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A Comprehensive Guide to USMLE

ACAlpina ChariJan 25, 2024

What is USMLE? 

The USMLE, or the United States Medical Licensing Examination, is a three-step examination that tests the knowledge, skills, and patient-centered care of medical graduates who wish to practice medicine in the US. The USMLE aims to assess whether medical graduates are competent and ready to enter residency training and unsupervised practice in various medical specialties. The USMLE is sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), which are two organizations that regulate and oversee the medical profession in the US. The USMLE was created in the early 1990s to replace the multiple examinations that offered paths to medical licensure in the past. The USMLE consists of three steps, each with a different focus and format, that cover the basic and clinical sciences and the application of medical knowledge in various settings. 

The USMLE is also a crucial step in the journey to medical licensure in the US, as it ensures that medical graduates are competent and ready to enter residency training and unsupervised practice in various medical specialties. The USMLE is a standardized test accepted by all state medical boards in the US and US territories and is required for obtaining a medical license and applying for residency programs. The USMLE tests the medical graduates on their knowledge, skills, and patient-centered care, using multiple-choice questions, clinical cases, and computer simulations. The USMLE also reflects the current and future needs of the medical profession and the health care system in the US and is updated regularly to incorporate the latest scientific and clinical advances. The USMLE helps in sorting and finding out the best candidates due to the tough competition and highly qualified applicants. It serves as a common and objective criterion for evaluating medical graduates from different schools, countries, and backgrounds, ensuring a fair and consistent selection process.

Overview of USMLE 

Conducted By  FSMB and NBME
Purpose  For medical licensure in the US, and some other countries
Duration of Test  Step 1: 8 hrs

Step 2 CK: 9 hrs

Step 3: 7 hrs (Day 1), 9 hrs (Day 2)

Exam Fees  Step 1: 670 USD (Domestic); 1,000 USD (International)

Step 2 CK: 670 USD (Domestic); 1,000 USD (International) 

Step 3: 925 USD

Exam Date  No fixed dates; open throughout the year

USMLE Eligibility 

The eligibility criteria for each step are different and depend on your medical school accreditation and degree. Here is a summary of the USMLE eligibility criteria for each step: 

Step 1 and Step 2 CK: You must be officially enrolled in, or a graduate of, one of the following types of medical schools at the time of application and on the day of the exam: 

  • A US or Canadian medical school program leading to the MD degree is accredited by the Liaison Committee on Medical Education (LCME) or the Committee on Accreditation of Canadian Medical Schools (CACMS). 
  • A US medical school program leading to the DO degree is accredited by the Commission on Osteopathic College Accreditation (COCA). 
  • A medical school outside the US and Canada that is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements and that meets other eligibility criteria of the ECFMG.

Step 3: You must have passed Step 1 and Step 2 CK, and have one of the following degrees at the time of application and on the day of the exam: 

  • An MD degree or a DO degree from a US or Canadian medical school that is accredited by the LCME or the COCA. 
  • The equivalent of the MD degree 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 that has obtained ECFMG Certification. 

The USMLE program recommends that you should have completed, or be near completion of, at least one postgraduate training year in an accredited US graduate medical education program that meets state board licensing requirements before taking Step 3.  

There is no specific age limit for the USMLE exam, as long as you meet the eligibility criteria for each step. However, you should be aware of the time limit and the number of attempts allowed for each step.

USMLE Exam Structure 

The USMLE is a three-step examination for medical graduates who want to practice medicine in the USA. It is owned by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). Here is a brief overview of the USMLE exam structure and admission process for each step:  

USMLE Step 1: This step tests your understanding and application of basic science concepts to the practice of medicine, with emphasis on principles and mechanisms underlying health, disease, and therapy. It consists of around 280 multiple-choice questions, divided into seven 60-minute blocks. The exam is computer-based and administered at Prometric test centers across the world. You can register for Step 1 through ECFMG’s online services on the USMLE official website. 

USMLE Step 2: This step has two components: Clinical Knowledge (CK) and Clinical Skills (CS). CK tests your ability to apply medical knowledge and clinical science to patient care under supervision, with a focus on health promotion and disease prevention. It consists of around 318 multiple-choice questions, divided into eight 60-minute blocks. The exam is computer-based and administered at Prometric test centers. CS tests your ability to gather information from patients, perform physical examinations, and communicate your findings. It consists of 12 patient encounters, each lasting 15 minutes, followed by 10 minutes of note-writing. The USMLE Step 2 CS is offered only at six test centers in the US: Atlanta, Chicago, Houston, Los Angeles, Philadelphia, and Washington, DC. However, due to the COVID-19 pandemic, the USMLE Step 2 CS has been suspended since March 2020 and is expected to resume in 2024 with some modifications.  

USMLE Step 3: This step assesses your ability to apply medical knowledge and clinical science to the unsupervised practice of medicine, with an emphasis on patient management in ambulatory settings. It consists of two parts: Foundations of Independent Practice (FIP) and Advanced Clinical Medicine (ACM). FIP tests your knowledge of basic science, biostatistics, epidemiology, and interpretation of medical literature. It consists of around 233 multiple-choice questions, divided into six 45-minute blocks. ACM tests your ability to diagnose and manage patients in various clinical scenarios. It consists of around 180 multiple-choice questions, divided into six 45-minute blocks, and 13 computer-based case simulations, each lasting 10 or 20 minutes. The exam is computer-based and administered at Prometric test centers in the USA.

USMLE Registration Process and Application Fees

The USMLE Registration Process is a series of steps that you need to follow to apply for the USMLE exams. The USMLE exams are divided into three steps: Step 1, Step 2 CK, and Step 3. Each step has its own eligibility criteria, application fee, and registration entity. Here is a brief overview of the USMLE Registration Process for each step:  

Step 1: This exam assesses your basic science knowledge and is usually taken after the second year of medical school. To apply for Step 1, you need to create an ECFMG account if you are a student or graduate of a medical school outside the US and Canada, or an NBME account if you are a student or graduate of a medical school in the US and Canada. Then, you need to fill out the online application form, pay the application fee, and submit the required documents. You also need to obtain a scheduling permit from ECFMG or NBME, which will allow you to schedule your exam date and location at a Prometric test center. The eligibility period is a three-month window in which the candidate can schedule and take the test. The candidate will receive a scheduling permit via email, which is required to schedule the test date and location at a Prometric test center. The candidate will also need to verify their medical education credentials and status with the ECFMG before taking the test.

Step 2 CK: This exam assesses your clinical knowledge and skills and is usually taken during the fourth year of medical school. To apply for Step 2 CK, you need to follow the same process as Step 1, except that you need to fill out a different online application form and pay a different application fee. The eligibility period is a 12-month window in which the candidate can schedule and take the test. The candidate will receive a scheduling permit via email, which is required to schedule the test date and location at one of the six CSEC centers in the US. The candidate will also need to verify their medical education credentials and status with the ECFMG before taking the test.

Step 3: This exam assesses your ability to practice medicine independently and is usually taken after completing the first year of residency. To apply for Step 3, you need to create an FSMB account and fill out the online application form. You also need to pay the application fee and submit the required documents. You need to have passed Step 1 and Step 2 CK before applying for Step 3. The eligibility period is a three-month window in which the candidate can schedule and take the test.

Test Dates and Fees 

The USMLE exam dates are not fixed but depend on the availability of test centers and the eligibility period of the candidates. Here is some detailed information about the USMLE deadlines and test dates for each step:

USMLE Step 1: The USMLE Step 1 is offered throughout the year, except for the first two weeks of January. Candidates can choose an eligibility period of three months, during which they can schedule their test date at any Prometric center. The suggested period to take USMLE Step 1 is till the end of April. The application fee for USMLE Step 1 is 670 USD for US and Canadian students and graduates, and 1,000 USD for international students and graduates.  

USMLE Step 2 CK: Step 2 CK is usually taken during the fourth year of medical school and is required to apply for residency programs. This is also offered throughout the year, except for the major local holidays. Candidates can choose an eligibility period of three months, during which they can schedule their test date at any Prometric center. The application fee for USMLE Step 2 CK is 670 USD for US and Canadian students and graduates, and 1,000 USD for international students and graduates.  

USMLE Step 3: Step 3 is usually taken after the first year of residency and is required to obtain a medical license. This test is offered throughout the year, except for the first two weeks of January and the major local holidays. Candidates can choose an eligibility period of three months, during which they can schedule their test date at any Prometric center in the US and its territories. The application fee for USMLE Step 3 is 925 USD for all candidates.  

Candidates are advised to schedule their USMLE exam date as soon as possible, as the appointments at some test centers fill up quickly. Candidates can reschedule their USMLE exam date without any fee if they do so at least 31 days before their scheduled test date. If they reschedule within 30 days of their scheduled test date, they will have to pay a rescheduling fee that varies depending on the USMLE Step and the time of rescheduling. 

USMLE Scoring 

The USMLE scores are reported on a three-digit scale from 1 to 300, with the exception of Step 1 which is reported as pass/fail only. The three-digit scores are derived from a statistical process that converts the raw number of correct answers into a standardized score that reflects the difficulty level of the exam. The USMLE program does not provide percentile ranks or normative data for individual examinees. Here is a brief overview of the minimum scoring requirement for each step of the USMLE. 

Step 1: As of January 26, 2022, Step 1 score reporting has transitioned from a three-digit numerical score and pass/fail outcome to pass/fail only. Step 1 is usually taken after the second year of medical school and is required to proceed to Step 2 CK and Step 3. 

Step 2 CK: Step 2 CK is administered as a one-day, computer-based test with 316 multiple-choice questions. The score report includes a three-digit score and a pass/fail outcome. The current minimum passing score is 214. 

Step 3: The score report includes a three-digit score and a pass/fail outcome. The current minimum passing score is 200. 

The USMLE scores are used by various stakeholders for different purposes. For medical licensing authorities, the USMLE scores are used to verify the medical competence of applicants and to grant them the right to practice medicine in the United States. For residency programs, the USMLE scores are used to screen, rank, and select applicants for interviews and positions. For medical students and graduates, the USMLE scores are used to monitor their progress, identify their strengths and weaknesses, and plan their career goals.  

However, the USMLE scores are often used as a cutoff or a threshold to filter out applicants who do not meet the minimum requirements or expectations of the program. Therefore, it is important for applicants to prepare well for the USMLE exams and to aim for high scores that reflect their abilities and potential.  

The USMLE program publishes annual performance data for each Step exam, which shows the passing rates and the mean and standard deviation of the three-digit scores for various examinee groups. The performance data can help applicants to compare their scores with the national and international averages and to evaluate their competitiveness for residency programs. However, the performance data should not be used to predict the outcome of the residency match process, as there are many other factors involved

How to Prepare for the Exam?

To prepare for the USMLE exam, you can follow these general steps:  

  • Review the content outline and sample questions for each step of the exam on the USMLE website. 
  • Choose the best resources for your learning style and goals. 
  • Create a study plan that covers all the topics and allows enough time for practice and revision. You can use a USMLE prep course or a guide to help you with this. 
  • Take practice tests and self-assessments to monitor your progress and identify your strengths and weaknesses. You can use the NBME practice exams or the UWorld self-assessments for this purpose. 
  • Register for the exam at least six months in advance and choose a test date and location that suits you. You will need to submit your eligibility information to your medical school and receive a token to schedule your exam. 
  • Prepare for the test day by reviewing the exam day information and the exam security policies. You should also familiarize yourself with the test center and the computer interface.

Where Do USMLE Scores Apply?

The USMLE is required for anyone who wants to practice medicine in the United States, but it is also accepted in some other countries as an equivalent to their national medical exam. Some of these countries are  

Australia: International medical graduates who have passed all three steps of the USMLE and completed a minimum of two years of graduate medical education in an accredited residency program can apply for the Competent Authority pathway, which allows them to register with the Medical Board of Australia after a year of supervised practice. 

Ireland: International medical graduates who have passed Steps 1 and 2 of the USMLE within the last seven years can apply for the PRES Level 3, which is a clinical examination that assesses their competence to practice medicine in Ireland. 

Israel: Israeli and immigrant physicians who have studied medicine abroad and passed the USMLE are exempt from the Israeli Medical Licensing exam, which is otherwise mandatory for anyone who wants to practice medicine in Israel. 

United Arab Emirates: International medical graduates who have passed all three steps of the USMLE are exempt from the oral and written exams that are required for obtaining a license to practice medicine in the UAE. Those who have only passed Steps 1 and 2 still need to take the oral exam. 

These are some of the foreign countries where the USMLE scores are accepted, but there may be other requirements and regulations that vary depending on the country and the specialty of the physician. Therefore, it is advisable to check the official websites of the relevant medical authorities before applying for a license to practice medicine abroad.

Conclusion 

In conclusion, The USMLE is a challenging but rewarding examination that assesses your readiness for medical practice in the United States. Whether you are a U.S. or an international medical graduate, the USMLE is your gateway to a fulfilling career in medicine. However, it’s important to note that USMLE scores are not the only factor that determines the success of applicants for residency programs. Other factors such as academic performance, letters of recommendation, personal statement, research experience, extracurricular activities, and interview skills are also considered by residency program directors. We hope that this guide has been instrumental in providing you with a comprehensive overview of the USMLE. For more information on medical studies in the US and detailed guidance, reach out to us at Gyanberry. Book your free video call appointment now.

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Frequently Asked Questions

Step 1 evaluates basic science knowledge, Step 2 assesses clinical knowledge and skills, and Step 3 evaluates clinical skills and management of patient cases. Each step builds upon the previous one, with Step 3 focusing more on clinical decision-making and patient management.

Step 1 is typically taken after completing the preclinical years of medical school, Step 2 during or after completing clinical rotations, and Step 3 after graduating from medical school and before starting residency training.

Effective preparation involves utilizing a variety of study resources such as review books, question banks, and practice exams. Creating a study schedule, focusing on weaknesses, and utilizing active learning techniques like spaced repetition can enhance the preparation and retention of knowledge

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