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United States Medical Licensing Examination (USMLE)

The United States Medical Licensing Examination (USMLE) is a multi-part professional exam sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). Physicians with an M.D. degree are required to pass this examination before being permitted to practice medicine in the United States of America; see below for requirements of physicians with a D.O. degree

All three steps of the USMLE exam must be passed before a physician with an M.D. degree is eligible to apply for an unrestricted license to practice medicine in the United States. U.S. osteopathic medical school graduates are permitted to take the USMLE for medical licensure, which they can also obtain by passing the multi-part Comprehensive Osteopathic Medical Licensing Examination (COMLEX) professional exam. Students who have graduated from medical schools outside the US and Canada must pass all three steps of the USMLE to be licensed to practice in the US, regardless of the title of their degree. Overall pass rates for first time USMLE Step 1 test takers are: 94% for U.S. M.D. medical school graduates, 89% for U.S. D.O. osteopathic medical school graduates, and 73% for international medical school graduates. First-time USMLE Step 2 CK test taker pass rates are: 97% for U.S. M.D. medical school graduates and 93% for U.S. D.O. medical school graduates. First-time USMLE Step 2 CS test taker pass rates are: 98% for U.S. M.D. medical school graduates and 88% for U.S. D.O. medical school graduates. Overall pass rates for first time USMLE Step 3 test takers are: 97% for U.S. M.D. medical school graduates, 94% for U.S. D.O. medical school graduates, and 78% for international medical school graduates. (In these statistics, "U.S. M.D. medical school graduates" includes graduates of Canadian M.D. programs.

The USMLE first started out as a paper examination, converting to a computer based multiple choice examination. The test can be taken at parametric test centers worldwide. However, the Step 2 CS and the Step 3 can only be taken in the USA

Step 1

The USMLE Step 1 (more commonly just Step 1 or colloquially, The Boards) is the first part of the United States Medical Licensing Examination. It assesses whether medical school students or graduates can apply important concepts of the sciences fundamental to the practice of medicine. US medical students typically take Step 1 at the end of the second year of medical school. Graduates of international medical schools must also take Step 1 if they want to practice in the US.

Step 2

USMLE Step 2 is designed to assess whether medical school students or graduates can apply medical knowledge, skills and understanding of clinical science essential for provision of patient care under supervision. US medical students typically take Step 2 during the fourth year of medical school. Step 2 is further divided into two separate exams.

Step 2-CK

The USMLE-Step 2-CK ("Clinical Knowledge") is the nine-hour long multiple-choice portion of the second part of the United States Medical Licensure Examination. It assesses clinical knowledge through a traditional, multiple-choice examination. In contrast to the USMLE Step 1, the focus is much more on clinical application of medical knowledge. It assesses the ability to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision. The USMLE Step 2 is generally taken during the 4th year of medical school by medical students The subjects included in this exam are clinical sciences like Medicine, Surgery, Pediatrics, Psychiatry and Obstetrics & Gynecology.

Step 2-CS

USMLE Step 2 CS is designed to assess clinical skills through simulated patient interactions, in which the examinee interacts with standardized patients portrayed by actors. Each examinee faces 12 Standardized Patients (SPs) and has 15 minutes to complete history taking and clinical examination for each patient, and then 10 more minutes to write a patient note describing the findings, initial differential diagnosis list and a list of initial tests. Administration of the Step 2-CS began in 2004. The examination is only offered in five cities across the country:

  • Philadelphia
  • Chicago
  • Atlanta
  • Houston
  • Los Angeles

Step 3

Step 3 is the final exam in the USMLE series of examinations. It is part of the licensing requirements for Doctors of Medicine (M.D.), Doctors of Osteopathic Medicine (D.O.), and international medical graduates to practice medicine in the United States. The USMLE Step 3 exam is considered as the final step in the series of medical licensure examinations. Generally, it is a pre-requisite of the majority of the state licensing boards.

USMLE Step 3 tests several concepts that are often required to provide general health care to a patient. USMLE Step 3 is a mandatory exam that must be passed in order to obtain license as a practicing physician. Some International Medical Graduates are required to pass USMLE Step 3 in order to obtain an H1 Visa.

Most of the USMLE Step 3 exam (75 percent) consists of multiple choice questions, while the remaining 25 percent are clinical case simulations. A full description of the content of the exam can be found on the USMLE website. USMLE Step 3 exams are delivered online and are available throughout the year to the examinees. The examinee needs to register via a state licensing board for this exam.

Starting from 2014 USMLE Step 3 will be divided into two parts.