A Comprehensive USMLE Guide 2023: Exam Stages, Fees, Registration, Resources and Licensing Process

The United States Medical Licensing Examination (USMLE) is an essential requirement for medical professionals seeking to practice medicine in the United States. It is a standardized assessment of the skills and knowledge necessary for safe and effective patient care. This comprehensive USMLE guide provides all the vital information you need, including details on eligibility, registration, fees, and the various steps involved in the exam. 

Whether you are a student or a physician trained outside the US, this guide offers invaluable insights and materials to help you prepare and succeed in the USMLE. The USMLE exam is designed to focus on problem-solving rather than mere memorization, it sets a high standard for all candidates, ensuring that they meet the requirements to deliver quality healthcare.

What is USLME? Your Gateway to Medical Licensure in the US

USLME stands for United States Medical Licensing Examination. The USMLE exam is the pivotal examination required to obtain a medical license in the United States. Collaboratively sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), the USMLE aims to establish a standardized assessment for allopathic physicians, ensuring consistent evaluation standards across all state medical boards. 

The USLME examination is divided into three distinct multiple-choice tests: Step 1, Step 2 Clinical Knowledge, and Step 3. Step 1 examines foundational knowledge, while Step 2 Clinical Knowledge assesses clinical concepts. Finally, Step 3 evaluates the application of patient-centered skills. For a comprehensive breakdown of each step, delve into the USMLE Steps section below. 

What USLME Exam assesses?

The USMLE assesses a physician’s ability to apply crucial knowledge, concepts, and principles, and evaluates their patient-centered skills. These skills are essential for health and disease management, and form the basis of safe and effective patient care.

Who is required to take the USLME?

All physicians practicing in an unsupervised setting, regardless of whether they graduated from a medical school in the United States or internationally, are required to take the USMLE exam. This is because having a license to practice medicine is a must, and the USMLE is a necessary step in obtaining that license. The requirement applies to both American and international graduates, making sure that doctors trained outside the US are evaluated using the same criteria as American medical students and graduates.

Eligibility Criteria for USMLE Exam:

In order to be eligible to take the USMLE exam, you must satisfy the following requirements, which are applicable during the application process as well as on the day of the test:

Eligibility Criteria Step 1 and Step 2 CK:

You must be in one of the following categories:

Note: Official enrollment is required; dismissal or withdrawal from medical school renders one ineligible for the USMLE exam.

Eligibility Criteria for USLME Step 3:

To be eligible for Step 3 of the USMLE, you are required to have successfully completed both Step 1 and Step 2 of the exam before submitting your application.

Must hold one of the following:

  • MD or DO degree from a US or Canadian medical school accredited by the LCME or COCA
  • The equivalent of MD degree from a medical school outside of the US and Canada listed in the World Directory of Medical Schools, meeting ECFMG eligibility requirements. ECFMG Certification is must for those who qualified outside of the US and Canada

For more details on eligibility criteria, attempts, and time limits, please refer to the USMLE official website.

Duration of the USMLE Examination

The USMLE examination consists of multiple steps, each with varying durations. Here are the exam lengths for each step:

  • Step 1 – approximately 8 hours
  • Step 2 Clinical Knowledge – approximately 9 hours
  • Step 3:
    • Day 1 – approximately 7 hours
    • Day 2 – approximately 9 hours

Step 1 Duration:

Step 1 of the USMLE is a full-day examination that spans approximately 8 hours. This comprehensive test evaluates the basic science knowledge and understanding necessary for medical practice.

Step 2 Clinical Knowledge (CK) Duration:

Step 2 CK is also a full-day examination, lasting around 9 hours. This step assesses the clinical knowledge and problem-solving skills of medical students and graduates.

Step 3 Duration:

Step 3 of the USMLE is the final step and is designed to evaluate a candidate’s ability to apply medical knowledge in the context of patient care. The duration of Step 3 is approximately 2 days, with a total of 16 hours allocated for the exam.

It is important to note that the exact duration of each step may be subject to change, and candidates should refer to the official USMLE website for the most up-to-date information on exam lengths.

USMLE Steps and Exam Format

The USMLE consists of three multiple-choice tests: Step 1, Step 2 CK (Clinical Knowledge) and Step 3.

USMLE Step 1: Questions Format

  • Length: One-day exam
  • Total Time: Approximately eight hours, including breaks
  • Number of Questions: Approximately 280 multiple-choice questions
  • Assessment Area: Application of important basic science concepts to clinical scenarios, focusing on underlying principles and mechanisms of health, disease, and therapy.

USMLE Step 2 Clinical Knowledge: Questions Format

  • Length: One-day exam
  • Total Time: Approximately nine hours, including breaks
  • Number of Questions: Approximately 318 multiple-choice questions
  • Assessment Area: Application of medical knowledge, skills, and understanding of clinical science essential for patient care, with emphasis on health promotion and disease prevention.

Recommended: USMLE Preparation Tips

USMLE Step 3: Questions Format

Step 3 of the USMLE consists of two parts: Foundations of Independent Practice (FIP) and Advanced Clinical Medicine (ACM), which are completed over a span of two days. This step evaluates your capacity to apply medical knowledge and comprehend biomedical and clinical science. The emphasis is on patient management in ambulatory settings.

Day 1 – Foundations of Independent Practice (FIP)

  • Length: One-day exam
  • Total Time: Approximately seven hours, including breaks
  • Number of Questions: Approximately 232 multiple-choice questions
  • Assessment Area: Knowledge of basic medical and scientific principles essential for effective care.

Day 2 – Advanced Clinical Medicine (ACM)

  • Length: One-day exam
  • Total Time: Approximately nine hours, including breaks
  • Number of Questions: Approximately 180 multiple-choice questions and 13 computer-based case simulations (CCS)
  • Assessment Area: Application of knowledge in health and disease to patient management, focusing on ambulatory settings.

Please refer to the official USMLE website for the most up-to-date information on the exam format and content for each step.

Disciplines covered in USLME Step-1, Step-2 and Step-3 CK

What subjects are covered in USMLE Step 1?

​The following disciplines are covered in the USMLE Step 1 exam:

DisciplineRange, %
Biochemistry & Nutrition14–24
Gross Anatomy & Embryology11–15
Histology & Cell Biology8–13
Behavioral Sciences8–13
Note: Percentages are subject to change at any time.

What subjects are covered in USMLE Step 2 CK?

​The following disciplines are covered in the USMLE Step 2 CK exam:

DisciplineRange, %
Obstetrics & Gynecology10–20
Note: Percentages are subject to change at any time.

USMLE Timeline: Planning Your Exam Progression

Taking USLME Step 1 and Step 2 can be done in any order, but it is advisable to follow these recommendations:

  • Step 1: Ideally, complete Step 1 at the end of your second year of study in an LCME-accredited medical school.
  • Step 2: Aim to complete Step 2 during your fourth year of study.
  • You can only take Step 3 once you have successfully completed Step 1 and Step 2. It is recommended to have completed, or be near completion of, at least the first year of postgraduate training in an accredited US graduate medical education program before attempting Step 3.

Most licensing authorities specify a seven-year period to complete Steps 1, 2, and 3 of the USMLE. This period starts from the time you pass your first step. It is important to adhere to this timeframe to ensure your eligibility for medical licensure.

USMLE Registration: How to apply for USLME?

The USMLE Step 1, Step 2 CK, and Step 3 are all computerized exams administered at Prometric Centers.

Note: Step 3 is only administered in the US and its territories. Locate your nearest Prometric Center by visiting their website.

Registration Routes for Different USMLE Steps

The registration process for each step of the USMLE varies depending on your educational background and where you studied. Here are the registration routes:

Step 1 and Step 2 Clinical Knowledge:

Step 3:

  • All Medical School Graduates who have passed Step 1 and Step 2: Apply through the FSMB website.

Application and Scheduling Process

Once you have registered through the appropriate route, the application and scheduling process remains consistent across all steps of the USMLE, regardless of your educational background. Follow these steps:

  1. Select your preferred eligibility period for testing.
  2. Keep an eye on your email for the scheduling permit, which will be sent to you.
  3. Visit the Prometric website to schedule your exam.

For more detailed information on registration and application procedures for the USMLE, visit their official website. You can also find resources and assistance to guide you through the registration process.

Fee Structure for USLME

The USMLE exam fees for the various stages of the exam are provided below. Please note that all fees are in U.S. dollars and are subject to change. For the most current fee structure, it is essential to visit the official website. The fees mentioned here are applicable for the year 2023.

USLME Exam Fees and official links:

TypeFeeHow to Apply
Application for ECFMG Certification$160Online using IWA
Step 1 and Step 2 CK$1,000 – Examination Fee + International Test Delivery Surcharge, if testing outside the United States and CanadaOnline using IWA
Extension of Eligibility Period (Step 1/Step 2 CK only)$100 per examOnline using IWA
Step 1/Step 2 CK Testing Region Change$90 per region changeForm 312
Step 1/Step 2 CK Rescheduling Fee$0 – varies (depending on exam, testing region, and date of cancellation)Contact Prometric
Score Recheck (Step 1/Step 2 CK)$80 per examForm 265
ECFMG Exam Chart$50 per request form (up to three copies)Form 184
ECFMG CSA History Chart$50 per request form (up to three copies)Form 297
USMLE Transcript – Paper$70 per request form (up to 10 transcripts)Form 172 (requests from individuals)
USMLE Transcript – Electronic Transmission for ERAS$80 per ERAS seasonOnline at MyERAS

Other fees and official links to apply:
TypeFeeHow to apply
Application to a Pathway for ECFMG Certification for 2024 Match$925Online using Application for Pathways for ECFMG Certification for 2024 Match
Medical School Transcript$250N/A
ERAS Token$165On-line using OASIS
Electronic Transmission of USMLE Transcript for ERAS$80 per ERAS seasonOnline at MyERAS
Application for J-1 Visa Sponsorship$370 ****An additional $220 SEVIS fee, payable to the Department of Homeland Security, is required of initial applicants for J-1 sponsorship.Application Information
Verification to State Medical Licensing Authority$66Online using CVS ON-LINE

Please note that for Step 3, the application fee is non-refundable and non-transferable from one eligibility period to another or from one application to another. For more details on rescheduling fees for Step 1, Step 2, and Step 3, you can refer to the USMLE rescheduling fees page.

USMLE Study Resources

The USMLE website offers a variety of practice materials to assist you in preparing for the exam. These resources include:

  • Content Description and General Information Booklets
  • Sample Test Materials and Questions
  • Tutorials and Practice Test Items

In addition, they provide the option to take a practice exam at a Prometric test center, allowing you to familiarize yourself with the test center environment. It’s important to note that there is a fee associated with this service. To learn more about the practice session, fees, and how to book, please visit the USMLE website.


In conclusion, the USMLE plays a crucial role in the journey of becoming a licensed physician. By successfully completing each stage of the exam – Step 1, Step 2 Clinical Knowledge, and Step 3 – individuals become eligible to apply for a license to practice medicine. This license grants them the ability to practice independently in various healthcare settings, free from direct supervision. 

The USMLE serves as a standardized assessment, ensuring that aspiring doctors possess the necessary knowledge and skills to provide safe and effective patient care. With dedication and thorough preparation, individuals can embark on a fulfilling career in medicine, making a positive impact on the lives of patients.

USMLE Frequently Asked Questions (FAQs)

1. What are the exams included in the USMLE?

The USMLE consists of three exams: Step 1, Step 2 Clinical Knowledge, and Step 3.

2. Where are the USMLE exams administered?

All USMLE exams are administered at Prometric Centers, which are specialized testing facilities.

3. Can I take the USMLE exams internationally?

Step 1 and Step 2 Clinical Knowledge exams are available internationally. However, Step 3 is only administered in the United States and its territories.

4. How can I find the nearest Prometric Center for my USMLE exam?

To locate the nearest Prometric Center, you can visit the official Prometric website and use their search tool.

5. What should I do to prepare for my USMLE exam at a Prometric Center?

It is important to familiarize yourself with the policies and guidelines of the Prometric Center where you will be taking your exam. This includes understanding the exam day procedures, arrival time, permitted materials, and any specific instructions provided by the center.

6. Are there any specific requirements for scheduling the USMLE exams?

The scheduling process for USMLE exams remains the same regardless of where you study or graduate from. After registering through the appropriate route, you will need to select your preferred eligibility period, receive your scheduling permit via email, and then schedule your exam on the Prometric website.

7. Where can I find more information about registering and applying for the USMLE?

You can find additional information about registering and applying for the USMLE on the official USMLE website. They provide comprehensive guidance and resources to support candidates throughout the registration process.

8. What happens if I fail in USMLE?

If you fail the USMLE Step 1, you can retake the exam up to six times. However, you can only take Step 1 a maximum of three times within a 12-month period. After the third attempt, there must be a minimum of 12 months between subsequent attempts. Additionally, if you plan to take Step 1 more than three times, there must be at least six months between your third attempt and any additional attempts. These guidelines ensure sufficient time for preparation and improvement before attempting the exam again.

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