All persons intending to apply for licensure as a physician in
Tennessee must successfully complete a written examination pursuant to this
rule. Such written examination must be completed prior to application for
licensure. Certification of successful completion must be submitted by the
examining agency directly to the Board Administrative Office as part of the
application process contained in Rules
The Board adopts FLEX, USMLE and the
National Board of Medical Examiners (NBME) examination as its written licensure
examinations. Successful completion of one of those examinations is a
prerequisite to licensure according to the following:
After December 31, 1999, with the
exception of applicants applying pursuant to Rule
the only examination acceptable for licensure is the USMLE Steps 1, 2 and
The Board will accept any of
the following examinations or combinations of examinations if completed prior
to December 31, 1999:
1. The NBME Parts I, II
and III; or
2. FLEX Components I
and II; or
3. Predecessor FLEX Days
I, II and III; or
NBME Part I or
USMLE Step 1 plus
NBME Part II or USMLE Step 2 plus
NBME Part III or USMLE Step 3; or
5. FLEX Component I plus USMLE Step 3;
NBME Part I or USMLE Step 1
NBME Part II or USMLE Step 2 plus
FLEX Component II
7. Combinations of the Predecessor FLEX Days
I, II and III are not allowed with any other examination.
Passing Scores - The Board
accepts the following scores as constituting successful completion of the
(a) The Board adopts
the NBME's and the USMLE's determination of the passing scores for each Part or
Step of their examinations.
passing scores adopted by the Board for the FLEX examinations are as follows:
FLEX I and II
Component I = 75
Component II = 75
2. Predecessor FLEX Days I, II and III - A
FLEX weighted average (FWA) of 75 or greater.
(c) If an applicant fails any step of the
USMLE or FLEX examinations more than four (4) times, then the Board shall
require proof of board-certification by an ABMS-recognized specialty board and
proof of meeting requirements for Maintenance of Certification prior to
application before consideration for licensure.
Oral examination may be required pursuant
The Board may also, in its discretion, require an applicant for licensure to
take and pass the SPEX examination prepared by the FSMB. The circumstances
under which the Board may require the SPEX examination include, but are not
limited to, applicants for licensure who have been disciplined in another
state; applicants who would be subject to discipline in Tennessee based on
their conduct or condition; or applicants who have not engaged in the clinical
practice of medicine for more than two (2) years.
Deadlines - An applicant must have
achieved passing scores on the licensure examinations within the following time
(a) FLEX and Predecessor FLEX and NBME
- Ten (10) years from the date on which either the Day I or Component I or Part
I of the examinations was taken.
(b) USMLE - Ten (10) years from the date of
whichever step of the examination was successfully completed first.
(c) The deadlines in subparagraphs (a) and
(b) apply regardless of the combination of examinations utilized to apply for
licensure. Provided however, if the ten (10) year limitation set forth in
subsections (a) and/or (b) are not met, the applicant will be subsequently
considered for licensure once it can be documented that the applicant has
retaken and successfully completed the necessary steps or parts of the
examination(s) in such a manner that all steps or parts of the examination(s)
have been successfully completed within a ten (10) year time period.
The ten (10) year limitation for the
USMLE contained in subparagraph (4)(b) of this rule will not apply to
1. Are or have been working
towards both an M.D. and Ph.D. degree in an institution or program accredited
by the Association of American Medical Colleges' Liaison Committee on Medical
Education and regional university accrediting body; and
2. Was or is a student in good standing, who
was or is enrolled in the institution or program; and
3. Ph.D. studies are in a field of biological
sciences tested on Step 1 of the USMLE. (These fields include but are not
limited to anatomy, biochemistry, physiology, microbiology, pharmacology,
pathology, genetics, neuroscience, and molecular biology. Fields explicitly not
included are business, economics, ethics, history, and other fields not
directly related to biological science); and
4. Presents a verifiable and rational
explanation for the fact that he or she was unable to meet the ten (10) year
The amount of time an applicant has actively served while in continuous
training and practice in the armed forces of the United States shall not be
counted in calculating the ten (10) year limitation for the USMLE contained in
subparagraph (4)(b) of this rule. Further, the ten (10) year limitation for the
USMLE will not apply to applicants who:
board-certified at the time of application by a board recognized by the
American Board of Medical Specialties; or
2. Have been and are at the time of
application currently in active clinical practice in a single state or
territory for a period of at least one year and have held a full, unencumbered
license in that state for at least one year since successfully completing the
3. Present satisfactory
evidence of extraordinary circumstances as determined by the Board which
prevented the applicant from timely completing the steps.
(5) All applicants for the USMLE
shall submit all application inquiries, applications, fees and all necessary
admission documentation, including evidence satisfactory to the USMLE
administering agency of successful completion of a one (1) year post graduate
medical educational training program for applicants for Step 3 of that
examination, directly to the USMLE administering agency. The Board does not
distribute or process applications for the USMLE.
(6) Submission of any document or set of
documents required by this rule or submission of verification of the
authenticity, validity and accuracy of the content of any document or set of
documents required by this rule directly from the FCVS to the Board
Administrative Office shall be deemed to be submission of originals of those
documents or sets of documents by the issuing institution(s).
Tenn. Comp. R. & Regs.
Original rule filed February 26, 1991; effective April 12, 1991.
Amendment filed January 10, 1992; effective February 24, 1992. Amendment filed
April 14, 1994; effective June 28, 1994. Amendment filed March 29, 1996;
effective June 12, 1996. Amendment filed February 3, 1998; effective April 19,
1998. Amendment filed September 4, 1998; effective November 11, 1998. Amendment
filed August 25, 2000; effective November 8, 2000. Amendment filed December 5,
2003; effective February 18, 2004. Amendment filed December 28, 2004; effective
March 13, 2005. Amendment filed July 27, 2006; effective October 10, 2006.
Amendment filed April 17, 2007; effective July 1, 2007. Amendment filed May 27,
2008; effective August 10, 2008. Amendments filed January 26, 2015; effective
April 26, 2015. Amendments filed February 1, 2017; effective May 2, 2017.
Amendments filed March 8, 2022; effective
Authority: T.C.A. §§
63-6-101, and 63-6-207.