Preparing for The United States Medical Licensing Examination (USMLE)

The United States Medical Licensing Examination (USMLE) is a three-step exam required for medical licensure in the U.S. The test is taken at different stages while in medical school. The goal of the USMLE is to assess a physician’s ability to apply knowledge, concepts, and principles, to demonstrate fundamental patient-centered skills that are important in health and disease, and to constitute the basis of safe and effective patient care.

Three-Step Overview and Exam Formats

As mentioned above, the USMLE is a three-step exam. Each step covers different content, has a set time, and its own format. Here is a brief description of each:

Step 1 – Step 1 is a one-day exam divided in to seven 60-minute blocks and administered in one 8-hour testing session. Questions per block vary but will not exceed 40 (or a total of 280 for the overall exam). The goal of this exam is to assess whether you understand and are able to apply concepts of the sciences basic to the practice of medicine, with emphasis on principles and mechanisms underlying health, disease, and modes of therapy. The exam ensures mastery of the sciences and scientific principles.

Step 2 – Step 2 is a two-day exam broken down into two sections – clinical knowledge (CK) and clinical skills (CS). The goal of this exam is to assess your ability to apply medical knowledge, skills and understanding of clinical science essential for patient care, with emphasis on health promotion and disease prevention. The exam ensures that attention is devoted to the principles of clinical sciences and basic patient-centered skills.

• The CK portion of the exam is divided into eight 60-minute blocks and administered in one 9-hour testing session. Questions per block vary but will not exceed 40 (or a total of 318 for the overall exam).
• The CS portion of the exam uses standardized patients to test medical students and graduates on their ability to gather information from patients, perform physical examinations, and communicate their findings to patient and colleagues. This will require travel to one of the five testing centers around the country.

Step 3 – Step 3 is a two-day exam broken down into two sections – Foundations of Independent Practice (FIP) and Advanced Clinical Medicine (ACM). The goal of this exam is to assess your 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. The exam provides a final assessment of physicians assuming independent responsibility for delivering general medical care.

• The FIP portion of the exam is divided into six 60-minute blocks and administered in one 7-hour testing session. Questions per block are multiple choice and include 38-39 items (or a total of 232 for the overall exam).
• The ACM portion of the exam is divided into six 45-minute blocks and administered in one 9-hour testing session. Questions per block are multiple choice and include 30 items (or a total of 180 for the overall exam). This exam also includes a 5-minute optional tutorial, a 7-minute CCS tutorial, and a 13-case simulation which is allotted a maximum of 10-20 minutes each.

Tips to Prepare for the USMLE

If you are a medical student pursuing a M.D., at some point you will need to start preparing to take your USMLE. The majority of resources and tools available to practice can be found on the USMLE website. Here are 5 tips to use when preparing for the USMLE:

1. Identify a Goal – If this is your first time taking the USMLE, determine what score you’d like to get. If you’ve already taken the exam, use your score as a baseline and decide what score you’d like to get the second time around.

2. Study – Conduct a thorough review of the exam content using the USMLE’s practice materials. Establish study sessions on particular days and times to review content – remember to break down the content and not try to do everything at once.

3. Establish a Baseline – Once you’ve prepared, take a non-timed practice test. The goal is to hone in on your test-taking skills and identify areas of improvement.

4. Take a Timed Practice Test – Each step within the USMLE exam has an allotted time – familiarize yourself with these times. Then take a timed practice test to establish a good pace.

5. Practice On-The-Go – Outside of your study sessions, try to review material while on the go. There are a few free apps that you can download and use when traveling, taking a break at work etc.

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