The United States Medical Licensing Examination (USMLE) is a medical licensing exam that physicians are required to pass to practice medicine in the United States. It is a 3-step process that takes place throughout the individual’s medical education. Its purpose is to assess a physician’s mastery and ability to apply the knowledge, concepts, and skills learned to diagnose and treat patients.
The USMLE is regulated by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) and can be taken by scheduling with a Prometric Center on a year-round basis.
Medical students of a school program that leads to becoming a Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) should take the USMLE. Students of osteopathic medicine can take a similar test called the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) instead of the USMLE.
As mentioned earlier, the USMLE consists of three steps that you will need to take at different stages of your medical education.
The USMLE Step 1 is a one-day exam that medical students usually take at the end of their second school year. It evaluates their proficiency in basic sciences, such as anatomy, behavioral sciences, biochemistry, immunology, microbiology, pathology, pharmacology, and physiology. It also includes subjects on nutrition, genetics, and aging.
The exam is arranged by topics, making it easy for test-takers to focus and follow. Questions are divided into sections on organ systems like cardiology, gastroenterology, and neurology, and by physician tasks and aptitudes, such as accurate diagnosis and effective management of a case.
The exam is divided into seven blocks, 60 minutes each, spanning 8 hours. Each hour block consists of varying numbers of questions that will not exceed 40, with the whole exam having no more than 280 items in multiple-choice format.
Test-takers receive a three-digit score from 1 to 300 for the Step 1 exam, usually made available 3 to 4 weeks after the exam date. Currently, the passing score is 194, with most examinees scoring between 140 to 260.
On February 12th, 2020, it was announced that the USMLE Step 1 would transition to pass/fail.
Taking the USMLE will cost $645 for Step 1 and $70 for each eligibility period extension (expires after three months).
The USMLE Step 2 is a two-part exam that is typically taken during the fourth year of medical school. It is designed to evaluate a medical student’s ability to apply their knowledge, skills, and understanding of clinical science fundamental in providing patient care under supervision, emphasizing health promotion and disease prevention. Step 2 is further divided into two exams, as follows:
The first USMLE Step 2 exam is called Clinical Knowledge or CK, consisting of multiple-choice questions on clinical sciences like gynecology, internal medicine, obstetrics, pediatrics, and surgery. It also covers topics related to many organ systems that are divided into pathological and physiological processes.
The CK exam is divided into eight blocks that are 60 minutes each and taken over 9 hours. Each block consists of questions that may differ but will not exceed 40. The whole exam will have no more than 318 multiple-choice questions.
The second USMLE Step 2 exam is called Clinical Skills or CS, which requires students to diagnose actors posing as patients and gather information, perform physical exams, and report their findings to their patients and colleagues. It covers content that is similar to CK but is administered in a hands-on format.
For Step 2 CS, students need to travel to one of only five testing center locations around the United States, namely, Philadelphia, Chicago, Atlanta, Houston, and Los Angeles.
As with Step 1, test-takers receive a three-digit score from 1 to 300 for the Step 1 CK exam. Currently, the passing score is 209.
Meanwhile, for Step 2 CS exams, there is no numerical passing score. Instead, students are graded on three sub-components on a pass or fail basis. These sub-components are Communication and Interpersonal Skills (CIS), Spoken English Proficiency (SEP), and Integrated Clinical Encounter (ICE). You need to pass all three to achieve a passing rate for the USMLE Step 2 CS.
It costs $645 for the USMLE Step 2 CK and $70 for each eligibility period extension (expires after three months). There are no new posted fees for Step 2 CS as it is suspended due to COVID-19. However, the 2019 cost for Step 2 CS was $1,290.*
The USMLE Step 3 is a two-day test typically taken after a physician’s first year of residency. It is the final step in assessing whether a medical degree holder is ready to practice general medicine without supervision. As in Step 2, Step 3 centers on patient management, including diagnosis, treatment, and care.
Day 1 of the exam is Foundations of Independent Practice (FIP), which focuses on the medical and scientific principles fundamental to effective health care. Topics covered include the application of foundational sciences; application of social sciences, including communication and interpersonal skills, medical ethics, systems-based practice, and patient safety; and understanding of biostatistics and epidemiology/population health, and interpretation of the medical literature.
USMLE Step 3, Day 1 exams have 232 multiple-choice questions divided into six blocks of 60 minutes test time each. The whole test lasts 7 hours, which includes a 45-minute break and a 5-minute optional tutorial.
Day 2 of the exam is on Advanced Clinical Medicine (ACM). This test day centers on assessing the medical resident’s ability to apply their understanding of health and disease and its evolution to administer patient management and care. Topics covered include assessment of diagnosis and management, health maintenance and screening, prognosis and outcome, therapeutics, and medical decision making.
Step 3, Day 2 exams have 180 multiple-choice questions divided into six blocks of 45 minutes test time each. This test day also includes a 7-minute computer-based case simulations (CCS) tutorial. This is succeeded by 13 case simulations, which is allotted a maximum of 10 or 20 minutes each.
Same with Step 1 and Step 2 CK, test-takers receive a three-digit score from 1 to 300 for the Step 3 exam. On January 1, 2020, the passing score for Step 3 was raised to 198 from 196.
It costs $895 to take the USMLE Step 3. This fee is non-refundable and cannot be used from one eligibility period to another if the initial 3-month eligibility has expired.
The length of time needed to prepare for the USMLE is varied because it will mostly depend on the student’s knowledge of medical foundations. Most test-takers agree that a good 6 to 8 months of preparation is needed for Step 1 and Step 2 Clinical Knowledge. For Step 3, a little less time of 4 to 6 months is enough.
Because Step 2 Clinical Skills is a practical exam that evaluates the examinee’s communication and clinical skills, preparation for this is a bit different. Most suggest that the best way to review for this exam is clinical rotations.
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