Written electronic examinations are in a multiple-choice, single-best-answer format and follow the National Board of Medical Examiners (NBME) item-writing guidelines, which are also used in developing questions for the United States Medical Licensing Examination (USMLE). The USMLE is a three-step examination for medical licensure in the United States, jointly sponsored by the NBME and the Federation of State Medical Boards (FSMB).