United States Medical Licensing Examination Test (USMLE)

The United States Medical Licensing Examination, or USMLE, is a 3-step exam for medical licensure to practice in the USA. The exam assesses a physician's application skills 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 non-profit organizations representing state boards of the US and its territories.

Committee members, including biomedical scientists, educators, and clinicians, develop the examination content. Each of the three steps in the USMLE exam complements the others, and none of these three steps can stand alone individually in assessing the candidate's readiness for practicing medicine independently.

Eligibility for Steps 1 and 2 USMLE

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

• Candidate should be a medical student who has enrolled in or has graduated from an LCME-recognized medical school in Canada or the US with an MD degree.
• Candidate should be a medical student who has enrolled in or has graduated from a COCA-recognized medical school in Canada or the US with a DO degree.
• Candidate should be a medical student enrolled in or graduated from a medical school listed in the World Directory of Medical Schools outside the US and Canada.

Eligibility for Step 3 USMLE

Candidates applying for the third step of the examination must meet the following requirements to complete their application.

• Candidate should get an MD degree or a DO degree.
• Candidate must clear Step 1 and Step 2 CK of USMLE.
• It is recommended that they complete at least one year of postgraduate training in an accredited US graduate medical education program due to the practical nature of Step 3.

Fees for USMLE

The fee structure for candidates taking the USMLE is as follows-

Step	Fee (US/Canada)	Fee (Other Countries)
Step 1	$680	$1,020 + $205*
Step 2 CK	$680	$1,020 + $230*
Step 3	$935	NA

Registering for USMLE

Only Prometric centers are authorized to administer Step 1, Step 2 CK, and Step 3. Step 3 of the test is only administered in the United States and its territories, even though the other steps are also administered outside the country. The following are the relevant organizations that candidates can register with to take the test:

• For US/Canadian Candidates (including US territories):
  • Step 1 and 2 CK- NBME website
  • Step 3- FSMB Website
• For Candidates outside the US and its territories and Canada: Before applying, medical students and graduates from institutions outside of the US and Canada should see if the World Directory of Medical Schools has their institution listed. They must then adhere to the guidelines provided on the ECFMG website to register for Step 1 and Step 2 CK of the test. To register for Step 3 of the test, they must follow the instructions on the FSMB website.

When they apply for the exam, candidates must indicate which eligibility period they would like to test during. After their registration, a scheduling permit with their eligibility period will be issued and emailed to candidates. Upon securing the scheduling permit, candidates can go to the Prometric website and book a test date up to six months ahead.

USMLE Format

USMLE consists of three steps that are taken at different times. There is no set order for Step 1 and Step 2, although it is recommended that both these steps be taken in the correct order since Step 1 includes the fundamentals and Step 2 includes the practical application of these fundamentals. Step 3 has to be taken after passing Steps 1 and 2.

Each Step of USMLE has questions that can be classified in one of the 18 major areas. The questions can be related to a single organ or a group of organs. The 18 areas can be broadly classified as:

• Human Development
• Immune System
• Blood and Lymphoreticular System
• Behavioral Health
• Nervous System and Special Senses
• Musculoskeletal System/Skin and Subcutaneous Tissue
• Cardiovascular System
• Respiratory System
• Gastrointestinal System
• Renal and Urinary System and Male Reproductive System
• Pregnancy, Childbirth, and the Puerperium
• Female Reproductive System and Breast
• Endocrine System
• Multisystem Processes and Disorder
• Biostatistics and Epidemiology/Population Health/Interpretation of Medical Literature
• Social Sciences: Legal/Ethical Issues and Professionalism/Systems-based Practice and Patient Safety

Step 1 of USMLE

Step 1 of the examination deals with the different basic and important concepts of the sciences required for practicing medicine, but this is focused mainly on the aspects of health, disease, and mode of therapy required for each condition. The questions require the candidates to interpret the specimens based on the graphical and tabular data provided.

This section has a maximum of 280 questions in the multiple-choice format, divided into seven 60-minute blocks. Each block will have a maximum of 40 questions. There is an optional 15-minute tutorial. The examination is considered one day long since it is conducted at an 8-hour test session.

The examination content will be flexible since the questionnaire is created by experts who focus on emerging domains in the field. This implies that the examination content 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.

Step 2 of USMLE

This step of the examination deals mainly with applying medical knowledge to care for patients under supervision. It focuses primarily on health promotion and disease prevention. The exam is titled Clinical Knowledge/CK.

The competency of the candidate is assessed according to their medical knowledge in patient care in analyzing History and Physical Exam, Laboratory and Diagnostic Studies, Diagnosing, Prognosis and Outcome, Health Maintenance and Disease Prevention, Pharmacology, Clinical Interventions, Mixed Management, Professionalism, and Systems-based Practice and Patient Safety.

This section has a maximum of 318 multiple-choice questions. It is divided into eight 60-minute blocks, with a maximum of 40 questions in each block. The examination is conducted in a single day within a nine-hour session. The candidates will receive at least a 45-minute break between the exams. The content for this examination step focuses only on clinical science and considers emerging domains and technologies.

Step 3 of USMLE

This is the final Step of the USMLE, which assesses the candidate's knowledge in biomedical and clinical science essential in the unsupervised practice of medicine. This exam is a foundation for an independent practice where physicians must function under pressure within context-specific cases.

The exam is conducted over two days. The first day is the Foundation of Independent Practice/ FIP, and the second is the Advanced Clinical Medicine/ ACM.

First Day of USMLE Step 3

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

Second Day of USMLE Step 3

The second examination day lasts 9 hours, with a 45-minute break. It contains 180 multiple-choice questions divided into six blocks, each 45 minutes long. After this, there are 13 computer-based case simulations, each 10-20 minutes long.

USMLE Score Reports

USMLE scores are available within 4 weeks of the test being administered, although candidates can expect to receive them as early as two weeks. There are several reasons why score reporting could be delayed. It is recommended that candidates allow a minimum of eight weeks for notification of the availability of their score report before enquiring about the results. An email notification is sent to the candidates when their results are available by the organization that registered candidates for the test. After the date of the email notification, the candidates' score reports will be accessible for about 365 days on the registered organization's website. After this period, an official report can be requested for a fee.
The minimum required score for each Step is as follows-

• Step 1 - Pass/Fail
• Step 2 CK - 214
• Step 3 - 200

Withholding USMLE Scores

ECFMG and NBME send the results to the medical schools of the students for Step 1 and Step 2. If students do not want their scores reported to their school, they should email the organization registering them for the test (ECFMG or NBME) at least 10 days before the test.
For Step 3, the candidates should specify this preference in their FSMB application.
Student performance and exam data might be provided to third parties for research purposes. This data is confidential and provided to third parties without any identification markers. Should the candidate choose not to have this information accessible to third parties, they should email the USMLE Secretariat at least 30 days before their test.
Contact info:

• NBME/USMLE Secretariat- webmail@nbme.org
• ECFMG- https://secure2.ecfmg.org/emain.asp?app=iwa

USMLE Test Centers

Candidates must go to the Prometric website to learn the locations of the test centers in a given area. The USMLE will have a "Locate" option under each step. Candidates will be redirected to a new page after clicking the link, where they will be required to enter their address, city, and zip/postal code. They will then be prompted to choose a start and end date. Remember that the end date must fall within two weeks of the start date selected. After completing these steps, candidates will find the list of test centers in their area.

Rescheduling the Test

Candidates can reschedule their exams on the Prometric website. If the test is rescheduled or the test center location is changed within forty-five days or less before their scheduled test date, Prometric will charge a fee. There is no fee if a test appointment is changed 46 or more days before the scheduled test date. Candidates must ensure that their rescheduled test date(s) falls within their allocated eligibility period when rescheduling. The cost to reschedule is displayed in the table below:

Date	Testing region	Step 1	Step 2 CK	Step 3
46 or more days before (but not including) the first day of the scheduled test date	All testing regions	No Fee	No Fee	No Fee
31-45 days and before (but not including) the first day of the scheduled test date	All testing regions	$35	$35	$35
6-30 days before (but not including) the first day of the scheduled test date	All testing regions	$100	$100	$100
five or fewer days before (but not including) the first day of the scheduled test date	US and Canada	$140	$157	$279*
five or fewer days before (but not including) the first day of the scheduled test date	Outside the US and Canada	$358	$403	N/A

* For Step 3 administrations, candidates will be charged a $140 rescheduling fee if they reschedule one or more, but not all, days of their appointment between 1 and 5 days before their first scheduled test date.

Canceling the Test

Once paid, the USMLE registration cannot be canceled. Most candidates will not cancel their registration since the USMLE is the pathway to a medical career. The costs are non-refundable. Candidates only have the option to reschedule their test or change their testing location.

Requesting Additional Break Time

Through the USMLE website, candidates can apply for extra break/standard testing time by completing the form. They will only be permitted to do so for medical reasons or extenuating circumstances. Requests should be submitted before or when registering for the exam. Examinees should be aware, however, that if they take an additional break, Step 2 turns into a two-day exam, and Step 3 becomes a three-day exam.

Top Medical Schools

The best medical schools 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

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