USMLE Exam : - Details, Exam Pattern and Process for How to apply for USMLE

What is The USMLE Exam?

USMLE or The United States Medical Licensing Examination is a 3 step examination. This exam conducts for medical licensure in the U.S. In short, if you want to work as a doctor in the United States you have to clear the USMLE exam. This exam is sponsored by the Federation of State Medical Board (FSMB) and the National Board of Medical Examiners (NBME). Whether you are an IMG (International Medical Graduate) or AMG (American Medical Graduate) this exam is mandatory to practice as a doctor in America. Many students across the globe apply for this exam every year.

In the following article, I will try to give you a brief overview of all the requirements and processes of the exam. Also, I will tell you about the exam pattern and the syllabus of each step.

As this is a 3 steps examination, the main focus of this exam is the assessment of knowledge in basic medical sciences as well as deep understandings of its applications in clinical scenarios.

The steps of the exam are as following: -

• USMLE Step 1
• USMLE Step 2 (CK and CS )
• USMLE Step 3

 

Pre-Requisites before applying for USMLE

Before diving into the actual article there are some pre-requisites that you should consider. These are:-

1. Make Sure that your college or medical school is listed in the World Directory of Medical Schools (WDOMS). Here is the link to check. You need to select your college and country to check whether it's listed or not. Only listed college students are eligible to apply for USMLE.
2. You must have to have your MBBS mark sheets with you. You will need them while applying for the match process
3. You have to clear your TOEFL exam, any time before applying for the VISA. You should have to get it ready before applying for the Step 2 CS exam.

 

These are the things that you should keep in mind. There is only one absolute requirement before applying for step 1 and that is your college must be listed for the World Directory of Medical Schools.

The other 2 requirements are also necessary but they will not be problematic at the beginning of the application for step 1.

 

USMLE Step 1

USMLE Step 1 is the first part of this 3 steps long exam, as the name suggests. You can apply for this exam right after the completion of the second year of your medical college. Most of the students in India apply for this exam in the starting or in the mid of their third year.

This step consists of an 8-hour long exam having 7 blocks of 40 questions each. For now, the result of this exam is a 3 digit score with the qualifying Marks of 192. But from January 2022, the exam will be pass-fail only. All the competitive features from the step 1 exam will exclude and the step 2 CK score will gain more importance. The Pattern of Step 1 exam is:-

·        Exam Type:- Online computer Based

·        Exam Centers:- Global

·        Duration of Exam:- 8 Hours

·        Number of Questions:- 280

·        Division of Questions:- Block System, 1 hour block, 40 questions each block

·        Syllabus for Step 1 will be: -

o   Anatomy

o   Behavioral Sciences

o   Biochemistry

o   Biostatics and Epidemiology

o   Pathology

o   Pharmacology

o   Physiology

o   Microbiology

USMLE Step 1 Fees 

The examination fees for USMLE Step 1 will be 965$ with an additional delivery surcharge of 165$ i.e. the total of 965+165$ for an IMG. For students and graduates of Medical schools in the United States and Canada, the fees are 645$ for 2020-2021.

Before applying for the USMLE Step 1 you have to apply for the ECFMG certification and the fees for this are 140$ with an additional delivery surcharge of 160$.

 

USMLE Step 2

This Step is having 2 sets of examinations namely Clinical Skills and Clinical Knowledge. In short, it is known as Step 2 CK and Step 2 CS. These 2 exams have a lot enough gaps in between. Step 2 CK is an MCQ based exam which you can give from your country, as it’s a computer-based examination. But for Step 2 CS you have to go to the US, and you have to apply for it at least 4 months prior. This exam will have all clinical subjects but you need to have a good background of Step 1 content as you will see a lot of questions integrated with basic sciences. The pattern of Step 2 CK will be as follows:-

USMLE Step 2 CK 

·        Exam Type:- Online computer Based

·        Exam Centers:- Global

·        Duration of Exam:- 9 Hours

·        Number of Questions:- 320

·        Division of Questions:- Block System, 1 hour block, 40 questions each block

·        Syllabus for Step 2 CK will be:-

o   Obstetrics/Gynecology

o   Preventive medicine

o   Psychiatry

o   Surgery

o   Internal Medicine

o   Dermatology

o   Emergency medicine

o   Ophthalmology

o   ENT

Questions in Step 2 CK will describe a clinical situation and require you to provide one or more of the following: -

·        Prognosis

·        Diagnosis

·        Suitable Investigation of Choice

·        Indications or mechanism of diseases

·        Management and preventive measures

·        Qualifying marks for the Step 2 CK exam are 209.

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USMLE Step 2 CK Fees

The fees for the Step 2 CK exam are 965 $ with an additional deliver surcharge of 165$, similar to step 1. These fees might be changed in the future. It is mentioned here as per the year 2020-2021

The fee for an extension of the eligibility period for USMLE Step 1 and Step 2 CK will be 90$.

USMLE Step 2 CS

Once you have qualified Step 2 CK you can apply for Step 2 CS. But as I said earlier you have to apply for the exam 4 months prior. At that time your TOFIL exam certificate will come into action. As this exam have only 6 centers in America so you have to go there for Step 2 CS. The pattern of the Step 2 CS exam is:-

·        Exam Type:- Offline, Practical exam

·        Exam Centers:- the US only

·        12 patients or simulations will be allotted

·        15 minutes + 10 minutes for every spot will be given

This exam will test your skills in communication and history taking. This is a pass-fail exam and no marks will be given in this step.

USMLE Step 2 CS Fees

The fees for Step 2 CS is 1600$ for each exam registration. The Fee for a rescheduling a Step 2 CS testing appointment will be 0-1300$ (depending on the date of cancellation)

 

After you clear your Step 2 you can apply for Step 3. Before applying for step 3 you have to apply for the United Stated Clinical Experience (USCE) if you are an IMG.

 

What is USCE?

USCE or the United States Clinical Experience which is considered important if you an IMG and want to apply for residency in the US. It will help you to get some Letters of Recommendation which you can use for your match process. I would suggest you not look at USCE as means to get those letters rather look at it as a learning opportunity.

There are 2 types of USCE

1.      Externship or Sub-Internship

2.      Observerships or Shadowing

In brief, Externships are the rotations that are not undertaken in the home institution. During an externship, you can actually treat a patient and can interact with them. They are preferred over Observerships.

In Observerships you are not allowed to treat any patient. You can only observe all the process silently. There will be no direct involvement in inpatient care from your side. This is probably the most popular way to gain USCE as an International Medical Graduate (IMG).

 Now, you are completely ready for your Step 3 application.

 

USMLE Step 3

This is the last and final step towards your residency in The USA. This exam is a 2 days long exam. The exam committee will do a complete assessment of your knowledge in these 2 days.

Day 1

·        Questions:- 230 MCQs

·        Division of questions: - 6 blocks

·        Duration: - 7 hours

Day 1 focus on the assessment of knowledge on Basic Sciences, History taking, physical examination, and use of proper diagnostic tests.

Day 2

·        Questions: -180 MCQs + 13 Computer Case Simulation (20 mins each)

·        Division of Questions: - 6 blocks

·        Duration: - 9 hours

Day 2 focus on the assessment of your ability to apply you medical knowledge in the context of patient care and it tests your medical decision making skills.

USMLE Step 3 Fees

The examination fees for the Step 3 exam is 895$ as per fsmb.org. Fees must be paid via American Express, aster card, or Vis

 

After everything is done and you have qualified all exams, now it’ time to submit an application for an interview. You have to apply to different hospitals to get your desired residency.

The application for the interview was submitted on 15 September each year. This application includes: -

·        Step 1 score

·        Step 2 score

·        MBBS Score Card

·        Letters of Recommendations

·        Strong Personal statement

·        Your Research Papers (published if any)

The Medical Board will select your applications and if get selected they will call you for an interview. After clearing the Interview you can join your allotted residency.

Takeaway Points

• USMLE is a 3 step exam for getting a residency in the US.
• This Exam is sponsored by NBME and FSMB.
• There are some prerequisites for the exam. Your college should be listed in WDOMS.
• Step1 is a single day exam of 8 hours duration, with 280 questions having 7 blocks of 1 hour having 40 questions each.
• Right now qualifying criteria for Step 1 is 192 marks out of 280 marks. But from 2022 it will be a pass-fail exam.
• The examination fees of Step 1 the exam is 965$ with an additional delivery surcharge of 165$
• You have to have an ECFMGE certification before applying for USMLE Step 1. Fees for ECFMGE certification is 140$ with an additional delivery surcharge of 160$
• Step 2 has 2 parts CK and CS. The CK exam is 9 hours long exam with 320 questions and CS is a practical exam.
• 209 is the qualifying score for Step 2 CK and Step 2 CS is a pass-fail exam.
• Step 2 CK exam fees are similar as step 1 and CS fee is 1600 $ for IMGs.
• USCE is considered important for IMGs before applying for step 3.
• Step 3 is a 2-day long exam and after that you have to apply for your interviews after clearing the interview you are ready for doing a residency in the USA.