USMLE Overview
A complete guide to understanding the United States Medical Licensing Examination, from eligibility and structure to scoring and exam day.
The United States Medical Licensing Examination (USMLE) is a three-step examination process required for medical licensure in the United States. The USMLE assesses an examinee's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills. The USMLE is jointly sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME).
Health care consumers throughout the U.S. enjoy a high degree of confidence that doctors who have passed all three Steps of the USMLE have met a common standard.
The USMLE standardizes medical knowledge and clinical skills assessment across all applicants seeking licensure in the U.S. Residency programs rely heavily on USMLE scores to evaluate and rank applicants, especially International Medical Graduates (IMGs). Although Step 1 is now reported as pass/fail, it remains an important milestone. Step 2 Clinical Knowledge (CK) continues to provide a numeric score that is often used in residency selection.
- Step 1 and Step 2 CK:
- To be eligible for Step 1 or Step 2 CK, you must either be a current medical student or a graduate from one of the following:
- A U.S. or Canadian MD program accredited by the LCME
- A U.S. DO program accredited by the Commission on Osteopathic College Accreditation (COCA)
- An international medical school listed in the World Directory of Medical Schools, recognized by the ECFMG, and meeting ECFMG eligibility requirements
- You must meet these conditions both at the time of application and on the day of the exam.
- Step 3:
- To be eligible for Step 3, you must:
- Have passed Step 1 and Step 2 CK
- Hold an MD or DO degree from an LCME- or COCA-accredited U.S. or Canadian medical school, or an equivalent degree from a recognized international school and have obtained ECFMG Certification
- Meet all additional criteria outlined in the USMLE Bulletin of Information
- Although not mandatory, it's strongly recommended that Step 3 applicants complete or be near completing at least one year of postgraduate training in an accredited U.S. residency program.
The USMLE is divided into three Steps:
- Step 1: Assesses knowledge of basic medical sciences foundational to clinical medicine, including anatomy, biochemistry, microbiology, pathology, pharmacology, physiology, and behavioral sciences. Step 1 is now graded as pass/fail.
- Step 2 Clinical Knowledge (CK): Focuses on clinical sciences necessary for patient care under supervision, testing clinical reasoning, diagnostic skills, and understanding of clinical management. Step 2 CK provides a numeric score.
- Step 3: Tests the ability to apply medical knowledge in managing patients independently, including ambulatory settings and hospitals. Step 3 consists of multiple-choice questions and computer-based case simulations (CCS) across two testing days.
Testing Format & Duration:
- Step 1 & Step 2 CK: Single-day, computer-based tests administered at Prometric centers worldwide. Each consists of multiple-choice questions divided into timed blocks. Step 1 lasts approximately 8 hours, while Step 2 CK takes around 9 hours to complete, including breaks.
- Step 3: Two-day exam. Day 1: multiple-choice questions. Day 2: multiple-choice questions plus CCS cases. Total testing time ~16 hours over two days.
More details and practice materials:
Application procedures differ depending on your status:
- U.S. and Canadian Medical Students/Graduates: Apply via NBME for Steps 1 and 2, and via FSMB for Step 3.
- International Medical Graduates (IMGs): Apply through ECFMG Online Services for all steps.
Once approved, you receive a scheduling permit valid for 3 months to book an exam at a Prometric center. Early scheduling is recommended to secure preferred test dates, especially during peak months (May-July, December-January).
Visit our Form Filling Guide for more information about how to fill the form.
Scheduling and rescheduling policies, fees, and procedures are detailed on the official USMLE websites:
Effective USMLE preparation requires a structured, comprehensive study plan over several months. Recommended study resources include:
- UWorld: High-quality question bank for all Steps.
- First Aid for the USMLE Step 1 & Step 2 CK: Comprehensive review books.
- NBME Self-Assessments: Official practice exams for self-evaluation.
- USMLE Sample Questions & Practice Materials: Available free on the official USMLE website.
Step 1: Reported as pass/fail only. No numeric score.
Step 2 CK and Step 3: Reported with a three-digit numeric score. Passing scores are established by the USMLE Management Committee and are periodically updated.
Score reports are available online approximately 3-4 weeks after the test date. Examinees receive notification when results are posted.
Check official score info here:
- Arrive at the testing center at least 30 minutes before your scheduled exam time.
- Bring a valid government-issued ID and your scheduling permit.
- All personal items including cell phones, notes, and watches must be stored in lockers.
- Test sessions include timed blocks with scheduled breaks.
- Eating, drinking, and smoking are prohibited inside the testing room.
Full exam day rules and security policies can be reviewed here:
Irregular behavior during USMLE exams includes cheating, falsification of documents, disruptive conduct, and unauthorized electronic device use. Such behavior may result in exam termination, score cancellation, invalidation of prior scores, and reporting to licensing authorities.
Appeals and reinstatement procedures exist but require documented evidence and are handled case-by-case.
Read more on policies and enforcement:
- Only schedule exams through official USMLE or Prometric channels. Beware of fraudulent services.
- Keep your personal and exam credentials secure.
- Read all instructions carefully before and during testing.
- Contact USMLE or Prometric immediately if you experience technical issues or emergencies on test day.
Official USMLE communications come from the NBME, FSMB, ECFMG (for IMGs), and Prometric. Verify the authenticity of emails or messages before acting on them. For questions or concerns, use official contact points: