At the end of second year, all medical students take the first part of the United States Medical Licensing Examination (USMLE-1), administered by the National Board of Medical Examiners (NBME). The purpose of the NBME is to prepare and administer a test that states feel confident in using to determine medical competency when deciding to issue a license to practice medicine. There is no national license to practice medicine. Each state has its own rules and issues its own license.
All medical students, from both MD-granting and DO-granting medical schools, are required to take and pass the medical board exam. The USMLE is a three-part exam:
- Step 1 is taken in the second year of medical school and tests your knowledge in the basic medical sciences.
- Step 2 is taken in the fourth year of medical school and tests whether you can apply your medical knowledge in providing patient care under supervision. Step 2 is divided into two parts: a written exam called "Clinical Knowledge" and a "Clinical Skills" portion that requires you to interact with patients played by actors.
- Step 3 is taken in the first year of residency (internship) and tests your ability to apply your medical knowledge in providing unsupervised medical care.
These are very difficult exams. However, over 95 percent of students from US or Canadian medical schools pass these exams [source: USMLE].
In the third year, medical students begin rotating through each of the specialties of medicine, such as internal medicine, surgery, pediatrics, obstetrics and gynecology, psychiatry, neurology, radiology, emergency medicine, family medicine, etc. In the fourth year, more clinical rotations with a higher level of responsibility are completed, in addition to electives.