Learn what the US Medical Licencing Examination (USMLE) is and how people who studied medicine outside the US can also build a medical career in the United States. The USMLE is a three-part exam that every doctor must pass to receive a medical license in the country.

This examination is funded by the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB). Anyone with a Doctor of Medicine (MD) degree must pass the USMLE to practise medicine in the US.

International medical graduates (IMGs) must also obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG) before taking the USMLE.

A Quick Look at the USMLE

The USMLE is required for both American medical graduates and international students who want to practise medicine in the US. It consists of three parts:

• Step 1: Tests basic medical knowledge from the early years of medical school.

• Step 2: Evaluates clinical medical knowledge.

• Step 3: Assesses the application of clinical information in patient management.

Earlier, Step 2 also had a Clinical Skills component, but it was discontinued during the COVID-19 pandemic.

Most US medical students complete Step 1 and Step 2 during medical school and take Step 3 after the first year of residency.

Step 1 and Step 2 CK are conducted at Prometric test centres globally, while Step 3 is available only in the United States.

The USMLE was created so every licensure applicant is evaluated on the same standards. Over time, residency programs began using USMLE scores to select candidates and predict residency performance.

Doctors with a Doctor of Osteopathic Medicine (D.O.) degree do not need the USMLE to obtain a licence. However, around 60% of osteopathic students take at least one exam. They are licensed through the COMLEX exam conducted by the National Board of Osteopathic Medical Examiners.

USMLE Exam Sections Simplified

USMLE Step 1

USMLE Step 1 is a standardised test that checks how well a medical student understands basic science concepts and applies them in clinical practice. Most students take it in their second year of medical school.

This 8-hour exam contains 280 multiple-choice questions divided into seven blocks of 40 questions each. It covers subjects like anatomy, behavioural sciences, biochemistry, microbiology, pathology, pharmacology, and physiology.

It also includes topics such as genetics, ageing, immunology, nutrition, molecular biology, epidemiology, ethics, and empathy-based scenarios.

Every student receives a unique version of the test, but the subject distribution remains consistent.

In 2022, USMLE Step 1 officially shifted to a Pass/Fail scoring system. As of December 2023, the fee for Step 1 is about $660.

USMLE Step 2 CK

USMLE Step 2 CK is a 9-hour exam that tests clinical knowledge through multiple-choice questions. Unlike Step 1, Step 2 focuses more on applying medical knowledge to real-life clinical scenarios.

The exam includes eight 1-hour blocks, a 15-minute tutorial, and 45 minutes of break time. It is taken at global Prometric centres.

Questions cover internal medicine, paediatrics, OBGYN, psychiatry, preventive medicine, surgery, and other areas of supervised patient care.

Clinical scenarios often require interpretation of lab results, imaging, pathology slides, and diagnostic reports.

Step 2 CK uses a three-digit score ranging from 1–300. As of July 2022, the minimum passing score is 214. The average score for first-time US/Canada graduates in 2020–2021 was 246.

As of December 2023, the Step 2 CK fee is $660, increasing to $670 in 2024.

USMLE Step 3

USMLE Step 3 is the final step required for practising medicine in the US. It includes multiple-choice questions and computer-based case simulations (CCS).

Step 3 must be taken only in the US. Security is strict test-takers undergo ID checks, fingerprinting, and monitoring.

Day 1 focuses on Foundations of Independent Practice (FIP) with six 60-minute blocks containing 38–39 MCQs each.

Day 2 includes six 45-minute blocks on Advanced Clinical Medicine (ACM) and 13 case simulations.

To take Step 3, candidates must pass Step 1 and Step 2 CK, hold a medical degree, complete ECFMG certification (for IMGs), and meet all bulletin requirements.

As of January 2020, the passing score is 198.
As of December 2023, the Step 3 fee is $915, increasing to $925 in 2024.

How to Pass the USMLE

Passing the USMLE requires a well-planned and disciplined approach. Here are key tips:

• Create a structured study schedule and stick to it.

• Use high-quality books, question banks, and online resources.

• Focus on active learning with practice questions.

• Understand concepts instead of memorising facts.

• Make short notes or flashcards for revision.

• Take regular breaks to avoid burnout.

• Use self-assessment exams to track progress.

• Review practice test feedback to strengthen weak areas.

• Join study groups or forums for discussion and support.

• Maintain a healthy lifestyle with good sleep, nutrition, and exercise.

Understanding each step’s structure and requirements especially the new Step 1 pass/fail rule helps in planning strong preparation.

International Medical Graduates (IMGs) should also complete ECFMG certification before attempting the USMLE.

By staying consistent and using the right strategy, candidates can boost their chances of success and pursue a rewarding medical career in the US.

Frequently Asked Questions (FAQs)

Q1. What is the USMLE?
A three-part exam required for medical licensure in the United States.

Q2. Who sponsors the USMLE?
The NBME and FSMB.

Q3. Who must take the USMLE?
MD graduates and international medical graduates (IMGs) who want to practise in the US.

Q4. What are the USMLE steps?
Step 1 (basic sciences), Step 2 CK (clinical knowledge), Step 3 (patient management).

Q5. Do D.O. graduates need to take the USMLE?
No, but many still choose to. They are licensed through the COMLEX exam.

Q6. What is the Step 1 scoring system?
As of February 2022, Step 1 is Pass/Fail.

Q7. How long is Step 1?
8 hours.

Q8. What is the Step 1 fee?
About $660 as of December 2023.

Q9. When do students take Step 1 and 2?
During medical school; Step 3 is usually taken after the first year of residency.

Q10. What does Step 2 CK test?
Clinical science, medical knowledge, and supervised patient-care skills.

Q11. What is the Step 2 CK passing score?
214.

Q12. How long is Step 2 CK?
9 hours.

Q13. How long is Step 3?
7 hours on Day 1 and 9 hours on Day 2.

Q14. What is the Step 3 fee?
$915 (increasing to $925 in 2024).