USMLE

About USMLE – Quick Facts

What is USMLE? – An Introduction

If you have always dreamed of going abroad, specifically to the United States of America, and practising medicine, you need to appear for the USMLE exam. Short for the United States Medical Licensing Examination (USMLE), this test is sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). The USMLE is a three-step examination that you must take if your goal is to earn a license to practice medicine in the USA. The exam assesses a medical student’s ability to apply medical knowledge, principles and concepts. It also evaluates how well the medical practitioner can demonstrate fundamental and critical patient-centred skills, which are incredibly crucial in the practice of health and diseases. These skills constitute the foundation of effective and safe patient care procedures.

The USMLE exam was first designed in the late 1980s but introduced between 1992 and 1994. It replaced two of the most widely accepted medical licensing examination programs in the medical profession of that time, namely the NBME Part Examination Program, as well as the Federation Licensing Examination or FLEX program. Read on to know more about the USMLE.

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USMLE Steps

The three steps of the USMLE are divided as Step 1, Step 2 CK (Clinical Knowledge), and Step 3. Until 2020, Step 2 also included a CS (Clinical Skills) component as part of Step 2. However, the NBME and FSME announced the cancellation of Step 2 CS permanently in March 2021. While you can appear for Steps 1 and 2 in any sequence, you must pass the two steps before appearing for the Step 3 test.

USMLE Step 1

The USMLE Step 1 assesses your knowledge of basic science principles, including anatomy, biochemistry, behavioural science, microbiology, pharmacology, pathology and physiology. Step 1 also tests your knowledge of interdisciplinary areas like genetics, nutrition, and immunology.

USMLE Step 2

Step 2 CK assesses your ability to apply medical knowledge and skill and understand clinical science, critical to patient care, under supervision. It further emphasises diseases prevention and health promotion. The test includes a 45 minutes break and an optional tutorial of 15 minutes.

USMLE Step 3

Step 3 is a two-day examination, a final assessment that evaluates your ability to apply your medical knowledge and understanding of clinical and biomedical science in an unsupervised environment. It emphasises patient management under ambulatory settings and assesses if you can assume independent responsibility in delivering primary medical care. You have to answer 232 multiple-choice items, spread over six blocks of 38-39 items on the first day of Step 3. You are allotted 60 minutes to complete each block over a test time of 7 hours, including a break of 45 minutes and a 5-minute optional tutorial. The second day comprises a test session of 9 hours, which includes an optional tutorial of 5 minutes, followed by 180 multiple-choice items, spread over six blocks of 30 items, with a break time of 45 minutes. You are required to complete each block in 45 minutes. Further, you have to take a 7-minute CCS tutorial followed by 13 case simulations of 10-20 minutes each.

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USMLE - Eligibility Criteria

Eligibility for USMLE Step 1 & 2 Exams

To be eligible for the USMEL Step 1 and Step 2 exams, you should meet any one of the below eligibility criteria:

1. You should be officially enrolled in or have graduated from a medical school in the USA or Canada, leading to the MD degree. The medical school in the US or Canada should be accredited by the Liaison Committee on Medical Education or LCME, the accrediting body of MD programs in the two countries, and recognised by the US Department of Education.
2. You should be officially enrolled in or have graduated from a medical school in the USA, leading to the DO degree. Such a school should be accredited by the American Osteopathic Association (AOA) Commission on Osteopathic College Accreditation (COCA), the accrediting body for osteopathic educational institutions in the USA, as recognised by the US Department of Education.
3. You should be enrolled in or have graduated from a medical school listed in the World Directory of Medical schools or WDOMS, outside the US and Canada. Such a school should meet the Educational Commission for Foreign Medical Graduates (ECFMG) eligibility requirements and criteria.

Eligibility criteria for USMLE Step 3

To appear for the USMLE Step 3, you need to meet with ALL of the below-mentioned eligibility criteria:

1. You should hold an MD (or an equivalent, MBBS, for instance) degree from an LCME accredited medical school in the US or Canada.
2. You should hold a DO degree from AOA accredited medical school in the US OR an MD (or an equivalent, MBBS, for instance) degree from WDOMS listed medical schools located outside of the USA and Canada and possess the ECFMG Certification.
3. You should have successfully cleared USMLE Step 1 and Step 2 examinations.

Before you register for the USMLE exam, remember to verify that the institution from where you are pursuing your medical degree is listed in the WDOM. You can check the same by visiting the official WDOMS website. You will find the tab “Search the World Directory” on the Home Page, where you can enter the name of your medical school to check whether or not it is listed. Alternatively, you can use the drop-down menu, choose your country name, and enter details about your city and college to check if it is listed.

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USMLE Exam Fees

The schedule of USMLE fees for students from the US or Canada

Medical students from LCME or AOA accredited institutions or graduates from medical schools in the USA, or Canada need to apply via the NBME website to register for the exam.

The following is the structure of USMLE fees for Step 1 and Step 2 exams.

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USMLE registration for international students

If you wish to register for USMLE but are not a medical student from the USA or Canada, you will have to send your application through the ECFMG website. You will need to pay an $150 to apply for the ECFMG certification.

Additional costs associated with USMLE Step 1 and Step 2 exams

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USMLE Fees for Step 3

You can apply for USMLE Step 3 exam only after clearing Step 1 and Step 2 exams. You are required to send your applications for Step 3 exam via the FSMB website after creating your account and logging in. You need to pay the below fees:

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How to Register for USMLE exam?

As an international student intending to appear for the USMLE exam, you need to follow the steps mentioned below.

1. Create your account on the ECFMG website.

   Visit the website and select the ‘I want to apply for ECFMG Certification tab’ and place a request for a USMLE/ECFMG identification number. You will be redirected to another window with a new form for you to fill in your details and submit the form. After approximately two weeks, you will receive your ECFMG ID and password (which you may change).

2. Fill the USMLE step 1 application on the ECFMG website

   Login to your ECFMG account and select the ‘begin new application’ tab. Fill out the form, entering all your details appropriately, and pay the USMLE exam fee. Also, ensure you select your eligibility period wisely. Note that there is a three-month period you can choose for scheduling your test.

3. Fill Form 183

   Upon making the usmle exam fee payment, you see a link for Form 183 in the same window. Fill the form and get it signed and stamped by your medical school’s Dean. Ensure that the signature of the Dean matches that on the ECFMG records. Remember to emphasise this to your medical school’s office staff since your form will not be accepted if the signatures do not match.

4. Mail Form 183 to Philadelphia

   After filling Form 183, you have to mail it to the below address:

   IWA
   ECFMG
   3624 Market Street
   Philadelphia, PA 19104-2685
   USA

   Ensure the envelope in which you mail the form is from your Dean’s official stationery, bearing the Dean’s stamp. Typically, your medical college would be familiar with this process.

5. Wait to receive the scheduling permit

   Within 2-3 weeks of mailing Form 183, ECFMG will send an email containing your scheduling permit. This is an important document that you need to carry with you on your exam day. Review to permit and ensure the details mentioned in it are correct.

6. Book your date at a Prometric Centre

   You can now visit the Prometric website, the official testing service responsible for conducting all USMLE exams. You need to select USMLE, your testing location and your preferred exam date within your eligibility period. Complete the booking process by referring to and entering the details mentioned in the scheduling permit.

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USMLE - Step-wise Syllabus

Below is a step-wise categorisation of the USMLE syllabus

Step 1 Syllabus

USMLE Step 1 Syllabus comprises mainly the subjects learned by students during the first two years of their medical school. Here is the subject-specific information along with the weightage range.

USMLE Step 1 subject-wise distribution

Process

Step 2 Syllabus

Below is the information about subjects, along with the weightage range for those subjects for USMLE Step 2 CK:

Step 3 Syllabus

The various competencies and weightage held for the USMLE Step 3 exam are as under:

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USMLE - Scores Calculation

Reported scores for USMLE exam Step 1, 2 (CK) and 3 typically range from 1 to 300. Scores for each step may be compared across years and forms, and the minor differences in difficulty levels across forms and years are adjusted to use the statistical procedures. That said, it should be noted that the test content of all USMLE tests evolves over time. As such, examinations taken at two considerably different points in time may vary slightly, especially regarding including or emphasising certain specific content areas. Thus, students appearing for the USMLE should avoid comparing scores, especially those obtained at substantially different points of time. As the format and content of each examination are likely to change over time, you should avoid comparing individual scores separated in time by more than 3-4 years.

Refer to the below table to get a better understanding of the calculation of the USMLE score. It shows the mean and standard deviation (SD) for first-time test takers from LCME-accredited US and Canadian medical schools who appeared for the test between 2017 and 2019.

Score calculation formulas

Calculation the 3-digit USMLE scaled score

1. Calculating the raw score or ‘X’

   Raw score (X) =	Items Answered Correctly	x 100
   	All Test Items

2. Transforming raw score to standard (z) score

   z=	x-μ
   	σ

   Where:

   μ = sample mean

   σ = standard deviation

3. Converting z score to scaled USMLE (T) score

   T = SD (z) + Mean

   Where:

   SD = Desired Scale Standard Deviation (Set at 20 for USMLE)

   Mean = Desired Scaled Score Mean (Set at 200 for USMLE)

   Thus USMLE Score is calculated as

   USMLE = 20 z + 200

Conclusion

Earning a degree in a medical field form a prestigious university abroad can set you on your preferred career path. Since US degrees are recognised worldwide, you also get the freedom to practice in any corner of the world. The USMLE is by no means, an easy exam to crack as is evident by the various steps and the syllabus required. But the good news is that you can access all the study material you need and take practice tests to get an idea about the exam. Here is wishing you all the luck to pass these exams with flying colours.

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