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Last Updated: June 05, 2021

The United States Medical Licensing Examination Test

What is USMLE?

The United States Medical Licensing Examination, which is also known as USMLE is a 3-step exam for getting medical licensure to practice in the USA. The exam is conducted in order to assess the application skills a physician has after completing their theoretical study. This examination program is owned by the Federation of State Medical Boards and the National Board of Medical Examiners both of which are non-profit organizations representing state boards of the US and its territories.

The examination has its content developed through committees from every part of the US with its committee members including biomedical scientists, educators, and other clinicians. The exam was standardized for the US and its territories in order to have similar standards for the licensing procedure of allopathic physicians in the country.

This test consists of a 3-step procedure. Each of these three steps in the USMLE exam complements the remaining others, and none of these three steps can stand by themselves individually in assessing readiness, which is needed for getting medical licensure.

Eligibility for Steps 1 and 2 USMLE

The candidate ought to be in 1 of the categories mentioned below while applying for the test.

Eligibility for Step 3 USMLE

Candidates who are applying for the third step of the examination will have to meet the following requirements in order to complete their application.

Fees for USMLE

The fee structure for students/ graduates of Medical Schools that are accredited by LCME or AOA in Canada and the US are-
StepFee (2021-2022)
Step 2 CK$645
Step 3$895

Step 1 of USMLE

Step 1 of the examination deals with the different basic and important concepts of the sciences which are required for practicing medicine but this is focused mainly on the aspects of health, disease, and mode of therapy required for each condition. The competencies that are assessed through the test are Medical Knowledge, Patient Care through Diagnosis. Patient Care through Management, Communication and Interpersonal Skills, and Practice-based Learning and Improvement.

This section has a maximum of 280 questions in the multiple-choice format which are divided into seven 60-minute blocks. Each of these blocks will have a maximum of 40 questions. The examination is considered to be one day long since it is conducted at an 8-hour long test session.

The content of the examination will have a flexible nature since the question-based is created by experts who focus on emerging domains in the field. This implies that the content for the examination is subject to change with the arrival of newer fields of study. The candidate is supposed to be prepared and up-to-date with their education. The general content of the Step 1 examination of USMLE is-

Disciplines involved in Step 1

The different disciplines that are involved in the first step of the examination are generally traditional in nature and as follows-

Step 2 of USMLE

This step of the examination deals mainly with the application of medical knowledge in order to care for patients under supervision. It focuses mainly on health promotion and disease prevention. The exam is titled Clinical Knowledge/ CK. The second part of the exam called CS has been permanently canceled by USMLE.

The competency of the candidate is assessed according to their Medical Knowledge, Patient Care through History and Physical Exam, Patient Care through Laboratory and Diagnostic Studies, Patient Care through Diagnosis, Patient Care through Prognosis and Outcome, Patient Care through Health Maintenance and Disease Prevention, Patient Care through Pharmacology, Patient Care through Clinical Interventions, Patient Care through Mixed Management, Professionalism, and Systems-based Practice.

The section has a maximum of 318 questions which are all in a multiple-choice format. These questions have been divided into eight 60-minute blocks where each block will have a maximum of 40 questions. It is conducted as a one-day examination within a nine-hour-long session. The candidates taking the examination will be receiving at least a 45-minute break in between the exam. The content for this step of the examination focuses only on clinical science and considers emerging domains along with the curriculum they generally follow. The content outline of the examination is as follows-

Disciplines involved in Step 2

The disciplines involved in the second step of the examination are-

Step 3 of USMLE

This is the final step of the USMLE and assesses the knowledge the candidate has in biomedical and clinical science which can be used in the unsupervised practice of medicine. This exam is conducted as a foundation for an independent practice where physicians will be required to function under pressure within context-specific cases.

The exam is conducted over 2 days where the first day is called the Foundation of Independent Practice/ FIP and the second day is called the Advanced Clinical Medicine/ ACM. The general content of the examination is always subject to change but contains an integrated content outline from which students can expect questions.

First Day of Step 3 in USMLE

This exam will contain 232 questions in all which will be a multiple-choice format. These questions will be divided into six blocks with 38-39 questions each. Each block will be given a maximum of 60 minutes to complete. The exam will be conducted in 7 hours with a 45 minute or more break given in between.

Second Day of Step 3 in USMLE

The second day of the examination will be given 9 hours in total with a 45-minute break in between. It contains 180 multiple-choice questions in all which will be divided into 6 blocks each of 30 questions. After this, there will be 13 case simulations for which the candidate will get 10-20 minutes maximum.

USMLE Scores

The USMLE results are reported on either a two-digit scale or a three-digit scale except for the Step 2 CK which is accounted for as a Pass/ Fail. The current pass mark for each of the Steps are as follows-

Sending the Score Transcript for USMLE

In order to send the exam transcript or to send it to a third party, candidates will have to contact the ECFMG, FSMB, or NBME and pay a nominal amount for the same. The details for the institution they have to contact for the transcript will be dependent on the Steps the candidate has taken and the place they want to send it to.

For sending one or more USMLE Steps to the Medical Licensing Authority or any other recipient, they have to send the request to FSMB. For sending all 3 Steps to any recipient they have to request to the FSMB. For sending both Step 1 and 2 while registered under ECFMG, to any recipient other than a Medical Licensing Authority they have to request to ECFMG. And if they want to send Steps 1 and 2 while registered under NBME, to any recipient other than a Medical Licensing Authority they have to request NBME.

USMLE Test Centers

The USMLE test centers are located across most of the states in the US. The Step 2 CS exam, however, can be only taken in at 5 CSEC's or Clinical Skills Evaluation Centers which are located in the USA at:
  • Atlanta, Georgia
  • Houston, Texas
  • Chicago, Illinois
  • Philadelphia, Pennsylvania
  • Los Angeles, California Step 3 of the examination can only be taken in the US or its territories. The details of the test center for this step will be available only on the Prometric website.

    Top Schools for USMLE

    The best schools that can help the candidate in preparing for the USMLE in the US are as follows-
    • Harvard University, Boston, MA
    • Johns Hopkins University, Baltimore, MD
    • University of Pennsylvania, PA
    • Stanford University, Stanford, CA
    • University of California, San Francisco, SA
    • Washington University, St. Louis, MO
    • Yale University, New Haven, CT
    • Columbia University, New York, NY
    • Duke University, Durham, NC
    • University of Chicago, Chicago, IL

    USMLE - FAQs - Eligibility - timing - Retakes - Registration

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