The United States Medical Licensing Examination (USMLE) is a three-step examination process required for medical licensure in the United States. The USMLE is sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). The exam aims to assess a physician’s ability to apply medical knowledge, skills, and understanding of clinical science necessary for the unsupervised practice of medicine.
Step 1: Basic Science Knowledge The first step of the USMLE, known as Step 1, primarily tests the examinee’s understanding of basic science concepts, which are fundamental to the practice of medicine. Step 1 covers subjects such as anatomy, biochemistry, microbiology, pathology, pharmacology, and physiology. The exam consists of multiple-choice questions and is usually taken after the second year of medical school.
Format: Step 1 is a computer-based test consisting of approximately 280 multiple-choice questions divided into seven 60-minute blocks, totaling 7 hours of testing time. The questions are designed to test the examinee’s ability to apply basic science concepts to medical practice.
Step 2: Clinical Knowledge (CK) and Clinical Skills (CS) Step 2 of the USMLE is divided into two separate exams: Clinical Knowledge (CK) and Clinical Skills (CS).
Clinical Knowledge (CK): The CK portion of Step 2 assesses the examinee’s ability to apply medical knowledge, skills, and understanding of clinical science necessary for the provision of patient care under supervision. The test covers subjects such as internal medicine, obstetrics and gynecology, pediatrics, preventive medicine, psychiatry, and surgery.
Format: Step 2 CK is a computer-based test consisting of approximately 318 multiple-choice questions divided into eight 60-minute blocks, totaling 8 hours of testing time.
Clinical Skills (CS): The CS portion of Step 2 is a practical examination that tests the examinee’s ability to gather information from standardized patients, perform a physical examination, communicate findings, and develop a patient management plan. It evaluates the examinee’s proficiency in communication and interpersonal skills, spoken English, and clinical decision-making.
Format: Step 2 CS is a day-long examination consisting of 12 patient encounters, each lasting 15 minutes, with 10-minute breaks between encounters. After each patient encounter, examinees have 10 minutes to complete a patient note detailing their findings, diagnostic impressions, and a proposed plan of management.
Step 3: Clinical Management and Decision-Making The final step of the USMLE, Step 3, is designed to assess the examinee’s ability to apply medical knowledge, skills, and understanding of biomedical and clinical science essential for the unsupervised practice of medicine. Step 3 focuses on patient management, including initial assessment, diagnosis, prognosis, and treatment. The exam is typically taken after the first year of postgraduate training (residency).
Format: Step 3 is a two-day computer-based examination. On the first day, examinees face approximately 232 multiple-choice questions divided into six 60-minute blocks, totaling 6 hours of testing time. The second day consists of approximately 180 multiple-choice questions divided into six 45-minute blocks, along with 13 computer-based case simulations, totaling 7 hours of testing time.
Scoring and Results: The USMLE uses a three-digit scoring system for all three steps. The minimum passing scores for each step are determined by the USMLE Management Committee. The results are typically available within 3-4 weeks of taking the examination.
Upon successful completion of all three steps of the USMLE, an individual is eligible to apply for an unrestricted medical license in the United States. The USMLE is recognized as a rigorous and comprehensive evaluation of a physician’s medical knowledge, skills.
