This is your guide to the USMLE – a series of exams you’ll need to take if you want to practice Medicine in the US.

What Is The USMLE?

The United States Medical Licensing Examination (USMLE) is a three-step examination taken by medical graduates in order to practice Medicine in the US. The exam assesses your ability to apply medical knowledge as well as your patient-focused skills to ensure you are fit to practise safe and effective medical care.

If you are applying to take the USMLE outside of the US, your Medical School must be listed on the World Directory of Medical Schools.

This page will guide you through the USMLE’s three steps, how to register for them and exam preparation.

How Do I Apply For USMLE?

For American or Canadian students, applications are done through the National Board of Medical Examiners (NBME).

For UK and other international students, applications to take the USMLE are done by registering with the Educational Commission for Foreign Medical Graduates (ECFMG).

In order to take Steps 1 and 2, students must be enrolled in or be a graduate of an LCME accredited medical degree (for US or Canadian students) or an WDMS listed international medical degree (for foreign students).

To take Step 3, students must have passed Steps 1 & 2 and have attained their accredited medical degree as outlined above. It is worth noting that you do not need to have taken Step 3 in order to start your residency and many students choose to take the test later.

In summary, Steps 1 & 2 are taken during Medical School whereas Step 3 is taken after you have completed Medical School.


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USMLE Step 1

What is USMLE Step 1?

USMLE Step 1 is an eight-hour multiple choice examination divided into seven 60-minute blocks, each containing up to 40 questions. The exam includes a minimum amount of 45 minutes of break time and an optional 15 minute tutorial. Break time can be increased by finishing blocks early.

Step 1 primarily assesses pre-med subjects such as anatomy, biochemistry, behavioural sciences, immunology and pharmacology. Questions are usually formatted with a stem describing a patients illness or scenario and a following multiple choice question.

When do I take USMLE Step 1?

Students usually take Step 1 following their second year of Medical School. Tests are taken via Prometric test centres.

During registration, you must select a 3-month eligibility period in which you can take the exam. This period can’t fall on a major holiday or the first week of January. You can take the USMLE in international test centres (including the UK), meaning you do not need to fly to the US to take the exam.

How much does USMLE Step 1 cost?

USMLE Step 1 costs $1000 (£792) for international students, in addition to an international test delivery surcharge of $195 (£154). There is also an initial fee for ECFMG registration of $160 (£127).

In total, taking the USMLE Step 1 will cost you around £1073.

How do I prepare for USMLE Step 1?

It is suggested that preparation for USMLE Step 1 takes around six months, so cramming is not advised!

The USMLE website provides detail on the examination content and you are advised to revise this thoroughly. As with any exam, practice makes perfect and it is especially important to get used to the style of questions used in the USMLE.

USMLE Step 2

What is USMLE Step 2?

USMLE Step 2 used to comprise of two tests – Clinical Skills (CS) and Clinical Knowledge (CK). However, due to Covid, the CS component was cancelled and has since been permanently cancelled. Therefore, when you take Step 2, it will only consist of the Clinical Knowledge component.

USMLE Step 2 CK is similar to Step 1 in that it is a one day multiple choice exam. However, it is nine hours long and divided into eight blocks, with the same 45 minute break time and 15 minute optional tutorial. Questions here are focused on topics such as pharmacotherapy, diagnostics and clinical interventions in addition to disease categories such as the cardiovascular or musculoskeletal systems.

When do I take USMLE Step 2?

Step 2 is usually taken after a student’s third year of Medical School, once finishing clinical rotations. This is ideal as what you learn on clinical rotations is what Step 2 aims to assess and thus the content will be fresh in your mind.

Similarly to Step 1, examinations are taken at Prometric test centres and also use an eligibility period in registering for the test.

How much does USMLE Step 2 cost?

USMLE Step 2 also costs $1000 (£792) for international students, in addition to a international test delivery surcharge of $195 (£154).

As you will have already registered with ECFMG, Step 2 will cost you around £946.

How do I prepare for USMLE Step 2?

As with Step 1, it is a good idea to familiarise yourself with the format of USMLE questions by working your way through Step 2 practice questions.

If you take Step 2 shortly after your clinical rotations, this should be excellent preparation for the examination!

USMLE Step 3

What is USMLE Step 3?

USMLE Step 3 is a two-day examination.

Day one, Foundations of Independent Practice, is a seven-hour multiple choice test similar to Steps 1 & 2. It is divided into six 60-minute blocks with 45 minutes of break time.

Day two, Advanced Clinical Medicine, tests your knowledge of patient management and how diseases evolve over time. The format of this exam is slightly different. The first part comprises of 180 multiple choice questions divided into six blocks, each lasting 45 minutes. This is followed by 13 Computer Case Simulations (CCS), each lasting 10-20 minutes.

Day two takes nine hours in total and aims to assess your knowledge of diagnosis, care management and medical decision making.

When do I take USMLE Step 3?

USMLE Step 3 can only be taken after completion of Medical School. You do not need to take Step 3 in order to apply for and start residency, and in fact many students choose to take it later in order to have more experience.

Step 3 is also taken at a Prometric test centre within a specified three-month eligibility period.

How much does USMLE Step 3 cost?

USMLE Step 3 costs $895 (£709).

How do I prepare for USMLE Step 3?

The CCS component of this examination is new and so it is key to familiarise yourself with these kinds of patient scenarios, which can be done on the USMLE website.

In addition, practising multiple choice questions is also important in your revision for Step 3, similarly to the previous steps.

How Is The USMLE Scored?

Scores for each step of the USMLE are on a three digit scale from 1 to 300.

As of 2022, Step 1 is reported as pass or fail only. The current minimum passing scores for Step 2 and Step 3 are 214 and 198 respectively.

Total marks are calculated based on correct answers only, and there is no negative marking – so make sure you give an answer for every question even if it is just a guess!

Generally, scores between 230-245 are considered good, scores between 245-255 as very good and scores over 255 as excellent. Higher scores for Steps 1 & 2 will make you a more competitive candidate for residency applications.

How Many Times Can I Take The USMLE?

The USMLE has a limit of four attempts for any given Step, including incomplete attempts (and attempts at the now cancelled Step 2 CS), after which you are ineligible to apply for any further Steps.

Additionally, you may not take the same Step more than three times in a year, including incomplete attempts.


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