What is the Special Purpose Examination (SPEX)?

Reflecting the fact that unrestricted licensure in the United States is for the undifferentiated practice of medicine, the Special Purpose Examination (SPEX) measures the knowledge and cognitive abilities required of all physicians, regardless of specialty practiced. The questions used in SPEX focus on a core of clinical knowledge and relevant underlying basic science principles deemed necessary to form a reasonable foundation for the safe and effective practice of medicine. Content of SPEX is intended to reflect the knowledge and cognitive abilities of practicing physicians who are five years or more beyond medical graduation.

SPEX is constructed around two primary dimensions reflecting experience in medical practice: clinical encounter categories (well-care/preventive medicine; acute, circumscribed problems; ill-defined presentations or problems; chronic or progressive illness; emergency conditions, critical care; and behavioral/emotional problems) and physician tasks (data gathering; diagnostic assessment; managing therapy; and applying scientific concepts).

SPEX FAQ:

1. Where and when is SPEX offered?
SPEX is administered through a national computer-based testing network called Prometric Technology Centers. The test can be scheduled Monday through Friday throughout the year; some locations have Saturday hours. There are more than 250 test sites across the United States and Canada. Test site information will be provided to the applicant upon contacting Prometric to schedule their exam.

2. What is the SPEX fee?
The SPEX exam fee is $800.00 per administration, $265.00 of which is nonrefundable.

3. What kind of exam is SPEX?
The SPEX is a one-day, computer-administered examination consisting of eight blocks of 52 minutes each (50 questions in each block).

4. How do I register for the SPEX?
Download and print the SPEX application, then complete and return the application along with the appropriate fees and supporting documentation to the Federation of State Medical Boards (FSMB). Upon receipt of your application, the FSMB will determine your eligibility, process your application, and register you for the exam.  A Scheduling Permit will then be sent to you to confirm your SPEX registration.

5. Will I be able to take the exam if I am not computer literate?
Yes. SPEX is a ‘point and click’ exam. Studies have shown that there is no significant difference in the pass/fail rates between the computerized format and the former paper/pencil format.

6. What is the best way to prepare for the SPEX?
It is recommended that physicians study current medical textbooks, clinicals and periodicals. The FSMB provides a practice test this Web site. This practice test may be printed, and is available to anyone who is interested in it. Review of the items and the practice test on this site should provide familiarity with the formats used in the exam.

In addition, registered SPEX examinees may register with the FSMB and pay a nominal fee to Prometric Testing Center to take the SPEX Practice Test, which is designed to provide examinees with an opportunity to experience the entire testing environment prior to the actual day of testing. The Practice Test is a 2-hour exam that reflects the format of the current SPEX. It contains a tutorial and two one-hour sections of approximately 50 tests items each. The items exemplify the breadth of content included across the clinical encounters and tasks that comprise the examination. The items are grouped by item type in the same manner as the SPEX.—There are no test preparation courses affiliated with, or sanctioned by, the SPEX program.

7. I’m a specialist – will I be able to pass the SPEX?
Every physician, regardless of specialty, is expected to be familiar with a core of clinical principles that are essential for safe and effective patient care. Examinees who have stayed current with the general medical literature are unlikely to encounter many questions on the SPEX with which they are totally unfamiliar. SPEX content is organized by categories of clinical problems, not by specialty areas, and it emphasizes an individual’s ability to recognize frequently mishandled clinical problems, drug interactions, medical ethics, and current clinical procedures.

8. Upon receipt of my Scheduling Permit, how long do I have to sit for the exam?
Upon being registered, you will be given 90 days in which to take the exam. If your eligibility expires before you take the exam, a new application and fee must be submitted to the FSMB to be registered for the SPEX again.

9. Can I reschedule my appointment during my eligibility period?
Yes, but with certain restrictions. In order to reschedule within your eligibility period, Prometric must be notified at least 48 business hours in advance of your test date. To re-schedule your examination you must call the 800 telephone number provided on your scheduling permit. To cancel your application, you must submit a letter, either by mail or by fax with your signature to the FSMB.

10. When will scores be available?
Scores are mailed out approximately two to four weeks after the exam has been taken. Scores are reported by mail on official transcript paper and will not be given out over the telephone, by fax, or by email.

11. If I fail the SPEX exam the first time can I take it again right away or is there a waiting period?
A self-nominated examinee is limited to three attempts within a 12 month period. The examinee may retake an exam after the initial attempt with no waiting period and with the submission of a new application and fee. A third attempt requires a mandatory 90-day waiting period from the previous attempt. Any subsequent attempts require a one-year waiting period from the initial attempt. Board-sponsored examinees, at the sponsoring board’s discretion, may not be subject to the same waiting periods. Any additional reexamination eligibility requirements and procedures for unsuccessful examinees are established by the individual licensing boards, pursuant to the boards’ statutes and regulations.

12. If I take the SPEX for one licensing board or by Self-Nomination, can I later use those scores for licensure in another jurisdiction?
Generally, passing SPEX scores are accepted by a licensing board regardless of the jurisdiction for which the exam is taken. However, because each board establishes its own pass/fail score requirements as well as other specific requirements for licensure, it is recommended that you contact the board from which you desire licensure to confirm the acceptance of SPEX.

13. What if I need special arrangements to accommodate my disability?
The SPEX program provides reasonable accommodations for examinees with disabilities that are covered under the Americans with Disabilities Act (ADA). If you are a disabled individual covered under the ADA and require test accommodations contact the Federation for information regarding procedures and documentation requirements. In all cases, requests for testing accommodation must be made in writing before or at the time the SPEX application is submitted.