Many prospective doctors are relieved when they finish their Medical College Admissions Test in preparation for attending medical school -- but they shouldn't get too comfortable right away. There's another important examination a student will need to pass before being able to practice as a doctor: the United States Medical Licensing Exam. While the MCAT and the USMLE have very different purposes, both exams do test the student's problem-solving skills.
The MCAT is the primary exam that medical colleges use to assess potential candidates. The exam, therefore, tests whether a student has the skills needed to learn how to be a doctor. The USMLE, on the other hand, is designed to test whether a medical school graduate has the competencies necessary to serve as a physician in the United States. The exam tests how well a graduate can apply the skills learned in medical school to real-world situations.
The structures of the MCAT and the USMLE are very different. The MCAT is completely made up of multiple choice questions. The entire exam takes five hours and ten minutes, of which four hours and five minutes are spent on actual exam materials. The remaining time is for breaks in between sections. Students complete the exam in one sitting using a computer program at a testing center. The USMLE, meanwhile, is divided into three different "steps" of material. Unlike the MCAT, the USMLE is not entirely multiple-choice. For example, the "step 2, clinical skills" section involves 12 encounters with patients, where graduates must demonstrate their knowledge of dealing with patients, and the third step includes computer-based case simulations along with multiple-choice questions. The first step is completed in one eight-hour session, the second step includes one nine-hour session and one eight-hour session and the third session is completed in two eight-hour testing sessions.
Content of the Exams
The content of the MCAT and the USMLE varies considerably. The MCAT is broken down into three broad categories: verbal reasoning, physical sciences (including chemistry) and biological science. The MCAT tests knowledge of standard science, quantitative reasoning and communication principles. Its content is surprisingly not very medical science-specific. The USMLE, on the other hand, is divided into three steps, each of which tests medical-specific knowledge and applications. Step 1 tests the student's understanding of human health in areas such as anatomy, biochemistry and pharmacology. Step 2 tests how well a graduate understands specific medical procedures and methods, like obstetrics, surgery and psychiatry. A second part of Step 2 focuses on ensuring a student can apply the knowledge of the first half of Step 2 in practice. Finally, Step 3 examines whether a graduate understands the different stages of care, including emergency care and long-term care. Both exams ask questions that are intended to test the student's ability to think critically and to solve problems.
The way the MCAT and USMLE are scored also differs. On the one hand, the MCAT score is merely used to assess a student's knowledge relative to other applicants. As such, there is no real "pass/fail" point. Instead, a student must strive to perform as well as possible to be competitive in admissions. Each of the three MCAT sections are scored between 1 and 15, and these three scores are added together for a cumulative score. Students receive their scores within a month. The USMLE, on the other hand, is reported as a three-digit score. While the passing score threshold is reviewed and changed from time to time, as of 2013 the passing scores are 188 on Step 1, 203 on the knowledge portion of Step 2 and 190 on Step 3. The practical application portion of Step 2 is graded on a strict pass/fail scoring metric. Passing all the portions of this test allows a student to practice as a physician in the United States.