The United States Medical Licensing Examination(USMLE) is a three-step examination for medical licensure in the United States and is sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners(NBME)

1. U.S.M.L.E
United States Medical Licensing
Examination

2. Contents
• What is USMLE ?
• Step Examination (Step 1, Step 2 CK/CS, Step 3)
• Eligibility Criteria
• Number of Attempts, Exam Retakes
• Exam Retakes
• Scoring (Exam Results & Score Rechecking)
• Irregular Behaviour
• USMLE Statistics (2017)
• Exam Do’s and Don'ts
• Resources
• FAQ

3. What is USMLE ?
• The United States Medical Licensing Examination
(USMLE) is a three-step examination (Step 1, Step 2 CK
and CS, Step 3) for medical licensure in the United States.
• The USMLE assesses a physician's ability to apply
knowledge, concepts, and principles, and to determine
fundamental patient-centered skills that are important in
health and disease and that constitute the basis of safe
and effective patient care.

4. Step 1
• Assesses whether you understand and can apply
important concepts of the sciences basic to the practice
of medicine, with special emphasis on principles and
mechanisms underlying health, disease, and modes of
therapy.
• Ensures mastery of not only the sciences that provide a
foundation for the safe and competent practice of
medicine in the present, but also the scientific principles
required for maintenance of competence through
lifelong learning.

5. • Test Format
– Approximately 280 multiple-choice questions,
divided into seven 60-minute blocks
– Computer based – administered at Prometric Test
Centers around the world
• Length
– One day session of 8 hours

6. 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.

7. Step 2 CK (Clinical Knowledge)
• Assesses whether medical school students or graduates
can apply medical knowledge, skills, and understanding
of clinical science essential for the provision of patient
care under supervision and includes emphasis on health
promotion and disease prevention.
• Ensures that due attention is devoted to principles of
clinical sciences and basic patient-centered skills that
provide the foundation for the safe and competent
practice of medicine.

8. Step 2 CS (Clinical Skills)
• Assesses the ability of medical school students or
graduates to apply medical knowledge, skills, and
understanding of clinical science essential for the
provision of patient care under supervision, and includes
emphasis on health promotion and disease prevention.
• The exam contains the following subjects
– Integrated Clinical Encounter (ICE)
– Communication and Interpersonal Skills (CIS)
– Spoken English Proficiency (SEP)

9. • Step 2 CS uses standardized patients to test medical students
and graduates on their ability to gather information from
patients, perform physical examinations, and communicate
their findings to patients and colleagues.
• Test centers for Step 2 CS are as follows
– Atlanta, Georgia
– Chicago, Illinois
– Houston, Texas
– Los Angeles, California
– Philadelphia, Pennsylvania

10. • Test Format (CK)
– Approximately 318 multiple-choice questions,
divided into eight 60-minute blocks
– Computer based – administered at Prometric Test
Centers around the world
• Length
– One day session of 9 hours

11. • Test Format (CS)
– 12 patient cases: 15 minutes for each patient
encounter plus 10 minutes to record each patient
note
– Administered at test centers in the US: Atlanta,
Chicago, Houston, Los Angeles, and Philadelphia
• Length
– One day session of 8 hours

12. Step 3
• Step 3 assesses whether you can apply medical knowledge
and understanding of biomedical and clinical science essential
for the unsupervised practice of medicine, with emphasis on
patient management in ambulatory settings.
• The Step 3 examination devotes attention importance of
assessing the knowledge and skills of physicians who are
assuming independent responsibility for providing general
medical care to patients. The first day of the Step 3
examination is referred to as Foundations of Independent
Practice (FIP), and the second day is referred to as Advanced
Clinical Medicine (ACM).

13. • Test Format Day 1
– Approximately 235 multiple-choice test questions,
divided into six 60-minute blocks, each containing
approximately 44 questions
– Computer based – administered at Prometric Test
Centers in the US
• Length
– One day session of 7 hours

14. • Test Format Day 2
– Approximately 180 multiple-choice test
questions, divided into six 45-minute blocks,
each containing approximately 33 questions
– Thirteen computer-based case simulations
(CCS). Each simulation is allotted a maximum
of 10 or 20 minutes of real time
– Computer based – administered at Prometric
Test Centers in the US.
• Length
– One day session of 9 hours

15. Eligibility
• For Step1, Step2 CK and CS
– A medical student officially enrolled in, or a graduate of, a US or
Canadian medical school program leading to the MD degree
that is accredited by the Liaison Committee on Medical
Education (LCME)
– A medical student officially enrolled in, or a graduate of, a US
medical school leading to the DO degree that is accredited by
the American Osteopathic Association (AOA)
– A medical student officially enrolled in, or a graduate of, a
medical school that is outside the US and Canada, listed in
the World Directory of Medical Schools as meeting ECFMG
eligibility requirements, and that meets other eligibility criteria
of the ECFMG.

16. • Step 3
– Obtain the MD degree (or its equivalent) or the DO
degree from an LCME- or AOA- Accredited US or
Canadian medical school, or from a medical school
outside the US and Canada that is listed in the World
Directory of Medical Schools as meeting ECFMG
eligibility requirements.
– Pass Step 1, Step 2 CK, and Step 2 CS
– Additionally, for international medical graduates,
obtain certification by the ECFMG.

17. Maximum Attempts
• An examinee is ineligible to take a Step or
Step Component if the examinee has made six
or more prior attempts to pass that Step or
Step Component, including incomplete
attempts.

18. Exam Retakes
• Candidate cannot appear for same Step or Step Component for
more than three times in a 12-month period.
• Fourth and subsequent attempt must be 12 months after the first
attempt and six months after most recent attempt.
• If a candidate has not yet passed Step 3 and needs to retake a
previously passed Step 1 or Step 2 examination in order to meet a
time limit imposed by a US medical licensing authority or another
authority recognized by the USMLE program, he should understand
that if he fails a retake, he will no longer be eligible to take Step 3.
• In order to meet the examination requirements for Step 3 eligibility,
he must have achieved a passing performance on the most recent
administration of the examinations intended to meet those
requirements.

19. Scoring(Exam Results & Score Rechecking)
• Current Minimum Score for passing is as follows
• Step 1 : 194
• Step 2 CK : 209
• Step 2 CS doesn’t have a score. Result is reported
as Pass/Fail.
• Step 3 : 196

20. Steps Taken Recipient of Transcript Whom should you
contact ?
One or more Steps Medical Licensing
Authority
FSMB (Federation of State
Medical Boards)
All the 3 Steps
(Only when Candidate has
registered for or has given
Step 3)
Any recipient FSMB
Step 1 and/or Step 2 CK
and/or CS only, registered
by ECFMG
Any recipient other than a
medical licensing
authority
ECFMG (Educational
Commission for Foreign
Medical Graduates)
Step 1 and/or Step 2 CK
and/or CS only, registered
by NBME
Any recipient other than a
medical licensing
authority
NLES
Following table contains details about who should be contacted based on needs in order
to obtain transcript of USMLE Scores

21. • Score Availability – A candidate should allow a
window of atleast 8 weeks after appearing for the
exam in order to get notified for the result.
• Candidate will get notified via email from his
registration entity.
• Score report will remain available on candidate’s
registration entity's website for approximately 120
days from the date of the email notification.

22. • Score Rechecking - A recheck will be performed if candidate
submits a written request and service fee to his registration
entity.
• His registration entity must receive the request before 90 days
from the day his result was released to him.
• For Step 1,Step 2 CK and Step 3, when a request for a score
recheck is received, the original response record is retrieved
and rescored using a system that is different from the normal
processing routine.
• For Step 2 CS, the ratings received are retrieved, re-summed,
and reconverted into final scores to verify the accuracy of the
original score

23. Irregular Behavior
• Irregular Behavior includes any action by examinee,
applicant or a potential applicant that can compromise
the validity and integrity of USMLE process.
• Some of the irregular behavior practices are
– Seeking, providing, and/or obtaining unauthorized
access to examination materials.
– Providing false information or making false statements
on or in connection with application forms, scheduling
permits, or other USMLE-related documents.

24. – Taking or attempting to take an examination for which
you are not eligible.
– Taking an examination for someone or engaging
someone to take an examination for you.
– Seeking, providing, or obtaining unauthorized
assistance during the examination or attempting to do
so.
– Making notes of any kind while in the secure areas of
the test center, except on the writing materials
provided at the test center for this purpose.

25. USMLE Statistics
• Step 1 (2017)
– US/Canadian Schools
• Appeared - 25,217
• Percent Passing – 94%
– Non US/Canadian Schools
• Appeared – 17,203
• Percent Passing – 73%

26. • Step 2 CK (2016-2017)
– US/Canadian Schools
• Appeared – 23,652
• Passing Percent – 95%
– Non US/Canadian Schools
• Appeared – 14,291
• Passing Percent – 76%

27. • Step 2 CS (2016-2017)
– US/Canadian Schools
• Appeared – 21,110
• Percent Passing – 96%
– Non US/Canadian Schools
• Appeared – 13,758
• Percent Passing – 81%

28. • Step 3 (2017)
– US/Canadian Schools
• Appeared – 20,107
• Percent Passing – 97%
– Non US/Canadian Schools
• Appeared – 9,665
• Percent Passing – 84%

29. Examination Do’s and Don’ts
• Do’s
– Review the USMLE Rules of
Conduct prior to taking your
examination .
– Follow all test center staff
instructions on the day of your
examination.
– Remember to bring a copy of
your scheduling permit
(electronic or paper) and
required identification (see
below); you will not be permitted
to test without them.
– Arrive 30 minutes prior to your
testing appointment (computer-
based examinations); for Step 2
CS, arrive at the time listed on
your confirmation notice.
• Don’ts
– Feel compelled to test if you are ill,
under unusual stress or unprepared
for the examination.
– Bring family and friends to the center
instead, arrange to meet them after
the examination ends.
– Bring unauthorized items to the
testing room: for computer-based
examinations, only soft-foam
earplugs are allowed; for Step 2 CS,
only your white lab coat and
stethoscope are allowed.
– Write on laminated note boards prior
to entering your Candidate
Identification Number (CIN) and
starting your test session (computer-
based examinations) or write on
anything other than the laminated
note boards.

30. • Do’s
– Confirm that your
headphones are working,
either before the examination
begins or during the tutorial
(computer-based
examinations) .
– Use personal items only when
on an authorized break; you
are not permitted to access
your locker during
unauthorized breaks
(computer-based
examinations) .
– Be sure to complete all
sections of the examination
• Don’ts
– Work past the
announcements instructing
you to stop.
– Access your locker or use
your cell phone on an
unauthorized break.

31. FAQ
• How can I apply for USMLE ?
– For US/Canadian Schools
• Step 1, Step 2 CK and Step 2 CS : Apply through NBME
on NLES
• URL - http://examinee.nbme.org/interactive/
– For Non US/Canadian Schools
• Step 1,Step 2 CK and Step 2 CS: Apply through ECFMG
on IWA
• URL - https://iwa2.ecfmg.org/

32. – For Step 3
• Apply through FSMB
• URL - http://www.fsmb.org/licensure/usmle-step-3/

33. • What are the subjects included in Step 1 ?
– Anatomy,
– Behavioral sciences,
– Biochemistry,
– Microbiology,
– Pathology,
– Pharmacology,
– Physiology,
– Interdisciplinary topics, such as nutrition, genetics,
and aging

34. • What is considered a good score in the USMLE Step 1
and 2 CK?
– For USMLE, there is no fair and square figures for
a good score.
– However , 240+ in both steps are considered safe
but please note that that doesn’t ensure a spot
for residency. USMLE is a lot more than just
scores.

35. • How long does it take to clear all steps of USMLE?
– It is a very subjective question because it 100%
depends on you when one plans to clear his steps.
– Ideally this is the generalized breakdown
• Step 1 : 3-6 months (note that some people take even 1
year to prepare because they have a more spread-out
study plan)
• Step 2 CK: 1-3 months
• Step 2 CS: 1-3 months

36. • Will it affect my results if I take USMLE CS before step 1
and step 2?
– No. Each test is graded individually. Step 1 and Step 2
CK are simply graded by how many answers you get
right, which is standardized and translated to a score.
Step 2 CS is graded by the simulated patients and by
physicians who read your notes. They have no
knowledge of how you scored on Step 1 and Step 2
CK, and probably they won’t even know if you’ve even
taken it or not.

37. • If a physician currently holds a license in one state
and has not taken USMLE, is it necessary to pass
USMLE to seek licensure in another state?
– No, although it should be verified with individual
medical licensing authorities or FSMB.

38. • How do you get ECFMG certification?
– Completion of the Application for ECFMG
Certification
– Passing performance on USMLE Step 1, Step 2
Clinical Knowledge, and Step 2 Clinical Skills
– Primary-source verification of your medical
education credentials.

39. • What is the time limit for completing USMLE for international
students ?
– Once a candidate has passed a Step or Step Component,
he will have seven years to pass all of the other Step(s) or
Step Component(s) required for ECFMG Certification.
– This seven-year period begins on the exam date of the first
Step or Step Component passed and ends exactly seven
years from that exam date.
– If he does not pass all required Steps and Step
Components within a maximum of seven years, his earliest
USMLE passing performance will no longer be valid for
ECFMG Certification.

40. Resources
• Step 1
– First Aid for USMLE Step 1
– Kaplan USMLE Step 1 Qbook
– BRS Physiology
– BRS Behavioral Science
– PharmCards
– First Aid Cases for USMLE Step 1
– USMLE Step 1 Secrets

41. • Step 2 CK
– First Aid for Step 2 CK
– Master the Boards (USMLE Step 2 CK)
– Step Up to USMLE Step 2 CK
– Kaplan USMLE Step 2 Qbook
– Crush Step 2

42. • Step 2 CS
– First Aid for Step 2 CS
– Kaplan USMLE Step 2 CS Core Cases
– Kaplan USMLE Step 2 CS Complex Cases
– Kaplan USMLE Step 2 CS Strategies, Practices and
Review

43. • Step 3
– First Aid for USMLE Step 3
– Master the Boards USMLE Step 3
– Crush Step 3 CCS
– USMLE Step 3 Qbook

44. • USMLE Course Providers
– NYCSPrep (http://www.nycsprep.com/)
– Doctors in Training (https://www.doctorsintraining.com/)
– USMLE Success Academy (https://www.usmlesuccess.net/)
– Crush the USMLE Exam (https://crushtheusmleexam.com)
– Smash USMLE (https://www.smashusmle.com/)
– Board Vitals (https://www.boardvitals.com/)

45. • Information Source - http://www.usmle.org/