Computer-Based Testing (CBT) and the USMLE

The United States Medical Licensing Examination (USMLE) is a three-step national competency test required for physicians before they can practice medicine. Step 1 is traditionally taken by second-year medical students, and tests basic physiologic mechanisms and principles. Step 2 emphasizes clinical diagnosis and disease pathogenesis, and is traditionally taken at the end of medical school. Step 3 tests first year residents in clinical management.

Those seeking ECFMG certification can take Step 1 and Step 2 in any order, but must pass both in order to take Step 3. Since their introduction (Steps 1 and 2 in 1992 and Step 3 in 1994) each has been administered twice annually in a two-day format consisting of multiple-choice questions (MCQs), either "one best answer" or "extended matching."

Until last year the USMLE was only administered as a written exam, commonly referred to as pen-and-paper testing (PPT). In March 1999, the National Board of Medical Examiners (NBME) -- after years of study and development, accompanied by much controversy -- launched computerized-based testing (CBT). USMLE Step 1 was computerized in May, Step 2 in August, and Step 3 will be computer-administered in mid-November of 1999. By the end of November, a great many medical students and physicians-in-training will have experienced national standardized CBT.