The United States Medical Licensing Examination (USMLE) is a three-step examination taken by both US and international medical graduates 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 practice safe and effective medical care. If you are applying to take USMLE outside the US, your medical school must be listed on the World Directory of Medical Schools.

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

How do I apply to the USMLE?

From the UK, you apply to take USMLE by registering with the Educational Commission for Foreign Medical Graduates (ECFMG).

You’ll then need to take USMLE Step 1 (Basic Medical) and Step 2 (Clinical Knowledge) – these can be taken while you’re studying for your Medicine degree. Afterwards, you can take USMLE Step 2 (Clinical Skills). After you’ve passed all three of these stages, you’ll receive a Standard ECFMG certificate.

Graduates need full ECFMG certification to apply for Graduate Entry Medicine (GEM) programmes in the US, and completion of one to three years of GEM is required to practice Medicine. The final stage, USMLE Step 3, is then usually taken after the first year of GEM. After your graduate entry programme, you can apply for a license from the US state you wish to practice Medicine in.

USMLE Step 1

What is USMLE Step 1?

USMLE Step 1 is an eight-hour multiple choice examination. It is divided into seven 60-minute blocks. This step examines your basic understanding of the sciences behind Medicine. It covers a range of topics including anatomy, biochemistry, behavioural sciences, immunology and pharmacology. Questions will often take the form of detailing a patient illness or scenario and the multiple choice answers will commonly ask you identify the patient’s illness or recommended examination.

How much does USMLE Step 1 cost?

The examination fee for Step 1 is $880 (this is roughly £722). If you’re taking the test outside the US, there is also an international fee of $185 (roughly £150).

How can I prepare for USMLE Step 1?

It’s suggested that preparation for USMLE Step 1 takes around six months – so cramming is not advised! USMLE’s advice is to revise the content of each exam thoroughly – specific Examination Content is available here. In addition, there are a range of Step 1 Practice Questions and answers available on USMLE’s website – practice makes perfect, so try to complete as many of these questions as you can to get used to the way different topics are tested.

A good preparation tip is to begin revising early to find out how you learn: do you revise best in a group setting, while discussing with others? Or do you learn better independently and keeping to your own revision timetable? Once you know, you can then start to plan ahead – sitting down every week with a friend, or booking yourself onto a USMLE course, or scheduling some silent study in the library.

USMLE Step 2 (Clinical Knowledge)

What is USMLE Step 2 (Clinical Knowledge)?

The USMLE Step 2 CK assesses whether you can apply medical knowledge and clinical science to patient care. Similar to Step 1, it’s a one-day multiple choice examination lasting for nine hours and divided into eight blocks. Questions cover physician tasks, such as pharmacotherapy, diagnostics and clinical interventions. Step 2 also covers disease categories, including the cardiovascular system, the musculoskeletal system and biostatistics.

How much does USMLE Step 2 (Clinical Knowledge) cost?

The examination fee for Step 2, like Step 1, is $880 (this is roughly £722). For students taking the test outside the US, there is also an international fee of $210 (roughly £170).

How can I prepare for USMLE Step 2 (Clinical Knowledge)?

As with Step 1, it’s a good idea to familiarise yourself with the format of Step 2’s questions by working your way through USMLE’s range of Step 2 Practice Questions. The more practice papers you sit, the more you can familiarise yourself with the format – and train your brain to digest each patient-focused vignette easily!

It’s generally recommended that Step 1 and Step 2 (Clinical Knowledge) are taken while you’re studying for your Medicine degree, as a lot of the information will be fresh in your mind – so if you know you want to take USMLE, plan ahead and start practicing!

USMLE Step 2 (Clinical Skills)

What is USMLE Step 2 (Clinical Skills)?

This is the second part of Step 2 – this tests your ability to face patients and address diagnostic challenges. The twelve patients you will see, similar to the MMI Interview in the UK, will be professional actors trained to act as real patients with clinical problems. The cases and symptoms you will be faced with will vary, but may include cardiovascular issues, musculoskeletal issues or women’s health. This step lasts eight hours, with 15 minutes for each patient, who you may see face-to-face or speak to on the phone. You will have 50 minutes of breaks – but, unlike Step 1 and Step 2 CK, this is at set times during the day. You can find full information on interacting with the patients in USMLE’s Step 2 (Clinical Skills) guide.

How much does Step 2 (Clinical Skills) cost?

Step 2 (Clinical Skills) costs £1,535 – which is approximately £1,246. Something else to keep in mind is that if you’re taking the USMLE from the UK, you’ll need to travel to the US to a designated CSEC Testing Centre. These are in Georgia, Illinois, California, Texas and Pennsylvania – so be prepared for the flight cost!

How can I prepare for Step 2 (Clinical Skills)?

Unlike Step 1 and Step 2 (Clinical Knowledge), this component of Step 2 is harder to prepare for. A good idea may be to run through a couple of scenarios with friends who are also taking the test, so you can take turns interacting with patients and practicing physical examinations.

Another thing to remember is timing: you’ll get 15 minutes with each patient, and an extra ten to write up your notes (this is typed, not by hand – so get used to typing efficiently and accurately. Don’t forget: there’s no spell-check, so you may want to practice your spelling!). Practice with your friends in 15 minute slots using the same USMLE Patient Note you’ll be using in the exam. You can also see Patient Note examples to get an idea of the format.

USMLE Step 3

What is USMLE Step 3?

You’re nearly there! USMLE Step 3 is a two-day exam. Day one, Foundations of Independent Practice, is a seven hour multiple choice test similar to Step 1 and 2 (CK). It is divided into six 60-minute blocks, with 45 minutes of break time. It tests knowledge of medical diagnosis, interpersonal skills and understanding of scientific abstracts and pharmaceutical adverts.

Day two, Advanced Clinical Medicine, tests your knowledge of patient management and how diseases evolve over time. This is divided into 198 multiple choice questions, and 13 computer-based care simulations each lasting 10-20 minutes. This exam is nine hours long, divided into six 45 minute blocks. This day assesses your knowledge of diagnosis, care management and medical decision making.

How much does Step 3 cost?

Step 3 costs $830, which is £674.

How can I prepare for USMLE Step 3?

As with the other multiple choice exams, USMLE has practice Step 3 questions available on their website, including single item questions (a patient-focused vignette with one question and set of multiple choice answers), multiple item sets (a patient-focused vignette with a few questions and multiple choice answers, related to the vignette but can be answered in any order) and sequential sets (a patient-focused vignette with a few questions and multiple choice answers testing a different point and must be answered in order). Go through these questions carefully to mark any topics you’re unsure of, and revise them thoroughly.

Another key aspect of revision for USMLE Step 3 is starting the animated demonstration of the Computer Case Studies. This will help you familiarise yourself with the kinds of patient scenarios the section covers.

USMLE: Top 5 Tips

  1. Get used to working with breaks – For Step 1, 2 (CK) and 3, you’re allowed personal breaks totalling 45 or 50 minutes. You can choose when to take these – but you’re not allowed more than six. There’s also an optional tutorial at the beginning of each exam, so if you choose to skip this, you can add the time to your breaks. Once you start taking practice tests, it’s a good idea to repeat a break structure so that you can get used to working under these conditions.
  2. Answer all of the questions – once you’ve closed a block of questions, you can’t re-open it, so make sure you’ve answered everything! If you’re unsure of a question in Step 1, 2 (CK) or 3, the best idea is to guess. An unmarked answer will automatically be read as wrong, whereas you may get it right if you make an educated guess!
  3. Get a good night’s sleep – you won’t be able to sit an exam for eight or nine hours if you were up trying to cram the night before! Try to get at least eight hours, and eat a good breakfast in the morning to make sure you perform to the best of your ability.
  4. Practice as much as you can – for Step 1, 2 (CK) and 3, practice questions (and lots of them!) are the way to go. For Step 2 (CS), practice your spelling and typing so that your patient notes are written to the best of your ability and run through patient scenarios with your friends in 15 minute slots. When exam day comes, you’ll feel fully prepared.
  5. Check the requirements – double check USMLE’s Examination Day and Testing page of what you need to bring with you on the day, as well as details of what you can bring into the testing room – and when you need to arrive!

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