USMLE Exam Details : Steps, Eligibility, Cost & Scoring

usmle exam details

The United States Medical Licensing Examination (USMLE) is a necessary medical license to practice in the United States of America (USA). The FSMB (Federation of State Medical Boards) and NBME (National Board of Medical Examiners) are co-sponsors of the USMLE. The USMLE is a three-step exam and measures a candidate’s ability to apply the knowledge, concepts, and patient-centered skills that form the basis for safe and effective care. However, every medical licensing authority has its own rules and regulations for passing the examination and qualifying for a license. Hence, it is important to know all the USMLE exam details. 

One of the crucial USMLE exam details for Indian students is that the assessment takes place both online and offline. Steps 2 and 3 assess the candidate’s basic Clinical Knowledge (CK).

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USMLE Exam Details – Eligibility Criteria

Checking USMLE exam eligibility before applying is necessary. Every stage of the examination comes with specific requirements. 

Criteria for Steps 1, 2 CK: 

  • Should be a graduate of a Canadian or US medical school program or enrolled in a program leading to the MD qualification, as accredited by the Liaison Committee on Medical Education (LCME)
  • Should be a medical student enrolled officially in a US medical school, leading to a DO degree or a graduate of the same, as per accreditation from the Commission on Osteopathic College Accreditation (COCA).¬†
  • A medical student with official enrollment or graduation from a medical school outside Canada or the US, which is listed in the World Directory of Medical Schools.¬†

Applicants have to fulfil any of these criteria to take Steps 1 and 2.

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Criteria for USMLE Step 3: 

 Here are the criteria for the Step 3 USMLE exam eligibility requirements for Indian students: 

USMLE Step 3: 

  • Aspirants should successfully clear Step 1 and Step 2 CK.
  • They should have MD or DO degrees from LCME or COCA accredited Canadian or US medical schools.¬†

An alternative to the above criteria may be an equivalent degree to MD from any medical school outside Canada and USA, with a listing in the World Directory of Medical Schools.

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USMLE Examination Requirements

 There are many USMLE requirements for international students the aspirants should keep in mind: 

  • After completing the application procedure, applicants will get an email notification about scheduling permit availability.¬†
  • They have to go to the Prometric official site to schedule the examination date.¬†
  • Applicants should safely keep their scheduling permits for the examination.¬†

 Aspirants should carefully review the Rules of Conduct for the test while following all instructions at the testing center and carrying copies of scheduling permits and identity proof. They should not bring other family members or friends to the testing venue. 

 They should avoid unauthorised accessories though soft-foam earplugs are permitted. Only the stethoscope and white laboratory coat are permissible for Step 2 CS. They should never write on laminated note boards before visiting the CIN (Candidate Identification Number) and beginning the session. 

USMLE Step 1 and Step 2 CK can be attempted in any sequence, but USMLE Step 3 can only be attempted after completing the first two steps. 

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USMLE Steps in Detail

The USMLE exam syllabus focuses on testing the candidate’s overall skills. The content outline is classified into 18 major areas focussing on organ systems. The next organizing construct is designed on physician tasks and competencies. The steps also cover content related to traditional disciplines and interdisciplinary areas.¬†

Here is a step-wise explanation for USMLE exam: 

USMLE Step 1

  • Aims to evaluate knowledge and capabilities regarding various scientific and medical concepts: diseases, underlying health, and modes of therapy.¬†
  • A total of 280 multiple-choice questions were spread into seven blocks of 60 minutes each.¬†
  • The online testing mode covers an eight-hour testing session.

USMLE Step 1 Outline & Specifications:

Here is a brief about some examples for the USMLE Step 1 syllabus and specifications

Specification type

System

Content specification

General principles, Behavioral Health & Nervous Systems/Special Senses, Cardiovascular System, reproductive & Endocrine Systems, Social Sciences: Communication and Interpersonal Skills, and many more.

Physician Tasks/Competencies

Medical knowledge: Applying foundation Science Concepts, Communication and Interpersonal Skills, Practice-based Learning & Improvement, and more.

Discipline 

Pathology, Pharmacology, Histology & Cell Biology, Genetics, and more.

USMLE Step 2 (CK): 

  • Evaluate capabilities of applying medical skills and knowledge, and understanding of clinical science. Emphasis is given on health promotion and disease prevention.¬†
  • A total of 318 multiple-choice questions spread through eight blocks of 60 minutes each.¬†
  • Online testing mode covering a day‚Äôs session of nine hours.¬†

USMLE Step 2 Outline & Specifications

  • Here is a brief about some examples for Step 2 syllabus and specifications

Specification type

System

Content specification

General principles of foundational science, Immune System, respiratory System, pregnancy, childbirth & the puerperium, multisystem processes & disorders and more. 

Physician Tasks/Competencies

Medical knowledge: Applying foundation Science Concepts, patient care: history and physical exam, patient care: mixed management, practice-based learning & improvement, and many more. 

Discipline 

Medicine, Surgery, Obstetrics & gynecology, psychiatry,and pediatrics

USMLE Step 3: 

  • Evaluate knowledge of biomedical and clinical science for patient management and ambulatory settings.¬†¬†
  • It is a two-day examination. There are 232 multiple-choice items during the first day of the test. It is divided into 6 blocks of 38-39 items. 60 minutes are allocated for each block. The first testing day is 7 hours with a break of 45 minutes and an optional tutorial of five minutes.¬†
  • There are 180 multiple-choice questions in six blocks of 45 minutes each, on the second day of the test. 13 computer-based case simulations are allotted 10-20 minutes each in real-time.¬†
  • The online testing mode covers one day.¬†

USMLE Step 3 Outline & Specifications:

Day 1: Foundation of Independent Practice (FIP)

The day focuses on assessing the knowledge of the candidate based on medical and scientific principles necessary for effective health care. Content specifications include application of foundation sciences, interpretation of the medical literature, understanding of biostatistics and epidemiology/population health and medical ethics, among others. Knowledge of history and physical examination and the use of diagnosis and its studies are also assessed on the test day. 

Day 2: Advanced Clinical Medicine (ACM)

The second day of the test focuses on the assessment of comprehensive knowledge of health and disease for patient management. Content areas for assessment include the knowledge of diagnosis and management, health maintenance and screening, medical decision making, and more.

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USMLE Exam Details: Retakes, Time Limits & Number of Attempts

 USMLE applicants can only attempt a Step a maximum of four times. Attempts made in Step 2 CS are also included towards the limit. The three attempts should be made within the 12-month period. The fourth attempt should be at least 12 months after the first attempt at that examination. It should also be at least six months after the last examination attempt. 

If the applicant passes the Step or Step Component, then there are no retakes for it, except for complying with the time limit given by the authority for US physician licensing. It means that all Steps are required for completion within this deadline.

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USMLE Exam Centers 

Candidates may check examination center lists on the official Prometric website. The testing regions like India, Japan, the Middle East, and Europe are grouped, and applicants should choose the examination center at the time of registration. Note that centers may change without any advance notice. Here is a list for your perusal (Steps 1 and 2 only): 

Area of Testing

Specific Areas

The 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.

Asia

India, Bangladesh, Nepal, Japan, Malaysia, Thailand, People’s Republic of China, Taiwan, Indonesia, Singapore, and the Philippines.

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.

Aspirants can take USMLE Step 3 within the US and its territories. Students qualifying USMLE Step 1 and Step 2 will need to travel to US to take the test.

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USMLE Scoring System

 Results are published online by the USMLE, and officials release scorecards with candidates’ marks. Authorities also intimate all applicants about result availability. FSMB officials issue notifications when Step 3 results are published. 

 Electronic formats generate score reports, with results declared three-four weeks post exam completion. Candidates should get at least 194 in Step 1 and 209 in Step 2 (CK). They should get at least 196 in Step 3.

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USMLE Registration Entity

 The examination covers three steps. Separate application forms exist for every step in the digital mode. Candidates should clear USMLE Steps 1, and 2 CK for completing Step 3. They have to submit application forms to respective entities for registration. After applying, they have to schedule examination dates. The registration and schedule permit is shared with the candidates over email.

 Here is a guide for you: 

USMLE Steps 1, 2 CK and 2 CS USMLE Steps 1, 2 CK and 2 CS USMLE Step 3
For graduates or students of AOA or LCME accredited medical courses in Canada or the US.  For graduates or students of medical schools outside Canada and the USA. All graduates of medical school who have cleared Steps 1, 2 CK, and 2 CS.
Applications at the official NBME website.   Applications on IWA through ECFMG. Application via FSM.

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USMLE Exam Fees

For COCA or LCME accredited graduates or students in Canada or the US, applications are done via NBME. For graduates or medical students outside Canada or the US, applications happen via ECFMG (Educational Commission For Foreign Medical Graduates). The costs include: 

  • ECFMG Application Charges- $160
  • Application Fees for Step 1- $985 (including Examination fee + test delivery surcharge)¬†
  • Application Fees for Step 2 CK- $985 (including Examination fee + test delivery surcharge)
  • Extension of Eligibility Tenure for Step 1 or 2 CK- $100 for each Step
  • Step 1 or 2 CK Change in Testing Region- $90 for each Step¬†
  • Score Rechecking Fee- $80 for Step 1 and $80 for Step 2 CK¬†
  • ECFMG Examination Chart- $50 for Step 1¬†
  • USMLE Transcript Paper- $70 for each request (up to 10 transcripts)¬†
  • USMLE Transcript- Electronic Transmission (ERAS)- $80 for each session of ERAS

Rescheduling Fee

The change in fees and rescheduling fees for the computer-based exam are as follows:

Date for change in appointment

Prometric USMLE Testing Region

Step 1

Step 2 (CK)

Step 3

46 or more days before the scheduled date of exam

All testing regions

Zero Fee

Zero Fee

Zero Fee

31 -45 days before the scheduled date of exam

All testing regions

$35

$35

$35

6-30 days before the scheduled date of exam

All testing regions

$100

$100

$100

5 or fewer days before the scheduled date of exam

US and Canada

$128

$144

$256

5 or fewer days before the scheduled date of exam

Outside US and Canada

$328

$369

N/A

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FAQs:

Q. What is USMLE Exam?

A. The full form of USMLE is the United States Medical Licensing Examination. USMLE is an individual medical licensing authority that grants licenses to the candidates to practice medicine in the US. The USMLE program is owned by the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB).

Q. Is USMLE Valid in India?

A. Technically speaking, US residency degrees have validity in India. But, the residency should have ACGME (Accreditation Council for Graduate Medical Education) accreditation. All residency program degree holders (accreditation from ACGME) will have equivalence with MD degrees in India. One doesn’t need to give any other entrance to practice in India.

Q. How to Apply for USMLE for Indian Students?

A. The application procedure covers applying for USMLE/ECFMG identification numbers, setting up accounts, and completing applications. It also involves completing and notarizing the certificate of identification form 183. This form is sent to Philly, and after two to three weeks, you will get an email with a scheduling permit. The final step is booking a date at Prometric.

Q. Is USMLE Hard?

A. The USMLE Step 1 is regarded as one of the toughest medical examinations in the world. The performance in this test will set the foundation for a good residency program ahead. More than anything, USMLE is a long process and tests a candidate’s patience. Also, the exam is very competitive.

Q. When is USMLE Held?

A. The USMLE Step 1 may be taken throughout the year, with the first week of January and major public holidays exceptions. The conducting bodies do not reveal the USMLE exam details. The candidate needs to book the exam date for a particular step after registration and receipt of the eligibility period.

Q. Which Countries Accept USMLE?

A. USMLE is one of the most reputed medical licensing exams. It is difficult to crack because of its level of toughness and competition. Medical licensing authorities accept the USMLE program in the United States, Israel, New Zealand, UAE, and Qatar. These countries accept the USMLE scores and exempt candidates from other eligibility criteria.

Q. Who Can Give the USMLE Exam from India?

A. Indian doctors should pass their equivalent examination with more than 230 marks to take the USMLE exam. Students may sit for USMLE-2 CK examinations to qualify for a Residency in the United States. They may apply for US work visas upon receiving confirmation of residency.

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