What Is The USMLE

Updated on 22/05/2024 in
What is the USMLE

USMLE is an abbreviation of the United States Medical Licensing Examination. It is a three-step exam that every doctor-to-be needs to take before getting a medical license in the US. The exam assesses your ability to apply your fundamental medical skills and knowledge to ensure that you are fit to become a doctor and be entrusted with someone’s life. 

You will need to pass each step one by one. Step 1 verifies your basic medical knowledge. After Step 1, you can sit an exam in Step 2 - Clinical Knowledge. Once you pass these tests and verify your clinical knowledge, you can take the Step 2 Clinical Skills exam. To complete the Step 2 Clinical Skills exam, you must travel to the US and pass the test in one of the designated CSEC Testing Centres. 

It is similar to the UKMLA exam in the UK, but with some differences.

Also, if you intend to take USMLE outside the US, then make sure that your medical university is listed on the World Directory of Medical Schools. At Medlink students, all medical schools we work with are listed there.

Step 1

Step 1 aims to ensure that you understand the basic scientific principles and can apply them. Besides ensuring that you can safely and competently practice medicine, the test also assesses your life-long learning potential, which is necessary for any doctor.

All this might sound complicated, but remember, the test is meant for 2nd-year students. It assesses your understanding of anatomy, biochemistry, behavioural sciences, microbiology, immunology, pathology, pharmacology and physiology. Additional topics such as nutrition, genetics and ageing are also covered. 

All questions are multiple-choice. And the passing score is 194 points out of 300 points.

The examination fee for Step 1 is $975 (roughly £703 or €810). If you are taking the test outside of the US, you must pay an additional international fee of $185 (roughly £150 or €153).

Step 2

All participants must pass Step 1 before continuing to Step 2.

Step 2 takes two days and is divided into Clinical Knowledge and Clinical Skills. Both tests mainly evaluate your knowledge of general medicine and particularly of diseases. You can move on to the “Clinical Skills” part of the exam only after you pass the “Clinical Knowledge” exam.

The Clinical Knowledge part is like the test from Step 1. The entire test is divided into eight 1-hour blocks, and the passing score is 209 out of 300 points. In total, the test takes 9 hours, including 45 minutes that you have for breaks.

The examination fee for Step 2 Clinical Knowledge is $975 (roughly €810). If you are taking the test outside of the US, you must pay an additional international fee of $210 (roughly £170 or €174).

After you pass this part, you can move on to part 2, where your Clinical Skills will be tested. Here, you are judged based on your communication skills with your patient, your analytical skills to understand the problem, and lastly, how you will fix the problem, which tests your general medical knowledge. This part of the exam has no score; you can only pass or fail.

The examination fee for Step 2 Clinical Skills is $1535 (roughly £1,246 or €1272). If you are taking the test outside of the US, you must pay an additional international fee of $210 (roughly £170 or €174).

Important detail: The Clinical Skills part must be taken in the US! If you study in the UK or abroad, you must travel to one of the designated CSEC Testing Centres. These are in Georgia, Illinois, California, Texas and Pennsylvania – so be prepared for the flight cost!

Step 3

USMLE Step 3, just like Step 2, is a two-day exam. The final exam will determine whether you are ready to practice medicine in an unsupervised setting.

During the first day of the exam, you will sit an exam which consists of six 60-minute blocks. The exam on day 1 will last for 7 hours, including a 45-minute break. The purpose of this test will be to assess your diagnosis and patient-treatment skills.

The examination fee for Step 3 Clinical Knowledge is $830 (roughly £674 or €687).

The minimum passing score is 198 out of 300.

On day 2, you will be presented with 198 questions, segmented into six 45-minute block tests and 13 computer-based simulations, each lasting approximately 15 minutes. In total, the test is going to last 9 hours. On day 2, your interpersonal skills, ability to make an accurate diagnosis, and decision-making will all be tested. 

When is the best time to take USMLE?

  1. If you are an international graduate, you can do USMLE whenever possible. Step 1 is administered all year long except on holidays (Refer to the United States Medical Licensing Examination). You can reschedule it once by paying a fee depending on specific criteria.
  1. As a medical student in a US medical school, you can do USMLE only after your second year as per the mandate.


This depends if you study outside of the US and Canada or not. 

If you don’t, you should apply through NBME on NLES (NBME Licensing Examination Services).

However, if you study abroad, you should use ECFMG on IWA (Interactive Web Applications).

To know more, you can check out the official USMLE website here.

When should you start preparing for USMLE?

If you are an American or Canadian student, we recommend you start studying in January of your second year. This way, you will start refreshing your knowledge, which will be fresh in your mind before you take the test. You will have approximately 3 months to study, which should be enough to get high scores.

But if you are an international student, we recommend you do everything after graduation.

If you want to learn how to study effectively, check out our article. It will help you motivate yourself and organise your studying routines to be as efficient as possible.

Article written by Dr Sam El Mais
Dr Sam El Mais, MD, MSc, BSc, graduated from a renowned medical school in Romania in 2019. He uses his professional knowledge and personal experience to guide students on crucial aspects such as university selection, admissions processes, and cultural adjustments.
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