The United States Medical Licensing Examination (USMLE) provides state medical boards a national standard with which to assess the competence of individuals pursuing licensure. The medical boards use USMLE scores to inform their decisions on whether to grant people who studied medicine practice licenses. Designed to adhere to professional testing standards while ensuring fairness among examinees, USMLE outcomes are reliable benchmarks for medical boards, ensuring both effective and safe medical care.
The USMLE is administered as three tests: Step 1, Step 2 CK, and Step 3. Examination committees composed of hundreds of volunteer medical educators and practicing clinicians come together to create and review examination materials annually. State licensing professionals are also represented in these committees. Once they develop an exam, two or more expert committees critically appraise them, revising outdated material to ensure every exam question and case is consistent with current medical knowledge and practices.
Step 1 evaluates examinees based on their understanding of important concepts in the basic sciences. Special emphasis is given to the principles and mechanisms that underlie health, disease development, and treatments. The examination contains about 280 questions divided into seven blocks. Each block has a 60-minute allocation so the entire test takes about eight hours, breaks included.
Step 2 CK evaluates candidates on their ability to apply medical skills and knowledge to patient care while under supervision. It places emphasis on preventing disease and promoting overall health. The exam contains about 320 questions divided into eight blocks. Examinees should complete each block in one hour so the exam takes nine hours, with breaks.
Step 3 (for student who have graduated from medical school) examines candidates’ ability to apply the essentials of biomedical and clinical sciences in unsupervised medical practice. Emphasis here is on patient care in ambulatory settings. The test is administered over two days. On the first day, candidates sit for a foundations of independent practice (FIP) exam, which tests their understanding of basic medical principles. This exam comprises about 230 questions divided into six blocks. Each block is scheduled for one hour.
On the second day, examinees sit for the advanced clinical medicine (ACM) exam, which tests their ability to apply health and disease knowledge to manage patients over time or the course of a disease. The test has about 180 questions divided into six blocks, each scheduled to take 45 minutes to complete. Examinees can take Step 1 and Step 2 CK in any sequence, but can only take Step 3 after successfully completing the first two.
USMLE publishes performance standards for exam scores. These are usually based on candidates’ levels of proficiency. There are no predetermined percentages for those who will pass or fail.
To apply to take the USMLE exam, candidates must meet certain eligibility requirements. To sit for the Step 1 and Step 2 CK exams, candidates must be medical students enrolled in or having graduated from an eligible US, Canadian or Foreign medical school, working toward or holding medical degrees that are accredited by the Liaison Committee on Medical Education or DO degrees that are accredited by the Commission on Osteopathic College Accreditation. Medical students enrolled in or having graduated from medical schools outside the United States and Canada can also apply for the exams if their medical schools meet the ECFMG eligibility requirements and are listed on the World Directory of Medical Schools.
To apply for the Step 3 exam, students must have successfully completed the first two USMLE exams and meet additional eligibility criteria listed on the USMLE Bulletin of Information. For example, they must have completed or be close to completing one year of postgraduate training.
Qualifying candidates from US or Canadian schools can apply for the Step 1 and Step 2 CK exams through the NBME website. Those from schools outside the US and Canada can apply by following the instructions on the ECFMG website. Candidates who want to take the Step 3 exam can follow the applications on the FSMB website.
