USMLE is a standardized examination used to evaluate applicants’ competence for purposes of medical licensure in the United States and its territories. The USMLE is designed to assess a physician’s ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that constitute the basis of safe and effective patient care. USMLE is accepted by virtually all licensing boards in the US as evidence of competence to practice medicine in the US. State medical boards rely upon successful completion of the three USMLE component exams, or “Steps,” as an important element in the process for licensing physicians. Because of the test’s importance to the public’s safety and to examinees, maintaining its fairness and integrity is a priority for the NBME.