As the only peer-reviewed quarterly publication dedicated to topics and issues critical to medical regulation in the United States and around the world, the Journal of Medical Regulation addresses all aspects of this vital element of public protection. JMR’s “Assessment Briefs” offer periodic updates on important developments in the examinations relied upon for medical licensure in the United States and globally.

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

Following the spring 2020 suspension of USMLE Step 2 Clinical Skills (CS) due to the COVID-19 pandemic, USMLE announced its intention to take 12–18 months to bring back a modified Step 2 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, USMLE announced in January 2021 the discontinuation of Step 2 CS.

State medical boards are reminded of several important operational and policy considerations:

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

  • USMLE examinees with four or more unsuccessful attempts, including incomplete attempts, on any USMLE Step (including Step 2 CS) are ineligible to apply for any USMLE Step.

  • The USMLE transcript now includes the following statement: “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 Clinical Knowledge (CK), and Step 3.”

State medical boards are encouraged to check their examination requirements for licensure, including any modification or temporary criteria set during the COVID-19 disruption. USMLE encourages state medical boards to keep the following in mind:

  • The examination prerequisite for Step 3 is passing Step 1 and Step 2 CK.

  • A failing Step 2 CS result does not disqualify individuals from eligibility for USMLE Step 3 if the candidate’s exam history does not include 4 or more unsuccessful attempts at Step 2 CS.

  • The USMLE program defines successful completion of the USMLE sequence as passing Step 1, Step 2 CK, and Step 3.

Meanwhile, NBME continues pilot research on behalf of the USMLE program evaluating communication and clinical reasoning testing formats to bolster the assessment of these competencies with the discontinuation of Step 2 CS. Piloting and feedback has included external participants (eg: 3rd and 4th year medical students) as well as individuals from USMLE’s two advisory panels: the State Board Advisory Panel to USMLE and the USMLE Medical Student & Resident Advisory Panel.

Finally, the USMLE continues to prioritize engagement and direct participation by the state medical board community. Since the program’s inception in 1991, over 300 individuals from nearly 60 state medical boards have participated with the USMLE program in some capacity. The annual USMLE orientation for state board members and staff remains a primary means for introducing the USMLE to state board members and staff. The most recent orientation—held October 3, 2022, at the FSMB offices in Texas—saw twenty participants from twelve medical boards.

Individuals with experience on state medical boards, both current and former members, including both physician and non-physician members, have opportunities to participate with the program in one of many capacities, e.g., service on a committee, work group, panel, focus group, etc. Interested individuals wishing to learn more about the annual USMLE orientation or other participation opportunities should contact Frances Cain, MPA, FSMB Director for Assessment Services, at [email protected].

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

  • On May 5, 2022, the National Board of Osteopathic Medical Examiners (NBOME) discontinued the reporting of three-digit scores for the Level 1 examination.

  • On July 1, 2022, COMLEX-USA attempt limit changed from 6 to 4 for any exam in the series.

COMLEX-USA Level 2-Performance Evaluation (Level 2-PE) was suspended indefinitely due to COVID-19 in February 2021 and formally discontinued in June 2022. COMLEX-USA candidates are currently verified by attestation from their COM dean that they have demonstrated competency in fundamental osteopathic clinical skills. Transcripts include the following notation:

The Level 2-PE examination was indefinitely suspended in March 2020. Some candidates who previously failed this examination may not have had the opportunity to retake the examination. Beginning with the Class of 2020, in the absence of the Level 2-PE, the NBOME requires an attestation from the COM Dean that candidates have demonstrated the fundamental osteopathic clinical skills necessary graduation. This will allow them to meet eligibility requirements for Level 3 and complete the COMLEX-USA series.

In February 2021 the NBOME assembled a Special Commission on Osteopathic Medical Licensure Assessment to review the COMLEX-USA program, evaluate defensible alternative pathways for verification or assessment of fundamental clinical skills and other competencies, and assure that the COMLEX-USA licensure examination pathway continues to evolve with the rapidly changing practice of osteopathic medicine, osteopathic medical education and health care.

The Special Commission recommended the development and piloting of a nationally standardized core competency capstone for osteopathic medical students that would assess patient-physician communication skills, hands-on physical exam, and osteopathic manipulation treatment (OMT) skills. In June 2022, the NBOME Board directed work to begin on this capstone. Verification of osteopathic clinical skills competencies by COM deans has been extended to the Class of 2025.