The Path to Licensure

Overview

First implemented in 1992 and accepted by all 50 state medical boards, the United States Medical Licensing Examination® (USMLE®) is part of a physician’s pathway to licensure.

The USMLE has three examinations, called “Steps” — which are taken at different points in an allopathic physician’s education and training. Examinees who pass each Step of the USMLE have demonstrated they understand and can apply medical knowledge, clinical concepts and fundamental patient-centered skills to obtain a license to practice medicine in the United States.

 

The Pathway to U.S. Medical Licensure, Simplified

The USMLE is an integral part of the pathway to licensure. In January 2026, the USMLE Service Transition simplified the examinee journey and created a more consistent and efficient process for examinees by consolidating all USMLE Step exam services, including exam registration, score report delivery, and customer service, under the USMLE co-sponsors, the Federation of State Medical Boards (FSMB) and NBME. 

Below you will find more about the USMLE process and the pathway to medical licensure for both students and graduates of U.S. medical schools and students and graduates of international medical schools.*
*These are the typical paths to licensure, but the details may look different for each person.  
 

For Students & Graduates of U.S. Medical Schools

If you are a student or graduate of a U.S. medical school, use the MyUSMLE Portal for all of your USMLE Step exam services. Explore the USMLE process for U.S. medical school students and graduates and learn more about your pathway to medical licensure below or download the path to medical licensure, simplified infographic.*

 

For Students & Graduates of International Medical Schools

If you are a student or graduate of an international medical school, use the FSMB's USMLE Portal for all of your USMLE Step exam services. Explore the USMLE process for international medical school students and graduates and learn more about your pathway to medical licensure in the United States below or download the path to U.S. medical licensure, simplified infographic.*
 

*These are the typical paths to licensure, but the details may look different for each person.

For Students & Graduates of International Medical Schools

  1.  

    Create a MyIntealth account and apply for ECFMG Certification

    Eligibility for ECFMG Certification must be determined before you can register for Step exams.

  2. NEW!

    Register for USMLE Step 1 exam in FSMB's USMLE Portal

    You'll use this account for all USMLE services.

  3. NEW!

    Register for Step 2 CK exam in FSMB's USMLE Portal

    Step 1 and Step 2 CK are required for ECFMG Certification.

  4.  

    Obtain your ECFMG Certification

    You must have a valid, unexpired ECFMG Certification to enter an accredited U.S. medical training program and take USMLE Step 3.

  5.  

    Appy for U.S. residency positions

    Once you begin residency, it's time to start thinking about Step.

  6.  

    Register for Step 3 exam in FSMB's USMLE Portal

    You're one step closer to reaching your goal.

  7.  

    Finish your residency and continue your medical career

    You're on your way to becoming a licensed physician in the United States! Visit fsmb.org to learn how to apply for a state medical license.

In phase two of the USMLE Service Transition, Step 3 services currently provided to students and graduates of U.S. medical schools by FSMB will transition to NBME on January 26, 2026.

For Students & Graduates of U.S. Medical Schools

  1.  

    Create a MyUSMLE Account with NBME

    You'll use this account for all USMLE services.

  2.  

    Register for Step 1 exam in the MyUSMLE Portal

    This typically happens during the second year of medical school.

  3.  

    Register for Step 2 CK exam in the MyUSMLE Portal

    This typically happens during the fourth year of medical school.

  4.  

    Appy for residency and finish medical school

    Once you've received your degree, you're eligible for Step 3 and residency.

  5. NEW!

    Register for Step 3 exam in the MyUSMLE Portal

    This typically happens during the first year of residency.

  6.  

    Finish residency and continue your medical career

    You're on your way to becoming a licensed physician! Visit fsmb.org for more information and to apply for a U.S. medical license.