United States Medical Licensure Examination

The United States Medical Licensing Examination is a multi-part professional exam medical doctors are required to complete before being authorized to practice medicine in the United States of America. It consists of three steps; all three must be passed before a physician is eligible to apply for a license to practice medicine. A parallel exam, the "Comprehensive Osteopathic Medical Licensing Examination" (COMLEX-USA), is required for osteopathic physicians in the United States of America.

The USMLE steps are:

Step 1

Step 1 of the USMLE assesses your ability to combine your academic knowledge with clinical practice. It covers the following subjects: Anatomy, Physiology, Biochemistry, Genetics, Behavioral medicine, Statistics, Microbiology (including Parasitology), Ethics, Pathology, Pharmacology, Histology, Immunology, Molecular biology, Epidemiology. US medical students usually take Step 1 at the end of the second year of medical school. It is an eight-hour computer-based exam consisting of 350 multiple-choice questions (MCQs) divided into seven blocks each consisting of 50 questions. Each block must be finished with an hour. The remaining hour is break time. An optional tutorial about how to use the computer program of the exam is offered at the beginning of the exam and takes 15 minutes. This time is deducted from the hour of alloted break time.

While not recommended by the creators of the USMLE, the Step 1 score is frequently used in medical residency applications as a measure of a candidate's likelihood to succeed in that particular residency (and on that specialty's board exams). More competitive residency programs usually accept applications with higher Step 1 scores.

Step 2

Assesses 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. Step 2 is further divided into two separate exams:

Step 2-CK

Assesses clinical knowledge through a traditional, multiple-choice examination.

Step 2-CS

Assesses clinical skills through simulated patient interactions, in which the examinee interacts with standardized patients portrayed by actors. Each student faces 12 Simulated Patients (SPs) and has 15 minutes to complete history taking and clinical examination for each patient. Administration of the Step 2-CS began in 2004.

The examination is offered in five cities across the country:

Step 3

Assesses whether medical school graduates can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine. Graduates of US medical schools typically take Step 3 at the end of the first year of residency. Foreign medical graduates can take Step 3 in about 10 US states before start of residency. Passing this step makes a foreign graduate eligible to apply for H1B visa.