Last Updated: December 25, 2023
USMLE Syllabus and Format
The three-step United States Medical Licensing Examination, or USMLE, is required to obtain a medical license in order to practice in the country. The purpose of the exam is to evaluate a physician's application skills following their completion of theoretical coursework. The Federation of State Medical Boards and the National Board of Medical Examiners, two non-profit organizations that represent state boards across the United States and its territories, are the owners of this examination program.
The USMLE provides excellent testing to help physicians prepare for practice across the continuum by developing, delivering, and continuously improving them. This helps medical licensing authorities and physicians in the United States.
State medical boards use the results of the USMLE to help them fulfill their public protection mission and to guide decisions about licenses. In order to provide examinees with fairness and equity and to identify pertinent information for medical regulators, the USMLE program complies with professional testing standards.
USMLE Test Format
The USMLE is a three-part test. There are multiple-choice questions in every step. Step 3 is a two-day test, whereas the other two are one-day tests. An additional organizing construct for the design of physician tasks and competencies is present in each step of the USMLE.
| Step | Number of Questions | Time Allotted |
| Step 1 | 280 MCQs | 8 hours |
| Step 2 CK | 318 MCQs | 9 hours |
| Step 3 | - Day1 -232 MCQs
- Day 2- 180 MCQs
| - Day 1- 7 hours
- Day 2- 9 hours
|
Step 1
Step 1 consists of 280 multiple-choice questions spread over seven 60-minute segments and is completed in a single 8-hour testing session. There won't be more than 40 questions in each block, with a focus on the fundamental ideas and workings of health, illness, and treatment modalities. Candidates receive a 15-minute optional tutorial in the beginning and a 45-minute break.
Step 1 evaluates the candidate's comprehension and application of key scientific concepts to the practice of medicine. It ensures mastery of the scientific principles necessary for maintaining competence through lifelong learning in addition to the sciences that currently form the basis for the safe and competent practice of medicine. As indicated in the Table below, the Step 1 exam covers material associated with both interdisciplinary and conventionally defined disciplines.
| Discipline | Range |
| Pathology | 44-52% |
| Physiology | 25-35% |
| Pharmacology | 15-22% |
| Biochemistry & Nutrition | 14-24% |
| Microbiology | 10-15% |
| Immunology | 6-11% |
| Gross Anatomy & Embryology | 11-15% |
| Histology & Cell Biology | 8-13% |
| Behavioral Sciences | 8-13% |
| Genetics | 5-9% |
Step 1's content specifications are as follows:
- General Principles- 12-16%
- Blood & Lymphoreticular/Immune Systems- 7-11%
- Behavioral Health & Nervous Systems/Special Senses- 9-13%
- Musculoskeletal, Skin & Subcutaneous Tissue- 6-10%
- Cardiovascular System- 5-9%
- Respiratory & Renal/Urinary Systems- 9-13%
- Gastrointestinal System- 5-9%
- Reproductive & Endocrine Systems- 9-13%
- Multisystem Processes & Disorders- 6-10%
- Biostatistics & Epidemiology/Population Health- 4-6%
- Social Sciences: Communication and Interpersonal Skills- 6-9%
Step 1 Physician Tasks/Competencies Specifications are as follows:
| Competency | Range |
| Medical Knowledge: Applying Foundational Science Concepts | 60-70%
|
| Patient Care: Diagnosis | 20-25%
|
| Communication and Interpersonal Skills | 6-9%
|
| Practice-based Learning & Improvement | 4-6%
|
Step 2 CK
Step 2 CK is a one-day test that is divided into eight 60-minute blocks and includes 310 multiple-choice questions. It is administered during a single, nine-hour testing session. There won't be more than 40 questions in each block, though it might vary. The concepts of clinical sciences and fundamental patient-centered abilities are covered in this step, which serves as the basis for the competent and safe practice of medicine under supervision. A minimum 45-minute break and an optional 15-minute tutorial are also included in the exam.
With a focus on health promotion and disease prevention, Step 2 CK evaluates the examinee's capacity to apply medical knowledge, skills, and clinical science comprehension necessary for the provision of patient care under supervision. The table below provides the Step 2 Clinical Knowledge (CK) content weighting for these topics:
| Discipline | Range |
| Medicine | 50-60% |
| Surgery | 25-30% |
| Pediatrics | 20-25% |
| Obstetrics & Gynecology | 0-20% |
| Psychiatry | 10-15% |
Step 2 CK's content specifications are as follows:
- General Principles of Foundational Science- 2-4%
- Immune System- 3-5%
- Blood & Lymphoreticular System- 4-6%
- Behavioral Health- 6-8%
- Nervous System & Special Senses- 6-8%
- Musculoskeletal System/Skin & Subcutaneous Tissue- 6-10%
- Cardiovascular System- 8-10%
- Respiratory System- 7-9%
- Gastrointestinal System- 7-9%
- Renal & Urinary System & Male Reproductive- 4-6%
- Pregnancy, Childbirth & the Puerperium- 4-6%
- Female Reproductive System & Breast- 4-6%
- Endocrine System- 4-6%
- Multisystem Processes & Disorders- 4-6%
- Biostatistics & Epidemiology/Population Health/Interpretation of Medical Literature- 3-5%
- Social Sciences: Legal/Ethical Issues & Professionalism/Systems-based Practice & Patient Safety- 10-15%
Step 2 CK Physician Task/Competencies Specifications are as follows:
| Competency | Range |
| Patient Care: Laboratory/Diagnostic Studies | 13-17% |
| Patient Care: Diagnosis | 16-20% |
| Patient Care: Prognosis/Outcome | 5-9% |
| Patient Care: Health Maintenance/Disease Prevention | 8-12% |
| Patient Care: Pharmacotherapy | 8-12% |
| Patient Care: Clinical Interventions | 6-10% |
| Patient Care: Mixed Management | 12-16% |
| Practice-based Learning & Improvement | 3-5% |
| Professionalism | 5-7% |
| Systems-based Practice & Patient Safety | 5-7% |
Step 3
The third examination step focuses on how important it is to evaluate the knowledge and abilities of doctors who are taking on independent responsibility for giving patients general medical care. It focuses on ambulatory patient management, which leads to a license to practice medicine unsupervised. In the context of a particular setting, the test items and cases mirror the clinical scenarios that a general practitioner who is not yet differentiated may encounter. The patients in Step 3 represent the age, gender, cultural group, and occupation diversity of the healthcare populations. The Step 3 examination is divided into two days: Foundations of Independent Practice (FIP) on the first day and Advanced Clinical Medicine (ACM) on the second.
DAY 1: Foundations of Independent Practice- Step 3 is a two-day test with 232 multiple-choice questions broken down into 6 blocks of 38-39 questions. Each block of test items has a 60-minute time limit to be completed. A 5-minute optional tutorial and 45 minutes of break time are included in the roughly 7-hour test session on the first day. However, break time can be extended by completing a block of test items or the optional tutorial before the allotted time runs out.
DAY 2: Advanced Clinical Medicine- There is a five-minute optional on the second testing day. There's also a seven-minute Computer-based Case Simulations (CCS) tutorial included. 180 multiple-choice questions total, broken down into 6 blocks of 30 questions each. Each test block has a 45-minute time limit to be completed. A maximum of 10 or 20 minutes of real-time are given to each of the 13 case simulations that come after the CSS tutorial. Candidates will use Primum software to manage patients. A clock in simulated time can be used to view test and procedure results, treatment effects, and requests for a physical examination and interval history. There is a minimum of forty-five minutes allotted for breaks. At the end of the second day, there is an optional survey that can be completed if time allows.
Content specifications of Step 3 are as follows:
- General Principles of Foundational Science- 1-3%
- Immune System, Blood & Lymphoreticular System, and Multisystem Processes/Disorders- 6-8%
- Behavioral Health- 4-6%
- Nervous System & Special Senses- 8-10%
- Skin & Subcutaneous Tissue- 4-6%
- Musculoskeletal System- 5-7%
- Cardiovascular System- 9-11%
- Respiratory System- 8-10%
- Gastrointestinal System- 6-8%
- Renal/Urinary & Male Reproductive Systems- 4-6%
- Pregnancy/Childbirth & Female Reproductive System & Breast- 7-9%
- Endocrine System- 5-7%
- Biostatistics & Epidemiology/Population Health & Interpretation of the Medical Literature- 11-13%
- Social Sciences: Communication Skills/Ethics/Patient Safety- 7-9%
MCQ Physician Tasks/Competencies Specifications are as follows:
| Competency | Day 1 | Day 2 |
| Medical Knowledge: Applying Foundational Science Concepts | 11-12% | - |
| Patient Care: Diagnosis | 33-36% | 33-36% |
| Patient Care: Management | - | 32-35% |
| Practice-based Learning & Improvement | 11-13% | - |
| Communication / Professionalism / Systems-based Practice & Patient Safety | 7-9% | - |
