The United States Medical Licensing Examination (USMLE) is required to gain a license to practice medicine within the US. It assesses the essential skills for safe and effective patient care and provides a common standard of assessment for medical licensure. This USMLE complete guide will provide all the information you need for applying and undertaking the USMLE, including eligibility, registration and fees, and the different USMLE steps and materials to prepare.
The USMLE, or the United States Medical Licensing Examination, simply refers to the examination required to gain a medical license within the US. Sponsored by two non-profit organizations – the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) – the USMLE was designed to provide a single national examination to be used by all state medical boards for the medical licensure of allopathic physicians. (Note: COMLEX-USA is used for osteopathic physicians). This ensures that all practicing allopathic physicians have met the same assessment standards, regardless of their previous training or which state they practice in.
The USMLE assesses physicians’ ability to apply knowledge, concepts, and principles, and evaluates their patient-centered skills. The exam is divided into three multiple-choice tests – Step 1, Step 2 Clinical Knowledge, and Step 3 – which are covered in more detail in the USMLE Steps section below.
All practicing physicians in an unsupervised setting (i.e. outside of postgraduate training), within the US, require the USMLE. This is because a license to practice medicine is mandatory and the USMLE is an essential requirement for being granted a medical license in the US.
The requirement is the same for graduates who qualified in the US or internationally and ensures that those who trained outside of the US are assessed against the same standards as US medical school students and graduates.
To be eligible for the USMLE exam, you must meet the following requirements, both at the time of your application and on the test day:
You must be in one of the following categories:
Note: students must be ‘officially enrolled’; if you are dismissed or withdrawn from medical school, even if you are in the process of appealing, you will not be eligible for the USMLE.
To be eligible for Step 3, you must have already completed Step 1 and Step 2 of the USMLE, prior to submitting your application.
You must also hold one of the following:
The USMLE website provides further information on eligibility requirements and attempts and time limits for the exam.
The length of the USMLE varies across the different 'steps'; the exam length for each is as follows:
You can find more information about each USMLE step and its format in the section below.
The USMLE consists of three multiple-choice tests: Step 1, Step 2 Clinical Knowledge, and Step 3. You may also see Step 2 Clinical Skills mentioned in relation to the USMLE; previously, Step 2 included this in addition to the Clinical Knowledge section, however, this has been discontinued.
The USMLE website provides details of the exam format for each section, which are as follows:
Step 3 is divided into two parts – Foundations of Independent Practice (FIP) and Advanced Clinical Medicine (ACM) – taken over two days. It assesses your ability to apply medical knowledge and understanding of biomedical and clinical science, with a focus on patient management in ambulatory settings.
Although there is no strict timeline for undertaking the various stages of the USMLE, there are some restrictions and recommendations that you should consider when planning when to complete each step.
Step 1 and Step 2 can be taken in any order; however, it’s recommended that for students in LCME-accredited medical schools, Step 1 is taken at the end of your second year and Step 2 within your fourth year of study.
You can only take Step 3 of the USMLE once you have successfully completed Step 1 and Step 2. It’s recommended that you should have completed, or be near completion of, at least the first year of postgraduate training in an accredited US graduate medical education program before you undertake Step 3.
The USMLE website also advises that most licensing authorities specify that you must complete Steps 1, 2, and 3 of the USMLE within seven years, starting from when you pass your first step.
The USMLE Step 1, Step 2 Clinical Knowledge and Step 3 are all computer-based exams administered at Prometric Centers. Note: Step 3 is only administered in the US and its territories. You can find your nearest Prometric Center on their website.
The registration process varies for the different stages of the USMLE and depending on where you study / graduated from. The following are the different registration routes:
Once you have registered through the appropriate route, the application and scheduling process remains the same for each element of the USMLE and regardless of where you study / graduated from. The steps you need to follow are:
You can find more information relating to registering and applying for the USMLE on their website.
The following are the USMLE fees for the different stages of the exam:
The 2021 – 2022 USMLE fees for students / graduates of LCME or COCA accredited medical schools within the US or Canada are as follows:
You can find more information on these fees on the USMLE website here.
For students / graduates of medical schools outside of the US or Canada, the USMLE fees are as follows:
You can find more information on international fees on the USMLE website here.
For USMLE Step 3, the application fee is non-refundable and non-transferable from one eligibility period to another or from one application to another.
For 2021 the fee is $895.
For information relating to rescheduling fees, for Step 1, 2 and 3 of the USMLE, visit the USMLE rescheduling fees page.
The USMLE website provides a range of 'practice materials' to support your exam preparations, including:
They also offer the option of completing a practice exam at a Prometric test centre, to help you to become familiar with the test centre environment; however, there is a fee involved with this service. You can find out more about the practice session, the fees and how to book on the USMLE website here.