Special Purpose Exam (SPEX)

This article is not a word to word translation from books, articles or other pages

I wrote this article based on my own experience of preparing, taking, and eventually passing the SPEX exam. I hope you find this helpful, but I wouldn’t say it will work for everyone.

Special Purpose Exam (SPEX) is “an examination of current knowledge requisite for the general, undifferentiated practice of medicine”. This quat is from the official exam webpage https://www.fsmb.org/spex-plas/”.


Based on the official webpage: “State boards may require SPEX for endorsement of licensure, reinstatement of a license, or reactivation of a license after a period of inactivity”.

When I knew that I needed to take the exam, 5 months ago, I was stressed out and didn’t know what to do. I was tired of taking exams, especially that I had already taken the specialty board exam, so I wasn’t “in the mood” of taking another exam.

I started by doing online search about the SPEX exam. I reviewed the information provided on the official webpage. I didn’t find many people talking about it. There were plenty of blogs and pages talking about the USMLE exams, but little about the SPEX exam. My search led to some websites that provided practice Qbank and flashcards. I knew that the exam is for general medicine practice, so I realized that taking the SPEX exam should be similar to taking the USMLE step 3 (sort of). My USMLE step 3 was about 11 years ago, so you can imagine the stress.

How did I prepare for the exam:

I am an orthopedic surgeon, so yeah, I needed a quick start to refresh all the medical knowledge in Cardiology, Pulmonology, Nephrology, Gynecology, Obstetrics, Dermatology, Pediatrics, Biostats and other specialties. I decided to read the “First Aid for the USMLE Step 3”, 5th edition, 2019. The book was easy to read. I didn’t finish it all though. I found it hard to memorize all what I was reading. I wanted to start practicing questions. This had always been my way to prepare for all exams, I am sure it is for most.

Which Qbank product did I use?

There were few sites that provided Qbanks designed for the SPEX exam. I wasn’t sure if I’d use any of them. I decided to go with UWORLD USMLE step 3. This is not an endorsement and I am not getting paid for it. Why UWORLD? I had to know what newbies were doing to prepare for the USMLE. I reviewed few comments on one of IMG USMLE preparation chat groups which recommended the same product. Other Qbank products were also recommended, but mostly for step 1 and 2 CK. In addition, I had previously used this product to prepare for the USMLE exams.

Until that point of time, I hadn’t registered yet for the exam. I first wanted to explore options for Qbank preparation. FSMB gives 3 months period to do the exam, otherwise a fee should be paid for a 3-months extension. UWORLD also comes with a 3 months activity allowance. I was not planning on taking too long to do the exam, therefore I registered for the exam and the Qbank at the same time.

The SPEX test is provided like all the USMLE exams by PROMETRIC. Unfortunately, SPEX is only available in USA and Canada. Taking the exam abroad is impossible. I decided to take the test in Canada. I determined the exam date at the end of SPEX registration period which gave 3 months study time. I then made the flight and hotel reservation. Just a tip here, try to explore the city on google maps and look up the test center location and accommodation options. There were three test centers in the city, so I chose the one that was easily accessible. I didn’t want to spend an hour in transportation to arrive on the exam day.

Studying for SPEX:

I used my smartphone to study the Qbank. The app allows to create customizable questions blocks. I started with untimed 5 questions blocks, then 15 questions blocks. When I completed about 500 questions (less than one third of the question) I started taking timed 40 questions blocks (the max number of questions per block).
Each question was provided with a thorough explanation. The app allows to create flashcards, by copy-paste from the explanation. What I did, I made a list of almost 700 flashcards which helped reviewing the information before the exam. If you’d like to have my flashcards, let me know and I’ll send them to you. I studied about 4-5 hours a day but not every day. It took me almost a month and a half to finish almost 1800 questions. Thereafter, I redid the questions again which took almost 3 weeks. I wasn’t trying to memorize the questions or the answers.

I reached to a point where I wanted to test my preparation for the exam. I did the free, paper & pencil practice test provided by FSMB. This test was very easy. I had the impression that I was well prepared for the exam. I then did the USMLE Step 3 sample test provided by USMLE.org using the interactive testing experience. This test was not bad at all. The UWORLD provided two self-assessment practice tests. I did the first one and I did not do well at all. The second test wasn’t that bad but still not as good as the test on USMLE.org. I wasn’t sure if I was ready for the exam. I decided to keep going with my plan without any change.

The week before the test:

My exam was on Friday. I flew to Canada on Sunday. I was lucky (did not plan for it) that that Monday was Syber Monday, so I did a full day of shopping (No tax refund in Canada, but the deals were good). I spent the days before the exam reviewing my flashcards. I didn’t do any Qbank practice. I didn’t hesitate to go for a walk even though the weather was cold. I also went to the prometric center to avoid any hassle finding the place on the exam day.

The exam day:

The test started at 9, but I had to present at the exam center at 8:30. I brought 2 bottles of water and something to eat (sweet for energy). The exam consisted of 5 blocks (39-40 questions / one hour each). There was a 45-minutes break time and a 15-minutes block for exam introduction (you can skip and use these 15 minutes for break time). I did the first block (I didn’t feel good about it) then I went for a 10-minutes break. I then returned for the second block (wasn’t that great either). When I tried to take a break, I mistakenly hit the (next block) button so I couldn’t go for a break. That block wasn’t that bad. I took a 10-minutes break and went back and did the last 2 blocks back-to-back.

My impression after the exam:

The exam was not easy. Do not be fooled by the practice test on FSMB. The test was also more difficult than the practice test for USMLE Step 3. Take these as a guide and prepare well.

When I finished my exam I didn’t feel good at all. I was very worried that I didn’t do well. I didn’t panic but I wasn’t happy about the exam. Surprisingly, the following day I woke up comfortable and forgot about the exam. I enjoyed the rest of my trip to Canada and flew back home.

The results:

FSMB typically sends SPEX results within 2-4 weeks by regular mail. I heard about the results on Christmas eve day. In fact, Noel (aka. Santa) delivered the message, like a present 😊. I passed the exam. The minimum score to pass is 75. I did not score high but enough to pass the exam and qualify for the license. My experience with this exam, as any exam, you must study and practice Qbank questions. Flashcards are helpful. I find writing your own cards is much better than reading ready to use flashcards.

Muayad Kadhim, MD

Leave a Reply