Assessment Briefs

The United States Medical Licensing Examination (USMLE), established in 1991 as a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), is a three-step examination for medical licensure in the United States.

The program announced major policy changes in February 2020 and further changes stemming from the disruption created by the COVID-19 pandemic. Several of these policy changes have now, or are about to become, operational. They include:

• The USMLE program is reducing the total number of attempts an examinee may take a Step from six to four. The policy change will be effective for all applications submitted on or after July 1, 2021. At that time, examinees who have four or more prior attempts, including incomplete attempts, on any USMLE Step (including Step 2 CS) and have not passed will be ineligible to apply for USMLE Steps.

• Step 1 will transition to reporting solely pass/fail outcomes for all administrations taken on or after January 26, 2022. Outcomes for Step 1 administrations occurring before January 26, 2022, will continue to include a three-digit score and pass/fail.

• Step 2 Clinical Knowledge (CK) and Step 3 examinations will continue to be reported as a three-digit score and pass/fail.

• Following the spring 2020 suspension of Step 2 CS due to the COVID-19 pandemic, USMLE announced its intention to take 12–18 months to bring back a modified USMLE Step 2 Clinical Skills (CS) exam appreciably better than the prior assessment. After reviewing current and anticipated progress with the exam and in consideration of the rapidly evolving medical education, practice and technology landscapes, the FSMB and NBME announced in January 2021 the discontinuation of Step 2 CS.

• Discontinuation of Step 2 CS resulted in several USMLE policy clarifications and/or changes, including:

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    All Step 2 CS results will continue to be reported on the USMLE transcript.

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    Language will be added to the USMLE transcript regarding the discontinuation of Step 2 CS. The following statement will be included: “The USMLE Step 2 CS examination was last administered March 16, 2020. Examinees with a failing outcome may not have had an opportunity to retest. The USMLE defines successful completion of its examination sequence as passing Step 1, Step 2 CK, and Step 3.”

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    Candidates who have reached the attempt-limit on Step 2 CS: Effective for applications submitted on or after July 1, 2021, USMLE examinees who have four or more attempts, including incomplete attempts, on any USMLE Step (including Step 2 CS) and have not passed will be ineligible to apply for USMLE Steps.

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    Effective April 29, 2021, Step 3 eligibility requirements were revised to match the criteria established before Step 2 CS became part of the USMLE.

The Special Purpose Examination (SPEX), a joint program of the FSMB and NBME, is a generalist examination for use by medical licensing authorities in evaluating the current medical knowledge of physicians who are some years away from having passed a national medical licensing examination.

Recent changes to SPEX include:

• An updated SPEX exam was introduced in January 2019. Specific improvements included an update of the exam blueprint, an update of the item pool (i.e., new test forms and questions), and implementation of new item formats (e.g., drug ads and abstracts). The exam was also shortened by 2.5 hours (from 8.5 hours to 6 hours) to better accommodate physicians’ busy schedules.

• Another refresh of the exam will take place in 2021, with changes anticipated to be implemented in 2022.

The Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) is a three-level, national standardized licensure examination designed for licensure for the practice of osteopathic medicine. The examination is administered by the National Board of Osteopathic Medical Examiners (NBOME). The COMLEX-USA Examination Series is designed to assess osteopathic medical knowledge, knowledge fluency, clinical skills, and other competencies essential for practice as an osteopathic generalist physician. It is also a graduation requirement for attaining a DO (Doctor of Osteopathic Medicine) degree from colleges of osteopathic medicine in the United States.

Upcoming changes to the assessment series include:

• Level 1 is changing to Pass-Fail reporting without numeric scores beginning in May 2022

• COMLEX-USA attempt limit is changing from six to four effective July 1, 2022

The COMLEX-USA Level 2-PE was temporarily suspended in March 2020 due to the COVID-19 pandemic. In February 2021, the NBOME indefinitely suspended the examination and formed a Special Commission for Osteopathic Medical Licensure Assessment. The Commission was first charged with evaluating defensible alternative pathways for verification or assessment of fundamental clinical skills. The Commission is structured to be representative of perspectives from across the UME-GME-Licensure continuum, including state licensing board representatives, student representatives and public members/patient representatives.

In the absence of a national clinical skills examination, alternate pathways for osteopathic clinical skills attestation for the Classes of 2020–2022 have been recommended and approved by the NBOME Board of Directors. These will be included with graduation attestation for these classes and will be noted on the NBOME transcript.

• COM Dean attests that the student is in good academic and professional standing, meets the requirements to graduate and has demonstrated the fundamental osteopathic clinical skills necessary for graduation.

• Enhancement to the COM Dean attestation that the student is in good academic and professional standing, meets the requirements to graduate and has demonstrated the fundamental osteopathic clinical skills necessary for graduation.

• Details of enhanced attestation were announced during the summer of 2021.

Phase 2 of the Special Commission began in May 2021 and will continue through April 2022. The Commission will also be reviewing the entire COMLEX-USA examination program to ensure that this licensure examination pathway continues to evolve with the rapidly changing practice of osteopathic medicine, osteopathic medical education and health care. Test content, emerging technologies in test delivery, and attention to diversity, equity and inclusion are key priorities.