PURPOSE: Chapter 334, RSMo requires each applicant for a permanent license as a physician and surgeon to be examined by the board. This rule specifies which examinations are acceptable to the board, explains the requirements for achieving a passing score on a licensing examination, limits the number of occasions on which an applicant may attempt to achieve a passing score on a licensing examination, requires additional postgraduate training before certain applicants may be examined by the board, establishes criteria which must exist before the board may waive certain requirements of this rule and authorizes the board to limit or restrict a license issued pursuant to a waiver of the requirements of this rule.

1. (1) The board shall not issue a permanent license as a physician and surgeon to any applicant who has not met the qualifications set forth under either subsection (1)(A), (B) or (C) of this rule:

   1. (A) Applicant has received a passing score on either any of the following:

      1. 1. A licensing examination administered

in one (1) or more states or territories of the United States or the District of Columbia;

1. 2. Components 1 and 2 of the Federation

Licensing Examination (FLEX) before January 1, 1994; or

1. 3. Each of the three (3) Steps of the

United States Medical Licensing Examination (USMLE) within a seven (7)-year period. Applicant shall not be deemed to have received a passing score on any Step of the USMLE unless applicant has received a passing score on that Step within three (3) attempts. Failure to pass any USMLE Step shall be considered a failure to pass that Step for purposes of Missouri licensure, regardless of the jurisdiction in which the Step was administered; or

1. 4. One (1) of the hybrid combinations of

FLEX, USMLE, NBME (National Board of Medical Examiners) and NBOE (National Board of Osteopathic Examiners) examinations as set forth here, if completed before January 1, 2000: NBOE Part I, NBME Part I or USMLE Step 1 plus NBOE Part II, NBME Part II or USMLE Step 2 plus NBOE Part III, NBME Part III or USMLE Step 3 or FLEX Component I plus USMLE Step 3 or NBOE Part I, NBME Part I or USMLE Step 1 plus NBOE Part II, NBME Part II or USMLE Step 2 plus FLEX Component 2; or

1. (B) Applicant has received a certificate of the NBME of the United States, chartered under the laws of the District of Columbia or a certificate of the National Board of Examiners for Osteopathic Physicians and Surgeons, chartered under the laws of Indiana; or
2. (C) Applicant has received both a passing score on the Licentiate of the Medical Council of Canada (LMCC) and the medalist award in either medicine or surgery from the Royal College of Physicians and Surgeons.

1. (2) Beginning January 1, 1994, the licensing examination administered by Missouri shall be Part 3 of the USMLE.
2. (3) To receive a passing score, the applicant must achieve a weighted average score of not less than seventy-five percent (75%) on the FLEX, a two-digit scaled score of not less than seventy-five (75) on the USMLE, or an average score of not less than seventy-five
3. (75) on any other licensing examination. Applicants who have taken the FLEX examination prior to 1985 may not average scores from a portion of the examination taken at one (1) test administration with scores from any other portion of the examination taken at another test administration to achieve a passing score. Applicants may not average scores from different Steps of the USMLE or from portions of different examinations in order to achieve a passing score.
4. (4) The board shall not issue a permanent license as a physician and surgeon or allow the Missouri State Board examination to be administered to any applicant who has failed to achieve a passing score cumulatively three
5. (3) times or more on licensing examinations administered in one (1) or more states or territories of the United States, the District of Columbia or Canada.
6. (5) The board shall not allow any applicant, who has failed to achieve a passing score cumulatively two (2) times or more on licensing examinations administered in one (1) or more states or territories of the United States, the District of Columbia or Canada to take the licensing examination administered by the board until the applicant has successfully completed one (1) additional year of postgraduate training in a program which is approved and accredited to teach postgraduate medical education by the accreditation counsel on graduate medical education of the American Medical Association or the education committee of the American Osteopathic Association following the second unsuccessful attempt to pass a licensing examination.

AUTHORITY: sections 334.031, 334.040 and 334.125, RSMo Supp. 1999 and 334.043, RSMo 1994.* This rule originally filed as 4 CSR 150-2.005. Original rule filed Feb. 17, 1988, effective May 12, 1988. Amended: Filed Sept. 5, 1990, effective Feb. 14, 1991. Emergency amendment filed July 17, 1992, effective Aug. 1, 1992, expired Nov. 28, 1992. Emergency amendment filed Nov. 16, 1992, effective Nov. 29, 1992, expired March 28, 1993. Amended: Filed July 17, 1992, effective April 8, 1993. Amended: Filed Oct. 4, 1993, effective April 9, 1994. Amended: Filed July 25, 2000, effective Dec. 30, 2000. Moved to 20 CSR 2150-2.005, effective Aug. 28, 2006.

*Original authority: 334.031, RSMo 1959, amended 1981, 1997; 334.040, RSMo 1939, amended 1941, 1945, 1951, 1959, 1981, 1993, 1997; and 334.125, RSMo 1959, amended 1993, 1995.