All About the USMLE®

Want to become a licensed doctor in the United States?
Here’s everything you need to know.

What is the USMLE?

The United States Medical Licensing Examination (USMLE) is a three-step examination for medical licensure in the US, licensed by the National Board of Medical Examiners (NBME). All physicians with an M.D. degree must pass all three steps of the USMLE exam before applying for a license to practice medicine in the US. The exams are the same for every student. The exams are as follows: Step 1, Step 2 CS, Step 2 CK, and Step 3.

Who can take the USMLE? 

To be eligible to take USMLE Step 1, Step 2 CK, and Step 2 CS, at the time of application and testing, you must be:

  • a current MD student or graduate of a LCME-accredited medical school in the US or Canada, OR
  • a current DO student or graduate of an AOA-accredited medical school in the US, OR
  • a medical student or graduate of a medical school outside the U.S. listed in the World Directory of Medical Schools who meets the eligibility criteria of the ECFMG.  

To be eligible to take USMLE Step 3, before submitting your application, you must have passed all previous Steps, obtained your medical degree from the aforementioned institutions, and met all ECFMG Certification requirements if applicable. It is also recommended that you have completed (or have almost completed) one year of postgraduate training at an accredited US program that meets state board licensing requirements.

For more detailed information about eligibility, please see the latest NBME bulletin.

About USMLE Step 1

The USMLE Step 1 is a test that assesses your understanding of the important concepts of basic medical sciences. The test focuses on the principles and mechanisms of health, disease, and modes of therapy. Step 1 is a computer-based exam comprised of seven 60-minute blocks, with a maximum of 40 questions in each block. These are administered in a one-day testing session. The test items in the USMLE Step 1 are single-item questions. Usually, there is a patient-centered vignette that is associated with one question, followed by four or more lettered response options (A, B, C, and D), of which only one is the best answer.

About USMLE Step 2

Step 2 CK 

The USMLE Step 2 Clinical Knowledge (Step 2 CK) exam is one part of the USMLE Step 2 exams, the other part being Clinical Skills (Step 2 CS). While Step 1 focuses on basic sciences, the Step 2 exams focus on physiological conditions and diseases, and important physician tasks. The Step 2 CK exam consists of eight 60-minute blocks and has to be completed in a one-day, ca. 9-hour testing session. You will be able to answer the questions in each block in any order, and you will also have the option to change your answers until you exit the block, or the allocated block time runs out. Once you exit a block, it will be locked and you will not be able to review test items or change answers.

Step 2 CS

The USMLE Step 2 Clinical Skills (Step 2 CS) exam is one part of the USMLE Step 2 exams, the other part being Clinical Knowledge (Step 2 CK). The Step 2 CS exam includes a day’s testing session in which you will have twelve patient encounters. The time allocated for each encounter is fifteen minutes, with ten more minutes to complete each patient note, which should be typed on a computer. If you do not use the entire fifteen minutes for the patient encounter, the remaining time will be added to the ten minutes that you normally have for typing the patient note.

About USMLE Step 3

The USMLE Step 3 exam is a two-day, computer-based exam which assesses your ability to apply medical knowledge, biomedical and clinical science required for the unsupervised practice of medicine. In addition to more than 400 multiple choice questions, the exam also includes 13 clinical case simulations (CCS), which are digitized patient encounters designed to assess your ability to take a history and physical examination, order diagnostic tests, choose initial treatments, and generally manage a patient.

About NBME

The National Board of Medical Examiners (NBME), together with the Federation of State Medical Boards (FSMB), co-sponsors the USMLE. As such, the NBME offers three types of self-assessments for students to evaluate their readiness for USMLE:

  1. The Comprehensive Basic Science Self-Assessment (CBSSA) is a multiple choice self-assessment with content resembling that found on Step 1, typically covered during basic science medical education courses. 
  2. The content of the Comprehensive Clinical Science Self-Assessment (CCSSA) is based on information covered during core clinical clerkships, which reflects that of Step 2 CK. 
  3. The content of the Comprehensive Clinical Medicine Self-Assessment (CCMSA) closely resembles that of the multiple-choice component of Step 3, information which is typically covered in clinical encounters. 

These self-assessments can be valuable tools for students preparing for USMLE Step 1 and Step 2 CK; however, the self-assessments do not necessarily predict your USMLE score. 

What is a good score on the USMLE?

The current minimum passing scores are as follows: 

  • Step 1: 194 
  • Step 2 CK: 209 
  • Step 2 CS: pass
  • Step 3: 198

Learn more about scores for:

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