USMLE

Completing medical schools doesn’t automatically guarantee that a graduate can practice medicine.  Another challenging phase comes next.  The USMLE (United States Medical Licensure Exam) assesses an aspiring practicing doctor’s ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that will be important parts of effectively carrying out their duties.  It comes in three steps, spread out over a period of about 2 years – beginning in a medical school student’s third year and going into their first year of residency.  All three steps need to be completed successfully in order to obtain a license to practice medicine in the U.S. 

Brief history of the test:

USMLE Step 1

The USMLE Step 1 is a one-day computer exam taken by most medical students at the end of their second year of medical school. It is also taken by thousands of international medical graduates (IMGs) who wish to practice medicine in the United States. Step 1 includes 322 questions and spans 8 hours of testing, broken down into seven 1-hour blocks of 48 questions each.  

  • Year created: 1915
  • Number of tests takers in 2008 (most recently updated year): 41,576
  • Length of test: 8 hours
  • Test format: computer-based test (CBT)
  • Sections on test: Emphasis on basic science principles, specifically anatomy, behavioral science, biochemistry, microbiology, pathology, pharmacology, and physiology.  Interdisciplinary areas such as genetics, immunology, and nutrition are also tested. 
  • Score range: When you take Step 1, Step 2 CK, or Step 3, the computer records test takers’ responses. After the test ends, their responses are transmitted to the National Board of Medical Examiners for scoring. The number of test items the test taker answers correctly is converted to two equivalent scores, one on a three-digit score scale and one on a two-digit score scale. On the three-digit scale, most Step 1, 2 CK, or 3 scores fall between 140 and 260. The mean score for first-time examinees from accredited medical school programs in the United States is in the range of 210 to 230, and the standard deviation is approximately 20.  
  • Cost of test: $525
  • How often the test it administered: administered by appointment on a year-round basis.
  • Administrator of test: National Board of Medical Examiners® (NBME®)
  • Interesting fact about the test: A combined 94% of American and Canadian test takers pass USMLE Step 1, though only 71% of non-American or non-Canadian test takers pass it. 

USMLE Step 2 CK

The USMLE Step 2 CK is a multiple-choice exam designed to determine whether the examinee possesses the medical knowledge and understanding of clinical science considered essential for the provision of patient care under supervision. The Step 2 CK includes 352 questions and spans 9 hours of testing, broken down into eight 1-hour blocks of 44 questions each.  The USMLE Step 2 CK includes two multiple-choice formats: Single Best Answer and Single Answer Matching. The exam may also contain patient-centered vignettes with associated questions.

  • Year created: 1915
  • Number of tests takers in 2008 (most recently updated year): 34,308
  • Length of test: 9 hours
  • Test format: computer-based test (CBT)
  • Sections on test: Topics are presented randomly. For example, there is no unique pediatrics section. Test takers face the challenge of having to switch from one topic to another without skipping a beat.
  • Score range: When you take Step 1, Step 2 CK, or Step 3, the computer records test takers’ responses. After the test ends, their responses are transmitted to the National Board of Medical Examiners for scoring. The number of test items the test taker answers correctly is converted to two equivalent scores, one on a three-digit score scale and one on a two-digit score scale. On the three-digit scale, most Step 1, 2 CK, or 3 scores fall between 140 and 260. The mean score for first-time examinees from accredited medical school programs in the United States is in the range of 210 to 230, and the standard deviation is approximately 20.  .
  • Cost of test: $525
  • How often the test it administered: The test is administered by appointment on a year-round basis.
  • Administrator of test: National Board of Medical Examiners® (NBME®)
  • Interesting fact about the test: The USMLE Step 2 CK score is one of many factors considered by residency programs in selecting applicants.

USMLE Step 2 CS

The USMLE Step 2 CS is a 8-hour, live exam that resembles a physician’s typical work day in a clinic, doctor’s office, emergency department, and/or hospital setting in the United States. Examinees have 15 minutes to examine each “standardized patient” (11 total), who is an actor chosen from a broad range of age, racial, and ethnic backgrounds and trained to portray a real patient. 

  • Year created: 1915
  • Number of tests takers in 2008 (most recently updated year): 34,573
  • Length of test: 8 hours
  • Test format: live exam, clinical
  • Sections on test: Test takers will be assessed on your ability to communicate with the patients in a professional and empathetic manner, elicit important historic information, perform an exam, answer any questions, inform them of any diagnoses, and inform them what tests will be ordered.  After each patient encounter, examinees must record pertinent history and findings, list diagnostic impressions, and outline plans for further evaluation. 
  • Score range: Pass or Fail
  • Cost of test: $1,120
  • How often the test it administered: The test is administered on a first-come, first-served basis during a 12-month eligibility window.
  • Administrator of test: National Board of Medical Examiners® (NBME®)
  • Interesting fact about the test: Historically, US students have taken Step 2 CS late in their senior year, prior to graduation. However, some residency programs (such as those at the University of California, San Francisco) now require students to record a passing score for both Step 2 CS and CK prior to February 15th of the application year.

USMLE Step 3

The USMLE Step 3 is a 2-day computerized examination with approximately 500 multiple-choice questions, as well as computer-based case simulations (CCS) which assess your ability to evaluate history and physical exam information, order diagnostic tests, select initial therapies, and manage the patient. 

  • Year created: 1915
  • Number of tests takers in 2008 (most recently updated year): 30,931
  • Length of test: Taken over a 2 day period
  • Test format: computer-based test (CBT)
  • Sections on test: Primarily focuses on patient management (45-55% of questions). Other topics include history and physical; lab and diagnostic studies; diagnosis; prognosis; and pathophysiology—each consisting of about 8-12% of the exam questions. In addition, each question falls into one of three clinical encounter frames: initial workup; continued care; and emergency care.
  • Score range: When you take Step 1, Step 2 CK, or Step 3, the computer records test takers’ responses. After the test ends, their responses are transmitted to the National Board of Medical Examiners for scoring. The number of test items the test taker answers correctly is converted to two equivalent scores, one on a three-digit score scale and one on a two-digit score scale. On the three-digit scale, most Step 1, 2 CK, or 3 scores fall between 140 and 260. The mean score for first-time examinees from accredited medical school programs in the United States is in the range of 210 to 230, and the standard deviation is approximately 20.  .
  • Cost of test: $730
  • How often the test it administered: The test is administered by appointment on a year-round basis.
  • Administrator of test: National Board of Medical Examiners® (NBME®)
  • Interesting fact about the test: A test taker has to have secured his or her MD before taking the exam.

*USMLE is a registered trademark of the National Board of Medical Examiners, which was not involved in the production of, and does not endorse, this product.