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USMLE

  • Test Name: USMLE
  • Description: The test is a computerised conducted in 3 steps, broadly referred to as Step 1, Step 2 (CK) and Step 3, conducted over a period of 3+ years.
  • Suitable For: Medical graduates’ intending to study and practice medicine in USA
  • Number of Countries in which Accepted: USA, but students with graduate level medical degrees from countries worldwide can apply.
  • Score range: 1-300
  • Flexibility: You can reschedule test dates and appear for the same step, up to three times in a 12-month period. Subsequent attempts should be at least 12 months after the first attempt, and at least six months after the most recent attempt. You cannot retake a step you have previously passed.
  • Registration fee: 610 -910 (depends on USMLE Step you are appearing for).
 

About USMLE – Quick Facts

About USMLE – Quick Facts

  • Introduced between 1992 -1994.
  • Designed to study and practice medicine in USA.
  • Computerised test conducted over 3 steps.
  • Steps 1 and 2 tests are conducted over 1 day, Step 3 test is conducted over 2 days.
  • Taken by 12,000 students each year, 8,000 are Indian students.

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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

USMLE Test Step

Exam Type

Total Duration

Number of Questions

Skills Assessed

Step 1

Computer based

1 Day

7 blocks of 40 MCQs, 280 in total

Basic Science Concepts + Application to medical practice

Step 2

Computer based

1 Day

316 MCQs across 8 blocks

Clinical Science Concepts + Application

Step 3

Computer based

2 Days

233+180 MCQs across 6 blocks (Day 1 & 2) +13 computer-based simulations

Biomedical & clinical science concept + applications, patient management, ambulance care etc.

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.

Items

USMLE Step-1

USMLE Step-2 (CK)

USMLE  Step-3

Test-Type

Computer-based

Computer-based

Computer-based

Total Duration (including break time)

8 hours

9 hours

8 hours on Day 1

9 hours on Day 2

Format

280 MCQs divided into 7 sixty-minute blocks each with 40 MCQs.
90 seconds for each question.

About 316 MCQs divided into 8 sixty minute blocks.
91 seconds for each question.

Day 1:

About 233 MCQs divided into 6 sixty minute blocks.

Day 2:

About 180 MCQs divided into 6 forty five minute blocks.

13 computer-based case simulations (CCS).
10-20 minutes for each simulation.

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.

USMLE Fee Type

USMLE Cost for Step 1

USMLE Cost for Step 2 (CK)

Application Fee

$975

$975

Rescheduling Fees

Up to $604

Up to $604

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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

USMLE Fee type

USMLE Price for Step 1

USMLE Price for Step 2 (CK)

Fee to Extend Eligibility Period

$70

$70

Fee to Change Testing Region

$85

$85

Fee to recheck scores

$80

$80

Fee for ECFMG Exam Chart

$50 per request form (up to three copies)

NA

Fee for ECFMG CSA History Chart

$50 per request form (up to three copies)

NA

FEE for USMLE Transcript paper

$70 per request (up to 10 transcripts)

$70 per request (up to 10 transcripts)

USMLE Transcript – Electronic  Transmission for ERAS

$80 per ERAS session

$80 per ERAS session

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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:

USMLE Fee Type

USMLE test fees

Application Fee

$895

Rescheduling Fee

N.A. (non-refundable and non-transferable)

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How to Register for USMLE exam?

Step 1 Create your ECFMG account.

Step 2 Fill the USMLE step 1 application.

Step 3 Fill and Mail Form 183 to Philadelphia.

Step 4 Wait for your Scheduling Permit.

Step 5 Book your date at a Prometric Centre.

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

System

Range

General Principles of Foundational Science

15% - 20%

Multisystem Processes & Disorders

15% - 20%

Biostatistics & Epidemiology

Population Health

Social Sciences

Immune System

60%-70%

Nervous System & Special Senses

Skin & Subcutaneous Tissue

Respiratory System

Pregnancy, Childbirth, & the Puerperium

Female Reproductive & Breast

Male Reproductive

Endocrine System

Blood & Lymph reticular System

Cardiovascular System

Musculoskeletal System

Behavioural Health

Gastrointestinal System

Renal & Urinary System

Process

Process

Range

Abnormal Processes

55% - 60%

Normal Processes

10% - 15%

Principles of Therapeutics

15% - 20%

Other

10% - 15%

Step 2 Syllabus

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

System

Range

General Principles of Foundational Science

1% - 3%

Population Health / Biostatistics & Epidemiology

1% - 5%

Interpretation of the Medical Literature

Immune System

85% - 95%

Multisystem Processes & Disorders

Blood & Lymph reticular Systems

Endocrine System

Behavioural Health

Male Reproductive System

Female Reproductive System & Breast

Nervous System & Special Senses

Renal & Urinary Systems

Skin & Subcutaneous Tissue

Gastrointestinal System

Musculoskeletal System

Respiratory System

Cardiovascular System

Step 3 Syllabus

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

Competency

Foundations of Independent Practice

Advanced Clinical Medicine

Communication and Professionalism

8% - 12%

NA

Medical Knowledge / Scientific Concepts

18% - 22%

NA

Systems-based Practice / Patient Safety and Practice-based Learning

22% - 27%

NA

Patient Care: Diagnosis

40% - 45%

NA

1. History/Physical Examination

2. Laboratory/Diagnosis Studies

3. Diagnosis

Prognosis/Outcome

NA

20% - 25%

Patient Care: Management

NA

75% - 80%

1. Health Maintenance/Disease Prevention

2. Pharmacotherapy

3. Mixed Management

4. Surveillance for Disease Recurrence

5. Clinical Interventions

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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.

SDs - First-time Test Takers from LCME-accredited US/Canadian Medical Schools

Step 1

 

Calendar Year

Mean (SD)

2017

229 (20)

2018

230 (19)

2019

232 (19)

Step 2 -  Clinical Knowledge

 

Academic Year

Mean (SD)

2017-2018

244(17)

2018-2019

244(16)

2019-2020

245 (15)

Step 3

 

Calendar Year

Mean (SD)

2017

226(15)

2018

226(15)

2019

227(15)

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

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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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Frequently Asked Questions

Yes, you may retake the USMLE. You may appear for the same examination (or step) up to three times within a period of 12 months. Any attempts made after the 12 months should be at least 1 year after the first attempt of that particular step and at least six months after your most recent attempt at that step.


To prepare for the USMLE, you can refer to the practice materials available on the exam website. You can also utilise the self-assessment information and study material available on the NBME website. Furthermore, registered examinees looking to get familiar with the environment at a Prometric test centre may appear for a practice exam at a test centre by paying a fee and registering for a practice session.


You can get information by visiting the website of the ECFMG website. ECFMG, through its certification program, assesses if you are ready to enter fellowship and residency programs in the US. You can get details about the ECFMG certification and preliminary information about entering into US programs in the ECFMG® Certification Fact Sheet.

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