USMLE – Everything You Need To Know
The US Medical Licensing Examination (USMLE) is a required medical licence in the United States of America (USA). The USMLE is co-sponsored by the FSMB (Federation of State Medical Boards) and the NBME (National Board of Medical Examiners). The USMLE is a three-part exam that assesses a candidate’s ability to apply knowledge, concepts, and patient-centered skills that are the foundation of safe and effective care. Each medical licencing authority, however, has its own set of rules and regulations for passing the examination and qualifying for a licence. As a result, it is critical to understand all USMLE exam details.
One of the most important USMLE exam details for Indian students is that the exam is administered both online and offline. Steps 2 and 3 evaluate the candidate’s fundamental clinical knowledge (CK).
Eligibility Criteria for the USMLE Exam
It is necessary to check USMLE exam eligibility before applying. Each stage of the examination has its own set of requirements.
Criteria for Steps 1 and 2 CK
- Must have graduated from a Canadian or US medical school programme or be enrolled in a programme leading to the MD qualification that has been accredited by the Liaison Committee on Medical Education (LCME)
- Should be a medical student officially enrolled in a US medical school leading to a DO degree, or a graduate of the same, according to Commission on Osteopathic College Accreditation (COCA).
- A medical student who has received official enrolment or graduation from a medical school that is not located in Canada or the United States and is listed in the World Directory of Medical Schools.
To proceed to Steps 1 and 2, applicants must meet any of the following criteria.
Criteria for USMLE Step 3
- The following are the eligibility requirements for the Step 3 USMLE exam for Indian students:
- Candidates must have passed Step 1 and Step 2 CK.
- They must hold MD or DO degrees from LCME or COCA-accredited medical schools in Canada or the United States.
- An equivalent degree to MD from any medical school outside Canada and the United States with a listing in the World Directory of Medical Schools may be considered as an alternative to the above criteria.
Examination Requirements for the USMLE
There are numerous USMLE requirements for international students that aspirants should be aware of:
- Applicants will receive an email notification of scheduling permit availability after completing the application procedure.
- They must visit the Prometric website to schedule the examination date.
- Applicants should keep their scheduling permits for the examination in a safe place.
Aspirants should carefully read the Rules of Conduct for the test and follow all instructions at the testing centre, as well as bring copies of their scheduling permits and identity proof. They should not bring any additional family members or friends to the testing location.
They should avoid wearing unapproved accessories, but soft-foam earplugs are permitted. For Step 2 CS, only the stethoscope and white laboratory coat are permitted. Before visiting the CIN (Candidate Identification Number) and beginning the session, they should never write on laminated note boards.
USMLE Step 1 and Step 2 CK can be taken in any order, but USMLE Step 3 can only be taken after the first two steps have been completed.
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Elaborate USMLE Steps
The USMLE exam syllabus is designed to assess the candidate’s overall skills. The content outline is divided into 18 major sections that focus on organ systems. The following organisational construct is based on physician tasks and competencies. The steps also cover content from traditional disciplines as well as interdisciplinary areas.
Here is a step-by-step breakdown of the USMLE exam:
USMLE Step 1
- Assesses knowledge and abilities in a variety of scientific and medical concepts, including diseases, underlying health, and modes of therapy.
- A total of 280 multiple-choice questions were distributed over seven 60-minute blocks.
- An eight-hour testing session is covered by the online testing mode.
Outline and Specifications for the USMLE Step 1 Exam
Here are some examples of Step 1 syllabus and specifications.
| Specification | System |
|---|---|
| Content specification | General principles, Behavioural Health & Nervous Systems/Special Senses, Cardiovascular System, reproductive & Endocrine Systems, Social Sciences: Communication and Interpersonal Skills, and many more. |
| Physician Tasks/Competencies | Medical knowledge includes the application of fundamental science concepts, communication and interpersonal skills, practice-based learning and improvement, and other skills. |
| Discipline | Pathology, Pharmacology, Histology & Cell Biology, Genetics, and more. |
USMLE Step 2 (CK):
- Assess your ability to apply medical skills and knowledge, as well as your understanding of clinical science. The emphasis is on disease prevention and health promotion.
- A total of 318 multiple-choice questions were distributed over eight 60-minute blocks.
- Online testing mode, covering a nine-hour session.
Outline and Specifications for the USMLE Step 2 Exam
Here are some examples of Step 2 syllabus and specifications.
| Specification | System |
|---|---|
| Content specification | Immune System, respiratory System, pregnancy, childbirth, and the puerperium, multisystem processes and disorders, and other topics are covered. |
| Physician Tasks/Competencies | Medical knowledge: Applying foundation Science Concepts, patient care: history and physical exam, patient care: mixed management, practice-based learning and improvement, and many other topics. |
| Discipline | Medicine, Surgery, Obstetrics & gynaecology, psychiatry, and paediatrics |
USMLE Step 3:
- Assess biomedical and clinical science knowledge for patient management and ambulatory settings.
- The exam lasts two days. On the first day of the exam, there are 232 multiple-choice questions. It’s divided into six blocks of 38-39 items each. Each block is allotted 60 minutes. The first testing day lasts 7 hours, with a 45-minute break and a 5-minute optional tutorial.
- On the second day of the exam, there are 180 multiple-choice questions spread across six 45-minute blocks. 13 computer-based case simulations are given 10-20 minutes of real-time time each.
- The online testing mode is only available for one day.
Outline and Specifications for USMLE Step 3
Day 1: The Fundamentals of Independent Practice (FIP)
The day focuses on assessing the candidate’s knowledge of medical and scientific principles required for effective health care. Content specifications include, among other things, the application of foundation sciences, the interpretation of medical literature, an understanding of biostatistics and epidemiology/population health, and medical ethics. On the test day, knowledge of history and physical examination, as well as the use of diagnosis and its studies, is assessed.
Day 2: Advanced Clinical Medicine on (ACM)
The second day of the exam is dedicated to evaluating comprehensive knowledge of health and disease for patient management. Assessment content areas include diagnosis and management knowledge, health maintenance and screening, medical decision making, and more.
Retakes, Time Limits, and Number of Attempts on the USMLE Exam
USMLE candidates are limited to four attempts at each Step. Step 2 CS attempts are also counted towards the limit. The three attempts must be completed within a 12-month period. The fourth attempt should take place at least 12 months after the first attempt. It should also be at least six months since the last attempt at the exam.
There are no retakes for the Step or Step Component if the applicant passes it, with the exception of meeting the time limit set by the authority for US physician licencing. This means that all Steps must be completed by the deadline.
USMLE Exam Locations
Candidates can check the official Prometric website for examination centre lists. Testing regions such as India, Japan, the Middle East, and Europe are grouped, and applicants must select an examination centre when registering. Please keep in mind that centres may change without notice. Here is a list for your convenience (only Steps 1 and 2):
| United States and Canada | Alberta, Guam, British Columbia, Puerto Rico, Labrador and Newfoundland, the Virgin Islands, Manitoba, Saskatchewan, Nova Scotia, Quebec, and Ontario. |
| Africa | Kenya, Ghana, Uganda, and South Africa. |
| Oceania | Australia and New Zealand |
| Europe | Denmark, Ireland, Armenia, France, Croatia, Italy, Turkey, Latvia, Israel, Netherlands, Spain, Portugal, Switzerland, and the United Kingdom. |
| Latin America | Brazil, Argentina, Chile, Bolivia, Colombia, Dominican Republic, Costa Rica, Guatemala, Peru, Mexico, Venezuela, and Trinidad and Tobago. |
| Middle East | UAE (United Arab Emirates), Kuwait, Qatar, Egypt, Jordan, Saudi Arabia, Lebanon, and Oman. |
| Asia | India, Bangladesh, Nepal, Japan, Malaysia, Thailand, People’s Republic of China, Taiwan, Indonesia, Singapore, and the Philippines. |
Aspirants can take the USMLE Step 3 in the United States and its territories. Students who pass USMLE Steps 1 and 2 must travel to the United States to take the exam. In the United States and its territories, aspirants can take the USMLE Step 3. Students who have passed USMLE Steps 1 and 2 must travel to the US to take the exam.
USMLE Scoring Methodology
The USMLE publishes results online, and officials release scorecards with candidates’ scores. The authorities also notify all applicants about the availability of the results. When Step 3 results are published, FSMB officials send out notifications.
Score reports are generated electronically, and results are announced three to four weeks after the exam. Candidates must score at least 194 on Step 1 and 209 on Step 2. (CK). In Step 3, they should get at least 196.
| USMLE Steps 1, 2 CK and 2 CS | USMLE Steps 1, 2 CK and 2 CS | USMLE Step 3 |
|---|---|---|
| Graduates or students of AOA or LCME accredited medical programmes in Canada or the United States. | For medical school graduates or students from countries other than Canada and the United States. | All medical school graduates who have passed Steps 1, 2, CK, and CS. |
| Applications are available on the NBME website. | Applications on IWA through ECFMG. | Application via FSM. |
Exam Fees for the USMLE
Applications are made through NBME for COCA or LCME accredited graduates or students in Canada or the United States. ECFMG accepts applications from graduates and medical students living outside of Canada or the United States (Educational Commission For Foreign Medical Graduates). The costs are as follows:
- $160 for ECFMG application fees
- Step 1 application fees are $985 (including the examination fee and the test delivery surcharge).
- Step 2 CK application fees are $985 (including the examination fee and the test delivery surcharge).
- Extension of Eligibility Tenure for Step 1 or Step 2 CK- $100 per Step
- CK Step 1 or 2 Changing the testing region costs $90 for each step.
- Fee for rechecking a score is $80 for Step 1 and $80 for Step 2 CK.
- $50 for Step 1 of the ECFMG Examination Chart
- USMLE Transcript Paper – $70 per request (up to 10 transcripts)
- USMLE Transcript – Electronic Transmission (ERAS) – $80 for each ERAS session
Fee for Rescheduling
The following fees and rescheduling fees have been changed for the computer-based exam:
| Change of Appointment Date | Prometric USMLE Testing Region | Step 1 | Step 2 (CK) | Step 3 |
|---|---|---|---|---|
| 46 days or more before the scheduled exam date | All testing regions | Zero Fee | Zero Fee | Zero Fee |
| 31-45 days before the scheduled exam date | All testing regions | $ 35 | $ 35 | $ 35 |
| 6 to 30 days before the scheduled exam date | All testing regions | $ 100 | $ 100 | $ 100 |
| 5 or fewer days before the scheduled exam date | US & Canada | $ 128 | $ 144 | $ 256 |
| 5 or fewer days before the scheduled exam date | Outside US & Canada | $ 328 | $ 369 | NA |
USMLE Syllabus
Syllabus for USMLE Step 1
- System Specifications – General Principles Of Foundational Science
- System Specifications – Behavioural Health
- System Specifications – Nervous System And Special Senses
- System Specifications – Female Reproductive System And Breast
- System Specifications – Male Reproductive System
- System Specifications – Endocrine System
- System Specifications – Respiratory System
- System Specifications – Renal And Urinary System
- System Specifications – Blood And Lymphoreticular System
- System Specifications – Immune System
- System Specifications – Multisystem Processes And Disorders
- System Specifications – Cardiovascular System
- System Specifications – Musculoskeletal System
- System Specifications – Skin And Subcutaneous Tissue
- System Specifications – Gastrointestinal System
- System Specifications – Biostatistics, Epidemiology/ Population Health, And Interpretation Of The Medical Literature
- System Specifications – Social Sciences
- Physician Tasks/ Competencies Specifications – Medical Knowledge/ Scientific Concepts
- Physician Tasks/ Competencies Specifications – Patient Care: Diagnosis
- Physician Tasks/ Competencies Specifications – Patient Care: Management
- Physician Tasks/ Competencies Specifications – Communication
- Physician Tasks/ Competencies Specifications – Professionalism, Including Legal And Ethical Issues
- Physician Tasks/ Competencies Specifications – Systems Based Practice, Including Patient Safety
- Physician Tasks/ Competencies Specifications – Practice – Based Learning
- Discipline Specifications – Behavioural Sciences
- Discipline Specifications – Biochemistry And Nutrition
- Discipline Specifications – Genetics
- Discipline Specifications – Gross Anatomy And Embryology
- Discipline Specifications – Histology And Cell Biology
- Discipline Specifications – Immunology
- Discipline Specifications – Microbiology
- Discipline Specifications – Pathology
- Discipline Specifications – Pharmacology
- Discipline Specifications – Physiology
Syllabus for USMLE Step 2 CK
- System Specifications – General Principles Of Foundational Science
- System Specifications – Immune System
- System Specifications – Blood And Lymphoreticular System
- System Specifications – Behavioural Health
- System Specifications – Nervous System And Special Senses
- System Specifications – Skin And Subcutaneous Tissue
- System Specifications – Musculoskeletal System
- System Specifications – Cardiovascular System
- System Specifications – Respiratory System
- System Specifications – Gastrointestinal System
- System Specifications – Renal And Urinary System
- System Specifications – Pregnancy, Childbirth, And The Puerperium
- System Specifications – Female Reproductive System And Breast
- System Specifications – Male Reproductive System
- System Specifications – Endocrine System
- System Specifications – Multisystem Processes And Disorders
- System Specifications – Biostatistics, Epidemiology/ Population Health, And Interpretation Of The Medical Literature
- System Specifications – Social Sciences
- Physician Tasks/ Competencies Specifications – Medical Knowledge/ Scientific Concepts
- Physician Tasks/ Competencies Specifications – Patient Care: Diagnosis
- Physician Tasks/ Competencies Specifications – Patient Care: Management
- Physician Tasks/ Competencies Specifications – Communication
- Physician Tasks/ Competencies Specifications – Professionalism, Including Legal And Ethical Issues
- Physician Tasks/ Competencies Specifications – Systems Based Practice, Including Patient Safety
- Physician Tasks/ Competencies Specifications – Practice – Based Learning
- Discipline Specifications – Medicine
- Discipline Specifications – Surgery
- Discipline Specifications – Pediatrics
- Discipline Specifications – Obstetrics And Gynecology
- Discipline Specifications – Psychiatry
Syllabus for USMLE 3
- System Specifications – General Principles Of Foundational Science
- System Specifications – Immune System
- System Specifications – Blood And Lymphoreticular System
- System Specifications – Multisystem Processes And Disorders
- System Specifications – Behavioural Health
- System Specifications – Nervous System And Special Senses
- System Specifications – Skin And Subcutaneous Tissue
- System Specifications – Musculoskeletal System
- System Specifications – Cardiovascular System
- System Specifications – Respiratory System
- System Specifications – Gastrointestinal System
- System Specifications – Renal And Urinary System
- System Specifications – Male Reproductive System
- System Specifications – Pregnancy, Childbirth, And The Puerperium
- System Specifications – Female Reproductive System And Breast
- System Specifications – Endocrine System
- System Specifications – Biostatistics, Epidemiology/ Population Health, And Interpretation Of The Medical Literature
- System Specifications – Social Sciences: Communication Skills/ Ethics/ Patient Safety
- CCS Test Content Specifications – Immune System, Blood And Lymphoreticular System, And Multisystem Processes/ Disorders
- CCS Test Content Specifications – Behavioural Health
- CCS Test Content Specifications – Nervous System And Special Senses
- CCS Test Content Specifications – Skin And Subcutaneous Tissue
- CCS Test Content Specifications – Musculoskeletal System
- CCS Test Content Specifications – Cardiovascular System
- CCS Test Content Specifications – Respiratory System
- CCS Test Content Specifications – Gastrointestinal System
- CCS Test Content Specifications – Renal/ Urinary System And Male Reproductive
- CCS Test Content Specifications – Pregnancy/ Childbirth, And Female Reproductive System And Breast
- CCS Test Content Specifications – Endocrine System
- CCS Test Content Specifications – Social Sciences: Communication Skills/ Ethics/ Patient Safety
- Physician Tasks/ Competencies Specifications – Medical Knowledge/ Scientific Concepts
- Physician Tasks/ Competencies Specifications – Patient Care: Diagnosis
- Physician Tasks/ Competencies Specifications – Patient Care: Management
- Physician Tasks/ Competencies Specifications – Communication
- Physician Tasks/ Competencies Specifications – Professionalism, Including Legal And Ethical Issues
- Physician Tasks/ Competencies Specifications – Systems Based Practice, Including Patient Safety
- Physician Tasks/ Competencies Specifications – Practice – Based Learning
- CCS Physician Tasks/ Competencies Specifications – Patient Care: Diagnosis
- CCS Physician Tasks/ Competencies Specifications – Patient Care: Management
- CCS Physician Tasks/ Competencies Specifications – Communication/ Professionalism/ Systems – Based Practice And Patient Safety.
FAQ About USMLE
Q. What is USMLE Exam?
A. USMLE stands for United States Medical Licensing Examination. USMLE is an individual medical licencing authority that grants candidates licences to practise medicine in the United States. The National Board of Medical Examiners (NBME) and the Federation of State Medical Boards own the USMLE programme (FSMB).
Q. Is the USMLE recognised in India?
A. Technically, US residency degrees are recognised in India. The residency, however, should be ACGME (Accreditation Council for Graduate Medical Education) accredited. All residency programme degree holders (with ACGME accreditation) will have equivalence to MD degrees in India. To practise in India, no other qualifications are required.
Q. How do Indian students apply for the USMLE?
A. The application procedure includes requesting USMLE/ECFMG identification numbers, creating accounts, and submitting applications. It also entails filling out and notarizing Form 183, Certificate of Identification. This form is sent to Philly, and you will receive an email with a scheduling permit in two to three weeks. The final step is to schedule an appointment with Prometric.
Q. How many times can you attempt for USMLE?
A. Each Step can have a maximum of four attempts (4). Examinees who have failed four or more USMLE Steps (including Step 2 CS) are ineligible to apply for USMLE Steps.
Q. How long are USMLE scores valid?
A. USMLE scores are valid for seven years. During that time, you must pass the additional ECFMG certification.
Q. Can I work as a doctor in the United States without taking the USMLE?
A. In order to receive your MD from a US medical school, you must pass parts 1 and 2 of the US Medical Licensing Examination (USMLE). The vast majority of DOs educated in the United States do as well. Furthermore, you cannot obtain a medical licence unless you have completed USMLE parts 1, 2, and 3.
Q. Is USMLE Hard Exam?
A. The USMLE Step 1 is widely regarded as one of the most difficult medical exams in the world. The results of this test will lay the groundwork for a successful residency programme in the future. Above all, the USMLE is a lengthy process that tests a candidate’s patience. Furthermore, the exam is extremely competitive.
Q. When is the USMLE Exam Held?
A. The USMLE Step 1 can be taken at any time of year, with the exception of the first week of January and major public holidays. The USMLE exam details are not disclosed by the organising bodies. After registering and receiving the eligibility period, the candidate must reserve an exam date for a specific step.
Q. Can I obtain residency in the United States without taking the USMLE?
A. As a foreign medical graduate, you cannot apply for residency in the United States unless you have passed the USMLE (Steps 1 and 2). If you do not pass all USMLE components, including Step 3, you will be unable to apply for a medical licence in the United States.
Q. Which countries recognise the USMLE?
A. The USMLE is a well-known medical licencing exam. Because of its toughness and competition, it is difficult to crack. The USMLE programme is accepted by medical licencing authorities in the United States, Israel, New Zealand, the United Arab Emirates, and Qatar. These countries accept USMLE scores and exempt candidates from additional eligibility requirements.
Q. Is there an age limit for taking the USMLE?
A. There is no upper age limit for the USMLE.
Q. Who in India Can Take the USMLE?
A. To take the USMLE exam, Indian doctors must pass their equivalent examination with more than 230 points. To qualify for a residency in the United States, students may take the USMLE-2 CK examinations. After receiving residency confirmation, they may apply for US work visas.
