Planning to take the USMLE soon?

Taking the USMLE surely has its benefits, but preparing for the different exams can be a bit of a nightmare!

To simplify the information, we have compiled a comprehensive review of what the USMLE exam is, explained each of the steps, defined the eligibility criteria required to write the exam, and so much more.



USMLE Frequently Asked Questions

What is the USMLE? What are its components?

The United States Medical Licensing Examination®  -  USMLE® for short - is a three-step examination owned, governed, and administered by the Federation of State Medical Boards (FSMB®) and the National Board of Medical Examiners (NBME®). It is intended to ensure that all licensed physicians working within the United States have the same assessment standards, no matter the medical school or country where they completed their basic medical education or the state in which they practice.

The USMLE is commonly referred to as the Steps, because that’s exactly how you will be taking them - in installments, as described below:

  • USMLE Step 1

  • USMLE Step 2:

    • Clinical Knowledge (CK) exam

    • Clinical Skills (CS) exam

  • USMLE Step 3


What does the USMLE cover?

  • USMLE Step 1  covers content related to the following disciplines: anatomy, behavioral sciences, biochemistry, biostatistics & epidemiology, microbiology, pathology, pharmacology, and physiology. It also covers content related to the following interdisciplinary areas: aging, genetics, immunology, molecular & cell biology, and nutrition. The exam is organized both by organ systems (i.e. neurology, cardiology, gastroenterology, etc.) and by physician tasks and competencies (i.e. mastering of scientific concepts, correctly diagnosing and effectively managing a case).

  • USMLE Step 2 Clinical Knowledge (CK) covers content related to most organ systems and questions are divided into physiological and pathological processes. The aim of this exam component is to assess whether “you can apply medical knowledge, skills, and understanding of clinical sciences essential for the provision of patient care under supervision”. Other than by organ systems, the exam is also organized by physician tasks and competencies.

  • USMLE Step 2 Clinical Skills (CS) covers content similar to that covered by the Step 2 CK, albeit in a practical format (see next question).

  • USMLE Step 3 covers almost all topics related to clinical medicine and will assess whether “you can apply medical knowledge and understanding of biomedical and clinical sciences essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings”. Other than by organ systems, the exam is also organized by physician tasks and competencies.

For a more detailed breakdown of the content outline for each USMLE component, check out this link.


How are USMLE components organized?

  • Step 1  is a one-day written exam that spans 8 hours. It is divided into seven 60-minute blocks of up to 40 questions each. You will have a minimum of 45 minutes of break time. You can use this time to rest or have a quick bite to eat in between question blocks. The amount you have for breaks is increased if you finish a question block before the allotted time expires.

  • Step 2 is split into two components, which are taken separately:  

    • Clinical Knowledge (CK) is a one-day written exam that spans 9 hours. It is divided into eight 60-minute blocks of up to 40 questions each. You will have a minimum of 45 minutes of break time. You can use this time to rest or have a quick bite to eat in between question blocks. The amount you have for breaks is increased if you finish a question block before the allotted time expires.

    • Clinical Skills (CS) is a one-day practical exam where you will have 12 simulated patient encounters. At each station, you will have 15 minutes for the patient interview and 10 minutes to write a comprehensive patient note.

  • Step 3 is a two-day mixed exam:

    • Day 1 (Foundations of Independent Practice) includes a written exam spanning 7 hours, split into six 60-minute blocks of up to 40 questions each. You will have a minimum of 45 minutes of break time. You can use this time to rest or have a quick bite to eat in between question blocks. The amount you have for breaks is increased if you finish a question block before the allotted time expires.

    • Day 2 (Advanced Clinical Medicine) includes both a written exam of six 45-minute blocks of 30 questions each and a practical exam with 13 case simulations of 10-20 minutes each. You will have a minimum of 45 minutes of break time. You can use this time to rest or have a quick bite to eat in between question blocks or case simulations. The amount you have for breaks is increased if you finish a question block before the allotted time expires.


How long should I prepare for the USMLE exams?

Preparation time depends both on how efficient you are at assimilating information and your personal preference. The majority of test takers report they needed between 6 and 8 months to prepare for Step 1, around 6 months to prepare for Step 2 Clinical Knowledge (CK), and between 4 and 6 months to prepare for Step 3. This time encompasses both freshening up on medical knowledge and practicing exam-style questions.

Preparation for Step 2 Clinical Skills (CS) is a bit different, since it's a practical exam and mostly assesses clinical and communication skills. Most test takers seem to agree that clinical rotations are the best - continuous - exercise to prepare for this exam.

It’s worth noting that most students in “traditional curricula” in the US are expected to pass Step 1 by the end of their second year, Step 2 Clinical Knowledge (CK) by the middle of their third year, and Step 2 Clinical Skills (CS) before September of their final (graduation) year, in order to meet the timeline for applications for residency programs.


Am I eligible to take the USMLE?

  • For Step 1, Step 2 Clinical Knowledge (CK), and Step 2 Clinical Skills (CS), you must be in one of the following categories, both at the time you apply for the exam and on the day of your examination:

    • Be a medical student enrolled in, or a graduate of, a US or Canadian medical school program leading to the MD degree that is accredited by the Liaison Committee on Medical Education (LCME), OR

    • Be a medical student enrolled in, or a graduate of, a US medical school leading to the DO degree that is accredited by the American Osteopathic Association (AOA), OR

    • Be a medical student officially enrolled in, or a graduate of, a medical school that is outside the US and Canada, listed in the World Directory of Medical Schools as meeting ECFMG® eligibility requirements.

  • For the USMLE Step 3 you must fulfill all the conditions below, before submitting your application:

    • Obtain a MD degree (or its equivalent) or a DO degree from a LCME- or a AOA- accredited US or Canadian medical school, or from a medical school outside the US and Canada that is listed in the World Directory of Medical Schools as meeting ECFMG® eligibility requirements, AND

    • Pass Step 1, Step 2 CK, and Step 2 CS, AND

    • Additionally, for international medical graduates, obtain certification by the ECFMG®.


Where can I take the USMLE?

  • You can take Step 1 and Step 2 Clinical Knowledge (CK) at any Prometric™ test center worldwide that offers these exam components.

  • You can take Step 2 Clinical Skills (CS) at one of only six centers in the United States. These are located in Atlanta, Chicago, Houston, Los Angeles, and Philadelphia (x2).

  • You can take Step 3 at any Prometric™ test center in the United States that  offers this exam component.

You can find a list of Prometric test centers via this link.


How much does the USMLE cost?

  • Step 1 and Step 2 Clinical Knowledge (CK) each cost US$895*. If you are testing outside the United States, there will be an additional "International Test Delivery Surcharge**," which varies depending on the region where you are taking the test.

  • Step 2 Clinical Skills (CS) costs US$1,550*

  • Step 3 costs US$850*

* All fees are as of December 2017, and are subject to change by the test authorities at any time and without prior notice.
** For more information on the "International Test Delivery Surcharge," you can check out this link.


How do I register for the USMLE?

The process of registering for a USMLE exam can be quite complicated and confusing. It will not only require information and effort from your side, but necessitates also a lot of help from your medical school administration, so be sure to be in contact with them. It also is a long process, especially for international medical graduates. We tried to simplify it below:

  1. First, you need to make sure you are eligible for the USMLE by checking if your medical school is listed on the World Directory of Medical Schools. Only if your medical school is listed in this directory will you be able to apply for certification by the Educational Committee for Foreign Medical Graduates (ECFMG®), which is necessary for applying for the USMLE.

  2. Next, apply for a USMLE/ECFMG® Identification Number. To do that, please go to ECFMG.org > On-Line Services > IWA - Interactive Web Application. On the IWA page, click to establish an account, carefully read the instructions, and fill in the application form.

    It is crucial that your name and date of birth match the information on your passport!

  3. Allow for at least 5 working days to pass. ECFMG® will process your request and you will then receive your USMLE/ECFMG® Identification Number and a temporary password via email.

    Delays are totally possible... be patient! You may contact the ECFMG® Applicant Information Services at +1-215-386-5900 for inquiries, but do not try to re-apply for another number as duplicate applications may cause further delays.

  4. You can now apply via the IWA - Interactive Web Application. Follow the instructions to fill out and print forms 183/186 (if you are a student) and additional forms (if you are a graduate). Date and sign the forms and send them to your medical school administration to be dated, signed, and stamped.

  5. Your medical school administration should prepare copies of your final diploma and transcripts. Your administration should then combine the transcripts and diploma with the IWA form you completed, and they should send everything back to ECFMG via regular mail, in sealed envelopes. The envelopes and forms should be addressed from the administration,  not in your name

    Please check the ECFMG® Reference Guide for Medical Education Credentials to see the exact final diploma required for you to receive the ECFMG® Certification. If your final diploma and/or transcripts are issued in a language other than English, you must translate them through a certified translator.

  6. Allow approximately 3 weeks for processing, after which you will receive the ECFMG® Certification. Only after receiving this certification can you officially register for a USMLE exam.

    Again, delays are possible, so be patient, and try contacting the ECFMG Applicant Information Services for inquiries.

  7. For Step 1 and Step 2 Clinical Knowledge (CK), you have to first choose a three-month eligibility period (example January-February-March) during which you would like to take your exam, and then choose a test date within that period. You may reschedule your test date at any time, provided the new selected test date is within your eligibility testing period. A rescheduling fee might apply (see below).

    If you are unable to take your exam within your original eligibility period, you may request a one-time period extension. If you fail to take your exam within your original or extended eligibility, you will have to re-apply by submitting a new application and pay the fees again.

  8. For Step 2 Clinical Skills (CS), you will be automatically assigned a one-year eligibility period that starts from the day the processing of your application is done. Once assigned, this period cannot be extended. You can schedule a testing appointment for any available date in your eligibility period. A rescheduling fee might apply (see below).

  9. For Step 3, registration is done via the Federation of State Medical Boards (FSMB®) website, and not through the ECFMG®.

    • Create an account here.

    • Follow the on-screen instructions, submit your application, and process your payment.

    • Download a Certificate of Identity (CID) form from this link, fill it out and sign it, notarize it, and send it back to FSMB by regular mail.

    • Your registration will be finalized within 5-7 working days after (1) FSMB® receives your online application with fees & CID, and (2) FSMB verifies you meet all eligibility criteria (see above). You will be notified by email.

You can use the Step 3 Candidate Website to track your application, check the availability of your scheduling permit and score report, and schedule your exam.


How are the USMLE components scored?

  • For Step 1, Step 2 Clinical Knowledge (CK), and  Step 3, you will receive a 3-digit score on a scale from 1 to 300. Test authorities have not and will not disclose how this score is calculated from the raw score (i.e. the sum of points earned from correct responses). Test results are usually made available within three to four weeks after your test date, however, delays are possible, and for various reasons.

    • Minimum passing score for Step 1 (as of January 1, 2014): 192

    • Minimum passing score for Step 2 Clinical Knowledge (CK) (as of July 1, 2014): 209

    • Minimum passing score for Step 3 (as of January 1, 2016): 196

  • For Step 2 Clinical Skills (CS), you will not receive a numerical grade. You will be graded on three sub-components on a pass or fail basis. You need to pass all three sub-components to pass the USMLE Step 2 Clinical Skills (CS).

    • Communication and Interpretation Skills (CIS)

    • Spoken English Proficiency (SEP)

    • Integrated Clinical Encounter (ICE)


Can I reschedule my USMLE test date?

Rescheduling your USMLE test date is only possible within your eligibility period, however a rescheduling fee* may apply, depending on your testing region and the time of rescheduling relative to your original test date:

  • For Step 1, the rescheduling fee varies from US$0 to US$506

  • For Step 2 Clinical Knowledge (CK), the rescheduling fee varies from US$0 to US$569

  • For Step 2 Clinical Skills (CS), the rescheduling fee varies from US$0 to US$1,280

  • For Step 3, the rescheduling fee varies from US$0 to US$228

You may request a one-time extension** of your eligibility period (only in the case of Step 1 and Step 2 CK), and this will cost US$70.

* For a more detailed breakdown of rescheduling fees, check out this page.
** For more information about the eligibility period, check out the section on USMLE registration above.


Can I retake a USMLE component I've already taken?

If you pass a USMLE component (see above), you are NOT allowed to retake it, except to comply with certain requirements as approved by the USMLE governance.

If you fail a USMLE component, you may retake it no more than three times within a 12-month period. Your fourth and subsequent attempts must be at least 12 months after your first attempt at that exam, and at least six months after your most recent attempt at the exam. You are ineligible to retake a USMLE component if you made six or more prior attempts to pass it, including incomplete attempts, regardless of when the examinations were taken. For purposes of licensure, many state medical boards will require you to successfully complete all Step components within seven years


What happens after completing the USMLE?

Once you complete Step 1, Step 2 Clinical Knowledge (CK), and Step 2 Clinical Skills (CS), you can start the process of applying to residency programs in the USA. This application process - called The Match - is entirely separate from that of taking the USMLE, and is administered and governed by different entities. We are in the process of preparing a comprehensive guide for The Match, so stay tuned!

As for Step 3, you can choose to take it before you apply for residency programs, during the application process, or after you start your residency.


Happy to Help! 

We're here at hello@amboss.com if you run into problems or have any questions.


 

How can AMBOSS help you prepare for the USMLE?


“AMBOSS is the perfect companion to guide you through medical school - it has challenged me to both refine and evaluate my learning throughout the year, rather than waiting until the last minute. This way, I have way more balance and can keep up my interests outside medical school.”

- Victoria Garwood, University of Melbourne, Australia


 

See it all in action!


Happy to Help! 

We're here at hello@amboss.com if you run into problems or have any questions.

 

Legal Notes

The information presented on this page is intended to be a guide for international students wishing to take the USMLE®. All reasonable precautions have been taken to verify the information contained herein. However the guide is published without warranty of any kind, either expressed or implied. The responsibility for the interpretation of the material herein lies with the reader.

The United States Medical Licensing Examination® (USMLE®) is a joint program of the Federation of State Medical Boards (FSMB®) and the National Board of Medical Examiners (NBME®). None of the trademark owners are affiliated with AMBOSS.

The World Directory of Medical Schools (WDOMS) is a joint venture of the World Federation for Medical Education (WFME) and the Foundation for the Advancement of International Medical Education and Research (FAIMER®). Neither the directory nor its management are affiliated with AMBOSS.

Prometric is a wholly-owned subsidiary of Educational Testing Services (ETS). Neither Prometric nor ETS are affiliated with AMBOSS.