National Board of Medical Examiners
A United States nonprofit organization that develops and administers medical education and physician-licensure assessments.
Last updated August 31, 2026
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Overview
The National Board of Medical Examiners (NBME) is a United States nonprofit organization focused on the assessment of physicians and other health professionals across education, training, and practice. Founded in Philadelphia in 1915, it originally sought to create a voluntary medical licensing examination that states and territories could accept in place of, or alongside, their own examinations. Its standardized examinations gradually became influential in physician credentialing: by 1943, 45 of the 48 states accepted NBME examinations in conjunction with state examinations, and by 1992, 49 of the 50 states did so. NBME is best known for its role in the United States Medical Licensing Examination (USMLE), which it sponsors jointly with the Federation of State Medical Boards (FSMB). The USMLE is a multi-part examination sequence used by United States medical licensing authorities to help evaluate whether applicants are qualified for medical licensure. NBME develops and manages substantial portions of the examination program, while state medical boards retain authority over licensing decisions. USMLE Step 1 and Step 2 Clinical Knowledge are generally taken during medical school or postgraduate preparation, while Step 3 is part of the pathway toward authorization for unsupervised medical practice. Graduates of international medical schools may also take relevant USMLE examinations when seeking postgraduate medical training in the United States. Beyond the USMLE, NBME produces assessments for medical schools, educators, residents, practicing physicians, and health systems. Its offerings include subject examinations, basic and clinical science assessments, comprehensive examinations, advanced clinical examinations, health systems science testing, and International Foundations of Medicine examinations. The organization also provides self-assessment forms that allow examinees to rehearse examination content and review performance. Beginning in 2021, most of its self-assessment forms included explanations for both correct and incorrect answers. A group of newer forms numbered 25 through 30 replaced retired forms 18 through 24 in March 2021. NBME describes its mission as protecting public health through state-of-the-art assessment of health professionals. Although physician assessment remains central, its stated remit extends across the continuum from health-professions education to clinical practice and includes research on evaluation and the development of assessment instruments. This places NBME at the intersection of medical education, professional testing, licensing policy, and public-health protection. The organization is headquartered on and adjacent to the University City Science Center research campus in Philadelphia. Its work is consequential for students, international graduates, residency applicants, medical schools, educators, and state licensing authorities. The COVID-19 pandemic exposed the operational dependence of its examinations on third-party testing-center infrastructure. Prometric closures and capacity restrictions in 2020 disrupted scheduling for NBME-developed assessments and generated criticism concerning communication, equity, and testing access. NBME and the USMLE program responded with measures including fee waivers for certain eligibility-period extensions and testing-location changes. A further area of public debate concerned the timing of the transition of USMLE Step 1 score reporting to pass/fail; criticism intensified in 2020, and the change was implemented in 2022.
History
The National Board of Medical Examiners was established in Philadelphia in 1915 during a period when medical licensing standards varied significantly among United States jurisdictions. Its founding objective was to create a voluntary examination that states and territories could recognize as an alternative to administering entirely separate examinations. A common examination was intended to make the evaluation of physicians more consistent and to support movement across state boundaries, although licensing authority remained with individual states. NBME Certifying Examinations, often referred to as Part examinations, expanded in use during the years before the Second World War. States continued to administer their own examinations and used interstate arrangements associated with the Federation of State Medical Boards to recognize credentials from other jurisdictions. Even within that decentralized system, NBME examinations became increasingly important. By 1943, 45 of the 48 states accepted NBME examinations together with their own state examinations. After the war, states continued using NBME results when determining whether applicants should receive medical licenses. The resulting system enabled students and graduates in different states to sit for a common assessment. By 1992, 49 of the 50 states accepted NBME examinations in conjunction with their state licensing examinations. A major institutional change occurred in 1992 with the introduction of the United States Medical Licensing Examination. The USMLE is sponsored jointly by NBME and the Federation of State Medical Boards. It consolidated elements of the earlier examination structure into a multi-step program intended to assess medical knowledge and clinical competence at stages relevant to medical education and licensure. Students at United States medical schools generally take Step 1 and Step 2 Clinical Knowledge before or during the transition to residency, while Step 3 is associated with the final phase of the examination sequence and is normally required before a physician can seek authorization for unsupervised practice. International medical graduates seeking United States residency training also use the relevant USMLE steps as part of their professional pathway. NBME's activities extend beyond physician licensing. It develops examinations for medical schools and educators, including basic science, clinical science, comprehensive, advanced clinical, and health systems science assessments. It also produces International Foundations of Medicine examinations and other tools used in international medical education. Its self-assessment portal gives examinees access to practice forms for examinations such as USMLE Step 1, USMLE Step 2 Clinical Knowledge, NBME Subject Examinations, and IFOM. In 2021, most self-assessments were expanded with explanations for answers marked correct and incorrect. On March 24 of that year, forms 25 through 30 replaced retired forms 18 through 24. The organization frames assessment as a public-health function. Its stated mission is to protect the public through advanced assessment of health professionals, while also supporting research in evaluation and the creation of assessment instruments across the continuum of health-professions education, training, and practice. NBME is headquartered on and near the University City Science Center research campus in Philadelphia. The COVID-19 pandemic created one of the most significant operational disruptions described in the available record. In March 2020, Prometric closed testing centers in response to local health and safety requirements. Administrations of NBME-developed examinations, including USMLE, health-professions assessments, and NBME Subject Examinations, were suspended for several months. When Prometric resumed selected essential-service testing in May 2020, capacity was reduced. Examinees and members of the medical community criticized the handling of closures, scheduling, and communications, arguing that the disruption created confusion and unequal burdens. USMLE waived certain fees associated with extending eligibility periods and changing testing locations, and Prometric apologized to NBME for communication problems. Another prominent policy debate concerned USMLE Step 1 score reporting. During 2020, some members of the medical community criticized NBME and related stakeholders for not moving more quickly to a pass/fail reporting model. The change was not implemented before 2022. The issue reflected broader debates about examination pressure, residency selection, test preparation, and the role of numerical scores in medical education. NBME therefore occupies a distinctive position: it is a nonprofit assessment institution rather than a conventional consumer brand, but its examinations influence educational progression, residency access, and professional licensure for physicians in the United States and beyond.
- 2022
USMLE Step 1 score reporting changed to pass/fail
[1]The long-debated transition away from a three-digit Step 1 score was implemented.
- 2021
Self-assessment forms updated
[1]Forms 25 through 30 replaced retired forms 18 through 24, while most self-assessments gained detailed answer explanations.
- 2020
Pandemic testing disruption
[1]Prometric closures and capacity restrictions interrupted administrations of NBME-developed assessments.
- 1992
USMLE introduced
[1]NBME and the Federation of State Medical Boards introduced the multi-part United States Medical Licensing Examination.
- 1992
Near-universal state acceptance reported
[1]By this year, 49 of the 50 United States accepted NBME examinations together with their state examinations for licensing purposes.
- 1943
NBME examinations widely accepted by states
[1]Forty-five of the 48 states accepted NBME examinations alongside their own licensing examinations.
- 1915
NBME founded in Philadelphia
[1]The organization was founded to develop a voluntary medical licensing examination that could be recognized by states and territories.
Products and positioning
A public-interest medical assessment and standards organization whose examinations support physician education, residency progression, and state-based medical licensure.
Medical licensing examination · 1992
United States Medical Licensing Examination
The USMLE is a multi-step examination program sponsored by NBME and the Federation of State Medical Boards. It helps United States licensing authorities evaluate physician applicants. Step 1 and Step 2 Clinical Knowledge are taken during medical education or preparation for residency, while Step 3 forms part of the pathway toward a license for unsupervised practice. International medical graduates also use the sequence when pursuing postgraduate medical training in the United States.
Medical school assessment
NBME Subject Examinations
Subject Examinations are standardized assessments used by medical schools and educators to evaluate learning in defined areas of basic science and clinical medicine. They give institutions a common testing framework that can be used alongside local curricula and internal examinations.
Examination preparation
NBME Self-Assessments
NBME self-assessments provide practice forms for examinations including USMLE Step 1, USMLE Step 2 Clinical Knowledge, NBME Subject Examinations, and IFOM examinations. Most forms received explanations for both correct and incorrect answers beginning in 2021, making them useful for identifying knowledge gaps as well as rehearsing test conditions.
International medical assessment
International Foundations of Medicine examinations
The International Foundations of Medicine, or IFOM, examinations assess foundational and clinical medical knowledge in international education and credentialing contexts. They extend NBME's assessment work beyond the United States medical licensing pathway.
Health systems assessment
Health Systems Science Exam
Developed in cooperation with and at the request of the American Medical Association, the Health Systems Science Exam assesses knowledge related to healthcare systems and economics, adding systems-level content to NBME's physician assessment portfolio.
Brand decisions
2022
Implementation of pass/fail reporting for USMLE Step 1StrategyBackground
Medical educators and examinees debated whether numerical Step 1 scores placed excessive pressure on students and distorted residency selection.
Action taken
USMLE Step 1 reporting transitioned to pass/fail rather than providing the former three-digit score.
Aftermath
The change altered how medical schools, residency applicants, and program directors interpreted the examination, while debates continued over the role of other selection measures.
2021
Replacement of NBME self-assessment formsOtherBackground
NBME revised its self-assessment catalogue and retired forms 18 through 24.
Action taken
Forms 25 through 30 replaced the retired forms beginning March 24, 2021, and most self-assessments included detailed answer explanations.
Aftermath
Students received newer practice materials with expanded feedback functionality.
2020
Pandemic examination-continuity measuresStrategyBackground
Prometric testing-center closures and later capacity limits disrupted administrations of NBME-developed examinations during the COVID-19 pandemic.
Action taken
USMLE waived fees associated with certain testing-eligibility extensions and testing-location changes, while examinations resumed through reduced-capacity essential-service testing.
Aftermath
Examinees and medical organizations criticized the resulting scheduling confusion and unequal access. Prometric apologized to NBME over communication problems related to exam administration.
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