Learn about the United States Medical Licensing Examination or USMLE

The decision to become a licensed medical professional in the United States is a huge one. You’ll be devoting many years of your life to learning the profession before establishing your practice and serving patients. To become a licensed physician, you need to take the three-step USMLE or the United States Medical Licensing Examination.

In the United States, the individual medical licensing authorities or state medical boards of the various jurisdictions grant a license to physicians to practice medicine. The USMLE is owned by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) which are both non-profits that work to ensure health professionals are licensed, assessed, tracked and accountable to the public. USMLE is governed by a committee comprising of the members from FSMB, NBME, the Educational Commission for Foreign Medical Graduates (ECFMG) and the public.

With input from experts in all regions of the United States, the USMLE delivers a single national exam through approved USMLE test centres, which is accepted in every state and region in the United States. This ensures that all licensed MDs in the country have met the same assessment standards. Before USMLE, there were multiple examinations - the NBME Parts examination and the Federation Licensing Examination, but now, USMLE provides one path to medical licensure for allopathic physicians in the United States.

How to Apply For USMLE

The application process depends on the appropriate registration body. You can find more information about that here. Fees to take the test at a USMLE exam centre depends on which exam you are taking (Step 1, Step 2 CK, Step 2 CS etc.,), where you graduated medical school from (US/Canada or outside) and other details. So it’s important to read and understand the test process before registering with a USMLE test centre and arranging to take the exam. The site offers a contact form for any questions you may have about the application process.

What’s the Eligibility for the USMLE?

The USMLE is designed for students of allopathic medicine, who are on the path to becoming an MD. Anyone applying for a license must pass the exam at a certified USMLE test centre. To be eligible to take the test, candidates must belong to one of the following categories at the time of application and on the day of the examination.

A medical student enrolled in, or a graduate of

• A US or Canadian medical school program leading to the MD degree accredited by the Liaison Committee on Medical Education, OR
• A US medical school leading to the DO degree accredited by the American Osteopathic Association (AOA), OR
• A medical school that is outside the US and Canada, listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements, and meets other eligibility criteria.

How Does the USMLE Work?

As noted, the USMLE is a three-step, knowledge-based exam that assesses how well you can apply your skills, values, and attitudes to real life, patient-centered scenarios.

You can retake the steps in the exams – which is a relief to many. Exams are stressful, and there are times when you aren’t at your best, so knowing you can schedule a retake can take a lot of pressure off. You may take the same exam up to three times within one year, but, you are only able to schedule a retake if you didn’t pass that step’s exam. There is a maximum of six retake attempts and remember that no-shows or incomplete exams count in the six attempts.

The exams are conducted under strict guidelines. Those scheduled to take a USMLE exam should check the website to understand the rules around attendance. This includes things like using only the materials provided to you at the exam centre and not bringing any non-permitted items to the exam room such as notebooks, electronics or personal belongings. You must also be prepared to present a valid ID that includes your photo, name and signature on the day of the exam as you will go through a security procedure on exam day. Failure to comply with the rules outlined by the USMLE site, the USMLE exam centre or exam centre staff may result in your being asked to leave the exam without completing it.

Step 1

Step 1 is a one-day examination, which assesses understanding and application of concepts of the sciences basic to the practice of medicine. It is divided into seven 60-minute blocks and is administered in one 8-hour testing session. The number of questions per block may vary, but will not exceed 40.

Step 2 CK (clinical knowledge)

This step tests the ability to apply medical knowledge, skills and understanding of principles of clinical sciences and basic patient-centred skills. This is also a one-day exam, but includes eight one-hour blocks with a maximum of 40 questions per block.

Step 2 CS (clinical skills)

This step assesses whether a candidate possesses not only clinical competence but also the ability to communicate effectively with patients and colleagues. The test includes twelve patient encounters. These include a small number of nonscored patient encounters, which are added for pilot testing new cases and other research purposes.

Step 3

This two-day exam assesses the knowledge and application of biomedical and clinical science needed for an unsupervised practice of medicine. It is the final exam in the sequence leading to a license to practise medicine.

The first day is divided into six blocks of one-hour each for a total of 232 multiple-choice questions. The second day is divided into six blocks of 45 minutes each for a total of 180 multiple choice questions followed by 13 case simulations of 10 to 20 minutes each.

Becoming a licensed doctor is a big commitment, one that requires a lot of effort and dedication. Take the time to review the USMLE site and understand the exams to ensure you know the testing requirements and are as prepared as possible.