United States Medical Licensing Examination (USMLE)

The United States Medical Licensing Examination (USMLE), is a three step examination. It is a USMLE exam is conducted by United States (US). The USMLE is owned by two entities Federation of State Medical Boards (FSMB) and National Board of Medical Examiners (NBME). It has to be given by the medical students who have passed MD and wants to practice medicine. Each medical licensing authority sets its own rules and regulations and requires passing an examination that demonstrates qualification for licensure. USMLE is governed by a committee of  ECFMG, FSMB, NBME and public.   

Federation of State Medical Boards (FSMB)

FSMB is a non-profit organization which represents 70 state medical boards of United States. FSMB is actually responsible for licensing physicians, solving patients complaints and maintaining the law for physicians.

National Board of Medical Examiners (NBME)

National Board of Medical Examiners or NBME is a non-profit organization which represents 80 members in board of national medical examiners. It is the conducting body which serves the public through designing the exam patterns. NBME creates a number of assessments for medical sciences education, licensure domestically and internationally. It also gives the report of research and development intended to advance medical education.

One National Examination – United States Medical Licensing Examination or USMLE

Before the commencement, of USMLE various examination are conducted NBME i.e., National Board of Medical Examiners, FLEX i.e., Federation Licensing Examination. The basic idea of conducting USMLE examination is to maintain one national examination for all the MD passed out doctors. It is to ensure that all the students have passed out from the same assessment standards.

Eligibility to apply for United States Medical Licensing Examination (USMLE) examination

The candidates should know the eligibility criteria for applying in the USMLE examination. USMLE examination is necessary to passed by all the doctors who want to obtain the license for practicing in US. The students who are willing to practice in US but they are doing their MBBS in India are also eligible to apply for USMLE examination.

USMLE Steps	Eligibility
Step 1, Step 2 CK, Step 2 CS	1. The candidate must be enrolled in/outside or a graduate of a medical college in US/Canada , listed in World Directory of Medical School.
Step 3	1. The candidates must clear the Step 1, Step 2 CK, Step 2 CS. 2. The candidates must obtain an MD degree (or its equivalent) or a DO degree from a U.S. or Canadian medical school that is accredited by the LCME or the AOA.

United States Medical Licensing Examination (USMLE) – A three step examination

USMLE is a three step examination conducted to test the ability of the candidates who want to attain the medical degree license. So, this USMLE examination is conducted in three steps and each step contains some process. The process includes some tests, on field tests i.e., clinical tests and knowledge. All the steps are concisely explained here, as follow as:

Step 1: System and Process

It is a 1 day examination of seven 60 minutes block and administered one 8-hour testing session. The number of questions per block on a given examination form may vary, but will not exceed 40. The total number of items on the overall examination form will not exceed 280.

The step 1 is conducted to see the competence of the candidates that how they use their basic concepts in practice of medicine. Read more

Step 2 CK i.e; Clinical Knowledge, Step 2 CS i.e; Clinical Sciences

Step 2 CK is a one-day examination. It is divided into eight 60-minute blocks and administered in one 9-hour testing session. The number of questions per block on a given examination will vary but will not exceed 40. The total number of items on the overall examination will not exceed 318.

For students / graduates of LCME-or AOA-accredited medical programs in the US or Canada:  

The candidates are required to fill up the application form and apply through NBME on NLES i.e., NBME Licensing Examination Services.

For students / graduates of medical schools located outside the US and Canada:

The candidates are required to fill up the application form and apply through ECFMG on IWA Interactive Web Application. Read more

Step 3:

All medical school graduates who have passed Step 1, Step 2 CK, and Step 2 CS are eligible to apply through FSMB  i.e., Federation of State Medical Boards. Read more

United States Medical Licensing Examination (USMLE) Application Form

United States Medical Licensing Examination (USMLE) is a three step examination. For appearing the examination the aspirants have to fill up the application form. To apply for USMLE examination, the candidates must submit the application form. The candidates must follow the steps to fill up the application form.

Application Fee Information

Step 1; Step 2 CK; Step 2 CS Application Fee Information For LCME-or AOA- accredited medical students or graduates in the US or Canada who are applying through the NBME on NLES.

Fees	Step 1	Step 2 CK	Step 1 and 2 CK	Step 2 CS
Application Fee	$645	$645	$70	$1300
Rescheduling Fee	$0-$506	$0-$569	–	$0-$1290

Application for ECFMG

For students / graduates of medical schools located outside the US and Canada who are applying through the ECFMG.

Particulars	Fees
Application for ECFMG	$ 135

Examination

Particular	Step 1	Step 2 CK	Step 2 CS
Examination Fee	$ 940	$ 940	$ 1580
Extension of Eligibility Period	$ 80 per exam	$ 80 per exam	–
Step 1/Step 2 CK Testing region change	$ 75	$ 75	–
Rescheduling Fee	$0-$569	$0-$569	$0-$1290
Score recheck	$ 80	$ 80
ECFMG Exam Chart	$ 50*
ECFMG CSA history chart	$ 50*
USMLE Transcript Paper	$ 70*
USMLE Transcript for ERAS	$ 80**

* per request form.
** per ERAS season.

Rescheduling Fee

For Appointments at Prometric Test Centers for Step 1, Step 2 CK, and Step 3 Examinations:

USMLE allows the candidates to change their testing appointment such as rescheduling the test centre, cancelling the scheduled date of appointment by charging a fee. Prometric will not charge any fee for changing the test appointment 31 or more days prior to the first day of the scheduled test. The candidates have to approach to their Regional Registration Center for changing their scheduled date of appointment.

Steps to fill up the Application Form	Prometric Testing Centres	Step 1	Step 2 CK	Step 3
31 or more days before the first day of scheduled date	All testing regions	No Fees	No Fees	No Fees
Fewer than 31 days and more than 5 days of the scheduled date	All testing regions	$50	$50	$50
5 or fewer days before the first day of the scheduled date	US and Canada	$114	$128	$228
	Africa, Asia (including Hong Kong, Pakistan), Australia, China, India, Indonesia, Latin America, Middle East (including Egypt), Thailand	$276	$311	N/A
	Europe (including Israel), Korea, Taiwan	$314	$353	N/A
	Japan	$506	$569	N/A

Appointment Change Fees For Computer Based Examination

For Step 2 CS Examination Appointment

The candidates who are unable to give their exam on the scheduled date then they can reschedule the exam date. The candidates are allowed to change their test location, cancel their scheduled test location/centre. However, no canceling is allowed beginning at 12:00 AM, Eastern Time in the United States, on your scheduled test date. The date that you cancel your testing appointment will determine the amount of your rescheduling fee. If a candidate cancel,

• more than 14 calendar days before the scheduled test date, the candidates will not be charged a fee when they reschedule.
• between 3 and 14 calendar days before the scheduled test date, the candidates will be charged a $400 fee when they reschedule.
• 2 calendar days before the scheduled test date, the candidates will be charged a $645 fee when they reschedule.
• 1 day before the scheduled test date, the candidates will be charged a $1,290 fee when they reschedule.
• If a candidate miss their scheduled testing appointment without canceling, the candidates will be charged a $1,290 fee when they reschedule.

Full Description of the United States Medical Licensing Examination (USMLE) Steps

United States Medical Licensing Examination (USMLE): Step 1

The candidates who have enrolled themselves in the medical colleges/institutions recognized by World Directory of Medical Schools. The first step includes the assessment of candidates knowledge of the concepts of science in all terms of medical practice.

Step 1 of 1: Test Specifications

System	Range %
General Principles	13 – 17
Blood & Lymphoreticular/Immune Systems	7 – 11
Behavioral Health & Nervous Systems/Special Senses	9 – 13
Musculoskeletal,  Skin & Subcutaneous Tissue	6 – 10
Cardiovascular System	6 – 10
Respiratory & Renal/Urinary Systems	9 – 13
Gastrointestinal Systems	5 – 9
Reproductive & Endocrine Systems	9 – 13
Multisystem Processes & Disorders	7 – 11
Biostatistics & Epidemiology/Population Health	5 – 7
Social Sciences: Communication Skills/Ethics	3 – 5

Step 1 of 2: Process Specifications

Processes	Range %
Normal Processes	10 – 15
Abnormal Processes	55 – 60
Principles of Therapeutics	15 – 20
Others	10 – 15

Step 1 of 3: Physician Tasks/Competencies Specifications

Competency	Range %
Medical Knowledge	52 – 62
Patient Care: Diagnosis	20 – 30
Patient Care: Management	7 – 12
Communication/Professionalism	2 – 5
Practice-based Learning & improvement	5 – 7

Step 1 of 4: Discipline Specifications

System	Range %
Pathology	45 – 52
Physiology	26 – 34
Pharmacology	16 – 23
Biochemistry & Nutrition	14 – 24
Microbiology & Immunology	15 – 22
Gross Anatomy & Embryology	11 – 15
Histology & Cell Biology	9 – 13
Behavioral Science	8 – 13
Genetics	5 – 9

United States Medical Licensing Examination (USMLE): Step 2 CK and CS

USMLE step 2 CK and Step 2 CS assesses the candidates to show their medical skills and knowledge. The examination is conducted to see the candidates ability to understand the clinical knowledge to care for patients under the supervision of the seniors and includes the detection and prevention of the disease.

Step 2	Duration	Total Question	Block	Break time
Step 2 CK	9 hour	318	8 blocks	45 + 15 minutes
Step 2 CS		12 Patients	15 mins each

Step 2 CK is a one-day examination. It is divided into eight 60-minute blocks and administered in one 9-hour testing session. The number of questions per block on a given examination will vary but will not exceed 40. The total number of items on the overall examination will not exceed 318.

The examination also includes a minimum allotment of 45 minutes of break time and a 15-minute optional tutorial. The amount of time available for breaks may be increased by finishing a block of test items.

United States Medical Licensing Examination (USMLE): Step 3

The candidates who have passed the step 1, step 2 CK, step 2 CS are eligible to given step 3 examination. The USMLE step 3 is the final step of USMLE examination. This step intends to see that the aspirants are able to provide clinical services. The Step 3 is a 2 day examination. It is divided into two parts Federation of Independent Practice (FIP), Advanced Clinical Medicine (ACM).

Step 3	Duration	Total No. of Questions	Block	Break time
Day 1	7 hours	232 Questions	6 block	45+5 minutes
Day 2	9 hours	180 Questions	6 block	45+7 minutes

Day 1 Federation of Independent Practice (FIP), of Step 3 examination

The test basically includes assessment of knowledge of basic medicine and scientific principles, health care, medical ethics, patients safety. The first day includes 232 multiple choice questions/ items that are divided into 6 blocks of 38-39 items. The total time allotted for the first day examination is 7 hours with 45 minutes of break and 5 minutes of optional tutorial. For completing each block 60 minutes are allotted.

Day 2 Advanced Clinical Medicine (ACM), of Step 3

The day 2 test includes the assessment of knowledge of diagnosis and management. The test focuses on the prognosis and maintaining health of the patients and medical decision making. The candidates have to go through the diagnostic studies and physical examination.  The second day includes 180 multiple choice questions/ items that are divided into 6 blocks of 30 items. The total time allotted for the second day examination is 9 hours with 45 minutes of break and 7 minutes of optional tutorial. This is followed by 13 case simulations, each of which is allotted a maximum of 10-20 minutes of real time. For completing each block 45 minutes are allotted.

Frequently Asked Questions

Author: Rima Kochar