What is the USMLE exam?

What is the USMLE exam?

The United States Medical Licensing Examination (USMLE) is a three-step medical licensure examination in the United States. The USMLE offers a common standard for evaluating medical licensure applicants. 

If you’re planning to apply for a medical license, you will need to pass the USMLE exam. For two reasons, this test is uncommon. Next, you take part in a different level of your medical education. Second, unlike most standardized tests, the USMLE merely measures your mastery of the content, not how well you take the test. 

Getting Started With The USMLE Test

What are the eligibility criteria for USMLE?
If you are a U.S. citizen, your qualifications for the USMLE must be in one of the categories listed at the time of your submission and on the day of your assessment:

USMLE Steps USMLE Eligibility
USMLE Step 1
  • Must be enrolled in or graduate of a medical school outside of the US and Canada, which is registered in the World Directory of Medical Schools.
  • Aspirants must meet ECFMG certification eligibility criteria.
USMLE Step 2 CK and CS
  • Must be enrolled in or graduate of a medical school outside of the US and Canada, which is registered in the World Directory of Medical Schools.
  • Aspirants must meet ECFMG certification eligibility criteria.
USMLE Step 3
  • Completed Step 1, Step 2 CK, and Step 2 CS
  • Candidates must have an MD or DO from LCME-or AOA-Accredited U.S. or Canadian med school or equivalent mentioned in the World Directory of Medical Schools
  • International medical graduates are required to obtain ECFMG certification.

Who is Eligible to take USMLE?
Anyone who has completed their 2nd year of medical school and meets one of the above-mentioned requirements may apply for USMLE Step 1, Step 2 CK, or Step 2 CS.

How much does USMLE cost?
Below are the break-down of the fees for the USMLE:

Component Fee
Application for ECFMG Certification USD $135
USMLE Step 1 USD $940 (country dependent surcharge: $0-$365)
USMLE Step 2 CS USD $1,580
USMLE Step 2 CK USD $940 (country dependent surcharge: $0-$410)
USMLE Step 3 USD $875
Extension of Eligibility Period (Step 1/Step 2 CK) USD $80 per exam
Testing Region Change (Step 1/Step 2 CK) USD $75
Rescheduling Fee (Step 1/Step 2 CK) USD $0 – $569 (depending on the exam, testing region, and date of cancellation)
Rescheduling Fee (Step 2 CS) USD $0 – $1,290 (depending cancellation date)
Score Recheck (Step 1/Step 2 CK/Step 2 CS) USD $80 per exam

Note: Fees are subject to change.

USMLE Test Structure and Format

  • USMLE Step 1 Test Structure

The USMLE Step 1 is a one-day computer-based exam undertaken by most med students at the end of their 2nd year of med school. It’s also taken by hundreds of international medical graduates (IMGs) who want to study medicine in the United States. Step 1 contains no more than 280 multiple-choice questions and comprises 8 hours of testing, subdivided into seven 1-hour sections of 40 questions each.

USMLE Step 1 discusses basic science concepts such as anatomy, biochemistry, microbiology, behavioral science, pharmacology, pathology, and physiology. Interdisciplinary fields such as immunology, biology, and nutrition are also being examined.

The USMLE Step 1 test content can be classified into two categories: system and process, and physician competencies and tasks.  

Dimensions Percentage of Test Content
System

  • General Principles of Foundational Science
  • Immune System; Blood & Lymphoreticular System; Behavioral Health; Nervous System & Special Senses; Skin & Subcutaneous Tissue; Musculoskeletal System; Cardiovascular System; Respiratory System; Gastrointestinal System; Renal & Urinary System; Pregnancy, Childbirth, & the Puerperium; Female Reproductive & Breast; Male Reproductive; Endocrine System
  • 15% – 20%
  • 60% – 70%
Process

  • Normal Processes
  • Abnormal Processes
  • Principles of Therapeutics
  • Other
  • 10% – 15%
  • 55% – 60%
  • 15% – 20%
  • 10% – 15%

In addition to the system-and process-based categorization of the test material, the USMLE Step 1 exam can also be classified by physician competency and task.

Physician Competency/Task Percentage of Test Content
Scientific Concepts/Medical Knowledge 55% – 65%
Patient Care: Diagnosis 

  • History/Physical Examination
  • Laboratory/Diagnostic Studies
  • Diagnosis
  • Prognosis/Outcome
20% – 30%
Patient Care: Management

  • Health Maintenance/Disease Prevention
  • Pharmacotherapy
15% – 20%
Communication Professionalism 2% – 5%
Practice-based Learning and Improvement 4% – 8%
  • USMLE Step 2 CK Test Structure

The USMLE Step 2 CK (Clinical Knowledge) is a multi-choice test designed to measure whether the examiner holds the professional knowledge and understanding of clinical science considered necessary for the provision of controlled patient care.

Step 2 CK consists of roughly 318 questions and comprises 9 hours of testing, subdivided into eight 1-hour sections of nearly 40 questions each. The test also comprises a minimum allocation of 45 minutes of break time and an optional 15-minute tutorial.

The USMLE Step 2 CK will contain two multi-choice formats: Single Best Answer and Single Answer Matching. The test may also include patient-centered vignettes with several related questions. Topics are presented randomly.

The scope of the USMLE Step 2 CK exam is divided into 18 areas of organ systems and general principles.

System Percentage of Test Content
General Principles of Foundational Science 1% – 3%
Immune System; Blood & Lymphoreticular Systems; Behavioral Health; Nervous System & Special Senses; Skin & Subcutaneous Tissue; Musculoskeletal System; Cardiovascular System; Respiratory System; Gastrointestinal System; Renal & Urinary Systems; Pregnancy, Childbirth, & the Puerperium; Female Reproductive System & Breast; Male Reproductive System; Endocrine System; Multisystem Processes & Disorders 85% – 95%
  • Biostatistics & Epidemiology/Population Health
  • Interpretation of the Medical Literature
1% – 5%

 

Physician Competency/Task Percentage of Test Content
Scientific Concepts/Medical Knowledge 10% – 15%
Patient Care: Diagnosis 

  • History/Physical Examination
  • Laboratory/Diagnostic Studies
  • Diagnosis
  • Prognosis/Outcome
40% – 50%
Patient Care: Management

  • Health Maintenance/Disease Prevention
  • Pharmacotherapy
  • Clinical Interventions
  • Mixed Management
  • Surveillance for Disease Recurrence
30% – 35%
  • Professionalism
  • Systems-based Practice/Patient Safety
  • Practice-based Learning
3% – 7%
  • USMLE Step 2 CS Test Structure

The USMLE Step 2 (Clinical Skills) exam evaluates the test takers’ ability to implement the medical expertise, knowledge, and skills of the clinical sciences that are vital for the provision of supervised patient care. It focuses on health promotion and disease prevention. It comprises of 2 major components on the day of the test:

On-site Orientation

The Patient Encounter

The Patient Encounter is the portion that decides the candidate’s Pass/Fail status. It consists of a total of 12 patient encounters, each lasting 15 minutes. A small proportion of these 12 patient encounters is for pilot training and thus does not count towards the final score of the applicant.

Step 2 CA uses structured patients to assess the ability of medical students and graduates to collect information, perform physical exams, and communicate their results with patients and colleagues.

  • USMLE Step 3 Exam Pattern

The USMLE Step 3 is a 2-day computer-based test of about 500 multiple-choice questions, as well as computer-based case simulations (CCS) that evaluate the ability to analyze history and physical exam details, request diagnostic tests, choose initial therapies, and handle the patient. It is divided into two parts:

  • Day 1 – Foundations of Independent Practice (FIP)

Phase 3 Day 1 is 7-hour long and consists of 6 separate 60-minute sections. Each one of these blocks has between 38 to 40 questions, and the overall test for Day 1 does not exceed 233 questions.

  • Day 2 – Advanced Clinical Medicine (ACM)

The Step 3 Day 2 test will take 9 hours and consists of 6 separate blocks, each with 30 questions. In addition, there will be 13 case simulations in the evaluation and a total of 180 questions.

The USMLE Step 3 test content can be classified into two categories: system and process, and physician competencies and tasks.  

System Percentage of Test Content
General Principles of Foundational Science 1% – 3%
Immune System; Blood & Lymphoreticular System; Behavioral Health; Nervous System & Special Senses; Skin & Subcutaneous Tissue; Musculoskeletal System; Cardiovascular System; Respiratory System; Gastrointestinal System; Renal & Urinary System; Pregnancy, Childbirth, & the Puerperium; Female Reproductive System & Breast; Male Reproductive System; Endocrine System; Multisystem Processes & Disorders 80% – 85%
Biostatistics & Epidemiology/Population Health, & Interpretation of the Medical Literature, Social Sciences 14% – 18%

 

Physician Competency/Task Percentage of Test Content
Day 1 – FIP Day 2 – ACM
Scientific Concepts/Medical Knowledge 18% – 22%
Patient Care: Diagnosis

  • History/Physical Examination
  • Laboratory/Diagnostic Studies
  • Diagnosis
40% – 45%
Patient Care: Diagnosis

  • Prognosis/Outcome
20% – 25%
Patient Care: Management

  • Health Maintenance/Disease Prevention
  • Pharmacotherapy
  • Clinical Interventions
  • Mixed Management
  • Surveillance for Disease Recurrence
75% – 80%
Communication and Professionalism 8% – 12%
Systems-based Practice/Patient Safety and Practice-based Learning 22% – 27%

USMLE Scoring System

The USMLE results are usually published every Wednesday, and the scores are available on the internet for candidates 3-4 weeks after the test date.

The USMLE scores for Step 1, Step 2 CK, and Step 3 are recorded on a three-digit scale. The number of right answers you get, commonly known as raw score, is converted into two numerical ratings, one on a three-digit scale and one on a two-digit scale. These are merely two ways to report the very same result to universities. You’ve got to earn 75 on a two-digit scale to pass. Minimum passing scores for these tests are needed for the applicant to complete the test successfully. The USMLE Step 2 CS result is recorded only with Pass/Fail status and no corresponding ratings.

While it is not reported by USMLE how the three-digit score is computed, USMLE Step 1 scores range from 1 to 300. Most test-takers score between 140 and 260. The USMLE passing score is 194, and the national average and standard deviations are roughly 229 and 20, accordingly.

The score for the USMLE Step 2 CS evaluation is calculated based on the candidate’s results in three different sub-components:

  • Communication and Interpersonal Skills (CIS)
  • Spoken English Proficiency (SEP)
  • Integrated Clinical Encounter (ICE)

The current minimum USMLE passing scores based on the 2019 exam are as follows:

USMLE Component Minimum Pass Marks
USMLE Step 1 194
USMLE Step 2 CK 206
USMLE Step 3 196

Note: The minimum required passing score shall be reviewed on a periodic basis and may be changed at any time. Notice will be published on the USMLE website at usmle.org

USMLE Registration

Applicants may register for USMLE once they have received ECFMG certification. International applicants are required to submit for USMLE through the ECFMG’s Interactive Web Applications (IWA). Applicants may apply for the USMLE registration for Step 1 and Step 2 (CK and CS) via ECFMG.

Requirements for completing the USMLE Exam Application:

  • Personal computer with updated web browsers and Adobe Acrobat Reader
  • e-mail address
  • USMLE/ECFMG Identification Number
  • On-Line Services Password
  • valid CREDIT CARD (Visa, MasterCard, Discover, or American Express)
  • US Bank Checking Account: You must have either a valid U.S. driver’s license or a U.S. social security number to pay by electronic check.

Applicants who have a USMLE / ECFMG Identification Number can pay in advance to ECFMG using Form 900. When the payment has been collected and credited to the applicant’s ECFMG financial account, the applicant can begin the IWA registration process. Applicants may check the status of their ECFMG financial account using the ECFMG OASIS or the MyECFMG mobile application.

Frequently Asked Questions

Is IELTS or TOEFL required in USMLE?

IELTS or TOEFL is not compulsory to be able to take the USMLE. All candidates with an acceptable graduation degree in the United states are eligible for the test.

What is USMLE and its benefits?

USMLE, or the United States Medical Licensing Exam, is a 3-step medical practitioner exam. It has a lot of benefits which includes:

  • Apply for residency and citizenship in the US
  • Attain lifetime validity of ECFMG certificate
  • Receive approval to work in New Zealand, Canada, Australia, or Dubai
  • Avail better educational and research facilities
  • Speed up green card processing

For how many years USMLE score is valid?

For the sake of residency training, both Step 1 and Step 2 scores are valid for 7 years. State licensing standards for time limits for completion of all steps, and the maximum number of attempts permitted, vary from state to state.

Is there a limit on age for USMLE?

There is no age restriction on the USMLE. You may take USMLE even if you’re 70 (according to online sources). However, some implicit issues limit the higher age group from taking the exam.

Is USMLE acceptable in Australia?

No, USMLE results are not accepted in Australia. Although it is close in nature to the AMC exams, it is not accepted.

USMLE Sample Questions

Question #1

A 14-year-old boy is brought to the emergency department after being hit with a baseball bat on the lateral side of his leg immediately below the knee. He is unable to dorsiflex his foot. Which of the following nerves is most likely injured?

  • Common fibular (peroneal)
  • Femoral
  • Obturator
  • Sural
  • Tibial

Question #2

A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure over the past 2 years. She has not yet started dialysis. Examination shows no abnormalities. Her hemoglobin concentration is 9 g/dL, hematocrit is 28%, and mean corpuscular volume is 94 μm3. A blood smear shows normochromic, normocytic cells. Which of the following is the most likely cause?

  • Acute blood loss
  • Chronic lymphocytic leukemia
  • Erythrocyte enzyme deficiency
  • Erythropoietin deficiency
  • Immunohemolysis
  • Microangiopathic hemolysis
  • Polycythemia vera
  • Sickle cell disease
  • Sideroblastic anemia
  • β-Thalassemia trait 

Question #3

Arthrocentesis is done. The synovial fluid is cloudy. Gram stain is negative. Analysis of the synovial fluid shows a leukocyte count of 120,000/mm3 and 90% neutrophils. Which of the following is the most appropriate additional test on the synovial fluid?

  • Culture for bacteria
  • Glucose measurement
  • Polarized light microscopy
  • Protein level

Question #4

A 30-year-old man comes to the emergency department because of an acute episode of renal colic. Medical history is remarkable for episodes of painful urination and passing of what he calls “gravel in my urine.” Urinalysis demonstrates microscopic hematuria with some crystalluria and no casts. Supine x-ray of the abdomen shows no abnormalities. A 4-mm renal calculus is detected in the distal right ureter on ultrasonography. There is no evidence of dilation of the collecting system. The patient’s pain is responsive to narcotic medication. In addition to administering intravenous fluids, which of the following is the most appropriate next step?

  • Acidification of urine by drinking cranberry juice
  • Cystoscopic removal of the calculus
  • Cystoscopic ureteral lavage
  • Shock wave lithotripsy
  • Straining of the urine

Question #5

During a clinical study examining the effects of exercise, men between the ages of 20 and 30 years are evaluated during a 15- minute session on a treadmill. The average pulse for the last 2 minutes of the session is 175/min. During the last minute of exercise, various measurements are taken. Compared with the measurement before the session, which of the following is most likely to be decreased?

  • Cardiac output
  • Oxygen consumption
  • Pulse pressure
  • Stroke volume
  • Systolic blood pressure
  • Total peripheral resistance
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