If you are someone who wishes to practice medicine in the US, you must start preparing for the United States Medical Licensing Examination (USMLE). It is a three-step examination that allopathic physicians must pass to obtain a medical license for practicing medicine in the United States.
It measures a candidate’s ability to apply the knowledge, concepts, and patient-centered skills that form the basis for safe and effective care.
Now that you know how crucial the USMLE is, let us dive into the important details of the USMLE exam for Indian students.
Candidates wanting to practice medicine in the US must pass the USMLE exam, regardless of where they completed their medical school. The USMLE is important for several reasons:
Ensures a strong foundation in medical knowledge and clinical skills: Passing the USMLE demonstrates that a doctor has a solid understanding of the core medical sciences and the ability to apply that knowledge to patient care.
Protects public health: The USMLE establishes a baseline standard of medical knowledge and skills that all physicians must possess. This helps guarantee that doctors are proficient in essential areas like diagnosing illnesses, prescribing medications, and performing procedures.
Provides a fair and objective assessment of a doctor's qualifications: The USMLE is a standardized test administered to all candidates, regardless of where they went to medical school. This helps to ensure that all doctors are evaluated fairly.
Who Conducts USMLE
The USMLE exam is jointly administered and developed by two organizations:
The National Board of Medical Examiners (NBME), responsible for creating the exam content and ensuring its validity and reliability.
The Federation of State Medical Boards (FSMB), representing the state medical boards that license physicians.
Who Can Take USMLE 2024
The USMLE is for medical graduates who have completed their medical education at a medical school accredited by a body recognized by the Accreditation Council for Continuing Medical Education (ACCME).
International medical graduates can also take the USMLE if a body recognized by the ACCME accredits their medical school.
What Does USMLE Assess
The USMLE exam assesses a physician's ability to apply medical knowledge, skills, and principles across various scientific disciplines relevant to the practice of medicine. These include anatomy, behavioral sciences, biochemistry, microbiology, pathology, immunology, physiology, and pharmacology. It ensures a strong foundation for patient care.
Where Can I Take USMLE
The USMLE is offered at Prometric testing centers located throughout the United States, Canada, and internationally. The specific locations will be provided in your registration materials.
Documents Needed for USMLE Exam
You will need a valid passport, a passport-size photo, a current medical school transcript (if applicable), an official document from your designated school official verifying your medical education, Form 186 (obtained during the registration process), and a medical school degree certificate (for graduates only).
USMLE Pass Rates by Exam
Pass rates for the USMLE exam vary depending on the specific exam and the test year. Given below is the pass rate for the year 2023:
Step 1: 90% for US/Canadian schools and 68% for non-US/Canadian schools.
Step 2: 97% for US/Canadian schools and 86% for non-US/Canadian schools.
Step 3: 97% for US/Canadian schools and 89% for non-US/Canadian schools.
USMLE Exam Details – Eligibility Criteria
Checking USMLE exam eligibility before applying is necessary. Every stage of the examination comes with specific requirements.
Criteria for Steps 1 & 2 CK:
Should be a graduate of a Canadian or US medical school program or enrolled in a program leading to the MD qualification, as accredited by the Liaison Committee on Medical Education (LCME)
Should be a medical student enrolled officially in a US medical school, leading to a DO degree or a graduate of the same, per accreditation from the Commission on Osteopathic College Accreditation (COCA).
Should be a medical student with official enrollment or graduation from a medical school outside Canada or the US, listed in the World Directory of Medical Schools.
Applicants must fulfill any of these criteria to take USMLE Steps 1 and 2.
USMLE Step 1 and Step 2 CK can be attempted in any sequence, but USMLE Step 3 can only be attempted after completing the first two steps. Here are the Step 3 USMLE exam eligibility requirements for Indian students:
Aspirants should successfully clear Step 1 and Step 2 CK.
They should have MD or DO degrees from LCME or COCA-accredited Canadian or US medical schools.
An alternative to the above criteria may be an equivalent degree to an MD from any medical school outside Canada and the USA, with a listing in the World Directory of Medical Schools.
The USMLE exam syllabus focuses on testing the candidate’s overall skills. The content outline is classified into 18 major areas focusing on organ systems. The next organizing construct is designed on physician tasks and competencies. The steps also cover content related to traditional disciplines and interdisciplinary areas.
Here is a step-wise explanation for the USMLE exam:
USMLE Step 1
Key Highlights of the Exam:
Aims to evaluate knowledge and capabilities regarding various scientific and medical concepts: diseases, underlying health, and modes of therapy.
A total of 280 multiple-choice questions are spread into seven blocks of 60 minutes each.
The online testing mode covers an eight-hour testing session.
USMLE Step 1: Outline & Specifications
Here is a brief about some examples of the USMLE Step 1 syllabus and specifications
Specification type
System
Content specification
General principles, Behavioral Health & Nervous Systems/Special Senses, Cardiovascular System, reproductive & Endocrine Systems, Social Sciences: Communication and Interpersonal Skills, and many more.
Physician Tasks/Competencies
Medical knowledge: Applying foundation Science Concepts, Communication and Interpersonal Skills, Practice-based Learning & Improvement, and more.
Discipline
Pathology, Pharmacology, Histology & Cell Biology, Genetics, and more.
USMLE Step 2 (CK):
Key Highlights of the Exam:
Evaluates capabilities of applying medical skills, knowledge, and understanding of clinical science. Emphasis is given to health promotion and disease prevention.
A total of 318 multiple-choice questions spread through eight blocks of 60 minutes each.
Testing mode is online, covering a day’s session of nine hours.
USMLE Step 2: Outline & Specifications
Here is a brief about some examples for the Step 2 syllabus and specifications
Specification type
System
Content specification
General principles of foundational science, Immune System, Respiratory System, pregnancy, childbirth & the puerperium, multisystem processes & disorders, and more.
Physician Tasks/Competencies
Medical knowledge: Applying foundation Science Concepts, patient care: history and physical exam, patient care: mixed management, practice-based learning & improvement, and many more.
Discipline
Medicine, Surgery, Obstetrics & gynecology, psychiatry, and pediatrics
USMLE Step 3:
USMLE Step 3 evaluate biomedical and clinical science knowledge for patient management and ambulatory settings.
It is a two-day examination. There are 232 multiple-choice items on the first day of the test. It is divided into six blocks of 38-39 items. 60 minutes are allocated for each block.
There are 180 multiple-choice questions in six blocks of 45 minutes each on the second day of the test. 13 computer-based case simulations are allotted 10-20 minutes each in real-time.
The day focuses on assessing the knowledge of the candidate based on medical and scientific principles necessary for effective health care.
Content specifications include the application of foundation sciences, interpretation of the medical literature, understanding of biostatistics and epidemiology/population health, and medical ethics, among others.
Knowledge of history & physical examination and the use of diagnosis & its studies are also assessed on the test day.
Day 2: Advanced Clinical Medicine (ACM)
The second day of the test focuses on the assessment of comprehensive knowledge of health and disease for patient management.
Content areas for assessment include the knowledge of diagnosis and management, health maintenance and screening, medical decision-making, and more.
USMLE Exam Details: Retakes, Time Limits & Number of Attempts
USMLE Attempts
USMLE applicants can only attempt a Step a maximum of four times. Attempts made in Step 2 CS are also included towards the limit. The three attempts should be made within the 12-month period.
The fourth attempt should be at least 12 months after the first attempt at that examination. It should also be at least six months after the last examination attempt.
Those who have attempted any USMLE Step four or more times and have not cleared it are not eligible to apply for other USMLE Steps.
If the applicant passes the Step or Step Component, then there are no retakes for it, except for complying with the time limit given by the authority for US physician licensing. This means that all steps are required to be completed by this deadline. The time limits for each USMLE step:
Step 1: eight hours
Step 2: CK: nine hours
Step 3: two days with allotted testing times within each day.
Candidates may check examination center lists on the official Prometric website. The testing regions like India, Japan, the Middle East, and Europe are grouped, and applicants should choose the examination center at the time of registration.
Note that centers may change without any advance notice. Here is a list for your perusal (Steps 1 and 2 only):
Area of Testing
Specific Areas
The USA and Canada
Alberta, Guam, British Columbia, Puerto Rico, Labrador and Newfoundland, the Virgin Islands, Manitoba, Saskatchewan, Nova Scotia, Quebec, and Ontario.
Africa
Kenya, Ghana, Uganda, and South Africa.
Asia
India, Bangladesh, Nepal, Japan, Malaysia, Thailand, the People’s Republic of China, Taiwan, Indonesia, Singapore, and the Philippines.
Oceania,
Australia, and New Zealand
Europe
Denmark, Ireland, Armenia, France, Croatia, Italy, Turkey, Latvia, Israel, Netherlands, Spain, Portugal, Switzerland, and the United Kingdom.
Latin America
Brazil, Argentina, Chile, Bolivia, Colombia, Dominican Republic, Costa Rica, Guatemala, Peru, Mexico, Venezuela, and Trinidad and Tobago.
Middle East
UAE (United Arab Emirates), Kuwait, Qatar, Egypt, Jordan, Saudi Arabia, Lebanon, and Oman.
Aspirants can take USMLE Step 3 within the US and its territories. Students qualifying for the USMLE Step 1 and Step 2 must travel to the US to take the test.
Results are published online by the USMLE, and officials release scorecards with candidates’ marks. Authorities also intimate all applicants about the availability of results. FSMB officials issue notifications when Step 3 results are published.
Electronic formats generate score reports, with results declared three-four weeks post exam completion. Candidates should get at least 194 in Step 1 and 209 in Step 2 (CK). They should get at least 196 in Step 3.
The USMLE is a challenging test that requires extensive preparation to pass successfully.
Firstly, the key to success in the USMLE is to start early and study consistently. Many students start preparing for the exam a year or two in advance, using various resources such as textbooks, review courses, and practice questions.
Secondly, it is important to identify and focus on weak areas. The exam covers a broad range of medical topics, so it is essential to prioritize and allocate more time to the areas where one needs improvement.
Thirdly, taking practice exams is essential. They help in familiarizing oneself with the format and content of the actual exam, identify weak areas, and improve time management skills.
Lastly, it is crucial to maintain a healthy lifestyle during preparation for the exam. This includes getting enough sleep, regular exercise, and healthy eating. A healthy lifestyle can help to reduce stress, improve focus, and increase retention.
In conclusion, preparing for the USMLE requires hard work, dedication, and commitment. With a systematic approach and consistent effort, one can achieve success in the exam and become a licensed physician in the United States.
The examination covers three steps. Separate application forms exist for every step in the digital mode. Candidates should clear USMLE Steps 1 and 2 CK for completing Step 3.
Candidates submit application forms to respective entities for registration. After applying, they must schedule examination dates. The registration and schedule permits are shared with the candidates over email.
Here is a guide for you:
USMLESteps 1, 2 CK and 2 CS
USMLESteps 1, 2 CK and 2 CS
USMLEStep 3
For graduates or students of AOA or LCME accredited medical courses in Canada or the US.
For graduates or students of medical schools outside Canada and the USA.
All graduates of medical school who have cleared Steps 1, 2 CK, and 2 CS.
Applications are at the official NBME website.
Applications on IWA through ECFMG.
Application via FSM.
Read More: How to study abroad? All you need to know
USMLE Exam Fees
For graduates or medical students outside Canada or the US, applications happen via ECFMG (Educational Commission For Foreign Medical Graduates). The costs include:
ECFMG Application Charges- $160
Application Fees for Step 1- $1000 (plus international test delivery surcharge)
Application Fees for Step 2 CK- $1000 (plus international test delivery surcharge)
Extension of Eligibility Tenure for Step 1 or 2 CK- $100 for each Step
Step 1 or 2 CK Change in Testing Region- $90 for each Step
Score Rechecking Fee- $80 for Step 1 and Step 2 CK
ECFMG Examination Chart- $50 per request form
USMLE Transcript Paper- $70 for each request (up to 10 transcripts)
USMLE Transcript- Electronic Transmission (ERAS)- $80 for each session
Rescheduling Fee For USMLE 2024
The change in fees and rescheduling fees for the computer-based exam is as follows:
Date for change in appointment
Prometric USMLE Testing Region
Step 1
Step 2 (CK)
Step 3
46 or more days before the scheduled date of the exam
All testing regions
Zero Fee
Zero Fee
Zero Fee
31- 45 days before the scheduled date of the exam
All testing regions
$35
$35
$35
6-30 days before the scheduled date of the exam
All testing regions
$100
$100
$100
5 or fewer days before the scheduled date of the exam
US and Canada
$128
$144
$256
5 or fewer days before the scheduled date of the exam
The Educational Commission for Foreign Medical Graduates (ECFMG) is an independent organization that verifies the credentials of international medical graduates. ECFMG certification is a prerequisite for obtaining a medical license in the United States. Here's why it's important:
Fulfills a mandatory requirement: ECFMG certification is a prerequisite for obtaining a license to practice medicine in the US. Without it, IMGs cannot qualify for residency programs or practice independently.
Ensures qualification for residency programs: Residency programs in the US typically require ECFMG certification for applicants. It signifies that IMGs possess the necessary foundation for further specialization.
Role of NBME in USMLE
The National Board of Medical Examiners (NBME) is one of the organizations that co-develop and administer the USMLE. The NBME plays a critical role in the USMLE by:
Developing exam content: The NBME is responsible for creating the content of the USMLE exams. This includes writing test questions, selecting cases for simulations, and ensuring the exams cover all the relevant medical knowledge and skills.
Ensuring exam validity and reliability: The NBME uses rigorous procedures to ensure the USMLE exams are valid and reliable. This means that the exams accurately assess what they are intended to assess and that the results are consistent over time.
Form 183 and Its Significance in USMLE Process
Form 183 is the official registration form for the USMLE, specifically for international medical graduates. It is used to register for all three steps of the USMLE.
Completing Form 183 accurately and submitting it on time is crucial for participating in the USMLE. Here's why it's significant:
Mandatory for USMLE registration: Form 183 serves as the official enrollment form for the USMLE. IMGs need to accurately complete and submit it on time to participate in the exams.
Verification of medical education: This form acts as a verification process for an IMG's medical education. It requires an authorized official from IMG's medical school to certify their enrollment or graduation status.
The full form of USMLE is the United States Medical Licensing Examination. USMLE is an individual medical licensing authority that grants licenses to the candidates to practice medicine in the US. The USMLE program is owned by the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB).
Is USMLE Valid in India?
Technically speaking, US residency degrees have validity in India. But, the residency should have ACGME (Accreditation Council for Graduate Medical Education) accreditation. All residency program degree holders (accreditation from ACGME) will have equivalence with MD degrees in India. One doesn’t need to give any other entrance to practice in India.
How to Apply for USMLE for Indian Students?
The application procedure covers applying for USMLE/ECFMG identification numbers, setting up accounts, and completing applications. It also involves completing and notarizing the certificate of identification form 183. This form is sent to Philly, and after two to three weeks, you will get an email with a scheduling permit. The final step is booking a date at Prometric.
Is USMLE Hard?
The USMLE Step 1 is regarded as one of the toughest medical examinations in the world. The performance in this test will set the foundation for a good residency program ahead. More than anything, USMLE is a long process and tests a candidate’s patience. Also, the exam is very competitive.
When is USMLE Held?
The USMLE Step 1 may be taken throughout the year, with the first week of January and major public holidays exceptions. The conducting bodies do not reveal the USMLE exam details. The candidate needs to book the exam date for a particular step after registration and receipt of the eligibility period.
Which Countries Accept USMLE?
USMLE is one of the most reputed medical licensing exams. It is difficult to crack because of its level of toughness and competition. Medical licensing authorities accept the USMLE program in the United States, Israel, New Zealand, UAE, and Qatar. These countries accept the USMLE scores and exempt candidates from other eligibility criteria.
Who Can Give the USMLE Exam from India?
Indian doctors should pass their equivalent examination with more than 230 marks to take the USMLE exam. Students may sit for USMLE-2 CK examinations to qualify for a Residency in the United States. They may apply for US work visas upon receiving confirmation of residency.
What is Prometric USMLE?
Prometric is the testing service provider for the USMLE, which is a crucial step for obtaining medical licensure in the United States. The service ensures a standardized and secure testing environment for students worldwide.
What are the three steps of the USMLE exam?
The USMLE exam consists of three steps:
Step 1: Assesses foundational knowledge in the basic sciences. Step 2: Consists of two parts: a) Clinical Knowledge (CK): Evaluates clinical knowledge and diagnosis. b) Clinical Skills (CS): Assesses clinical skills through standardized patient encounters. Step 3: Focuses on the application of medical knowledge in the context of patient management.
Who takes the USMLE exam?
The USMLE exam is taken by medical students and graduates who have completed or are in the process of completing their medical education in the United States or internationally. It is required for individuals seeking licensure to practice medicine in the United States.
How is the USMLE exam scored?
The USMLE exam is scored on a three-digit scale. For Step 1 and Step 2 CK, scores typically range from 1 to 300, with a passing score determined by the medical licensing authorities. Step 2 CS is reported as pass/fail, and Step 3 is reported as a pass/fail outcome.
How can I prepare for the USMLE exam?
Preparation for the USMLE exam involves a comprehensive study plan. It is recommended to utilize official USMLE study materials, review textbooks, and practice with sample questions and practice exams. Many students also find it helpful to join study groups, attend review courses, and utilize online resources. Time management, consistent studying, and focusing on areas of weakness are essential for effective preparation.
Pragya Sharma is a content developer and marketer with 6.5+ years of experience in the education industry. She started her career as a social media copywriter for NIELIT, Ministry of Electronics & IT, and has now scaled up as a 360-degree content professional well-versed with the intricacies of digital marketing and different forms of content used to drive and hook the target audience.
She is also a co-author of 2 stories in an anthology based on the theme- women empowerment.
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