text: The USMLE is sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). They developed it originally to provide state medical boards in the United States with a common examination for all licensure applicants. However, over time it has also been extensively used by residency programs to predict residency performance and screen residents for selection during the National Resident Matching Program.
  Even though it was estimated that at least 60% of osteopathic medical students took at least one USMLE exam in 2020, physicians with D.O. degree are not required to take the USMLE for licensure or graduation. They are licensed as physicians by passing Parts I, II, and III of the COMLEX examination from the National Board of Osteopathic Medical Examiners.
  History
  The USMLE was created in the early 1990s. The program replaced the multiple examinations, including the NBME Part Examination program and the FSMB's Federation Licensing Examination (FLEX) program, that offered paths to medical licensing in the medical profession.
  The examination was originally imparted using pencil and paper. In 1999, computerized examination delivery was included.
  In 2004, an examination with standardized patients to assess clinical-skills was added to Step 2 of the USMLE (Step 2 Clinical Skills), and required for licensure beginning with the medical school graduating class of 2005. During the COVID-19 pandemic, USMLE Step 2CS was initially suspended and later discontinued.