Is it your dream to have a career as a doctor? Traveling the path of medical education to become a doctor is not easy. The years of study and examinations only lay the foundation for the practical use of your skills in the real world. So, how do you prove your skills are ready for real-life application?
Before you practice medicine on your own, you must become a medical licensed physician. Obtaining a medical license is a sign of approval that you meet the standards to provide care to the public. For the United States, one important examination for medical doctors in training is the USMLE.
No, it’s not “U- Smile”. USMLE is an acronym for the United States Medical Licensing Examination.
The USMLE Exam is required for any MD degree doctor or current medical student who plans to practice medicine in the United States. The exam gives different state boards and other medical licensing authorities a common assessment tool of skills and knowledge for various applicants for a medical license.
But wait, there’s more that you should know about the USMLE Exam.
What Is the USMLE Exam?
The USMLE Exam, commonly known as the medical school boards exam, is recognized nationally and federally in the United States. It’s sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). These two organizations research and provide the tools, assessments, and credentials that meet a publically approved standard of care.
There is a lot of information and skills covered throughout the medical education journey of a medical student. To fully assess knowledge and skills, the USMLE is split into steps.
- USMLE Step 1
- USMLE Step 2 CK (Clinical Knowledge)
- USMLE Step 2 CS (Clinical Skills)
- USMLE Step 3
Science and medicine are constantly changing—for the better. Even with medical education, changes have been made. Step 2 CS (Clinical Skills) is no longer a part of the USMLE Exam.
The current steps of the USMLE in 2022 are:
- USMLE Step 1- Assesses your knowledge of foundational sciences.
- USMLE Step 2 CK – This step is a clinical knowledge assessment of your application of medical science (skills and knowledge) to patient care under supervision.
- USMLE Step 3- As the final portion of the USMLE Exam, Step 3 assesses your knowledge and skills to provide efficient and effective care as an individual practitioner.
The first two steps of the USMLE don’t necessarily have to be taken in numerical order, but the first two steps have to be completed before you can move on to Step 3. You have to take the first two steps and pass them before taking step 3.
What does this mean for you? You must meet eligibility requirements before taking any portion of the USMLE Exam. Are you eligible to sit for the exam?
Who Can Take the USMLE?
The USMLE Exam is taken by U.S. and international medical students. It’s usually taken before you apply for a medical license. Portions of the USMLE exam can be taken while still attending medical school. The last portion of the exam, USMLE Step 3, requires that you be a graduate of an accredited medical school program.
Both allopathic (MD) and osteopathic (DO) medical students can take the USMLE. However, the USMLE isn’t required for DO degree doctors. They have their own licensing exam.
Each step of the USMLE has its own eligibility requirements. The requirements have to be met during the time you apply to sit for the exam, and on the day that you take the exam. To take the USMLE Exam Steps 1 and 2, you must be enrolled as a medical student or a graduate of the following type of programs:
- U.S. or Canadian LCME (Liaison Committee of Medical Education) Accredited MD program
- U.S. or Canadian COCA (Commission of Osteopathic College Accreditation) Accredited DO program
- ECFMG (Educational Commission of Foreign Medical Graduates) certified medical schools outside of the U.S. and Canada; Medical school programs in this category also have to be listed on the World Directory of Medical Schools.
Eligibility requirements for USMLE Step 3 are based on your results from Steps 1 and 2. You must have a passing score from USMLE Steps 1 and 2 and obtain your degree before you take Step 3.
Now you know how to determine if you’re eligible to sit for the USMLE Exam. Would you like to know what is on the actual exam?
What Is On the USMLE Exam?
Each portion of the USMLE Exam assesses different skills and knowledge. The overall assessment is to ensure that you will be able to provide safe and effective patient care using scientific principles and medical knowledge. All testing for the USMLE Exam is computer-based using specific software. All testing is completed in a monitored and proctored environment.
When you arrive at a testing site, biometric information such as facial ID and fingerprints are collected to verify you are the intended person to sit for the exam. A large amount of security, studying, designing, and research is done when developing the different USMLE tests. Various clinicians, biomedical scientists, researchers, and teachers make up the committee that creates the questions and case situations for the USMLE Exam.
The various studies of patients, scientific principles, and approaches are considered to ensure that the newer or incoming physicians are prepared to face real-world situations with their clinical expertise and knowledge.
How is the USMLE formatted to efficiently cover a large amount of information?
USMLE Step 1 Exam
USMLE Step 1 can be taken first or after Step 2. Testing for USMLE Step 1 is in the format of multiple-choice questions. The maximum number of questions is 280. The information assessed is from basic sciences like anatomy, physiology, pathology, and biochemistry. Specific content for the USMLE Exam Step 1 relates to the following topics:
- Various organ systems such as cardiovascular, musculoskeletal, gastrointestinal, reproductive, respiratory, endocrine, and lymphatic
- Behavioral Health
- Social Sciences, Communication skills
- Epidemiology, Public Health
- Genetics
- Pharmacology
- Pathology
- Histology and Cell Biology
- Biochemistry and Nutrition
USMLE Step 2 CK
Also formatted as multiple-choice questions, the maximum number of questions is 318. USMLE Step 2 CK tests your ability to apply medical science in a setting where you provide patient care under supervision. Step 2 also assesses your knowledge and skills for health promotion and disease prevention. Content-specific topics for USMLE Step 2 CK are:
- Immune System
- Blood and Lymphoreticular System
- Pregnancy, Childbirth, and Puerperium (after childbirth)
- Renal, Urinary, and Male Reproductive System
- Female Reproductive System and Breasts
- Professionalism
- Legal and Ethical Issues
- Diagnosis
- Patient Safety
- Different Organ Systems
USMLE Step 3
As the final portion of the USMLE Exam, USMLE Step 3 is split into two parts. Each is taken on separate days. The testing is computer-based, and composed of multiple-choice questions. Step 3 assesses your skills and knowledge to provide patient care independently.
Part one or day one of Step 3 focuses on your foundational skills such as the basic sciences, communication, patient examination, and patient safety. Part two or day two of USMLE Step 3 centers around medical decision making, health maintenance, and screening. Day 2 of Step 3 consists of multiple-choice questions and case simulations.
Other topics that could be covered in USMLE Step 3 are:
- Various organ systems
- Mixed Management
- Clinical Interventions
- Laboratory and Diagnostic Studies
- Systems-based Practice and Patient Safety
With the steps of the USMLE Exam, each builds upon the other. From assessing medical knowledge such as identifying the organ systems to testing interpersonal skills such as communication and professionalism, the USMLE Exam measures the skills a doctor needs to provide the best care to patients.
So, if you sit for the USMLE Exam, how long can you expect to sit there?
How Long Is the USMLE Exam?
Each step of the USMLE is taken at a separate time. The basic format of the test is multiple-choice questions that are given in blocks or sections. Depending on the time allotted and the time you have left, you have a brief break to rest during your exam.
USMLE Exam Step 1 takes one day to complete. It is up to 8 hours long with seven 60-minute blocks with a max of 40 questions per block. The maximum number of questions for Step 1 is 280.
USMLE Step 2 CK takes up to 9 hours to complete, or one day. It is split into eight 60-minute blocks with a max of 40 questions per block. The maximum number of questions is 318.
USMLE Step 3 is taken over two days. Day one takes up to 7 hours to complete with six 60-minute blocks with a max of 38 to 40 questions per block. The maximum number of questions is 233. Day two takes up to 9 hours to complete with six 45-minute blocks with a max of 30 items per block.
This portion of the exam uses case-based simulations; 13 computer-based case simulations will be on day two of Step 3.
In a nutshell, it will take you about 33 hours in about four days to take all the portions of the USMLE Exam. Unfortunately, the USMLE can’t be completed in four consecutive calendar days. You would be waiting for results from Steps 1 or 2 before you could move on to Step 3.
Like any other portion of your medical education journey, there’s a price associated with this test. How much does it cost to take the USMLE Exam?
How Much Is the USMLE Exam?
The pricing for the USMLE Exam depends on the testing administration. The testing administration differs for medical students and graduates outside of the U.S. and Canada. For medical students and graduates within the U.S. and Canada, USMLE Steps 1 and 2 are priced by the NBME (National Board of Medical Examiners).
Other international medical students and graduates apply for USMLE Exam testing through ECFMG (Educational Commission for Foreign Medical Graduates).
| USMLE STEP | NBME | ECFMG |
| Step 1 | $645 | $985 |
| Step 2 CK | $645 | $985 |
For USMLE Step 3, the test is administered through FSMB (Federation of State Medical Boards) for all medical school graduates. The application fee for USMLE Step 3 is $895.
The total cost for the USMLE, including Steps 1, 2 CK, and 3, is $2185 for U.S. and Canadian medical students. For international medical students, the total USMLE cost is $2865.
With a pricey administration fee, how many times will you take the USMLE? How difficult is the exam?
How Hard Is the USMLE Exam?
The content of the exam determines the difficulty. The USMLE exam covers various information from multiple sciences, body systems, diseases, diagnosis, procedures, medical ethics, communications, pharmacology, patient safety, and public health. That is a wealth of information to be assessed in just a few hours.
The USMLE Exam is made to be difficult. It has to present a challenge to assess the skills and knowledge of capable medical doctors. The assessment shows that you have the knowledge and skills to safely care for patients in the public and private sectors.
No need to worry. There are practice and study materials available to aid you in your preparation to take the exam. During the day of your exam, the test will be given on a computer using software. There are interactive tools available for you to use during the examination. NBME and FSMB thought it was a great idea to allow USMLE applicants to become more familiar with the testing software.
If you think the USMLE Exam will be difficult, dedicate time to preparation. Ease your nerves and build confidence while becoming more familiar with the software. You can also refresh or improve your practice case situations. Try different cases from settings like an ambulatory clinic, a pediatric hospital, or an emergency room.
After careful preparation, you want to know what score to aim for, right?
What Is a Good Score on the USMLE Exam?
Previously, Step 1 was scored numerically. However, in January 2022, scores transitioned to a pass/fail scoring system for Step 1. The remaining steps of the USMLE are based on a three-digit scoring system ranging from 1 to 300.
Currently, these are the minimum passing scores for the USMLE Exam.
| USMLE STEP | SCORE |
| Step 1 | Pass/Fail (196 on the three digit scale) |
| Step 2 CK | 209 |
| Step 3 | 198 |
A good rule of thumb is to aim well above the minimum to achieve high scores. If you have prepared, practiced using the available materials, and executed your testing knowledge well, you will have no problem obtaining a passing score.
If you’re plagued with fears and doubts, remain calm. You can retake the USMLE. However, there are restrictions. You can only take each part up to four times. If you passed a portion of the USMLE, but didn’t receive the score you want, you will not be able to retake the Step.
Final Thoughts
Taking the USMLE Exam is a major step to becoming a licensed medical doctor. The USMLE Exam is the measuring stick for all MD doctors seeking licensure to practice in the U.S. It is a key part of making your dream of becoming a doctor a reality.
However, some things will block your path to achieving your dream. If you’re ineligible to take the USMLE, you can’t be liscensed to practice in the U.S. If you’re not enrolled in an accredited medical program, you are not eligible to take the USMLE. If you did not graduate from an accredited medical program, you are not eligible to take the USMLE.
The USMLE is not the application for a medical license itself. It’s the only assessment tool and examination used to provide a standard measure for the different medical students with various backgrounds to practice medicine in the United States.
The USMLE is not limited to only local and Canadian medical students. All medical students are welcome to take the USMLE. So long as they meet the eligibility requirements.
Don’t be intimidated by the five-letter acronym. It is just an examination process that has been determined as required to prove your skill readiness to be licensed as an independent practicing medical physician. You should plan out your exam dates as much in advance as possible. This gives you the chance to then prepare using different practice materials.
After much practice and preparation, then you can execute the knowledgeable skills. Showcase your skills to the world.
