The United States Medical Licensing Examination (USMLE) is a three-step examination for medical licensure in the United States and is sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME).
The USMLE assesses a physician's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care. Each of the three Steps of the USMLE complements the others; no Step can stand alone in the assessment of readiness for medical licensure.
The exam is currently an eight-hour computer-based test taken in a single-day, composed of seven 44-question sections with a total of 308 multiple-choice questions. Beginning May 9, 2016, the NBME plans to shorten the test to seven 40-question sections. One hour is provided for each section, allotting an average of a minute and eighteen seconds to answer each question. Between test sections, the test taker is allotted a cumulative 45 minutes (during the test day) for personal breaks. (There is a 15-minute tutorial at the beginning of the exam, which the test-taker can choose to skip and have that time added to break time.) If the taker finishes any section before the allotted one hour time limit, the unused time is added to the break time total. The test is administered at any of several Prometric computer testing sites.
Before you can apply for a medical license, you must pass a three-step test called the United States Medical Licensing Examination (USMLE), also known as the board exam.
Studying for the USMLE
This test is unusual for two reasons. First, you take each part at a different stage of your medical education. Second, unlike many standardized tests, the USMLE actually assesses your mastery of the material, not how well you take a test. While there are some test-taking strategies that will improve your performance, you won't pass without comprehensive and detailed knowledge of the sciences, as well as an ability to apply that knowledge in a clinical setting.
Eligibility for USMLE
To be eligible, the candidates must be in one of the following categories at the time you apply and on your test day:
• a medical student officially enrolled in, or a graduate of, a US or Canadian medical school program leading to the MD degree that is accredited by the Liaison Committee on Medical Education (LCME),
• a medical student officially enrolled in, or a graduate of, a US medical school leading to the DO degree that is accredited by the American Osteopathic Association (AOA), or
• a medical student officially enrolled in, or a graduate of, a medical school outside the United States and Canada who meets the eligibility criteria of the Education Commission for Foreign Medical Graduates (ECFMG).
Who Takes the USMLE?
The USMLE is designed for students of allopathic medicine, who are on the path to an MD. Students of osteopathic medicine can take either the USMLE or a similar test called the Comprehensive Osteopathic Medical Licensing Examination (COMEX).
Overview of the Tests
The USMLE is divided into three steps:
Step 1 is a one–day test, usually taken at the end of the second year of med school. It emphasizes knowledge of basic sciences, including anatomy, biochemistry, behavioral sciences, microbiology, immunology, pathology, pharmacology and physiology. Topics such as nutrition, genetics and aging are also covered. All questions are multiple–choice.
Step 2 is a two–day test, usually taken in the fourth year of med school. It has two components. The first (called Clinical Knowledge, or CK), requires you to answer multiple–choice questions on clinical sciences like surgery, internal medicine, pediatrics and obstetrics and gynecology. The second (called Clinical Skills, or CS) requires you to examine and diagnose actors posing as patients. For the Step 2 CS, students must travel to one of five testing centers around the country.
Step 3 is a two-day test, usually taken after the first year of residency. This is the final assessment of whether or not you're prepared to practice general medicine in an unsupervised setting. Like Step 2, Step 3 focuses on the diagnosis and treatment of patients. It includes both multiple choice questions and computer simulations of patient care.
The Step 2 CS has no numerical score. You earn a "pass" or a "fail" based on your ability to gather data, communicate with the patient and write an effective report.
On all other parts of the test, the number of correct answers you earn is converted into two numerical scores, one on a three–digit scale and the other on a two–digit scale. These are simply two ways of reporting the same result to schools. You must earn a 75 on the two–digit scale to pass.
While your medical school education will give you many of the skills and much of the knowledge necessary to pass the USMLE, you are still likely to log a substantial amount of time reviewing and preparing for each stage of the test.