United States Medical Licensure Examination (USMLE/CSE)

A passing score on the USMLE Step 1 and Step 2 Clinical Knowledge (CK) examinations are required for graduation from medical school. Students must have the approval of the Academic Status Committee to be sponsored for each of the USMLE examinations.

USMLE STEP 1

All students must take USMLE Step 1 following the successful completion of Phase 1 (Principles of Medical Practice) and prior to beginning Phase 2 required clinical clerkships or an educational leave of absence. All students must complete USMLE Step 1, on or before the Sunday immediately prior to the start of orientation to Phase 2 clerkships. To support success on USMLE Step 1, all second-year students will receive an analysis of their academic performance through the second year fall semester that is predictive of their future performance on the USMLE Step 1 exam. All students must take the NBME Comprehensive Basic Science Exam (CBSE) within 1 week of completion of Phase 1 courses. Students will receive individualized reports to assist in their preparation for the USMLE Step 1 exam.

Students on Track

Students will be identified as on track to pass Step 1 in the following ways and may sit for Step 1:

  1. Prediction model indicates likelihood of passing Step 1; and
  2. Student achieves a score on the initial CBSE that corresponds to >50% chance of passing Step 1.

Students on Track may retake the CBSE again for self-assessment.

Students for Additional Testing

Students will be identified as needing additional testing in the following ways:

  1. Prediction model indicates likelihood of passing Step 1; and
  2. Student does not achieve a score on the initial CBSE that corresponds to >50% chance of passing Step 1.

These students identified for additional testing will be required to retake the CBSE or CBSSA after a period of study not to exceed 5 weeks and score at or above the historical equivalent Step 1 passing score to be sponsored for USMLE Step 1. IF the student does not meet the criteria to sit for Step 1 on the 2nd attempt at the CBSE or CBSSA they will be required to following the same process as the at risk students.

Students at Risk

Students will be identified as at risk for Step 1 failure in the following ways:

  1. Prediction model indicates significant risk of not passing Step 1; or
  2. Student does not meet CBSE/CBSSA criteria to sit for Step 1 before the beginning of clerkship orientation.

These at risk students will be required to:

  • Meet with the learning specialist and develop a structured learning plan.
  • Meet with an identified content expert(s).
  • After 4 weeks of intentional study; students identified above must retake the CBSE and score at or above the historical Step 1 equivalent passing score to be sponsored for USMLE Step 1.
  • Students who do not make the benchmark will delay the first clerkship and have a monitored individual study plan approved by the Academic Status Committee. These students must retake the CBSE or CBSSA and score at or above the historical equivalent Step 1 passing score to be sponsored for USMLE Step 1.

Students unable to meet criteria to sit for Step 1, and take the Step 1 examination by March 15th of the following year will be referred to the Academic Status Committee, and may receive adverse actions, i.e., probation or dismissal, for failure to make adequate academic progress.

*Of note: any student may take the CBSE again at the 4 week mark for self-assessment.

Not sitting for USMLE Step 1 prior to the beginning of Phase 2 required clinical clerkships in May results in an immediate one year leave of absence for the student. Deferrals may be granted by the Associate Deans of Student Affairs or Medical Education. Deferrals may be granted for medical reasons. Documentation from the student’s healthcare provider will be required. Deferrals may also be granted for significant personal reasons, such as life-threatening illness in a close relative.

If a student receives notification of USMLE Step 1 examination failure, the student may petition the ASC to request approval for a second administration of the USMLE Step 1 examination. If a second administration of the USMLE Step 1 examination is approved by the ASC, students who are otherwise in good academic standing may be allowed to finish their current clerkship. If they are on the Family Medicine Clerkship, they may finish the clerkship. They will then defer the next clerkship to study for the re-examination. They must prepare an individualized study plan and have this plan approved by the Associate Dean of Medical Education or the Associate Dean of Student Affairs. They must register for the re-examination prior to the onset of the next clerkship.

Students who are not in good academic standing (e.g., academic probation) at the time they receive notification of failure should follow the same course of action outlined above with one exception. If approved by the ASC for a second administration of the USMLE Step 1 exam; their study plan must also be approved by the ASC. Any student who does not pass USMLE Step 1 within one year of the end of the Phase 1 curriculum must appear before the ASC.

Students who subsequently fail a second administration of USMLE Step 1 examination and have previously failed a course or received an unsatisfactory grade will be on academic probation. These students may petition the ASC to request approval for a third administration of the examination. If approved by the ASC the student will be placed on a leave of absence for the remainder of the school year in order to prepare for the examination. Students must schedule the re-examination by March 15 so that the examination score is available before the start of the new Phase 2 academic year. Failure of USMLE Step 1 examination on the third attempt will result in dismissal of the student from medical school. The student may petition to review this action to the ASC. If the ASC denies the petition, the student may then appeal to the Deans’ Advisory Committee. The decision of the Deans’ Advisory Committee is final and will constitute final agency action.

MD-PhD Students and STEP 1

All MD-PhD students must follow the timeframe for completing the USMLE STEP 1 examination as outlined for medical students.  MD-PhD students must enroll in and comply with the USMLE STEP 1 course. If an MD-PhD student requests more study time for STEP 1, they must take a leave of absence from medical school and will forego the MD-PhD stipend while on leave.  Upon completion of USMLE STEP 1, they may enroll in a graduate course or research elective to have the stipend reinstated.

MD-PhD Students Return to MS3

All MD-PhD students are expected to return to Phase 2 of the COM curriculum with the new academic year (May).  An MD-PhD student can request an extension if 1) they already successfully completed a clinical clerkship before starting graduate school AND 2) they plan to return in time to join the medical students who have just completed the first Phase 2 clerkship rotation.  Students who did not complete a clinical clerkship prior to their PhD must start their clinical clerkships at the start of Phase 2.

USMLE STEP 2

All students are required take the USMLE Step 2 Clinical Knowledge examination after successful completion of Phase 2 and prior to October 31 of their fourth year. Exceptions due to extenuating circumstances may be approved by the Associate Deans of Student Affairs or Medical Education.  Students are not eligible for graduation unless they achieve a passing score on the USMLE Step 2 CK examination. Students who receive a failing score on the USMLE Step 2 CK will be referred to the ASC for review.

To support success on USMLE Step 2 CK, all third-year students will take the Comprehensive Clinical Science Self Assessment (CCSSA) within 1 week of completion of Phase 2 clerkships.

Students who fall within a cohort at risk of failing Step 2 CK based on a predictive model that uses core clerkship NBME subject examinations, will be required to achieve a score on the CCSSA equivalent to the Step 2 CK minimum passing score before being allowed to sit for Step 2 CK. 

CLINICAL SKILLS EXAMS (CSEs)

Seven Clinical Skills Exams (CSEs) are required within the UF COM educational program as outlined below:

  • Year 1 – One CSE is conducted during the spring of year 1 and successful completion is required for advancement to year 2.
  • Year 2 – One CSE is formatively assessed during the fall term. A second CSE (CSE 2B) is part of the USMLE Step 1 Preparation course and is a high stakes examination.  If a student fails CSE 2B they must meet with the Medical Director of the Anaclerio Learning and Assessment Center or their designee to develop a remediation plan. After successful remediation, the student may then progress to Phase 2 clerkships. 
  • Year 3 – Two CSEs are required independent of the clerkships in Phase 2.  The fall CSE formative. A spring CSE is a summative assessment of clinical skills and is conducted at the conclusion of Phase 2. A passing score of the spring CSE is a graduation requirement. Students who fail this examination must meet with the Medical Director of the Anaclerio Learning and Assessment Center (or designee) to develop a remediation plan, and with the Phase 3 Director or Associate Dean of Student Affairs to discuss modification of their senior schedule. To fulfill the graduation requirement, students needing remediation will be required to demonstrate mastery in the Clinical Skills Refresher course.
  • Year 4 – One formative CSE is required within the Transition to Residency course.