What is the USMLE?

What is the USMLE?

Do you want to practice medicine in the United States of America? If so, you must clear the USMLE exam. The USMLE (United States Medical Licensing Examination) is a three-step examination for allopathic medical licensure. It is a National Examination that is necessary for allopathic physicians in the United States.

USMLE is a test used to assess the individual’s skills that reflect safe and effective patient care and their ability to apply the learned knowledge and concepts. A medical graduate in the United States must pass this USMLE examination to practice medicine there. This blog will walk you through the three steps in the tests and its importance.

United States Medical Licensing Examination

The United States Medical Licensing Examination program is owned by The Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). The USMLE is governed by a committee of members from FSMB, NBME and ECFMG (Educational Commission for Foreign Medical Graduates) and the public. This committee identifies and takes responsibility for approving procedures for USMLE-related policies and procedures. USMLE was first designed in the late 1980s and was introduced between 1992 and 94.

The goals of USMLE are to provide licensing authorities with meaningful information from the assessments of physician characteristics, to engage medical educators, licensing authority members and other expert practitioner in the development of the assessments, to ensure fair and equity with the testing standards and to continue to develop assessments to make the process more accurate and comprehensive.

USMLE - 3-Steps Tests

The medical examination happens in a three-step process. While the first and second tests are one-day tests each, the third test will happen over a period of two days. Each of these exams is taken during different years of med school and residency, and the syllabus for the exams varies accordingly.

Step 1 - Second year of med school

Step 1 is the first in USMLE’s 3 step-process and this examination is a one-day test. It is usually taken by students at the end of the second year of med school and is a multiple-choice questionnaire. The syllabus for this test is based on basic sciences which includes subjects like anatomy, biochemistry, microbiology, immunology, pathology, physiology and others. Some of the topics will be nutrition, genetics, etc.

Number of Questions: 280 questions (7 blocks of 40 MCQs)

Skills Assessed: Basic science concepts and application to medical practice

Step 2 - Fourth year of med school

Usually taken at the end of the fourth year of med school, this step of USMLE is a one-day test process. The main component is CK aka Clinical Knowledge where the individual is required to take a multiple-choice test. As the name suggests, the syllabus covers clinical sciences like surgery, pediatrics, internal medicine, gynecology, etc.

PS: Until 2020, there was a second component in step 2 called Clinical Skills (aka CS) which requires you to examine and diagnose people (actors will be posing as patients). However, the NBME and FSME announced the cancellation of Step 2 CS permanently in March 2021.

Number of Questions: 316 questions (8 blocks)

Skills Assessed: Clinical Science concepts and application

Step 3 - First year of residency

Step 3 of USMLE is similar to Step 2, where the test happens over two days. This step is the final assessment in USMLE and is usually taken after the first year of residency. This step also focuses on diagnosis and treatments. So, it has both multiple-choice questions and computer simulations of patient care. This will be a final test in the medical licensing exam post the clearance of which you are certified to practice general medicine in an unsupervised setting.

Number of Questions: 233 + 180 MCQs (6 blocks)

Skills Assessed: Biomedical & clinical science concepts and applications like patient management, ambulance care etc.

How do the USMLE scores work?

The number of correct answers is converted into two numerical scores, one on a three–digit scale and the other on a two–digit scale. Both the results are reported. As for the pass/fail criteria, an individual must score 75 on the two-digit scale to pass.
Note: You can appear for steps 1 and 2 in any sequence but you must have passed the two steps before appearing for the step 3 test.

Eligibility criteria for USMLE

Test 1 and 2

Here are the criteria an individual must meet to be eligible for the USMLE step 1 and 2 exams. You must meet any one of these criteria to appear for the exams.

You should hold an MD degree and be officially enrolled in or a graduate of a medical school in the United States or Canada. The US Department of Education should recognise the medical school and it should be accredited by the Liaison Committee on Medical Education (LCME), which is the body that accredits MD programmes in both the US and Canada.

To obtain the DO degree, you must be formally enrolled in or a graduate of an American medical school, which is accredited by the American Osteopathic Association (AOA) Commission on Osteopathic College Accreditation (COCA). AOA and COCA are designated by the US Department of Education as the accrediting organization for osteopathic educational institutions in the country, should accredit such a school.

If you are not a US or Canadian citizen, you should be enrolled in or a graduate of a medical school that is listed in the World Directory of Medical Schools, or WDOMS. Such an institution ought to fulfill the qualifying standards and criteria set forth by the Educational Commission for Foreign Medical Graduates (ECFMG).

Step 3 Eligibility Criteria

To appear in step 3 of USMLE, you must meet all the three eligibility criteria mentioned below.

As we discussed previously, you should have successfully passed USMLE step 1 and step 2 tests to be able to appear for step 3.
You must hold an MD or any equivalent like an MBBS degree from an LCME-accredited medical school in the US or Canada.
You must hold a DO degree from AOA accredited medical school in the US or an MD (or another equivalent) degree from EDOMS-listed medical schools located outside of the USA and Canada and possess the ECFMG certification.


Who writes USMLE test questions and cases?

The members of USMLE write questions. The members include biomedical scientists, educators, clinicians from every US region, etc.

Is USMLE the only licensure examination in the United States?

Yes, USMLE is the one path examination to medical licensure for allopathic physicians in the United States. Before the development of USMLE, there were multiple examinations like the NBME Part Examination Program and the Federation Licensing Examination (FLEX program) but it was decided that one examination system that is acceptable in every state was desirable. A National examination ensures that all licensed MDs pass the same assessment standards irrespective of their training.

If not from the US or Canada, how can someone from a foreign country enter a graduate medical school or practice medicine in the US?

If you are not from the US or Canada, you can browse the website of Educational Commission for Foreign Medical Graduates (ECFMG) who provide a certification program which assesses if you are eligible and ready to enter fellowship and residency programs in the United States.

Is USMLE only for the students of allopathic medicine?

USMLE is a licensure test for allopathic physicians in the United States. Osteopathic physicians can take either USMLE or COMLEX-USA (the Comprehensive Osteopathic Medical Licensing Examination), which is another common test for them.

What are the USMLE exam fees?

For US and Canadian students, you can apply for the USMLE examination via the NBME website. The application fee for steps 1 and 2 is $975 each and if you need to reschedule the examination, you may have to pay up to an additional $604.

If you are an international student, that is you’re not a medical student from the USA or Canada, you can send your application through the ECFMG website. You must pay 4150 to apply for the ECFMG certification.

For USMLE step 3, you must send your application via the FSMB website. You need to pay the $895 application fee.

Can I retake the USMLE?

Yes, you may retake the USMLE and appear for the same step or test up to three times within a period of 12 months. If you are making an attempt after a period of 12 years, it should be at least 1 year after the first attempt of that particular step or 6 months after your most recent attempt.

Wrapping Up

Taking a nationalized examination like USMLE isn’t an easy task. There are several steps and syllabus you need to prepare but there is no need to fret. There are ample amounts of study materials available to help you take practice tests and prepare for the examinations. You can also utilize self-assessment information available on the NBME website. There are also a few practice exams conducted at test centers that will help you prepare for the exam environment and practice attending MCQs at a much faster pace.

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