Introduction

With the dreaded USMLE Step 1 now always around the corner -- it's now given 6 days a week, every week! -- the test has become a popular course of questions on Medscape Med Students' discussion boards. I decided to go straight to the source for some answers, so here's a Q & A with Chirag Amin, MD, and Tao Le, MD, 2 of the authors of that USMLE bible, First Aid for the USMLE Step 1 2001: A Student to Student Guide. Dr. Amin is now Vice President of Content and Community for www.medschool.com, where Dr. Le is Chief Medical Officer.

Medscape: Describe the USMLE.

Drs. Amin and Lee: The USMLE Step 1 computer-based test (CBT) is a 1-day test, taken on a computer, that's administered once a day (except Sunday) on a year-round basis at hundreds of testing centers around the world. The test consists of a total of 350 multiple-choice, single-best-answer questions that are broken down into seven 1-hour blocks, with 50 questions per block. Examinees are given short breaks between blocks, as well as a lunch break.

M: How long in advance of Step 1 should students start preparing? Should they make studying for the USMLE a part of studying for regular courses?

A&L: The USMLE Step 1 was designed to assess medical science knowledge and concepts taught during the preclinical years at a typical medical school. Therefore, medical students who studied diligently during their first- and second-year coursework end up minimizing the stress and workload of a USMLE Step 1 review. Regardless, most students start intensive examination preparation on a full-time basis (ie, 6-8 hours of studying per day) approximately 4-6 weeks before the actual examination date. Due to differences in their medical education/training and curriculum as well as the time that often lapses since the completion of basic science coursework, international medical graduates (IMGs) usually need 2-4 months of study before taking the USMLE Step 1.

M: If you have a month, as many schools deliver students, what's a good schedule?

A&L: In the month leading up to the exam, the majority of medical students find themselves studying anywhere from 6-12 hours each day, dividing their study time proportionally over the 7 traditional basic science disciplines, which include anatomy, behavioral sciences, biochemistry, microbiology/immunology, pathology, pharmacology, and physiology. In addition, many students devote the last week of their test preparation to comprehensive review as well as going through trial questions. Many students recommend thorough review of the high-yield facts in First Aid for the USMLE Step 1 during the last week. Generally, students devote more time to the more clinically relevant disciplines, such as pathology, pharmacology, and microbiology/immunology. However, a common mistake that students make is not spending enough time covering all subject disciplines thoroughly.

M: What books can you recommend for general review? For specific subjects?

A&L: Students usually find themselves buying anywhere from 10-25 review as well as question-and-answer (Q&A) books, but most will start with our First Aid for the USMLE Step 1. The major medical publishing companies such as McGraw-Hill, Lippincott Williams & Wilkins, Blackwell Science, and Harcourt Health Sciences have several excellent titles for USMLE review. In addition, many students have benefited from books that present this basic science material from a clinical perspective, such as our Underground Clinical Vignettes series.

M: What kind of surprises, in terms of subject material, have students told you about?

A&L: Many medical students that we have talked to underestimate the amount of clinical material on the USMLE Step 1 examination. For example, a significant portion of the anatomy that is tested on the USMLE test is based on one's ability to recognize anatomical structures on common radiographic images, such as x-rays, CT, and MRI scans. Furthermore, many students also leave the test feeling somewhat intimidated regarding the clinical slant of how the basic science material is tested. Knowing specific disease pathophysiology as well as drug mechanism of action in the context of a clinical scenario is essential for doing well on the USMLE.

M: Do courses work?

A&L: This depends on the student's learning style and level of discipline. Only a small percentage of students take a review course for the USMLE Step 1 examination. Many students feel that they can benefit more by organizing a study schedule that is focused around their own strengths and weaknesses. However, there are some students who are not effectively able to manage their own study time. Those students may benefit from a structured review course.

M: What about cramming?

A&L: Because the material tested on the USMLE Step 1 examination covers a large amount of information that is learned over the course of 2 years in medical school, strict cramming is usually not an effective method for USMLE preparation. Furthermore, since many questions on the test are asked from a clinical standpoint, requiring medical reasoning and problem-solving skills, a structured and disciplined review over the course of several weeks is far more effective in terms of doing well on the test as compared to cramming. That being said, anecdotes abound about medical students passing just by cramming First Aid for the USMLE Step 1. Again, cramming is not recommended.

M: What kind of advice do you have for international medical graduates?

A&L: The most important advice for international medical graduates is to become familiar with taking exams on the computer. The vast majority of international medical graduates have never taken an test on the computer, and this is a major obstacle. Factors such as eye strain and mouse dexterity can serve as a major obstacle when taking the examination. The more that one is able to become familiar with the specific test-taking environment, the better that person is able to concentrate on the test itself.

M: Any particular advice for students who are retaking the test after failing?

Honestly assess your weaknesses and shortfalls in your previous test preparation, and focus on improving in those areas. Retakers have the advantage of experience, and most use this advantage to their benefit in terms of revising their method of test preparation when studying the second time around. The good news is that retakers generally have a very high pass rate.

M: Can you list helpful resources?

A&L: There are a number of helpful resources for USMLE preparation. In terms of textbooks, one textbook that gives an excellent overview of the exam, including a database of high-yield facts and a detailed list of useful resources, is our First Aid for the USMLE Step 1. Many students consider this book the best place to start their test preparation. In addition, Medschool.com's community Web site (https://students.medschool.com) has a USMLE Study Center that provides a wealth of free information, including online USMLE lectures, trial training schedules, simulated test modules, recommended books, discussion forums, and much more. Another important resource is the National Board of Medical Examiners (NBME) Web site at https://www.nbme.org, which provides students with the most up-to-date information about the examination.

The following procedure will install the Exam4 software on your computer, and verify that it works.

Software Installation Steps:
This software will run on Windows 10/11 and Mac OS X 10.15.7-13 (Ventura).

• If you have used Exam4 on your computer before, DELETE ALL OLD DESKTOP ICONS/ Uninstall (Windows) previous versions of the Exam4 software.
  Go to www.exam4.com from a web browser. (e.g. Chrome, Firefox)
• Select "Law schools" from the left pane.
• Scroll down the page and under Missouri, click on "Saint Louis University School of Law".
• Enter your information as instructed.
• Choose your operating system from the list. (Win10/11, Mac10.15.7-13)
• Click on “Submit Form”.
• Place a check in the confirmation box after practicing the instructions, and click on the link at the bottom of the page, which will look like the line below:
  Exam4 for [your Operating System] > click here to download
• Once the file has downloaded, double-click on it to install the software.
• Installation of the software is now successful. Be sure to submit a Practice test well in advance of your first scheduled exam. 

Practice test & Submittal Steps:
You must be connected to the SLU-users wireless network. SLU-guest or outside networks will not work.

• Extegrity recommends that you CLOSE the software now, and re-launch using the red e icon on your desktop.
• Click OK through the Welcome screen.
• Select the button for Prepare to start a new exam, and click Next >.
• Enter your 4-digit final test number into the test ID fields. These numbers must match.
• For the Course fields, select “… Practice exam”, and click Next >.
• Check the confirmation box, and click OK.
• The next page should be left as is. Do not set any optional timers, alerts or font sizes. Click Next >.
• Read the following page closely, then check the Got it? box when you are ready, and click Next >.
• Under Type selected test Mode here: type in “CLOSED” (No quotes).
• Place a check in the check box, and click Next >.

You will soon be running the Exam4 software, which does NOT allow other windows to be open. You will need to print these directions BEFORE PROCEEDING in order to continue following them after this step.

• Click Begin Exam.
• If your computer passes the security check, the test software is working.

If it does NOT pass the security check, you may be unable to take exams on your laptop. Please contact Extegrity technical support directly through their website for assistance.  

There is not an actual test to take during the practice exam, but you can explore the features of Exam4 by typing some text and viewing the various menus at the top of the word processing screen, including the Multiple Choice window.

• When finished, select End test > End test Now, check the confirmation box, and click OK, End Exam.
• In the pop-up window, select the "Submit Electronically" button.  A message should pop up saying "Your file has been stored on the server". If you receive an error, verify that your laptop is connected to the SLU-users network and functioning.
• Select File and Save Options > Exit.
• Check the “I'm sure” box (if you are), and click Exit Exam4.
• You can rerun the Exam4 software anytime using the red E icon on your desktop.

USMLE™ - United States Medical Licensing Examination Centers

The following are postal addresses and phone numbers of the centers, where the US Medical Licensing Examination is held in India. This has started since May this year, with USMLE Step 1, and the Step 3 examination has also been shifted to the computer-based testing (CBT) since November 1

The Ministry of Health has indicated that it cannot automatically absorb all Sri Lankan doctors to the Heath Services. This, and many other reasons, may prompt a doctor to explore working overseas. One country that regularly employs a substantial number of foreign doctors is the United States of America. This question and answer session attempts to answer some of the initial questions posed by doctors interested in practicing in the US. We invite readers to ask questions from the author so that we may provide the most relevant information to those considering practicing medicine in the US.

Can Sri Lankan Doctors Practice Medicine in the United States of America?

Yes, there are no nationality barriers to practice medicine in the USA. The USA has a very fair system of examinations that are open to its nationals as well as foreigners. Both foreign doctors and American medical students/doctors sit for the same standardized examinations. However, hospitals usually interview their prospective doctors before they employ them. American medical graduates usually have an advantage because of the language, their familiarity with the US hospital system and the fact that there are fewer restrictions on them in general (i.e. no requirement for a work visa). However, as the amount of doctors that the US produces is grossly inadequate to cater to their demand, each year thousands of foreign doctors enter the US medical practice. In exact years about 6500 foreign medical graduates applied for US residency out of which about 45% succeed in securing a place. This is in addition to about 15,000 US medical graduate applicants out of which about 90% secure a place.
What are the things a doctor has to do to be eligible to practice medicine in America?

First, the doctor should have graduated from a medical school that is listed in the World Health Organization (WHO) directory of medical schools. Six Sri Lankan medical faculties are in the directory. They are Colombo, Peradeniya, Jaffna, Galle, Ragama (incuding North Colombo Medical College) and Sri Jayawardenapura medical faculties. A full list is available in the United States Medical Licensing Examination (USMLE) web site. Sri Lankan doctors who have gone abroad for medical education should check whether their medical school is in the directory.

The doctor should register with the Education Commission for Foreign Medical Graduates (ECFMG). This can be done online by visiting the ECFMG Web site (www.usmle.org) - CHECK. Registering involves answering many questions related to you and your medical education. All clinical appointments need to be entered with dates, consultants etc. No errors should be made during this process. Therefore it's a good idea to get the help of someone who has gone through the process to avoid delays and rejection of the application.

The doctor should pass the USMLE Step 1 and Step 2 (Clinical Knowledge and Clinical Skills) examinations to be eligible to apply for residency.

What is ECFMG ?
ECFMG is the Education Commission for Foreign Medical Graduates. It is the entity that coordinates all examination related affairs of a foreign medical graduate until he or she has completed residency. It also sponsors foreign medical graduates so that they legally work in the US during their period of training as a resident.

What is USMLE ?
USMLE is the United States Medical Licensing Examination . The USMLE consists of 3 steps, Step 1, Step 2 and Step 3. In step 1, students are mainly tested in the pre-clinical subjects. Step 2 has two parts, Step 2 CK or Clinical Knowledge and Step 2 CS or Clinical Skills. Then there is the Step 3. Step 3 is not necessary to get a residency. Most US doctors do Step 3 during their 2nd or 3rd year of residency. Doing Step 3 early is a special advantage to foreign doctors as there are certain advantages in securing a less restrictive working visa if all USMLE examinations have been passed at the time of applying.

How do I Register to take the USMLE?
Unlike US doctors, foreign medical graduates do not directly register with the USMLE. They register with the ECFMG to do the USMLE examination. As I have stated earlier, one should first visit the ECFMG web site, apply and get a registration number from ECFMG. This number is necessary to fill the online application for the USMLE examinations. The ECFMG and USMLE examination application process can take quite some time as the ECFMG writes directly to your medical school and gets your transcript etc.

This question and answer session is the first one in a series of three. In the next session, we will be addressing issues such as, details of the different USMLE examinations, whether there is any order in which you should sit the examinations, where you can sit the examinations, advise on preparation etc.
"Please log in to www.sl2college.com and visit the USMLE forum to post your questions. The questions will be used as a guide to generate the next article by the author."

At our institution, all medical students are now required to take and pass the United States Medical Licensing Examination , Step 2 Clinical Skills (CS) prior to graduation, and many of us have now received our "Pass" CS score report. But unlike passing Step 1 CS and Step 2 Clinical Knowledge (CK), receiving a passing score report on the CS only heightened our frustration with the entire experience. The CS has become a licensure requirement for all doctors graduating from medical school in 2005 or later. A similar test has been required since 1998 for foreign medical graduates to ensure a minimum proficiency in patient interaction and English communication, as part of the Educational Commission for Foreign Medical Graduates (ECFMG) certification.^[1] In its current form, the CS test claims to use "standardized patients to test medical students and graduates on their ability to gather information from patients, perform physical examinations, and communicate their findings to patients and colleagues.^[2]" As the inaugural subjects, we suffered with our colleagues around the country through all the trains and planes, rumors and rituals, pompous rhetoric, and laughable acting. All this, now combined with the stunningly inadequate feedback, confirms our prior suspicions about an entirely dubious enterprise.

Consider the CS score report, which includes no information about areas of weakness or strength, even with crudely defined criteria, such as thoroughness of history taking, physical test skills, or formulation of differential diagnosis. The report simply implies that we have met a very bare minimum requirement without providing any further information. This paucity of feedback underscores one of the critical inadequacies of this examination only briefly explored in previously published discussions.^[3,4] The 3 score categories that were mentioned -- Integrated Clinical Encounter, Communication and Interpersonal Skills, and Spoken English Proficiency -- are hopelessly broad, particularly when compared with structured categories of analysis offered by the Step 1 CS and Step 2 CK exams.^[5] In these 2 exams, the score report, pass or fail, provides detailed performance information for the specific subjects and disciplines covered on the test (internal medicine, psychiatry, biochemistry, etc). In comparison, the CS score report for the nearly 97% of test takers expected to pass the exam^[6] provides no helpful evaluation or feedback of any kind. Thus, it remains entirely unclear what students, medical schools, residency programs, or the general public ought to conclude about this test or the students who pass it.

The shortcomings of the CS feedback are even more evident when we compare it with the Objective Structured Clinical Examination (OSCE) exams currently held voluntarily and at great expense and effort by some three quarters of US medical schools, with nearly half of these requiring a satisfactory performance for graduation.^[7] (Of the remainder, many schools are in the process of creating OSCE exams and others are making them requirements for graduation.) On these exams, the standardized patient and an experienced physician observe every history question, physical test technique, and treatment formulation. Detailed evaluation and feedback come from the patient and physician observers on each stage and the overall exercise. This allows students to quickly and accurately address weak areas, while also building confidence in those skills of which they may already be proficient. This system also allows educators to monitor students' progress and focus on the needs of specific students or entire curricula. Students may find the OSCE experience to be anxiety-provoking, but evidence suggests that the exercises overall are very well received.^{[8,9,10,11,12]}

In addition to the superior feedback mechanism, the OSCE approaches the stated goals of the CS test much more rigorously, particularly in the area of the physical exam. An orthopaedist observes your low-back-pain exam; a cardiologist ensures that you can hear the murmur and describe it correctly; a neurologist increases the odds that your motor test has any chance of eliciting abnormal findings. In our experience, we found these specialists to be quite forthcoming, almost eager, with their constructive criticism. The CS test elicits the motions of a competent exam, but without an experienced clinician-observer in the room, nothing prevented us on test day from, say, auscultating the scapula. Similarly, the written component of the CS test compares poorly with the on-the-spot presentation of our history, findings, differential diagnosis, and decision making. Laying test findings bare before the faculty supports the immediate integration of communication and clinical thinking. Indeed, the supervision and evaluation of the OSCE attenuate a common criticism of standardized encounters generally: the artificial feel of "fake" patients. Physician-observers provide a real-time quality-control mechanism in which imitated physical findings or patient questions can be properly qualified and contrasted to genuine experience. Thus, even though both the CS and OSCE require often unrealistic portrayals of sick patients, the presence, supervision, and evaluation by a physician in the room support and facilitate a more worthwhile experience.

We submit that the OSCE precisely captures the supposed virtues of the CS exam, which itself adds little to our education or training at over $1000 per student. To some, this cost may seem minor compared with the overall costs of medical education -- recently estimated at $140,000 for public and $225,000 for private schools.^[13] We strenuously disagree with this reasoning, however, which substitutes obvious math for serious debate on the attitudes and principles driving modern medical instruction and healthcare generally. Claiming that the CS test is "just another $1000" fails to address the trends toward higher costs and subsequent barriers to accessing quality graduate medical education. This flippant attitude also ignores the way in which multiple smaller expenses -- textbooks, supplies, and student health insurance -- add up to increase the average student-debt burden. As with any new intervention offered in healthcare today, the CS test must justify its expense, whatever the magnitude. In our opinion, it does not.

We therefore applaud those schools already investing in the OSCE and encourage other schools to consider their funding priorities and develop OSCEs of their own. If the public indeed demands this manner of examination, as has been claimed, then perhaps all medical schools should be required by the National Board of Medical Examiners (NBME) to hold 1 or more OSCE exercises with satisfactory performances necessary for graduation. Holding these exams at each school, rather than at a few centers nationwide, would reduce the inconvenience and expense for students while allowing individual schools to adapt their curricula rapidly on the basis of areas of strength and weakness. Hopefully, this could be achieved without passing on additional expenses to students. This approach would keep the burden of creating skilled clinicians in the province of medical schools, where it belongs.

Indeed, what else does the CS test do but call into question the ability of American medical schools to teach a physician's most fundamental skills? We accept the tedium of written exams in order to certain a consistent fund of knowledge across the country; this is relatively easy to test and while providing helpful feedback. But the challenge of the clinical encounter -- earning trust and constructing a story, looking and listening, testing hypotheses and making decisions, and explaining and reassuring -- cannot possibly be met with this elaborate educational sham. Let us instead earn the public's trust by supporting rigor within medical schools, demanding of ourselves and our teachers a greater commitment to mastering the skills that matter most to our patients.

Getting into medical school is not easy. In 2018, only 41% of all applicants were accepted, with a low MCAT score listed as the “biggest application deal-breaker” in the application. For students who are applying to medical school with a lower-than-average GPA or MCAT score, they might be weighing their options to see if there are is another way to earn the title of “doctor.”  

There are dozens of medical specialties out there and various degrees associated with the medical field. There is more to the name “doctor” then you might realize. However, the terms “doctor” and “MD” are often used as synonyms, but this is not always the case. Licensed physicians can hold either an MD or DO degree. For students who are debating which path into medicine they want to take, they might be wondering why one is right for them and is one better than the other?

MD Vs. DO: Different Approaches

Both allopathic (MD) and osteopathic (DO) medical schools instruct their students in the necessary scientific foundations to become licensed physicians. However, the approaches the two schools take are very different. To obtain your medical doctor degree (MD), you must attend an allopathic medical school. Allopathic medicine uses science to diagnose and treat any medical conditions.

Osteopathic medicine is a little less-known and takes a more holistic approach.  Doctors who receive their DO degree study something called osteopathic manipulative treatment (OMT), a method that involves moving muscles and joints to promote healing. When OMT fits within a patient’s treatment plan, it can be used to complement drugs or surgery, adding another dimension to medical care.

Physicians with both an MD and a DO are licensed in all 50 states to practice medicine, perform surgeries and prescribe medication.

MD Vs. DO: Education

There are more than 152 accredited U.S. allopathic colleges, whereas there are just 35 accredited colleges of osteopathic medicine. Naturally, that means that there are more MDs than DOs, with roughly 25% of all doctors receiving their degree from an osteopathic medical school. The National Resident Matching Program surveyed all active medical school students who participated in the 2018 Main Residency Match. The number of seniors who attended allopathic medical school in 2018 numbered at 18,818 whereas the students of osteopathic medical schools numbered at just 4,275.

There is a stigma surrounding DOs and the level of work and academic success you must have achieved to be accepted. Years ago, it was believed that earning a degree in osteopathic medicine versus allopathic medicine was the more easily-accessible path to becoming a doctor.

As the gap has lessened, it can be just as difficult to be admitted into a DO program compared to an MD one. The average MCAT score for matriculants into a medical school was a 510.4, on the other hand, the average MCAT scores for matriculants into a college of osteopathic medicine averaged around 502.2.  

Once they enter into their respective medical schools, the path to becoming a doctor is very similar. Both MDs and DOs have earned bachelor’s degrees and then attend a four-year medical school. While in med school, they both learn the same basic knowledge regarding anatomy, physiology and pharmacology.

DOs spend an additional 200 hours learning about nerves, muscles, bones and how the connection between them will affect their patients’ overall health. When doctors of osteopathic medicine enter into the workforce, they can incorporate that training into their day-to-day patient interactions if they choose.

MD Vs. DO: Exams

The allopathic and osteopathic paths to becoming a doctor begin to split once the students take their licensing exams. Students at allopathic schools take the USMLE series, while osteopathic students often take the COMLEX sequence. Both of these exams are three-step exams and prospective doctors take them between the end of their second year of medical school and their first year of residency.

However, DOs can take the USMLE test as well as the COMLEX sequence. While it does add considerably to the student’s workload, it is worth it if they are considering a residency program that requires the USMLE.

These two exams might cover similar topics, but they are a bit different in the testing style. In general, allopathic students are better prepared for taking the USMLE examinations and tend to do better than osteopathic students. The mean USMLE Step 1 Score for all matched U.S. allopathic seniors was 233 while the mean USMLE Step 1 Score for all matched US osteopathic seniors was 227.

Ultimately, the student needs to assess their own individual goals and interests when deciding if they should take the USMLE. The USMLE will increase the number of programs the student can apply to and will deliver them greater access to more specialized programs. However, depending on the residencies the student is interested in, the USMLE might not be necessary for an osteopathic student.

Osteopathic students should be confident that they will do well on the USMLE before committing to taking it. According to the 2018 NRMP (National Resident Matching Program) Program Director, of the 1,333 programs surveyed, only 2% said that the USMLE was not required. Thirty percent of the program directors said they would never admit a student who failed the USMLE on their first attempts, and 58% said they would seldom admit a student who failed.

Of those schools, 46% of programs said that they do use the COMLEX-USA test when considering which applicants to invite for an interview. Taking the USMLE helps put the students on an even playing field; the directors can compare the students more easily if they have all taken the same exam.  

MD Vs. DO: Residency

According to the National Resident Matching Program, allopathic seniors preferred the specialties of radiology, neurological surgery, orthopedic surgery, and plastic surgery. They least preferred to match with a residency in pathology, family medicine, or internal medicine.

On the other hand, osteopathic medical seniors preferred family medicine, pathology, physical medicine and rehabilitation, and psychiatry more than other specialties. They were less likely to apply for a residency in otolaryngology, plastic surgery, radiation oncology, and orthopedic surgery.

Overall, 91.8% of US allopathic seniors matched with their preferred specialty. 82.6% of US osteopathic seniors paired with their preferred specialty.

As of 2019, MD students could only match with programs that were accredited by the Accreditation Council for Graduate Medical Education (ACGME) and DO students could match with residencies that are accredited by either the ACGME or the American Osteopathic Association (AOA). However, this is all about to change. In July of 2020, the accreditation councils will merge to form a single GME Accreditation system, allowing MD and DO students to apply to any residencies.

The purpose of this merger is to create a more consistent method of evaluating residencies. It will affect both current and future DO students, who no longer will have a safe haven of residencies that only DO students can apply to. That means that allopathic students will have more opportunities open to them, perhaps at the expense of weaker DO students.

When choosing between DO and MD, you should consider what you want your future specialty to be, as your chances of matching with your desired program can increase depending on if you go to an allopathic or osteopathic medical school. Being a DO does not make you any worse or better of a doctor. Your residency and your action will determine that, not what letters follow your name.

Research for this article was contributed by Moon Prep college counselor, Lindsey Conger.

CAMBRIDGE, Mass., July 14, 2023 /PRNewswire/ -- OpenEvidence, a generative Artificial Intelligence (AI) company working on aligning Large Language Models (LLMs) to the medical domain, announced today that OpenEvidence AI has become the first AI in history to score above 90% on the United States Medical Licensing Examination (USMLE). Previously, AIs such as ChatGPT and Google's Med-PaLM 2 have reported scores of 59% and 86%, respectively.

OpenEvidence AI Becomes the First AI in History to Score Above 90% on the United States Medical Licensing Examination

"The horizon of the possible in Artificial Intelligence (AI) has been redefined yet again, as OpenEvidence AI becomes the first AI in history to score above 90% on the United States Medical Licensing Examination (USMLE). Single-point differences on this benchmark translate into highly impactful differences in AI performance, since the USMLE contains hundreds of questions, and each additional USMLE score point represents multiple additional correct answers—each one of which corresponds to medical knowledge that could translate into life or death for a patient, if the AI system is used as a physician co-pilot in a clinical setting," said Daniel Nadler, PhD, Founder of OpenEvidence. "A widely cited study published in the BMJ in 2016 estimated that medical errors were the third leading cause of death in the United States, after heart disease and cancer. At that scale, any system that could augment a physician and reduce medical errors on an absolute basis by even 5-10% would be extraordinarily impactful to the lives of tens of thousands of patients in the United States alone. On a relative basis, and treating the previous state-of-the-art systems as a baseline, OpenEvidence AI makes 77% fewer errors on the US Medical Licensing test than ChatGPT, and 31% fewer errors than Google's Med-PaLM 2, thereby achieving the lowest error rate in the history of any AI on the USMLE. It's fair to consider the relative performance of these AIs in this manner, given the disproportionate effect of an error in medicine."

Generative AI & the US Medical Licensing Exam

The USMLE is a three-step examination for medical licensure in the United States. It assesses a physician's ability to apply knowledge, concepts, and principles, as well as demonstrate fundamental patient-centered skills that form the foundation of safe and effective patient care. The USMLE is a rigorous test that demands a broad understanding of biomedical and clinical sciences, testing not only factual recall, but also decision-making ability. Artificial Intelligence achieving a score above 90% on the USMLE—a feat almost unthinkable even 18 months ago—showcases the tremendous strides that Artificial Intelligence generally—and OpenEvidence specifically—have made in understanding and applying complex medical concepts.

As of July 11^th, 2023, both GPT-4 and ChatGPT incorrectly answer (A) Blood cultures, whereas OpenEvidence AI correctly answers (C) Human leukocyte antigen-B27 assay.

Best Paper of 2023: The Association for Health Learning and Inference (AHLI)

Earlier this year, The New England Journal of Medicine AI featured a paper titled "Do We Still Need Clinical Language Models?" published by OpenEvidence, in partnership with researchers from MIT and Harvard Medical School, that found that language models that have been specialized to deal with medical text outperform much larger general domain models trained on general text (such as GPT-3) when compared on the same medical domain-specific intelligence tasks. OpenEvidence's paper went on to win Best Paper at the 2023 Conference on Health, Inference, and Learning (CHIL), the preeminent community of computer scientists working in medical applications.

Founding Team from Harvard and MIT

OpenEvidence was founded by Daniel Nadler, a Harvard PhD who previously founded Kensho Technologies (which in 2018 was acquired in the largest AI deal in history at the time). OpenEvidence's key scientists, including CTO Zachary Ziegler, Jonas Wulff, Micah Smith, Evan Hernandez, and Eric Lehman, all come out of artificial intelligence labs at Harvard and MIT. Eric Lehman (MIT) was the lead author of both this study and OpenEvidence's award-winning paper, "Do We Still Need Clinical Language Models?" 

Mayo Clinic Platform

Earlier this year, OpenEvidence became a Mayo Clinic Platform Accelerate company. In a social media post, Mayo Clinic Platform said "OpenEvidence is using novel technology to organize the world's medical knowledge into understandable, clinically useful formats. As part of Mayo Clinic Platform Accelerate, they are one step closer to improving how health care information is structured." Dr. Antonio Jorge Forte, a Mayo Clinic physician and the Terrance D. and Judith A. Paul Director of MayoExpert, said: "OpenEvidence can be the foundational technology to power all clinical decision tools."

View original content to download multimedia:https://www.prnewswire.com/news-releases/openevidence-ai-becomes-the-first-ai-in-history-to-score-above-90-on-the-united-states-medical-licensing-examination-usmle-301877056.html

SOURCE Open Evidence

Almost seven in ten of the 2,926 candidates who took the CFP Certification test in July passed.

The CFP Board stats show that the 67% pass rate was the highest since July 2015 (70%), although the test blueprint has been updated twice since, in March 2016 and March 2022.

Ten states accounted for more than half (1,562) of those taking the test last month – California, Texas, Pennsylvania, Florida, Illinois, New York, North Carolina, Colorado, Ohio and Massachusetts – although the individual states’ pass rates is not reported.

Asked after the test why they wanted to gain CFP Certification, 41% said to demonstrate experience on the job (41%), and 25% said to distinguish themselves as a fiduciary.

Firms showed strong support for their candidates with 77% of test takers saying they had received some financial support from their employer during the examination process.

“As CFP Board continues to foster growth in the financial planning profession, we are committed to providing access to the tools CFP® certification candidates need to prepare for the exam,” said CFP Board CEO Kevin R. Keller, CAE. “Congratulations to candidates from across the country for passing this rigorous exam.”

Prepping for the exam

Exam takers from last month’s round were asked how they prepared for the examination.

The top answers included:

• CFP Board Practice test 1
• the test Candidate Handbook
• the Candidate Preparation Toolkit.

Other resources used included CFP Board supplementary resources and guidance documents, the CFP Board Candidate Forum and webinars.