USMLE Exam (United States Medical Licensing Examination) 2024-2025

Estimated reading time: 14 minutes

The USMLE (United States Medical Licensing Examination) is a licensing exam for physicians in the United States. This exam is a screening test for medical students who are seeking to obtain a medical license in the US. If you are preparing for the USMLE exam or have questions about USMLE preparation, the information provided above should be sufficient. Additionally, you can find USMLE exam preparation tips online..

The USMLE (NBME) is supported by two regulatory bodies in the United States, namely the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB). These non-profit organizations collectively represent 70 state boards of medicine and osteopathic medicine in the country. Each state has its own set of laws and regulations for medical licensure. The USMLE exam is the most widely used method for assessing initial medical licensure.

The governing body of this organization consists of 80 members. These members include representatives from various institutions such as the American Medical Association (AMA), the American Board of Medical Specialties (ABMS), the Council of Medical Specialty Societies (CMSS), the Association of American Medical Colleges (AAMC), the Resident and Fellows Section of the AMA, the American Medical Student Association (AMSA), and the Educational Commission for Foreign Medical Graduates (ECFMG).

USMLE Exam Process

STEP & PURPOSE	FORMAT	LENGTH
STEP 1 assesses the examinee’s understanding of and ability to apply important concepts of the basic sciences to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy	Approximately 280 multiple-choice questions (MCQs), divided into seven 60-minute blocks	One-day exam, approximately eight hours
STEP 2 CK assesses the examinee’s ability to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision, with an emphasis on health promotion and disease prevention	Approximately 318 MCQs, divided into eight 60-minute blocks	One-day exam, approximately nine hours
STEP 3 assesses the examinee’s ability to apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings
Day 1: FOUNDATIONS OF INDEPENDENT PRACTICE (FIP) assesses the examinee’s knowledge of basic medical and scientific principles essential for effective healthcare	Day 1 FIP: Approximately 232 MCQs divided into six 60-minute blocks	One-day test session, approximately seven hours
Day 2: ADVANCED CLINICAL MEDICINE (ACM) assesses the examinee’s ability to apply comprehensive knowledge of health and disease in the context of patient management and the evolving manifestation of disease over time	Day 2 ACM: Approximately 180 MCQs, divided into six 45-minute blocks and thirteen computer-based case simulations (CCS); each simulation is allotted a maximum of 10 or 20 minutes of real-time	One-day test session, approximately nine hours

If you meet the eligibility requirements, you may take Step 1 and Step 2 CK in any sequence. You may take Step 3 only after passing Step 1 and Step 2 CK.

How To Prepare for the USMLE Exam

Sample items are available free of charge on the USMLE website under the section ” Prepare for Your Exam. You may also view free learning resources via NBME Unlocking Assessment videos or purchase an online self-assessment by visiting the Taking an NBME Assessment section of the NBME website. Practice materials and self-assessments are available to all USMLE examinees.

For more information on each Step, including applications, practice materials, and updates, visit the USMLE website.

Eligibility for USMLE: Who Is Eligible to Take the USMLE Exam?

Step 1 and Step 2 CK

You must fall under one of the following categories both on the application date and the day of the exam if you want to be considered:

• A medical student officially enrolled in, or a graduate of, a US or Canadian medical school program leading to the MD degree that is accredited by the Liaison Committee on Medical Education (LCME), OR
• A medical student officially enrolled in, or a graduate of, a US medical school leading to the DO degree that the Commission accredits on Osteopathic College Accreditation (COCA), OR
• A medical student officially enrolled in, or a graduate of, a medical school that is outside the US and Canada, listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements, and that meets other eligibility criteria of the ECFMG

Step 3

Eligibility requirements for Step 3 are:

• Passing scores on Step 1 and Step 2 CK, AND
• An MD degree or the DO degree from an LCME- or COCA-accredited US or Canadian medical school, OR the equivalent of the MD degree from a medical school outside the US and Canada that is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements and obtain ECFMG Certification, AND
• Meet all other eligibility criteria as listed in the USMLE Bulletin of Information

The USMLE program advises that applicants should have finished, or be close to finishing, at least one postgraduate training year in an accredited US graduate medical education program that complies with state board licensing requirements to be eligible for Step 3.

Change in Eligibility Status: USMLE Exam

You must immediately inform the organization that registered you for your exam if your eligibility for a Step changes after submitting your application but before your scheduled test date(s). If you take a Step for which you are ineligible, the USMLE program may decide not to report your exam results or, if they have already been reported, to cancel them.

Graduates from Unaccredited Medical Schools in the US or Canada

Suppose you graduated from an unaccredited medical school in the US or Canada and are eligible for initial licensure as a physician by a US medical licensing authority. In that case, you may take the USMLE only upon specific request by that physician licensing authority. The physician licensing authority should submit the request to sponsor you to the USMLE Secretariat in advance of your application for each Step.

Number of Attempts and Time Limits: USMLE Exam

No matter when the exams were taken, all attempts at a Step count toward the cap. Many state medical boards demand that candidates pass all USMLE exam steps within a specific time frame. Information regarding state-specific requirements for licensure can be obtained on the FSMB website. Note: combined degree (e.g., MD/Ph.D.) students should reference the USMLE website for more specific information regarding exceptions to time limits.

Retaking Failed Examinations: USMLE

In a 12-month period, you may only perform the same Step once more than three times. At least six months must have passed since your most recent attempt, and at least 12 months must have passed since your first time taking the exam before you make your fourth attempt. This also applies to failed attempts.

Retaking Previously Passed Steps: USMLE

If you pass a Step, you are not allowed to retake it, except to comply with a time limit imposed by a US physician licensing authority for completion of all Steps or by another authority recognized by the USMLE program. Visit the USMLE website for more information.

You should be aware that failing a retake will disqualify you from taking Step 3 if you haven’t yet passed Step 3 and need to retake a previously passed Step 1 or Step 2 CK exam to meet a deadline set by a US physician licensing authority or another authority recognized by the USMLE program. You must have obtained a passing score on the most recent administration of the exams designed to satisfy those requirements to be eligible for Step 3.

Previously Licensed Physicians

You might not be allowed to take the USMLE if you have already received a physician license from a US medical licensing body based on another licensure exam, such as the Federation Licensing Examination (FLEX), the Medical Council of Canada Qualifying Examination, the NBME certifying exams, or the National Board of Osteopathic Medical Examiners COMLEX-USA. Those who have inquiries about their eligibility should get in touch with the relevant registration organization.

Applying for the Test and Scheduling Your Test Date

To apply for a USMLE Step, you must apply to the appropriate organization.

Step 1, Step 2 CK, and Step 3 are administered at Prometric centers. Step 3 is administered only in the US and its territories. Visit the Prometric website to find the test center closest to you and to schedule an appointment.

Appointments at some test centers fill up quickly. Examinees are encouraged to schedule at their preferred test center after receiving their scheduling permit.

Application Materials: USMLE Exam

For Students or Graduates of a Medical School In the US/Canada

Step 1 and Step 2 CK: Students and graduates of LCME- or COCA-accredited programs should apply for Step 1 and Step 2 CK by following the instructions on the NBME website.

Step 3: Graduates with an MD or DO degree from an LCME-, or COCA-accredited medical school should apply for Step 3 by following the instructions on the FSMB website.

For Students or Graduates of a Medical School Outside the US/Canada

Step 1 and Step 2 CK

Students and graduates of medical schools outside the US and Canada that are listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements should apply for Step 1 and Step 2 CK by following the instructions on the ECFMG website.

Step 3: Graduates of medical schools outside the US and Canada that are listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements should apply for Step 3 by following the instructions on the FSMB website.

Examinees with Disabilities Requesting Test Accommodations

In accordance with the Americans with Disabilities Act, the USMLE program offers reasonable accommodations to candidates with disabilities (ADA). For information on test accommodations, including procedures and documentation needs, visit the USMLE website before you apply for each Step if you are a person with such a disability and need them.

Requesting Additional Break Time Only: USMLE

Examinees may apply for additional break time or standard testing time by submitting the form available on the USMLE website if they have a medical condition, such as diabetes, or for another reason, such as the use of a breast pump for lactation. Before or after registering for a Step exam, requests for more break time should be made.

Personal Item Exceptions: USMLE

When you are in the test center’s secure areas, you are not allowed to have any personal items with you besides your ID and locker key. In a few select cases, there may be exceptions to this rule. On the USMLE website, you can find a list of approved personal items that might be allowed inside the secure testing area, subject to inspection by test center staff.

Check-in Process for USMLE

At least 30 minutes before your scheduled testing time, you should show up at the testing facility. You might not be admitted if you show up after your scheduled appointment time. You will not be admitted and will have to pay a fee to reschedule your test if you arrive more than 30 minutes after your scheduled testing appointment. Your new test date(s) must fall within your eligibility window.

You must bring a paper or digital copy of your scheduling permit and a legitimate, recently-issued government-issued photo ID to the test center when you show up. For information on additional identification requirements, please review your scheduling permit. Unused identification that is recognized includes:

• Passport
• Driver’s license with photograph
• National Identity Card
• Other forms of unexpired, government-issued identification

Your name must match the name on your form(s) of identification for your scheduling permit to be valid. The only permitted variations are variations in capitalization, the presence of a middle name on one document while the absence of a middle name, middle initial, or suffix is present on the other, or the presence of a middle name while the middle initial is present on both. The name on your ID must be written in the Latin alphabet, otherwise known as “English language letters.” You should immediately get in touch with the organization that registered you for your exam if the names on your identification and scheduling permit differ. Your signature and a current photo must be on your identification. To learn more, please review your scheduling permit.

On each day of your exam, you must bring your scheduling permit in paper or electronic (for example, via smartphone) form, along with acceptable identification; otherwise, you won’t be allowed to take the exam and will need to pay a fee to reschedule it. Your new test date(s) must fall within your eligibility window.

Break Time at USMLE

The duration of your test session is fixed, and the computer records the time allotted for each block and break. You have a total of 45 minutes of break time to use for authorized breaks and computer transitions between blocks at the beginning of the testing session. Any time you spend between test blocks, whether you stay seated or leave the testing area, is considered an authorized break. The remaining time will be added to your overall break time if you finish the tutorial or other testing blocks ahead of schedule.

You may not leave the room once a testing block has started (except in the event of an emergency). The block and daytime clocks will continue to run if you leave the room for a personal emergency while not on an authorized break, and the test center will report the incident to the USMLE program. The unauthorized break screen, which is described in the exam tutorial, will also show up on the screen after a predetermined amount of inactivity. You must enter your CIN to proceed with the test after the unauthorized break screen appears. The staff at the testing facility will note the time you entered and exited the testing room each time. Every time you come back from a break, you must show your ID.

Your total testing time will be reduced if you go over your allotted or accrued break time. To keep track of your time, use the time summary feature described in the tutorial on the day of your test.

Score Availability at USMLE Exam

You can usually get your results two to four weeks after the test date. However, a few things could cause the score reporting to be delayed. You should give yourself at least eight weeks to receive notification that your score report is available when choosing your test date and asking about results. Visit the Announcements section of the USMLE website’s home page for more detailed information about possible scoring delays.

The company that registered you for your exam will send you an email to let you know when your score is ready. For roughly 365 days following the date of the email notification, your score report will be accessible on the website of the company that registered you for your exam.

Your scores will only be made available as an official transcript for a fee after the score report has been taken down from the website.

How Do I Receive/Send Transcripts?

You must submit an online request and fee to obtain your USMLE transcript or have it sent to a third party.

Please visit the USMLE website to determine which organization to contact to request your transcript and the fees associated with the service.

Your USMLE transcript includes biographical information, complete examination history, and, if applicable, information regarding findings of irregular behavior and actions reported to the FSMB Physician Data Center.

Frequently Asked Questions: USMLE Exam (2024-2025)