USMLE Exam Guide: Steps, Tips, and Preparation

The United States Medical Licensing Examination (USMLE) is a 3 step examination taken by US & international medical students to practice Medicine in the US.

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The United States Medical Licensing Examination (USMLE) is a three-step examination taken by both US and international medical students to practice Medicine in the US. The exam tests how well you can use your medical knowledge and how well you can care for patients. This is done to make sure you are ready to give safe and effective medical care. The exam covers the whole medical school curriculum.

If you are a student applying to take the USMLE outside the US, your medical school must be listed on the World Directory of Medical Schools.

Understanding and applying for the USMLE can be difficult, so we've put together this ultimate guide to walk you through USMLE’s three steps, how to register for the test center and exam preparation.

How do I apply to the USMLE?

For medical students and graduates of LCME- or COCA-accreddited medical school programs in the US or Canada application is through the National Board of Medical Examiners (NBME).

For international medical graduates applicants, you apply to take the USMLE by registering with the Educational Commission for Foreign Medical Graduates (ECFMG).

You’ll then need to take USMLE Step 1 (Basic Medical) and Step 2 (Clinical Knowledge) – these can be taken while you’re studying for your Medicine degree.

Graduates need full ECFMG certification to apply for Graduate Entry Medicine (GEM) programmes in the US, and completion of one to three years of GEM is required to practice. The third final assessment stage, USMLE Step 3, is then usually taken after the first year of GEM. After your graduate entry programme, you can apply for a license from the US state you wish to practice Medicine in.

All sections of the USMLE program are administered in a test center. Medical schools prepare students to practice medicine and achieve a passing score that secures a spot on one of the residency programs. Scoring highly will allow students to select the top residency programs and clinical rotations.

USMLE Step 1

What is USMLE Step 1?

Step 1 is an eight-hour multiple-choice test. It is broken up into seven blocks of 60 minutes each. This step tests how well you know the basic science behind medicine. It talks about a lot of different things, such as anatomy, biochemistry, behavioural sciences, immunology, and pharmacology.

Questions will often describe a patient's illness or a situation, and the multiple-choice answers will usually ask you to name the patient's illness or tell you what tests you should give them.

The National Residency Matching Program (NRMP) survey of residency program directors, found 86.2% of residency program directors listed the USMLE Step 1 score as an important factor in deciding which applicants to interview.

How much does USMLE Step 1 cost?

The cost of taking Step 1 is $660, for students in the USA and Canada.

For international medical graduates there are fees of $160 to apply for ECFMG Certification and then Step 1 fees are $1,000.

How can I prepare for USMLE Step 1?

Preparing for USMLE Step 1 is said to take about six months, so cramming is not a good idea! USMLE says that you should go over the content of each exam carefully. You can find more information about Examination Content here.

On the USMLE website, you can also find a number of Step 1 Practice Questions and answers. Since practise makes perfect, try to answer as many of these questions as you can to get a feel for how different topics are tested.

A good way to get ready is to start reviewing early so you can figure out how you learn best. For example, do you learn best in a group setting while talking with other people? Or do you learn better when you study on your own and stick to your own schedule? Once you know, you can start making plans, like meeting with a friend every week, signing up for a USMLE course, or making time to study alone in the library.

USMLE Step 2 (Clinical Knowledge)

What is USMLE Step 2 (Clinical Knowledge)?

On the USMLE Step 2 CK, you will be tested on how well you can use your medical knowledge and clinical science to care for patients. It's a multiple-choice test that takes nine hours and is split into eight blocks, just like Step 1, covering general medical care and school topics.

Questions include things like pharmacotherapy, diagnosis, and clinical interventions. The cardiovascular system, the musculoskeletal system, and biostatistics are all disease categories that are covered in Step 2.

How much does USMLE Step 2 (Clinical Knowledge) cost?

The examination fee for Step 2, like Step 1, is $660 for US and canadian medical students.

For those graduating from medical school outside of the US and Canada Step 2 costs $1000.

How can I prepare for USMLE Step 2 (Clinical Knowledge)?

As with Step 1, it's a good idea to work your way through USMLE's Step 2 Practice Questions to get used to how the questions are set up. The more practise tests you take, the more you'll get used to the format and train your brain to quickly understand each patient-focused vignette.

It's usually best to take Step 1 and Step 2 (Clinical Knowledge) while you're studying for your Medicine degree, because a lot of the information will still be fresh in your mind. If you know you want to take USMLE, plan ahead and start practising!

USMLE Step 2 (Clinical Skills)

What is USMLE Step 2 (Clinical Skills)?

Prior to COVID-19 there was a second part to the USMLE Step 2 exam. This was indefinitely discontinued in 2021 by the request of the Federation of State Medical Boards (FSMB) and NBME. More communication and clinical skills scenarios were added to Step 1 and Step 2 to bolster this.

The Step 2 CS was a twelve patient OSCE designed to test your clinical skills using professional actors trained to act as real patients with clinical problems. This Step 2 CS gave you 15 minutes for each patient, who you may see face-to-face or speak to on the phone.

USMLE Step 3

What is USMLE Step 3?

Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care

The USMLE Step 3 test takes two days. Day one, called "Foundations of Independent Practice," is a seven-hour multiple-choice test similar to Steps 1 and 2. It is broken up into six blocks of 60 minutes each, with breaks of 45 minutes each. It checks how well you know how to diagnose medical problems, how well you get along with other people, and how well you understand scientific abstracts and drug ads.

On day two, you will be tested on how to take care of patients and how diseases change over time. This is broken up into 198 multiple-choice questions and 13 computer-based care simulations that each last 10–20 minutes. This test takes nine hours and is broken up into six 45-minute chunks. This day is a test of what you know about making diagnoses, managing care, and making medical decisions.

How much does Step 3 cost?

Step 3 costs $915.

How can I prepare for USMLE Step 3?

As with other multiple-choice exams, USMLE has practise Step 3 questions on their website. These include single item questions (a patient-focused vignette with one question and a set of multiple choice answers), multiple item sets (a patient-focused vignette with a few questions and multiple choice answers that are related to the vignette but can be answered in any order), and sequential sets (a patient-focused vignette with a few questions and multiple choice answers testing a different point and must be answered in order). Go through these questions carefully and mark the ones you aren't sure about. Then, go back and study them carefully.

Top 3 Tips For Passing The USMLE

  1. Get used to working with breaks – For Steps 1, 2, and 3, you can take breaks that add up to 45 or 50 minutes. You can take these whenever you want, but you can't take more than six. At the start of each exam, there is also an optional tutorial that you can skip. If you do, you can add the time to your breaks. Once you start taking practise tests, it's a good idea to repeat a break structure so you can get used to working under these conditions.
  2. Practice as much as you can – for Step 1, 2 (CK) and 3, practice questions (and lots of them!) are the way to go. For Step 2 (CS), practice your spelling and typing so that your patient notes are written to the best of your ability and run through patient scenarios with your friends in 15 minute slots. Selecting third party study materials is key and Shiken has a huge number of high quality practice questions and mock exams to prepare you for all parts of the USMLE exam.
  3. Check the requirements – double check USMLE’s Examination Day and Testing page of what you need to bring with you on the test day, as well as details of what you can bring into the testing room – and when you need to arrive!

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