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The USMLE organization, the single group responsible for certifying all American physicians, has added the USMLE Step 4 for all current and future medical residents.

This new Step will include 3 parts:

1) A written section similar to Step 3 but labeled Step 4CBK (Clinical and Book Knowledge) and will include a $550 registration fee and a $350 testing fee.

2) A Step 4CSK (Clinical Skills and Knowledge) that includes a $550 registration fee and a $2000 testing fee.

3) And finally a Step 4E (essay), like the MCAT, that will require students and residents to go to one of 2 convenient testing centers, located in Oklahoma City and Salt Lake City, and write an essay on anything they want, for a $7,000 testing fee (plus travel expenses). Each test, they added, must be taken separately.

“Step 4E [essay] is really a capstone on the future physician’s medical training. They had to write a long, critical essay when they took the MCAT, now a final essay when they leave medical education,” Sam Silver M.D. a USMLE board member said in a statement. “Like the MCAT, the written portion will be graded differently, this time using symbols found above the numbers on a standard qwerty keyboard, from ~ to [email protected]#$%^&*()_ and +.”

Dr. Silver also said the other parts of the test Step 4CBK will be given a number grading scale and Step 4CSK a pass/fail with a projected 99.9% of testers passing. Giving a final 3-part combined score of 35P^, where the ^ is the essay. Other Scores of 24P# and 22P( are possible. When asked why have a test when everyone passes anyway, he responded: “We have Step 2 CS, which most people pass, and that is a vital step in the licensing process.” He also reiterated that this announcement was in no way related to the ginormous debt the USMLE has accrued over the years.