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Overview

Overview

In 2020, more than 100,000 medical students and residents sat for one of three USMLE Step exams as part of their journey to become practicing physicians. State medical boards use USMLE outcomes to inform licensure decisions and to help achieve their mission of ensuring safe and effective patient care. USMLE is highly reliable and relevant to patient care today. As a national standard used by state medical boards to determine licensure in the US, the program adheres to professional testing standards to provide fairness and equity to examinees, while identifying important information to medical regulators.

This BOI provides you with the information needed to complete each Step of the USMLE. Please read it carefully and regularly check the USMLE website for announcements. By using this guide and our website, you will learn what to expect from each USMLE Step.

For All Applicants

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Cautions
  • You must become familiar with the information referenced in this Bulletin if you are an applicant with an eligibility period in 2021. If your eligibility period crosses into the next calendar year (ie, 2022), please note that you are responsible for reading and abiding by the policies and procedures described in both years’ editions of the USMLE BOI.
  • If your eligibility period extends into 2022 and you test in 2022, you must become familiar with and will be subject to the policies and procedures in the 2022 BOI.
  • If changes in the USMLE program occur after the release of this BOI, they will be effective when posted on the USMLE website. You are responsible for checking the USMLE website for updates and changes to the USMLE policies and procedures.
  • If you are a student or graduate of a medical school outside the United States or Canada with an eligibility period in 2021, in addition to becoming familiar with this BOI, you must also be familiar with the contents of the 2021 Information Booklet published by the Educational Commission for Foreign Medical Graduates (ECFMG®).
  • If you are a student or graduate of a medical school outside the United States or Canada and your eligibility period extends into 2022 and you test in 2022, you must become familiar with and will be subject to the policies and procedures in the ECFMG 2022 Information Booklet.
  • The ECFMG Information Booklet is available on the ECFMG website. Students and graduates of medical schools outside the United States and Canada are responsible for monitoring the ECFMG website to ensure they understand current ECFMG policies and procedures.

This BOI provides you with the information needed to complete each of the Steps of the USMLE. Please read it carefully and regularly check the USMLE website for announcements. By using this guide and our website, you will learn what to expect from each USMLE Step.

Purpose and Governance 

 

Purpose and Mission of the USMLE

The USMLE is a three-Step examination for medical licensure in the United States. It is sponsored by the FSMB and NBME. The USMLE program supports medical licensing authorities and physicians in the United States through development, delivery, and continual improvement of high-quality assessments across the continuum of physicians’ preparation for practice.

Why is the USMLE Important?

The USMLE assesses an examinee’s ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills. These skills constitute the basis of safe and effective patient care. Health care consumers throughout the nation enjoy a high degree of confidence that doctors who have passed all three Steps of the USMLE have met a common standard.

Examination Committees

Examination committees, composed of several hundred volunteer medical educators and clinicians, create, review, and update the examination materials each year. Committee members broadly represent the teaching, practice, and licensing communities across the United States. At least two committees of experts critically appraise each test question or case and revise or discard any materials that are outdated or inconsistent with current medical practice. These volunteers are also involved in its design, development, and continuous improvement.

How to Prepare

Sample items are available free of charge on the USMLE website under the section titled Practice Materials. 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.

How to Register

To apply for a USMLE Step, you must submit an application through the appropriate organization.

Appointments at some test centers fill up quickly. Examinees are encouraged to schedule at their preferred test center as soon as they have received their scheduling permit.

Where is the USMLE Administered?

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.

The USMLE: Purpose, Format, and Lengths

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STEP 1

Purpose

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

Format

Approximately 280 multiple- choice questions, divided into seven 60-minute blocks

Length

One-day exam, approximately eight hours

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STEP 2 CK

Purpose

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

Format 

Approximately 318 multiple- choice questions, divided into eight 60-minute blocks

Length 

One-day exam, approximately nine hours

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STEP 3

Purpose

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 

Format

  • Day 1: FIP
    • Approximately 232 multiple- choice questions, divided into six 60-minute blocks
  • Day 2: ACM
    • Approximately 180 multiple- choice 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

Length

  • Day 1: FIP
    • One-day test session, approximately seven hours
  • Day 2: ACM
    • One-day test session, approximately nine hours

Ownership and Copyright of Examination Materials

The USMLE examination materials are the confidential, copyrighted property of the USMLE program. If you reproduce and/or distribute any examination materials, by any means, including by memorizing and reconstructing them, you are violating the legal rights of the USMLE program. The USMLE program will use every legal means available to protect the copyrighted materials and secure redress against those who violate copyright law.

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