USMLE

Overview

The United States Medical Licensing Examination (USMLE) is the three-step exam sequence used for medical licensure in the United States. Step 1 covers the basic sciences, Step 2 CK (Clinical Knowledge) covers clinical science and patient care under supervision, and Step 3 covers the knowledge needed to practise medicine without supervision. Applications are handled by NBME for students and graduates of US programmes and by FSMB for international programmes. Exams are delivered at Prometric test centers.

Who can apply

Step 1 and Step 2 CK. You must be enrolled in, or a graduate of, one of these:

• a US MD programme accredited by LCME;

• a US DO programme accredited by COCA;

• an international medical school listed in the World Directory of Medical Schools that meets ECFMG requirements.

Step 3. You must have passed both Step 1 and Step 2 CK and hold an MD or DO degree from an accredited US school, or an equivalent degree from an international school together with valid ECFMG Certification. Completing, or nearly completing, at least one year of postgraduate training is recommended.

Attempt limits.

• If you have attempted a Step four or more times, counting incomplete attempts, without passing, you cannot apply for any Step.

• You may take a Step at most three times in any 12 months. A fourth attempt must be at least 12 months after your first attempt and at least 6 months after your most recent one.

• Once you have passed a Step you may not retake it, except to meet a state licensing time limit. Failing such a retake of Step 1 or Step 2 CK makes you ineligible for Step 3.

• You must tell your registration organisation promptly if your status changes. Leaving or being dismissed from medical school ends eligibility immediately.

Exam pattern

Step 1. A one-day exam within an 8-hour testing session.

Step 2 CK. A one-day exam within a 9-hour testing session.

Step 3. Taken over two days. Day 1 is titled Foundations of Independent Practice and Day 2 is titled Advanced Clinical Medicine. The exam combines multiple-choice questions with computer-based case simulations (CCS), in which you manage a simulated patient.

Syllabus

Step 1 tests the basic sciences that underpin medical practice, using an integrated outline organised by body system and by process.

Step 2 CK tests clinical science needed for patient care under supervision, with emphasis on health promotion, disease prevention and core patient-centred clinical skills. The outline covers systems, physician tasks and competencies, and disciplines.

Step 3 follows a model of general medical practice in the US and the situations an undifferentiated physician meets. Its multiple-choice content includes biostatistics and epidemiology (about 11 to 13 percent), the cardiovascular system (9 to 11 percent), the nervous system and special senses (8 to 10 percent), the respiratory system (8 to 10 percent), pregnancy, childbirth and the female reproductive system (7 to 9 percent), and social sciences and communication skills (7 to 9 percent), along with other systems. It assesses competencies such as medical knowledge, diagnosis, management and practice-based learning.

Marking and results

The USMLE programme reports a recommended pass or fail result for the Step examinations. There is no fixed pass mark. As a rough guide, examinees typically need about 60 percent of questions correct, but the figure differs by Step and between exam forms.

Results usually arrive 2 to 4 weeks after testing, though you should allow up to 8 weeks. You are emailed when the result is available on your registration organisation's website, where it stays for about a year. Score reports are for your own use only; to send results to a third party you need an official transcript from FSMB, for a fee. You can ask for a score recheck within 90 days of results.

Fees

For 2026 and 2027, the application fee is $695 for Step 1,$695 for Step 2 CK and $995 for Step 3.

How to apply

Apply through NBME if you are in a US MD or DO programme, or through FSMB if you are at an international school. Read the USMLE Bulletin of Information before applying, because you must agree to follow it. You then schedule your test with Prometric. Testing accommodations are available on request.

After the exam

Step 3 is the final exam in the sequence and leads to eligibility for a licence to practise without supervision, subject to the requirements of each state licensing board. International graduates need ECFMG Certification before Step 3.

Preparation tips

• Read the Bulletin of Information and the content outline for your Step first.

• Use the free sample questions and the interactive testing experience on the USMLE site to learn the exam interface.

• Practise with the 30-minute block timing if you test on or after the new-format dates.

• Do not sit a Step just to see the format. The programme prohibits this, and every attempt counts toward the limit.