USMLE
United States Medical Licensing Exam
USMLE is governed by a committee that includes members from the ECFMG, FSMB, NBME, and the public. Before you can apply for a medical license, you must pass a three-step test called the United States Medical Licensing Examination (USMLE), also known as the board exam. This exam is mandatory for Foreign medical graduates completing their MBBS from Medical schools and colleges outside US and Canada to get the license to practice as a doctor in USA.
The United States Medical Licensing Examination (USMLE) is a three-step examination for medical licensure in the United States and is sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME).
The basic eligibility criteria for appearing for USMLE are:
Physicians with an MBBS/MD degree are required to pass this examination before being permitted to practice medicine in the United States.
This is intended as a brief description of the organizations that are directly involved with or contribute to the USMLE program. The USMLE®, or the United States Medical Licensing Examination® program, is owned by two entities: the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners® (NBME®).
USMLE has 3 Steps:
USMLE Step 1
USMLE Step 2
USMLE Step 3
Let’s talk about each and every step in detail.
USMLE 1:
Step 1 is a one-day examination. It is divided into seven 60-minute blocks and administered in one 8-hour testing session. The number of questions per block on a given examination form may vary, but will not exceed 40. The total number of items on the overall examination form will not exceed 280.
It also touches upon these interdisciplinary areas: Genetics, Aging, Immunology, Nutrition And Molecular and Cell Biology.
The candidate must be enrolled in, or a graduate of, a medical school that is located outside the US or Canada and is listed in the World Directory of Medical Schools.
When To Apply:
After finishing the 2nd year of the medical school
Fee for the USMLE Step 1 is $965 (Examination Fee + International Test Delivery Surcharge, if testing outside the United States and Canada)
How to Apply :
Online Through ECFMG’s official website
Extension of Eligibility Period:
$90 per exam
Where to take the Exam?
USMLE 1 Exam is held at the various Prometric Computer Testing Centers all over the world
In application, the candidate can choose the centre of their choice and to change the test region a charge of $85 is required.
Step 1/Step 2 CK Testing Region Change$85 per region change
Step 1/Step 2 CK Rescheduling Fee$0 – $604 (depending on exam, testing region, and date of cancellation)
USMLE Step 1 Syllabus
USMLE Step 1 questions can be from the 18 core areas. These areas cover basic concepts and principles of the organ-systems or within individual organ-systems. The Step 1 of the USMLE covers topics related to traditionally defined disciplines as described in the table below:
Disciplines covered in USMLE Step 1
| Anatomy | Pathology |
| Behavioral Sciences | Pharmacology |
| Biochemistry | Physiology |
| Biostatistics and Epidemiology | Microbiology |
The following interdisciplinary areas are also covered in the USMLE 2018 step 1:
| Genetics | Aging |
| Immunology | Nutrition |
| Molecular and Cell Biology | |
| Genetics | Aging |
| Immunology | Nutrition |
| Molecular and Cell Biology |
USMLE Step 1 Syllabus
| System | Range |
| General Principles of Foundational Science | 15% – 20% |
| 1. Immune System
2. Blood & Lymphoreticular System 3. Behavioral Health 4. Nervous System & Special Senses 5. Skin & Subcutaneous Tissue 6. Musculoskeletal System 7. Cardiovascular System 8. Respiratory System 9. Gastrointestinal System 10. Renal & Urinary System 11. Pregnancy, Childbirth, & the Puerperium 12. Female Reproductive & Breast 13. Male Reproductive 14. Endocrine System |
60% – 70% |
| 1. Multisystem Processes & Disorders
2. Biostatistics & Epidemiology 3. Population Health 4. Social Sciences |
15%– 20% |
| Process | Range |
| Normal Processes | 10% – 15% |
| Abnormal Processes | 55% – 60% |
| Principles of Therapeutics | 15% – 20% |
| Other | 10% – 15% |
USMLE Step 1 Physician Competencies
| Competency | Range |
| Medical Knowledge/Scientific Concepts | 55% – 65% |
| Patient Care: Diagnosis | |
| History/Physical Examination | |
| Laboratory/Diagnostic Studies | |
| Diagnosis | |
| Prognosis/Outcome | |
| 20% – 30% | |
| Patient Care: Management*** | |
| Health Maintenance/Disease Prevention | |
| Pharmacotherapy | |
| 15%-20% | |
| Communication | |
| Professionalism | 2%–5% |
| Practice-based Learning and Improvement | 4%–8% |
USMLE Step 2
USMLE Step 2 has two steps:
USMLE 2 Clinical Knowledge and USMLE 2 Clinical Skills
USMLE 2 CK (Clinical Knowledge)
Step 2 CK assesses an examinee’s ability to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision and includes emphasis on health promotion and disease prevention.
Step 2 CK ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills that provide the foundation for the safe and competent practice of medicine under supervision.
USMLE 2 CK (Clinical Knowledge) Exam Pattern:
Step 2 CK is a one-day examination. It is divided into eight 60-minute blocks and administered in one 9-hour testing session. The number of questions per block on a given examination will vary but will not exceed 40. The total number of items on the overall examination will not exceed 318.
The examination also includes a minimum allotment of 45 minutes of break time and a 15-minute optional tutorial. The amount of time available for breaks may be increased by finishing a block of test items or the optional tutorial before the allotted time expires.
Step 2 CK Fees:
$965 (Examination Fee + International Test Delivery Surcharge, if testing outside the United States and Canada)
How to Apply :
Online Through ECFMG’s official website
When to take the Exam?
After passing of USMLE Step 1 and after 2nd year of Medical school
Where to take The Exam?
The USMLE Step 2 CK can be taken at Prometric Test Centers worldwide.
USMLE Step 2 CC (Clinical Skills)
USMLE Step 2 CS uses standardized patients to test medical students and graduates on their ability to gather information from patients, perform physical examinations, and communicate their findings to patients and colleagues.
It’s an interactive test where, the candidates examine and diagnose actors who are pretending to be patients with specific health conditions. It’s meant to test the ability to interview patients, do physical exams, fill out medical charts, and explain the findings.
Candidates who apply for this step will be issued a 12-month eligibility period. The eligibility period starts with acceptance of application form and verification of eligibility
On completion of registration, scheduling permits and eligibility permits will be issued.
Candidates can visit the USMLE website to schedule a test date.
When Should I Take The USMLE Step 2 CS?
According to the USMLE, most students take Step 2 CS in their fourth year. One of the unique aspects of Step 2 CS is that it’s the only portion of the USMLE not taken on a computer. Because it assesses a student’s ability to act like an intern with primary responsibility for a patient, many students take the exam late in the clinical years of their med school journey.
Where To Take The Exam?
The USMLE Step 2 CS is taken at Clinical Skills Evaluation Collaboration (CSEC) test centers in five locations: Atlanta, Chicago, Houston, Los Angeles, and Philadelphia.
USMLE Step 2 CS (Clinical Skills) Exam Pattern:
The USMLE Step 2 CS is an eight-hour pass/fail exam that includes 12 individual patient encounters.
You’ll be expected to communicate with the test patients in a professional, empathetic, and responsive way; answer their questions; and complete a patient note.
You’ll cover common situations a doctor is likely to experience in U.S. clinics, doctors’ offices, emergency departments, and hospital settings.
You’ll be tested on physical systems that may include these categories:
Cardiovascular
Constitutional
Gastrointestinal
Genitourinary
Musculoskeletal
Neurological
Psychiatric
Respiratory
Women’s health
USMLE Step 2 CS Fees:
Fees for USMLE Step 2 CS is $1550
ECFMG Certification: The Educational Commission for Foreign Medical Graduates (ECFMG), through its program of certification, assesses whether international medical graduates are ready to enter residency or fellowship programs in the United States that are accredited by the Accreditation Council for Graduate Medical Education (ACGME).
ACGME requires international medical graduates who enter ACGME-accredited programs to be certified by ECFMG.
After clearing USMLE 1 and both the USMLE step 2 exam, the candidates are eligible to apply for the ECFMG certificate. After getting ECFMG certificate, the candidate can apply for the residency in US. ECFMG certification is also the eligibility criteria for registering for USMLE Step 3.
ECFMG Certification is also one of the eligibility requirements for international medical graduates to take Step 3 of the three-step USMLE.
To meet the examination requirements for ECFMG Certification, applicants must:
- Satisfy the medical science examination requirement:
Step 1 and Step 2 Clinical Knowledge (CK) of the USMLE are the exams currently administered that satisfy this requirement.
- Satisfy the clinical skills requirement.
A passing performance on Step 2 CS of the USMLE satisfies this requirement.
To confirm that your medical school meets ECFMG’s requirements, access the World Directory at www.wdoms.org.
Note: The USMLE program has suspended the Step 2 Clinical Skills (CS) examination until at least June 2021.
Residency in United States
The USMLE Step 3 is only offered at Prometric test centers in the United States and its territories.
The USMLE program recommends that applicants have completed at least one full year of post-medical school training before taking the Step 3 exam. Therefore, many American and foreign medical school graduates use the first year of residency training as preparation for the USMLE Step 3.
After Receiving the ECFMG Certification, the candidates can apply for US Medical Residency Programs.
The USMLE program recommends that applicants have completed at least one full year of post-medical school training before taking the Step 3 exam.
USMLE Step 3
Step 3 is the final examination in the USMLE sequence leading to a license to practice medicine in the United States without supervision.
The USMLE Step 3 is only offered at Prometric test centers in the United States and its territories.
USMLE Step 3 assesses whether the candidate can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings.
It is the final examination in the USMLE sequence leading to a license to practice medicine without supervision. The examination material is prepared by examination committees broadly representing the medical profession. The committees comprise recognized experts in their fields, including both academic and non-academic practitioners, as well as members of state medical licensing boards.
The Step 3 examination devotes attention to the importance of assessing the knowledge and skills of physicians who are assuming independent responsibility for providing general medical care to patients. The first day of the Step 3 examination is referred to as Foundations of Independent Practice (FIP), and the second day is referred to as Advanced Clinical Medicine (ACM).
USMLE Step 3 Exam Pattern and Format:
Step 3 is a two-day examination. The first day of testing includes 232 multiple-choice items divided into 6 blocks of 38-39 items; 60 minutes are allotted for completion of each block of test items. There are approximately 7 hours in the test session on the first day, including 45 minutes of break time and a 5-minute optional tutorial. Note that the amount of time available for breaks may be increased by finishing a block of test items or the optional tutorial before the allotted time expires.
There are approximately 9 hours in the test session on the second day. This day of testing includes a 5-minute optional tutorial followed by 180 multiple-choice items, divided into 6 blocks of 30 items; 45 minutes are allotted for completion of each block of test items. The second day also includes a 7-minute CCS tutorial. This is followed by 13 case simulations, each of which is allotted a maximum of 10 or 20 minutes of real time. A minimum of 45 minutes is available for break time. There is an optional survey at the end of the second day, which can be completed if time allows.
Day 1 USMLE Step 3
Step 3 Foundations of Independent Practice (FIP)
This test day focuses on assessment of knowledge of basic medical and scientific principles essential for effective health care. Content areas covered include application of foundational sciences; understanding of biostatistics and epidemiology/population health, and interpretation of the medical literature; and application of social sciences, including communication and interpersonal skills, medical ethics, systems-based practice, and patient safety.
The test day also includes content assessing knowledge of diagnosis and management, particularly focused on knowledge of history and physical examination, diagnosis, and use of diagnostic studies. This test day consists solely of multiple-choice questions and includes some of the newer item formats, such as those based on scientific abstracts and pharmaceutical advertisements.
Day 2 USMLE Step 3
Step 3 Advanced Clinical Medicine (ACM)
This test day focuses on assessment of the ability to apply comprehensive knowledge of health and disease in the context of patient management and the evolving manifestation of disease over time. Content areas covered include assessment of knowledge of diagnosis and management, particularly focused on prognosis and outcome, health maintenance and screening, therapeutics, and medical decision making. Knowledge of history and physical examination, diagnosis, and use of diagnostic studies also is assessed. This test day includes multiple-choice questions and computer-based case simulations.
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