Last Updated: March 30, 2025
USMLE Syllabus and Format
The three-step United States Medical Licensing Examination, or USMLE, is required to obtain a medical license to practice medicine 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 representing state boards across the United States and its territories, own this examination program.
State medical boards use the results of the USMLE to help them fulfill their public protection mission and to guide decisions about licenses. 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. Every Step has multiple-choice questions, with Step 3 having real-life simulation questions. Step 3 is a two-day test, whereas the other two are one-day tests.
| Step | Number of Questions | Break-Time | Tutorial | Time Allotted |
| Step 1 | 280 MCQs | 45 minutes | 15 minutes | 8 hours |
| Step 2 CK | 318 MCQs | 45 minutes | 15 minutes | 9 hours |
| Step 3 | - Day 1- 232 MCQs
- Day 2- 180 MCQs + 13 case simulations
| - Day 1- 45 minutes
- Day 2- 45 minutes
| - Day 1- 5 minutes
- Day 2- 5 minutes + 7 minutes
| - Day 1- 7 hours
- Day 2- 9 hours
|
Content Coverage
Each step of the USMLE focuses on different sections. Below is an overview:
| Content | Step 1 | Step 2 | Step 3 MCQ |
| Human Development | 1-3% | 2-4% | 1-3% |
| Immune, Blood and Lymphatic System | 9-13% | 4-6% | 6-8% |
| Behavioral Health and Nervous System | 10-14% | 6-15% | 6-10% |
| Skin and Musculoskeletal System | 8-12% | 6-12% | 5-10% |
| Cardiovascular System | 7-11% | 6-12% | 9-11% |
| Respiratory System | 8-11% | 5-10% | 8-10% |
| Gastrointestinal System | 6-10% | 5-10% | 6-8% |
| Renal/Urinary & Male Reproductive Systems | 4-5% | 7-13% | 4-6% |
| Pregnancy, Childbirth & the Puerperium | 5-6% | 3-7% | 7-9% |
| Endocrine System | 5-10% | 3-7% | 5-7% |
| Biostatistics & Epidemiology/Population Health | 4-6% | 3-5% | 11-13% |
| Social Sciences: Communication Skills | 6-9% | 10-15% | 7-9% |
| Multisystem Processes & Disorders | 8-12% | 4-8% | - |
Step 1
Step 1 consists of 280 multiple-choice questions spread over seven 60-minute segments and is completed in an 8-hour testing session. There won't be more than 40 questions in each block, focusing 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. Candidates usually attempt it during the second or third year as it checks the fundamentals of medicine. The questions can be in graphical, tabular, or simple question form. As the table below indicates, the Step 1 exam covers material associated with interdisciplinary and conventionally defined disciplines.
| Discipline | Range |
| Pathology | 45-55% |
| Physiology | 30-40% |
| Pharmacology | 10-20% |
| Biochemistry & Nutrition | 5-15% |
| Microbiology | 10-20% |
| Immunology | 5-15% |
| Gross Anatomy & Embryology | 10-20% |
| Histology & Cell Biology | 5-15% |
| Behavioral Sciences | 10-15% |
| Genetics | 5-10% |
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 divided into eight 60-minute blocks with 310 multiple-choice questions. There won't be more than 40 questions in each block. The test is administered during a single, nine-hour testing session. There is an additional 45-minute minimum break and an optional 15-minute tutorial.
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 the supervision of a medical practitioner. The table below provides the Step 2 Clinical Knowledge (CK) content weightage for these topics:
| Discipline | Range |
| Medicine | 55-65% |
| Surgery | 20-30% |
| Pediatrics | 17-27% |
| Obstetrics & Gynecology | 10-20% |
| Psychiatry | 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 | 5-10% |
| 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
Step 3 of the USMLE is the most rigorous test usually attempted by candidates during their second year of residency. It is a two-day test that includes multiple choice questions and case simulations mimicking real-life problems.
DAY 1: Foundations of Independent Practice- Day 1 has 232 multiple-choice questions broken down into 6 blocks of 38-39 questions each. Each block has a 60-minute time limit. There is a 5-minute optional tutorial and a 45-minute break. The test is around 7 hours long.
DAY 2: Advanced Clinical Medicine- Day 2 is sub-divided into two parts. Part 1 starts with a five-minute optional tutorial. There are 180 multiple-choice questions, broken down into 6 blocks of 30 questions each. Each test block has a 45-minute time limit. Part 2 consists of Computer-based Case Simulations (CCS). There is a 7-minute optional tutorial followed by 13 case simulations. A maximum of 10 or 20 minutes
real-time is given to each case simulation. This is the actual time that would be spent with the patient in real time. For example, if the candidate decides to obtain a 'history and physical exam', the clock will move ahead accordingly. As the candidate views test and procedure results, treatment effects, and requests for a physical examination and interval history, the clock in simulated time will keep advancing. Candidates will use Primum software to manage patients. There is a 45-minute break time provided on day 2.
Step 3 is the final test that evaluates the knowledge and abilities of practitioners taking on independent responsibility of giving patients general medical care. In the context of a particular setting, the test items and cases mirror the clinical scenarios that a general practitioner may encounter. The questions in Step 3 have to be answered based on the patient's demographic information, symptoms, and medical history.
For case simulations, the examinee has to assume the role of a general practitioner who practices in an independent group practice and has privileges to work in a 400-bed regional hospital that has a fully functional Emergency Department, labor and delivery suite, radiology suite, Intensive Care Unit, and a Cardiovascular Unit. The hospital also has a helicopter evacuation service.
MCQ Physician Tasks/Competencies Specifications are as follows:
| Competency | Day 1/Day 2 MCQ sections |
| Medical Knowledge: Applying Foundational Science Concepts | 11-12% |
| Patient Care: Diagnosis | 33-36% |
| Patient Care: Management | 32-35% |
| Practice-based Learning & Improvement | 11-13% |
| Communication/Professionalism/Systems-based Practice & Patient Safety | 7-9% |
