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Structure of the United States Medical Licensing Examination (USMLE)

The United States Medical Licensing Examination (USMLE) is a three-step examination which is required for medical licensure in the United States.

  • Step 1 and 2 are required to start clinical training in the US
  • Step 3 is usually taken during specialty training (residency) but can be taken before starting residency in some states.
  • Only Step 2 consists of both a written (Step 2 Clinical Knowledge or CK) and practical part (Step 2 Clinical Skills or CS).
  • Step 1, Step 2 CK and Step 2 CS can be taken in any order.
  • Step 1 and Step 2 CK are computer-based tests which can be taken anytime during the year at test centers which are located throughout the US and the world. They can be taken at the Prometric test center in Munich.
  • Step 2 CS can only be taken in five test centers all located within the US.

Content of the three steps of the USMLE

Step 1

Step 1 assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine. Step 1 includes test items in the following content areas:

  • anatomy
  • behavioral sciences
  • biochemistry
  • microbiology
  • pathology
  • pharmacology
  • physiology
  • interdisciplinary topics, such as nutrition, genetics, and aging

Step 2

Step 2 assesses whether you can apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision.

Step 2 CK

includes test items in the following content areas:

  • internal medicine
  • obstetrics and gynecology
  • pediatrics
  • preventive medicine
  • psychiatry
  • surgery
  • other areas relevant to provision of care under supervision.

Step 2 CS

Step 2 CS is a one-day live exam in which students typically encounter 12 standardized patients. Most encounters will involve interviewing, physical examination, counseling, and writing up a patient note.

Step 3

Step 3 assesses whether you can 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.