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SPEX Announcements


The SPEX ® is a computerized, multiple-choice examination of current knowledge requisite for the general, undifferentiated practice of medicine. The examination is used to re-examine a physician's ongoing level of basic medical knowledge and is intended for physicians who currently hold, or who have previously held, a valid, unrestricted license to practice medicine in the US or Canada. 

State boards may require SPEX for endorsement of licensure, reinstatement, or reactivation of a license after a period of inactivity. If the board has or is aware of concerns and/or questions about a physician's fitness to practice, SPEX results should be evaluated in conjunction with other available evidence to determine a physician's competence and fitness to practice. 

2019 SPEX 

A new, improved version of the SPEX will be implemented on January 15, 2019. The changes being made to SPEX help ensure that the exam continues to be relevant to current standards of practice.

Specific improvements being made to SPEX include an update of the exam blueprint, an update of the item pool (i.e., new test forms and questions), and implementation of new item formats (e.g., drug ads and abstracts).

The exam was also shortened by 2.5 hours to better accommodate physicians’ busy schedules.

Before registering for SPEX, please carefully review the following information for details about the new exam and how the registration, testing, & scoring processes will be impacted as we transition to the new exam.

If you take the SPEX in 2019, you are responsible for reviewing the 2019 SPEX Information Bulletin prior to testing.


How is the new version of the SPEX different from the current version?

Content: New item formats (e.g., drug ads and abstracts) are being implemented. The exam will also contain fewer questions. The new version will continue to focus primarily on tasks that physicians do in practice (i.e., patient management/care items) and less on mechanisms of disease items (i.e., disease applications relating to underlying basic sciences). 

Length: The length of the exam will be shortened by 2 ½ hours and will contain fewer items.

Current SPEX:  8½ hour exam with 336 items. Consists of 7 blocks of 64 minutes each, with 48 items per block; plus break(s) and tutorial.

New SPEX:  6-hour exam with 200 items. Consists of 5 blocks of 60 minutes each, with 40 items per block; plus break(s) and tutorial.

Why are these changes being made?

Best practices in testing require regular reviews and updates of the examination blueprint & item pool. The changes being made to SPEX will ensure that the exam continues to be relevant to current standards of practice. 

When and where will the new version of the SPEX be available?

Testing under the new version of the SPEX will begin on January 15, 2019. (The current version of the SPEX will no longer be available after December 31, 2018.)

The SPEX program will impose a “blackout” time from January 1-14, 2019, to allow us to complete the transition to the new version of the SPEX with the Prometric testing centers.  No SPEX exams will be available during this time. Please take this into account when registering for the SPEX and scheduling your testing date.

The test will still be administered at Prometric Testing Centers in the U.S. and Canada.


Will the eligibility requirements change under the new version of the SPEX?

No. The exam is still designed and being used for the same purposes (i.e., to assess the ability to apply, at a minimally acceptable level, the general medical knowledge considered essential for continued, unsupervised medical practice). Therefore, eligibility requirements will remain the same depending on your category of application:

Board-sponsored: To be eligible to take the examination through the board-sponsored process, you must hold or have held a current, unrestricted license in a United States or Canadian jurisdiction and otherwise have met eligibility requirements established by the individual licensing boards pursuant to their statutory and regulatory provisions. If you need or wish to take the examination as a board-sponsored candidate, you should contact the licensing authority from which you plan to seek a license to ask whether there are additional eligibility requirements you must meet. The FSMB maintains contact information for all licensing boards on its website (

Self-nominated: To be eligible to take the examination through the self-nominated process, you must have a current, unrestricted license to practice medicine in a United States or Canadian jurisdiction.


What is the SPEX fee?

The SPEX fee is currently $1,300 and is paid online via credit card. The SPEX fee is non-refundable and non-transferable from one eligibility period to another or from one application to another.  If you schedule an examination but do not take it and do not cancel with Prometric, you will forfeit your entire SPEX fee. 

Any future changes to the SPEX fee will be announced on the FSMB website. 

What if my 90-day eligibility period falls under both the current and new version of the SPEX?

You will be provided a 90-day eligibility period in which to take the examination. Eligibility periods are assigned immediately once your application is approved. It takes approximately two weeks to process an application. (Note: board-sponsored applications can take longer.)

If you do not take the test within your assigned eligibility period, you may submit an eligibility extension request for a one-time, contiguous 3-month extension of your eligibility period. Eligibility extension requests can only be submitted after your scheduling permit is available and must be received no later than 25 days after the end of your original eligibility period. Additional information about requesting an eligibility extension is available at:

If you do not test within your assigned or extended eligibility period, you must reapply with a new application, including the full fee. The SPEX fee is not transferable from one application to another.

Examinees who have eligibility periods that fall under testing for both the current and new version of the SPEX can sit for either version of the examination.  Examinees who sit for SPEX on December 31, 2018 or before will take the current version.  Examinees who sit for SPEX on January 15, 2019 or later will take the new version of the examination. 

If you would prefer to take the new version of the SPEX, we recommend submitting your application in December to ensure that most or all of your eligibility period will fall under the new version of the examination.  For applications approved on or after January 1, 2019, the entire eligibility period will fall under the new version of the examination.

Please note!  Initially, scores for the new version of the SPEX will not be available until 8-10 weeks after the testing date (e.g., scores for examinees who test SPEX in late January 2019 will be available in mid-April 2019).  Scoring for the current version of the SPEX will not be impacted and scores will be available within the standard 2-4 week reporting time.  Please take this into account when deciding which version of the examination to sit for and when submitting your application. 

See “Scores” section below for additional information about score reporting under the new version of the SPEX.


What will be the passing standard for the new version of the SPEX?

The recommended minimum passing score of 75 will remain as is. However, medical licensing authorities may accept the recommended pass/fail result, or they may establish their own passing score.

Recommended performance standards for the SPEX are based on a specified level of proficiency. As a result, no predetermined percentage of examinees will pass or fail the examination. The recommended minimum passing level is reviewed periodically and may be adjusted at any time. It should be noted that the reported score of 75 is NOT “75%” but a value on a scale that meets the requirements of licensing board statutes and regulations.

When will scores be available for the new version of the SPEX?

As mentioned above, examinees who take the new SPEX during the first few months will experience delays in receiving their scores (e.g., examinees who take the new SPEX late January 2019 will have their scores released in mid-April 2019.).  This is necessary for us to complete the quality assurance procedures for the new version of the exam.  Once the quality assurance process is complete, we will be able to resume the customary 2-4 weeks timeframe for reporting scores.

Please note!  We anticipate completing the new exam implementation process within the first 3 months of testing. However, low testing volume could delay completion of the process.  Therefore, the 8-10 week turnaround for score reporting could potentially impact examinees who test within the first 4-5 months (January – May).


What is the best way to prepare for the new version of the SPEX?

The most appropriate preparation for the SPEX is a well-planned and comprehensive review of up-to-date medical textbooks, clinical review publications, and periodicals.

FSMB offers a free paper and pencil practice test on its website. A link to the practice test is available at: (Scroll down to the “Preparing for your Exam section” of the page.) (Open the question “What is the best way to prepare for the SPEX?”)

A web-based “self-assessment” – the Comprehensive Clinical Medicine Self-Assessment (CCMSA) – is also available.  The CCMSA uses information typically covered in clinical encounters, and the content of the items resembles the content in SPEX.  The CCMSA will help you become familiar with the question formats used in the examination and with how to maneuver within the examination before your actual test date.  The CCMSA is available on the NBME website at

There are no test preparation courses affiliated with, or sanctioned by, the SPEX program.


What types of testing accommodations will be available for individuals covered under the Americans with Disabilities Act (ADA)?

Reasonable accommodations are provided to examinees with documented disabilities as defined by the Americans with Disabilities Act as amended in 2008, together (“ADA”). If you are a disabled individual covered under the ADA and require test accommodations, visit before you apply for information regarding test accommodations, including procedures and documentation requirements.

Processing of test accommodations requests may take up to eight weeks from the date sufficient documentation is received. If your request is approved, special arrangements and procedures will be established and communicated to you by the National Board of Medical Examiners (NBME) Disability Services unit.

SPEX score reports and transcripts do not include an annotation that a test accommodation was granted.