United States Medical Licensing Examination (USMLE)

The United States Medical Licensing Examination (USMLE) examination consists of three steps. The USMLE exam is administered by the United States (US). The ownership of USMLE is handed over to 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 want to practice medicine. Every medical licensing authority regulates unique rules and regulations and it is mandatory to pass an examination that makes them eligible for licensure. USMLE is authorised by a committee of ECFMG, FSMB, NBME and public.

Federation of State Medical Boards (FSMB)

FSMB is a non-profit organization. FSMB supports about 70 of America’s state medical boards in licensing, disciplining and regulating physicians and other healthcare professionals.

National Board of Medical Examiners (NBME)

The National Board of Medical Examiners was founded in 1915. It is a United States operation which sets state recognised examinations for medical students. It represents about 80 members on board of national medical examiners. It conducts and designs the exam patterns. It also contributes in research and development for the advancement of medical education.

One National Examination – United States Medical Licensing Examination or USMLE

Prior to the introduction of USMLE many different examinations were conducted by NBME i.e., National Board of Medical Examiners, FLEX, i.e., Federation Licensing Examination. The supreme reason behind the USMLE examination is to ensure one unique national examination for all the MD passed out doctors. It is also to make sure that all the candidates have passed out from the same standards of assessment.

Eligibility criteria for USMLE examination

USMLE examination is a mandatory exam to be cleared by all the doctors who wish to get the license for practicing in the US. Hence it is necessary to know about the eligibility criteria. The candidates pursuing their MBBS in India yetwishing to practice medicine in the US are also eligible to participate in the 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 the World Directory of Medical School.

Step 3

1. The candidates must clear 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 exam comprises three steps and is conducted to analyse the ability of the students who want to obtain the medical degree license. Hence the exam is conducted in a three step process and each step contains few procedures.This includes some tests, on field tests i.e., clinical tests and knowledge. The three steps are briefly explain below:

Step 1: System and Process

It is an exam of seven 60 minutes blocks conducted in 1 day and regulated in one 8-hour testing session. The number of questions in the given examination form may vary for each block, yet will not exceed 40. The overall number of questions in the examination form will not exceed 280.

Step 1 helps to qualify the candidates based on their competence and how they use their basic concepts in practice of medicine.

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

Step 2 CK is also a one-day examination. It comprises eight 60-minute blocks and is regulated in one 9-hour testing session. The number of questions in each block may vary yet without exceeding 40 questions. The overall number of questions in the examination form will not exceed 318.

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

The students have to fill in 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 students have to fill in the application form and apply through ECFMG on IWA Interactive Web Application.

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.

United States Medical Licensing Examination (USMLE) Application Form

United States Medical Licensing Examination (USMLE) is a three step examination. To appear in the examination, candidates have to submit the application form. The following steps have to be followed while filling up the application form.

Application Fee Information

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 permits the students 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 days or more before the first day of the scheduled test. The students have to contact their Regional Registration Center for swapping 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

When the candidates are unable to attend their exam on the scheduled date, they can reschedule the exam date. Students 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 14calendar 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 misses 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 appear in the medical colleges/institutions recognized by the World Directory of Medical Schools. The first step includes analyzing the candidates’ knowledge in 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 enables the students to analyse their medical skills and knowledge. It is conducted to check the students ability to understand the clinical knowledge to care for patients under the supervision of the seniors. It also 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

It also includes 45 minutes of break time and a 15-minute optional tutorial. The break time may be increased by finishing a block of test items.

Exam pattern of USMLE Step 2 CK and Step 2 CS

United States Medical Licensing Examination (USMLE): Step 3

The students who have cleared the step 1, step 2 CK, step 2 CS are eligible to apply for step 3 examination. Step 3 is the final step of the USMLE examination. This determines the students’ ability 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 is to determine the students’ knowledge of basic medicine and scientific principles, health care, medical ethics, and patient safety. The first day includes 232 multiple choice questions/ items that are divided into 6 blocks of 38-39 items. The total time period of the first day examination is 7 hours with 45 minutes of break and 5 minutes of optional tutorial. 60 minutes time is allotted to complete each block.

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

The second day test assesses the knowledge of diagnosis and management. It primarily focuses on the prognosis and maintaining health of the patients and medical decision making. The students have to undergo the diagnostic studies and physical examination. This consists of 180 multiple choice questions/ items that are divided into 6 blocks of 30 items. The total time period of the day-2 examination is 9 hours with 45 minutes of break and 7 minutes of optional tutorial. This is followed by 13 case simulations, each allotted a time period of 10-20 minute. 45 minutes time is allotted to complete each block.

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