USMLE Exam Details : Steps 1-2-3, Eligibility, Cost & Scoring

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 the USMLE exam details. 

One of the crucial USMLE exam details for Indian students is that the assessment takes place 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, 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, listed in the World Directory of Medical Schools. 

Applicants must 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 several 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 must 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 unauthorized 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 focusing 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 the 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 of the USMLE Step 1 syllabus and specifications

USMLE Step 2 (CK): 

• Evaluate capabilities of applying medical skills, knowledge, and understanding of clinical science. Emphasis is given to 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’s session of nine hours. 

USMLE Step 2 Outline & Specifications

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

USMLE Step 3: 

• Evaluate biomedical and clinical science knowledge for patient management and ambulatory settings.  
• It is a two-day examination. There are 232 multiple-choice items on 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. 

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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 the 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): 

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 are shared with the candidates over email.

 Here is a guide for you: 

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USMLE Exam Fees

For COCA or LCME accredited graduates or students in Canada or the US, applications are made 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 is as follows:

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