted to the CP3 for approval. The pupil should have passed the college’s CPX exam earlier than soliciting for the Step 2 CS exemption.

    The USMLE Step 1 and Step 2 CK are administered with the aid of laptop at Prometric examine centers. trying out happens all the way through the yr, apart from the primary two weeks in January.

    updated suggestions on the provision of testing times at Prometric is posted at http://www.prometric.com

    Scheduling makes it possible for for a practice look at various session may be received at http://www.usmle.org

    advice on NBME Self-evaluation services may also be found at: http//www.nbme.org/students/sas/sas.html

    checking out for Step 2 CS is at present offered at five facilities in different areas of the nation. suggestions on the vicinity may also be found on the web site.

    To practice for USMLE Step 1, log into the NBME site to comprehensive the on-line utility. at the end of the online application, there are guidelines for finishing a “Certification of Identification and Authorization form." Print and comprehensive the kind. attach a photo. post the accomplished form to the school of drugs Registrar’s workplace for completion.

    applications for Step 1 tests, and in some situations Step 2 checks, require an internet enrollment verification on the NBME web site by using the Registrar. The online verifications are instantly achieved as a minimum as soon as per week.

    up-to-date August 2018


    quick discovering broadcasts USMLE Step 1 direction for clinical Board exam | killexams.com Real Questions and Pass4sure dumps

    quick discovering's New USMLE Step 1 Bootcamp path presents prosperous-Media gaining knowledge of With expert teaching on All Required Board exam subject matters

    YORBA LINDA, CA--(Marketwire - Jan 31, 2012) - fast learning core, the main issuer of e-learning lessons for science, arithmetic and standardized look at various practise, is providing a rich-media bootcamp direction for medical students and graduates getting ready for the USMLE Step 1 exam, the primary a part of the USA clinical Licensing Examination. The online USMLE Step 1 course, that may even be taken by the use of DVD, is developed the same means required through the USMLE -- an integrated strategy with standard ideas and human organ techniques.

    swift gaining knowledge of develops and offers dynamic, prosperous-media courses that appeal to today's newcomers as a substitute for analyzing prep books or different static texts. The USMLE Step 1 prep teaches each and every and each required USMLE theme visually and abruptly through specialists in the subject be counted. For chapter-by-chapter contents of this direction, see the USMLE Step 1 direction Guidebook, an 86-web page publication in downloadable PDF.

    The USMLE Step 1 examination is likely one of the scientific board exams required for medical students in the U.S. and Canada who've completed the primary two years of medical college and for graduates of overseas scientific faculties. American medical faculties usually require the examine for progression to the medical third year.

    The rapid studying USMLE Step 1 evaluation path joins the more than one hundred rapid discovering classes in physical science, biological science, clinical science, and mathematics at the excessive college, school and graduate college ranges, as well as look at various prep classes on SAT, ACT, AP, CLEP, MCAT, OAT, USMLE, DAT, PCAT, and nursing faculty entrance checks.

    "The USMLE Step 1 examination is significantly essential for those pursuing careers within the medical field, and with so lots at stake, the speedy learning equipment presents quicker and richer discovering than the slower and monotonic book reading," commented Dr. Wayne Huang, Founder and schooling Director of fast researching, Inc. "This 24-chapter path gives the speedy visual review on eight disciplines and eleven systems. The large contents are taught by using field consultants systematically and visually, as a substitute of self-taught historically."

    quick getting to know courses are mainly designed for immersion study with intensity -- one hour per chapter with a complete of 24 chapters -- together with 24 wealthy-media tutorials (chapter videos), 24 issue solving quizzes (interactive drills), 24 tremendous evaluation cheat sheets (PDF printables), 24 printable eBooks, and 24 MP3 audiobooks. tailor-made to trendy college students, swift gaining knowledge of middle's instructors support college students gain knowledge of visually and impulsively, a incredibly eye-catching option to textbook analyzing.

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    For more assistance about speedy gaining knowledge of solutions, please consult with our site at www.rapidlearningcenter.com. college students, folks and educators are inspired to subscribe the ezines on study counsel and videos in biology, chemistry, physics, and math. Come construct your instinct, discover the quick route to rapid gaining knowledge of and become a wise learner nowadays.


    USMLE United States Medical Licensing Examination

    Study Guide Prepared by Killexams.com USMLE Dumps Experts


    Killexams.com USMLE Dumps and Real Questions

    100% Real Questions - Exam Pass Guarantee with High Marks - Just Memorize the Answers



    USMLE exam Dumps Source : United States Medical Licensing Examination

    Test Code : USMLE
    Test Name : United States Medical Licensing Examination
    Vendor Name : USMLE
    Q&A : 400 Real Questions

    It is Awesome! I got dumps of USMLE exam.
    I am ranked very excessive amongst my magnificence associates at the listing of awesome students but it handiest came about after I registered on this killexams.Com for some examination help. It become the excessive ranking studying application on this killexams.Com that helped me in becoming a member of the excessive ranks along with different high-quality college students of my magnificence. The sources on this killexams.Com are commendable because theyre particular and extraordinarily beneficial for education thru USMLE, USMLE dumps and USMLE books. I am satisfied to put in writing these words of appreciation because this killexams.Com merits it. Thank you.


    You just want a weekend for USMLE examination prep with the ones dumps.
    Passed the USMLE examination the alternative day. I would have by no means accomplished it without your examination prep substances. A few months ago I failed that exam the primary time I took it. Your questions are very much like real one. I handed the examination very without difficulty this time. Thank you very a lot on your assist.


    How an awful lot modern day for USMLE certified?
    Killexams.com was very refreshing entry in my life, mainly because the material that I used through this killexams.coms help was the one that got me to clear my USMLE exam. Passing USMLE exam is not easy but it was for me because I had access to the best studying material and I am immensely grateful for that.


    can i discover dumps questions state-of-the-art USMLE examination?
    I am one among the high achiever in the USMLE exam. What a fantastic Q&A material they provided. Within a short time I grasped everything on all the relevant topics. It was simply superb! I suffered a lot while preparing for my previous attempt, but this time I cleared my exam very easily without tension and worries. It is truly admirable learning journey for me. Thanks a lot killexams.com for the real support.


    Believe it or not, Just try once!
    I clearly required telling you that ive crowned in USMLE exam. All of the questions on exam desk have been from killexams. Its miles stated to be the real helper for me on the USMLE exam bench. All praise of my achievement is going to this manual. That is the real motive at the back of my success. It guided me in the right way for trying USMLE exam questions. With the assist of this have a look at stuff i used to be proficient to effort to all the questions in USMLE examination. This examine stuff publications a person within the proper way and guarantees you one hundred% accomplishment in exam.


    it's far genuinely first rate experience to have USMLE state-statemodern dumps.
    I used this dump to pass the USMLE exam in Romania and got 98%, so this is a very good way to prepare for the exam. All questions I got on the exam were exactly what killexams.com had provided in this brain dump, which is incredible I highly recommend this to everyone if you are going to take USMLE exam.


    USMLE actual question bank is actual look at, genuine result.
    I practically lost trust in me in the wake of falling flat the USMLE exam.I scored 87% and cleared this exam. Much obliged killexams.com for recovering my certainty. Subjects in USMLE were truly troublesome for me to get it. I practically surrendered the plan to take this exam once more. Anyway because of my companion who prescribed me to use killexams.com Questions & Answers. Inside a compass of simple four weeks I was completely ready for this exam.


    can i discover dumps questions state-of-the-art USMLE examination?
    I just bought this USMLE braindump, as soon as I heard that killexams.com has the updates. Its genuine, theyve covered all new areas, and the exam appears very fresh. Given the current update, their turn round time and help is top notch.


    observed those most USMLE Questions in real take a look at that I passed.
    Candidates spend months trying to get themselves prepared for their USMLE tests but for me it was all just a days work. You would wonder how someone would be able to complete such a great task in just a day Let me tell you, all I had to do was register myself on this killexams.com and everything was good after that. My USMLE test seemed like a very simple task since I was so well prepared for it. I thank this site for lending me a helping hand.


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    United States Medical Licensing Examination

    Pass 4 sure USMLE dumps | Killexams.com USMLE real questions | [HOSTED-SITE]

    Becker Professional Education Expands Beyond United States Medical Licensing Examination® (USMLE®) With New Collaborations and Offerings | killexams.com real questions and Pass4sure dumps

    DOWNERS GROVE, Ill.--(BUSINESS WIRE)--Becker Professional Education, a global leader in professional education and part of Adtalem Global Education, announced two major new initiatives to expand beyond the current USMLE preparation course. Becker is collaborating with 4MedPlus to ensure that its students have easy access via a single tool to key certifications needed prior to the start of their medical programs. In addition, Becker is also adding a GuideRN Self Study to prep nursing students for the NCLEX-RN - the standardized exam required to become a board certified nurse.

    New 4MedPlus Compliance iBookPlus+ Offering

    The 4MedPlus Compliance iBookPlus+ is an online course tool which allows practitioners, employers, educators and organizations to deliver access to required and recommended compliance learning for staff, students and members with a single click. Compatible with PC, MAC/iPad and Android on all browsers, the iBookPlus+ features an online interactive educational hub where students can quickly establish proficiency in regulatory, compliance and security topics in healthcare all at once.

    The six certificates of proficiency accessed by Becker students in the compliance iBookPlus+ include:

  • Understanding HIPAA for the Workforce Professional
  • NYS Mandated Infection Control and Barrier Protection
  • Bloodborne Pathogens Protection
  • Needlesticks and Sharps Safety
  • OSHA/PPE Basics for Healthcare Workers (OSHA/PPE)
  • Comprehensive Tuberculosis Prevention (TB)
  • Completion of each course in the bundle achieves a 4MedApproved Certificate of Proficiency with Nursing CEU's, Physician CME and College Credit available. The iBookPlus+ tool also provides access to hundreds of individual modules and numerous additional courses for customized compliance. All PDF certificates are dispatched upon iBookPlus+ completion to students as well as to the administrator or distribution list associated with the account and a comprehensive admin panel is included which allows for monitoring and management of student progress.

    Becker Launches New GuideRN, Self-Paced Learning Program, to Prep Nursing Students for NCLEX-RN

    Becker Professional Education is launching a new GuideRN Self Study program to help nursing students prepare for their NCLEX test required to become a board certified nurse. Featuring 21 core subject topics, the GuideRN self study includes a full curriculum of nursing subjects to help students prepare for the NCLEX, including Nursing Sciences, Fundamental Skills, Professional Standards, and Examination Preparation.

    In addition, the GuideRN tool offers more than 30 hours of modular online content grounded in the fundamentals of medicine, as well as full-color illustrations, photos and embedded animations to help bring medical topics to life and illustrate the processes of the human body. Also, the end of each chapter includes practice questions to enhance the understanding of specific nursing subjects and the user has the option to add more than 2,000 UWorld Question Bank questions providing detailed explanations that are written to simulate the NCLEX exam.

    “Through our partnership with 4MedsPlus and our new GuideRN Self Study program, we are transforming the traditional learning process within key areas of medical study to provide interactive, advanced exam prep solutions that are easily accessible across devices,” stated David Bartholomew, Vice President, Healthcare at Becker Professional Education. “Becker’s focused growth plan will continue to provide our students with resources tailored for comprehensive understanding and access to the key information needed to succeed in a variety of areas of medical exam and certification prep.”

    Becker Professional Education has helped nearly half a million people prepare to succeed on professional exams including the USMLE and now in both medical certifications and NCLEX. To learn more about Becker Professional Education, visit www.becker.com.

    About Becker Professional Education

    Becker Professional Education is a member of Adtalem Global Education (NYSE: ATGE), a global education provider headquartered in the United States. The organization's purpose is to empower students to achieve their goals, find success and make inspiring contributions to our global community. Becker is global leader in professional education serving the accounting, project management and healthcare professions. Nearly half a million professionals have prepared to advance their careers through its CPA Exam Review, ACCA® Courses, CMA Exam Review, PMP® Exam Review, USMLE® Review and Continuing Professional Education courses. Throughout its more than 60-year history, Becker has earned a strong track record of student success through world-class teaching, curriculum and learning tools that enable its students to develop the knowledge and performance skills necessary to stay ahead in an ever-changing business world. For more information about Becker Professional Education, visit www.becker.com.

    About Adtalem Global Education

    The purpose of Adtalem Global Education is to empower students to achieve their goals, find success and make inspiring contributions to our global community. Adtalem Global Education Inc. (NYSE: ATGE; member S&P MidCap 400 Index) is a leading global education provider, and the parent organization of Adtalem Educacional do Brasil, American University of the Caribbean School of Medicine, Association of Certified Anti-Money Laundering Specialists, Becker Professional Education, Carrington College, Chamberlain University, DeVry University and its Keller Graduate School of Management, Ross University School of Medicine and Ross University School of Veterinary Medicine. For more information, please visit adtalem.com.

    About the 4MedPlus Corporation

    4MedPlus Corporation is the leading provider of accredited continuing education CME/CEU on topics relating to Health IT, compliance, security, regulatory requirements, government incentives, health and safety, and more. Healthcare professionals are able to meet their ongoing training needs entirely online on their own schedule, which encourages more efficient delivery of medical services and effective time management for better patient care. 4Med delivers their courses through an extensive network of educational catalog partnerships and via their own online training catalog system.

    USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). Test names and other trademarks are the property of the respective trademark holders. None of the trademark holders are endorsed, sponsor or support Becker Professional Education in any manner.

    NCLEX-RN® is a registered trademark of the National Council of State Boards of Nursing and this trademark owner does not sponsor, endorse or support Becker Professional Education in any manner.


    Impact of the United States Medical Licensing Examination Step 2 Clinical Skills Exam on Medical School Clinical Skills Assessment | killexams.com real questions and Pass4sure dumps

    The United States Medical Licensing Exam (USMLE) Step 2 Clinical Skills (CS) exam constitutes a new requirement designed to standardize clinical skills assessment and ensure minimum competence for those seeking licensure as physicians. The exam has generated debate within medical schools about their role in preparing students for clinical practice and for the licensing exam.1 High registration fees, travel expenses, and limited feedback describing performance have dampened student enthusiasm for the new requirement.2

    Educators hoped that the Step 2 CS would motivate schools to enhance clinical skills curricula and testing in undergraduate medical education. The majority of schools now administer a comprehensive standardized patient assessment at the end of the core clerkships.3 However, the extent to which the national licensing requirement is promoting greater focus on content emphasized in the Step 2 CS is poorly understood. One study found that 55% of medical schools had modified their curriculum in response to the Step 2 CS exam, although the nature and extent of those modifications were not described.4

    We designed this study to explore the following questions with the directors of established clinical skills assessment programs: (1) what is the purpose of in-house clinical skills assessment after a major change in licensing requirements; and (2) how is the Step 2 CS affecting medical school clinical skills curricula and assessment?

    Method

    In a prior survey of curriculum deans,3 we identified schools that administered comprehensive clinical skills assessments and requested the names of individuals responsible for standard setting and remediation. A “comprehensive assessment” was defined as a multistation, cross-disciplinary exam outside of a single clerkship involving standardized patients. In Fall 2005, we randomly selected 44 of the 62 identified individuals and extended invitations to participate in an interview study. Potential subjects received up to two phone or e-mail invitations to participate. One subject declined the invitation. We interviewed 25 of the 44 invited subjects, stopping when thematic saturation was reached. The University of California, San Francisco, Institutional Review Board approved the study.

    We chose a qualitative methodology because closed-ended survey questions might not have captured the complexity of participant responses. Instead, we were able to elicit and consider respondents’ open and in-depth descriptions of the internal and external forces influencing their schools’ approaches to clinical skills training and assessment.

    One investigator (KMK) conducted semistructured telephone interviews lasting 30–60 minutes. Participants provided verbal informed consent. The five investigators developed the interview instrument based on group expertise and results of prior work.3 The interview included open-ended questions addressing participant perceptions of and experience with comprehensive assessments, as well as perceived impact of the Step 2 CS exam. After 14 interviews, the investigators refined the interview guide by adding probes, improving flow, and eliminating redundancy. The additional probes were designed to ensure that interviewees elaborated on the rationale for their current exam design, as well as the purposes of the exam in relation to other curricular and assessment activities. Interviews were recorded and transcribed verbatim. The interviewer reviewed all transcripts for accuracy prior to analysis.

    Interviews were coded to identify major themes. Three investigators (KH, AT, KMK) independently read three transcripts to generate codes, which were combined and reconciled. Four more transcripts were used to generate additional codes and refine previously identified codes. These three investigators used the refined code list to code 10 transcripts, and the remaining 15 transcripts were coded by two investigators. Discrepancies were discussed among the investigators until consensus was reached. All five investigators met to review the coded data and identify larger themes. ATLAS.ti V 5.0 software (Scientific Software Development GmbH, Berlin) was used to organize and retrieve coded data.

    Results

    The 25 participating schools represented all four U.S. geographic regions as defined by the American Association of Medical Colleges. Thirty-six percent of participating schools were private institutions and 64% were public—an exact match of the national distribution. Ten schools in the sample had been conducting exams for 10 or more years, whereas six schools had been conducting exams for three or fewer years.

    Respondents reported that their in-house exams serve multiple purposes: assessing competence, providing feedback to both curriculum and students, and preparing students for the Step 2 CS exam. One participant explained:

    We had a lot of debate about what’s the purpose of this exam, are we teaching to what was then a future clinical skills test, are we trying to ensure that our students are competent in their clinical skills before they leave us, are we trying to get information and feedback to the curriculum about student strengths and weaknesses, and knowledge base and skills. And we decided yes, all of those things.

    Prioritization and emphasis of these purposes varied, as did perceptions of how the exam needed to be structured to serve each defined goal.

    Competency assessment

    A major purpose of the in-house assessment was to ensure that students graduated with competency as defined by local faculty. Many schools revisited the need to conduct local assessments of basic competence in the setting of the new licensing requirement:

    We’ve had those conversations: do we want to continue this or not? We’ve said yes, we’re going to continue it. One for practice, and two as a school we wanted to make sure that our students were graduating with these skills.

    Most schools believed their in-house exams were more difficult than the Step 2 CS exam, a difference which they felt made their in-house programs superior both as measures of competence and as preparatory exercises for the national exam. Schools noted the importance of using their internal exams as a means of assessing competencies that were highly valued by their faculty but which were unlikely to be addressed in the national exam:

    We were interested in looking at oral presentation skills, so we built that in. We were also looking at test interpretation, so we build that in, and they don’t necessarily include that in the USMLE Step 2. We also tried to step up the level of our exam—my impression is that the USMLE Step 2 looks at common ambulatory problems. Very basic. So we try to make our patients a little bit more complex, a little bit richer for the students.

    Cases that challenged student skills with cultural competence, evidence-based medicine, and communication with complicated patients were referenced as local priorities not addressed in the national exam. Participants also cited numerous limitations of clerkship evaluations in assessing clinical skills competence, including grade inflation, reliance on knowledge assessments, and insufficient observation of students. For many, these deficiencies elevated the importance of conducting a comprehensive exam.

    Conflicts arose when the faculty had not defined or agreed on competencies. One participant explained:

    Does this in-house exam look like the curriculum? When we don’t have competencies driving the discussion, it’s a little sketchy, because we don’t have faculty saying every student should know how to do the following.

    Schools where students had failed the national exam at higher than expected rates were left to consider whether locally defined competencies aligned with the expectations of the national board. One of these schools described the challenge:

    To make sure my students pass the USMLE, I have to dummy them down a little bit. They exhibit such sophisticated skills that they do things that are not captureable. And they skip over some of the more dreary, routine things that these kinds of scoring require.

    Feedback to students

    Feedback to students was considered a critical purpose of the in-house exam. Schools diverged in their beliefs about the optimal balance of formative and summative feedback. Although all schools provided some feedback to all students, as a rule students with the lowest scores received the most information and follow-up. Many participants noted that the in-house exam created opportunities to engage students who had not previously received or responded to feedback about their performance:

    It gives me an opportunity to take a student who has an odd affect and now there’s data. Instead of me just saying, ‘Gee, this may be a problem; you don’t make good eye contact,’ I can say now, ‘This is a problem. You’re not making good eye contact. It’s been noted in your clerkships and, here on the OSCE, you did poorly.

    Many participants identified barriers to student feedback. Some schools that were heavily invested in administering a high-stakes exam offered no feedback to students during the exam and restricted student access to checklists or videotapes afterward. Others cited limited faculty time as a barrier to providing individual feedback. Another challenge was to ensure that students were focusing on concepts, as opposed to cases, when considering feedback on their performance.

    Students asked to see their checklist items, thinking that would help them—it was too vague to say that they had messed up on the history or physician patient interaction. But we didn’t give it to them purely because we felt it’s not just about this exam. So we didn’t want to train them too specifically to memorize certain skills.

    Participants described a tension between channeling resources for summative assessment versus clinical skills education:

    If you’re doing high-stakes exams, the students are not getting feedback because you can’t do that with a high-stakes exam. If schools are using it as an instructional tool then I think that’s great. It would be nice to be able to do that and then give feedback after each station by faculty members. It takes a lot of faculty members to sit and watch all the stations. We did that a couple of years and it was just a huge undertaking.

    Participants uniformly observed that the USMLE exam promoted student buy-in to standardized patient exams and enhanced students’ motivation to receive feedback on their clinical skills. Many schools devised strategies for providing such feedback, including class meetings, class letters highlighting common errors, and, at sites where policy did not prohibit providing detailed feedback on individual performances, individual score reports or videotape reviews. One school with a longstanding exam and a high degree of faculty commitment to it combined a format similar to the national exam with faculty observers who provided individualized teaching and feedback at each station. Another school with a small class assigned a dean to each student for score review and learning plan development.

    Feedback to curriculum

    Most respondents believed that exam data helped with curriculum evaluation, but few described specific, effective feedback mechanisms. Many described reporting exam results to educational leaders, though the efficacy of this practice varied:

    I go to the clerkship directors after each year’s results are available. I go to their meeting and they’re always so upset that the students don’t demonstrate the depth of questioning and feel that they need to teach that. They do teach that and they’ll teach it again, and next year it’s the same. So, it’s not clear we’re getting anywhere with that.

    At other schools, exam performance data describing pervasive deficiencies in students’ skills prompted new training efforts earlier in the clinical skills curriculum, such as special lectures or specific physical exam teaching in clerkships.

    Exam preparation

    All participants acknowledged the need to use in-house assessments as a tool for preparing students for the licensing exam. Overwhelmingly, schools followed the USMLE format when designing new in-house assessments, and those with longstanding exams implemented formatting changes that increased their exams’ similarity to the Step 2 CS. Common modifications included adjusting the number and length of stations and the interstation format.

    Although many schools viewed these changes positively, others were resigned to making changes for the purpose of national exam preparation. One school that had modified the in-house assessment format did so begrudgingly:

    We’ve altered what we ask the students to do at the close of the transaction. I had designed individual post visit assignments. And I changed all that and I went to writing SOAP notes, because that’s what you’ve got to do there. So it has crimped our style.

    Still, most schools did not feel that changing their exam format to mirror the USMLE significantly altered the primary purpose of their internal exam:

    We have always considered clinical skills to be very, very important here, and it’s always been a high priority. So I don’t think USMLE changed the priority. I think in terms of the in-house exam that it’s made the students more interested in using it as a preparation assessment for the thousand-dollar test.

    Two schools with longstanding clinical skills assessment programs felt that the licensing exam was redundant, though they agreed with the principle of national standards for clinical skills competency. Nonetheless, both had modified the format of their in-house assessments to increase similarity to the Step 2 CS.

    Local exams and the national exam

    Some schools with new in-house exams described struggles with basic administrative issues such as timing of administration, scoring methodology, and identifying mechanisms for reporting results to students and curricular leaders. These schools faced the dual challenge of securing faculty and student buy-in for their internal exams while also determining the extent to which their local efforts should be influenced by the new national requirement. In contrast, schools with established programs described firm values regarding student assessment and integration of standardized patient experiences throughout the curriculum:

    I’m just happy that we were able to set up our comprehensive exam before the CS exam came down the pike, because I feel that it was the right thing to do with our curriculum. We now have standardized patient exams starting in week 8 of our curriculum. It’s how we set up our model of education.

    The presence of the Step 2 CS exam as a measure of minimum competence led some schools to reassess the purpose of in-house exams. These schools did not plan to abandon standardized patient experiences, but rather to change the emphasis of their efforts:

    When the Board Exam became required for licensure, we began talking about: Do we need our exam as a high stakes exam? Can we take the funding and put that into a formative program within the context of the clerkships?

    All participants endorsed the national exam and in-house exams as validating the importance of clinical skills for medical students:

    It elevates clinical skills more to a par with the cognitive skills that up until now have been alone in what counts as a qualified student. The students of course complain a great deal about the inconvenience, the money, the travel, the time. As do we. But I am deeply grateful that the students now see, in terms that they cannot misunderstand, that the medical establishment requires demonstration of these interpersonal skills before they’re going to qualify them as a doctor.

    Discussion

    The Step 2 CS exam has motivated schools with established clinical skills assessments to view their exams not only as competency assessments but also as preparatory experiences for the licensing exam. Many schools have designed new exams or modified existing exams to reflect the Step 2 CS format, changes that many students and faculty perceive as important for familiarizing students with a testing situation in a realistic, lower-stakes setting.

    The Step 2 CS was created in part by a desire to focus attention on clinical skills training.5 Our results suggest that faculty and students have responded to the emphasis on testing clinical and interpersonal skills with enhanced motivation to ensure competency. Experience with other high-stakes testing indicates that learners perform better when they are given the opportunity to participate in setting learning goals and practice required skills,6 and the USMLE exam creates an institutional obligation to provide these experiences.

    Schools in our study varied in the perception that the national exam created a burdensome obligation to “teach to the test.” Whatever their enthusiasm for the USMLE exam, schools responded consistently to the licensing exam by mimicking its format, changes that were motivated by a desire to make their in-house exams more useful as preparation for licensure. However, to be truly useful for learning, a high-stakes in-house exam must be preceded by formative assessments that are based on the learning goals established by the teacher and the institution.7 Schools that articulated clear values about clinical skills training that predated the Step 2 CS exam were able to incorporate the external mandate into their training programs with relative ease. In contrast, many schools were still developing mechanisms to use assessment information to enhance the curriculum and provide individual student feedback. Whether the quantity, quality, and utility of this curricular and student feedback will increase over time is unclear.

    Our study is limited in that participants all had established clinical skills assessment programs; the minority of schools without such programs may perceive different challenges in clinical skills training. Further, our participants’ perceptions may differ from those of other faculty at their institutions. However, the study is strengthened by the fact that we interviewed individuals who were intimately involved in developing and implementing comprehensive clinical exams, individuals whose views are critical to understanding issues in clinical skills assessment. We had a large sample size for a qualitative study, which yielded a range and depth of information about a dynamic topic.

    This study illustrates the ways in which medical schools are incorporating a new licensing requirement into their vision of clinical skills training, and the tensions that influence defining competency, providing opportunities for formative and summative assessment, allocating resources, and preparing students for licensure.

    Acknowledgments

    The authors thank the Josiah Macy Jr. Foundation and the participating schools.


    3.22: United States Medical Licensing Examinations (USMLE) Requirements: Step 1, Step 2 CK and Step 2 CS | killexams.com real questions and Pass4sure dumps

    To graduate, students must pass USMLE Step 1 and Step 2 CK (Clinical Knowledge), and must have taken the Step 2 CS (Clinical Skills). The National Board of Medical Examiners (NBME) sets the level for passing the steps of the USMLE.

    Students must receive an overall pass on Step 1 of the USMLE within 12 months of the start of clinical clerkships. Students appearing on the agenda of the Committee on Performance, Professionalism and Promotion (CP3) as a result of academic deficiencies in pre-clerkship courses may be required to sit for the USMLE Step 1 prior to beginning clerkships. Exemptions to this policy must be approved by the CP3.

    Students must receive an overall pass on Step 2 CK (Clinical Knowledge). Students should apply for Step 2 by November 1 of their last year and must sit for the examination no later than March 30 in order to ensure that test scores are received by the School of Medicine Registrar in time to clear students for graduation.

    Failure to meet these requirements will result in review by the CP3. Passing an institutionally administered USMLE equivalency exam may, under certain circumstances and in the discretion of the CP3, serve to meet Step 2 CK requirements for the MD degree. Such institutionally administered USMLE equivalency exams do not, however, meet requirements for licensure to practice medicine.

    Students must take the USMLE Step 2 CS (Clinical Skills) examination prior to graduation. A passing score is not required for graduation but is required to sit for Step 3; passing Step 3 is required for licensure in California and virtually every other state. Note: Students not intending to enter the residency match may qualify for an exemption. A letter co-signed by the student and advisor must be submitted to the CP3 for approval. The student must have passed the school’s CPX exam before requesting the Step 2 CS exemption.

    The USMLE Step 1 and Step 2 CK are administered by computer at Prometric Test Centers. Testing occurs throughout the year, except for the first two weeks in January.

    Up-to-date information on the availability of testing times at Prometric is posted at http://www.prometric.com

    Scheduling permits for a practice test session may be obtained at http://www.usmle.org

    Information on NBME Self-Assessment Services can be found at: http//www.nbme.org/Students/sas/sas.html

    Testing for Step 2 CS is currently offered at five centers in different areas of the country. Information on the location can be found on the website.

    To apply for USMLE Step 1, log into the NBME website to complete the online application. At the end of the online application, there are instructions for completing a “Certification of Identification and Authorization Form." Print and complete the form. Attach a photo. Submit the completed form to the School of Medicine Registrar’s Office for completion.

    Applications for Step 1 exams, and in some cases Step 2 exams, require an online enrollment verification on the NBME website by the Registrar. The online verifications are automatically completed at least once a week.

    updated August 2018



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    USMLE USMLE Exam (United States Medical Licensing Examination) Detailed Information



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