United State Medical Licensing Examination, or USMLE, is a necessary milestone to pass for acquiring a medical license to practice in the US. It's a three-step process that examines a physician's ability to provide safe and effective patient-centric care. Owned by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), the USMLE program analyzes the application of knowledge and concepts to offer comprehensive medical care to patients.
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For assessment purposes, the one-national assessment program includes expert test committees with Liaison Committee on Medical Education (LCME) accredited alumni, biomedical scientists, and educators. These specialists in the medical field have drafted the USMLE exam syllabus. With the highest professional assessment standards, the USMLE exam checks the physicians' eligibility to get an allopathic medical license.
How to Register for USMLE?
The registration process for the USMLE exam is straightforward. The program offers three entities for submitting the application. These comprise the National Board of Medical Examiners (NBME), the Federation of State Medical Boards (FSMB), and the Education Commission for Foreign Medical Graduates (ECFMG).
The candidates must enroll for the test through two channels, i.e., NBME and ECFMG, for Step 1 and Step 2 of the USMLE exam if the students have graduated from LCME or Commission on Osteopathic College Accreditation (COCA)-accredited medical programs in the US or Canada, they've to opt for NBME. However, for foreign graduates attempting the exam from outside the US or Canada, ECFMG is the right channel to apply through.
For Step 3, i.e., the final milestone, USMLE requires registrations through the Federation of State Medical Boards (FSMB).
USMLE Exam Pattern & Eligibility
The USMLE exam is designed to analyze the abilities and comprehension of students at different stages during medical education. For this reason, all the aspiring students need to participate in the three steps, I.e., Step 1, Step 2 (Clinical Clinical Knowledge and Skills), and Step 3.
USMLE Step 1 Exam
Eligibility Criteria for USMLE Step 1 Exam
An enrolled or a graduate medical student in the US or Canadian medical program pursuing an MD degree with LCME accreditation, or
An enrolled or a pursuing graduate student in the US medical school leading to a COCA-authorized D.O. degree, or
An enrolled or pursuing graduate student in a foreign medical school (outside the US and Canada), which the World Directory of Medical Schools recognizes as meeting eligibility conditions of ECFMG.
Appearing Stage during Medical Education: After the second year
Test Pattern
The first test, i.e., USMLE Step 1, aims to analyze the candidates' mastery of sciences and competence for lifelong learning. In this one-day examination, the students must answer multiple-choice questions in seven 60-minute blocks. The applicants have to sit for the eight-hour testing duration with 15 minutes allowed break before every block.
Minimum Passing Score for Step 1: Reported as Pass/Fail (For candidates appearing after January 26, 2022)
USMLE Step 2 Exam
Appearing Stage during Medical Education: After the fourth year
Eligibility requirements for Step 2:Same as Step 1
Test Pattern
Step 2 analyzes the candidates' ability to apply prompt medical knowledge depending on the patient's condition. The one-day examination with eight 60-minute blocks checks the applicant's understanding of the patient-centric concept application. During the nine-hour testing duration, the appearing students have to answer multiple choice questions on surgery, pediatrics, etc.
Minimum Passing Score for Step 2 CK: 214
USMLE Step 3 Exam
Qualification Requisites for Step 3
Passing scores in both the previous steps
An MD degree or D.O. degree from an LCME or COCA-authorized US or Canadian school for medical studies, or the equivalent of the M.D. degree from a foreign medical school mentioned in the World Directory of Medical Schools fulfilling ECFMG eligibility requirements and obtain certification of ECFMG,
Meeting other eligibility essentials as released by USMLE from time to time.
Appearing Stage during Medical Education: After the first year of residency
Test Pattern
Step 3 is the pivotal test for candidates to clear for practicing medicine in the US. It checks the performance of the graduates in the biomedical and clinical science domains. It aims to understand the applicant’s knowledge of unsupervised medicine practice, focusing on ambulatory patient management services.
The expert panel prepares the test to gauge the candidates’ ability through data-based situational questions.
Minimum Passing Score for Step 3: 198
Depending upon their medical knowledge, the candidates can appear for the Step 1 and 2 tests in any sequence they want. However, both exams have to be cleared before attempting Step 3. Moreover, since these exams consider the comprehensive expertise and understanding of the subject, a re-test isn’t allowed once passed.
All USMLE examinations are designed based on a content outline created by medical experts from all domains. Depending upon the requirement in the medical field, the team adjusts the content structure along with the USMLE examination pattern.
The exhaustive content outline makes the USMLE syllabus include 18 major areas to prepare for in different subjects. Most of the test items or questions in Steps 1 and 2 revolve around analyzing the medical knowledge and the physicians' competency. The USMLE Step 3 exam syllabus carries comprehensive medical content for the physicians to deliver expert clinical assistance in the actual practice of medicine.
USMLE Step 1 exam syllabus
General Principles
It consists of the following:
Biochemistry and molecular biology
Biology of cells
Human development and genetics
Biology of tissue response to disease
Pharmacodynamic and pharmacokinetic processes: general principles
Microbial biology
Normal age-related findings and care of the healthy patien
Blood & Lymphoreticular/Immune Systems
Normal processes
Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis
Behavioral Health & Nervous Systems/Special Senses
Normal Processes involving psychodynamic and behavioral factors, adaptive responses, etc
Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis including psychotic, childhood, sexual, and gender identity disorders, etc.
Musculoskeletal, Skin & Subcutaneous Tissue
Normal processes involving embryonic development, fetal maturation, skin defenses, organ structure, etc
Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis of infectious disorders, bone metastases, etc
Cardiovascular System
Normal processes involving development, organ structure, cell tissue function, repair, and changes in life
Abnormal Processes, including neoplasms, heart failure, ischemic heart diseases, etc
Respiratory System
Normal processes involving airway structure and function, pulmonary mechanisms, cell structure, etc.
Abnormal processes, including upper respiratory infections, tonsillitis, malignant and benign neoplasms, and more
Gastrointestinal System
Normal processes involving anatomy of the alimentary canal, intestines, endocrine, and neural regulatory functions, etc
Abnormal processes include bacterial, viral, and fungal infections, etc.
Renal/Urinary Systems
Normal processes that comprise kidney functions, renal mechanisms in acid-base balance, repair and regeneration, etc.
Abnormal processes including infection in specific locations, tubular interstitial diseases etc.
Reproductive & Endocrine Systems
Female structure, hormonal system, reproductive system etc.
Diseases and management related to breasts, reproductive systems, neoplasms, fertility, menopause, menstrual disorder etc.
Multisystem Processes & Disorders
Normal processes consisting of nutritional processes, water metabolism, intracellular accumulations etc.
Abnormal processes involving Kawasaki diseases, parasitic disorders, neoplasms and related disorders.
Biostatistics & Epidemiology/Population Health
Population health, including measures of disease frequency, survival analysis, demographic changes
Study designs and types of selection studies
Measures of association
Principles of testing
Correlation and regression
Distribution of data
And more
Social Sciences: Communication and Interpersonal Skills
Communication and interpersonal skills involving patient interviewing, consultation, and interaction
Use of interpreter or surrogate
USMLE Step 2 Syllabus
The USMLE Step 2 syllabus contains two more specifications on top of the USMLE Step 1 syllabus. It includes:
Pregnancy, Childbirth & the Puerperium
Normal processes involving pregnancy fertilization, implantation, etc.
Abnormal processes involving prenatal care, obstetric complications, labor, delivery, etc.
Legal/Ethical Issues & Professionalism/Systems-based Practice & Patient Safety
Issues related to medical ethics involving consent to treatment informed and refusal etc.
Physical-patient relationship
System-based thinking and culture
Quality improvement
Patient safety
Health care economics
USMLE Step 3 Syllabus
The USMLE 2 exam syllabus carries different components to understand the physicians' ability to perform unassisted medical functions. In addition to the complete syllabus from Steps 1 and 2, the scenarios and setting-based questions consist of specifications, including the site of care, such as:
Ambulatory assistance, ie. In-office/health center, home care, outpatient hospice, and ambulatory surgical center.
Clinical Encounters critical to patient-physical interactions
USMLE Scoring
The USMLE exam provides a recommended pass or fails result with all the Steps. The passing level is periodically reviewed by the expert team consisting of scientists and medical educators.
In each Step, the passing percentage varies every year. However, each candidate must correctly answer 60% of the items to surpass the passing mark. In addition, the performance of case simulations in Step 3 determines the potential to pass the test.
The USMLE exam scoring committee undertakes various steps to ensure the accuracy and veracity of the scores by:
Electronic delivery of scores to NBME
Analysis for aberrant examinee response behavior
Final quality assurance procedures
Availability of score reports on a secure website
The scores are usually available after two to four weeks before the date. The notification is sent to each candidate's registered email address.
Frequently Asked Questions
How many times can candidates appear for each test in the USMLE exam?
The total number of attempts allowed for every application is four.
The number of attempts includes the incomplete attempts along with the failed ones in the exam. If a candidate has taken tests more than four times, they're ineligible to participate in any Step in the USMLE exam sequence.
What are the rules for retakes in Steps for the USMLE exam?
A student can take attempts in the Steps of USMLE exam a maximum ofthree times only within 12 months. The fourth attempt can be taken only after the finishing of the 12-months window from the first attempt and at least six months from the most recent attempt at that particular Step.
What are the fees charged for USMLE Step 1 and 2 tests?
For the students of medical institutions in the US and Canada accredited by LCME or AOA, the 2022 and 2023 fees are USD 645 and USD 660, respectively, for both Step 1 and Step 2 C.K.
The fee structure carries two components for students applying from outside the US and Canada, including certification and examination. For certificates, the student needs to submit USD 160. Additionally, the examination fee for Step 1 and Step 2 C.K. are USD 985 each.
Will there be any fee if the applicant changes the appointment for a Step?
No fees are charged if the student decides to change Prometric test centers 46 or more days before the first day of the USMLE exam. However, for any appointment change after the 46 days window, depending on the date, region, and time-lapse, the surcharge changes.
