The United States Medical Licensing Examination is not just another test – it’s much more. Unlike other knowledge-based exams, the USMLE thoroughly assesses how well you can apply your skills, values, and attitudes to real life, patient-centered scenarios.
Not only is it valuable practice for you as a future physician; it shows licensing authorities how you will operate on the job, both on and off the table. Now put on those mental scrubs and show them what you’re made of.
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. The Step 1 includes 308 multiple-choice questions and spans 8 hours of testing, broken down into seven 1-hour blocks of 40 questions each.
The USMLE Step 1 emphasizes basic science principles, specifically anatomy, behavioral science, biochemistry, microbiology, pathology, pharmacology, and physiology. Interdisciplinary areas such as genetics, immunology, and nutrition are also tested.
The test is administered by appointment on a year-round basis. When planning your USMLE prep, factor in 6 to 9 months for Step 1 review.
Step & purpose
Step 1 assesses the examinee’s:
Understanding of and ability to apply important concepts of the basic sciences to the practice of medicine,
Special emphasis on principles and mechanisms underlying health, disease, and modes of therapy
Approximately 280 multiple-choice questions, divided into seven 60-minute blocks
Length (including breaks): One-day test session –Approximately eight hours
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 approximately 355 questions and spans 9 hours of testing, broken down into eight 1-hour blocks of about 45 questions each.
The USMLE Step 2 CK will include two multiple-choice formats: Single Best Answer and Single Answer Matching. The exam may also contain patient-centered vignettes with a series of associated questions. Topics are presented randomly. For example, there is no unique pediatrics section. You’ll face the challenge of having to switch from one topic to another without skipping a beat.
The test is administered by appointment on a year-round basis. When planning your USMLE review, factor in 4 to 6 months for Step 2CK prep.
USMLE Step 2 CS
The communication skills component of the exam are evaluated through the following areas:
Fostering the relationship
Enabling patient behaviors
Over the longer term, more advanced functions will be incorporated.
Implementing this model will alter how standardized patients (SPs) are trained as well as broaden the range of behaviors on which examinees will be evaluated.
This evaluation process eliminates the history checklist formerly used by SPs to evaluate whether certain examinee behaviors occurred.
SPs are now trained on a particular personality profile, thus allowing them to respond in a more natural manner to examinee questions.
The NBME’s decision to refine the CS examination was based on the ever-increasing awareness of the importance of communication skills and changes in the nature of the doctor-patient relationship.
More patient-centered approaches, more patient involvement in decision-making and the need to support patients in making lifestyle changes are now commonplace and vital physician duties.
Because residents are deeply involved in all of these types of activities, the assessment of their communication skills must reflect and be adapted to assess these activities as well.
To be assured of taking Step 2 CS in its current format, you should act quickly to enroll in a Kaplan Step 2 CS course and schedule an examination date. Allow 6 weeks of USMLE review for Step 2 CS prep.
Step & purpose
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.
emphasis on health promotion and disease prevention.
Step 2 CS:
Uses standardized patients to test examinees on their ability to gather information from patients,
Perform physical examinations,
Communicate their findings to patients and colleagues.
Clinical Knowledge (CK)
Approximately 318 multiple-choice questions, divided into eight 60-minute blocks
CK: One-day test session – Approximately nine hours
CS: One-day test session – Approximately eight hours
USMLE Step 3
The USMLE Step 3 is a 2-day computerized examination with:
Approximately 500 multiple-choice questions.
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.
The USMLE Step 3 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.
The test is administered by appointment on a year-round basis.
Step & purpose
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 health care.
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 1 FIP: Approximately 232 multiple- choice test questions, divided into six 60-minute blocks. Computer-based, administered at Prometric test centersin the US.
Day 2 ACM: Approximately 180 multiple-choice test questions, divided into six 45-minute blocks. Thirteen computer-based case simulations (CCS). Each simulation is allotted a maximum of 10 or 20 minutes of real-time Computer-based, administered at Prometric test centers in the US.
Length (including breaks):
FIP: One-day test session – Approximately seven hours
ACM: One-day test session – Approximately nine hours