USMLE Information

United States Licensing Examination

In the United States and its territories (“United States” or “US”), the individual medical licensing authorities (“state medical boards”) of the various jurisdictions grant a license to practice medicine. Each medical licensing authority sets its own rules and regulations and requires passing an examination that demonstrates qualification for licensure. Results of the USMLE are reported to these authorities for use in granting the initial license to practice medicine. The USMLE provides them with a common evaluation system for applicants for medical licensure.

  • Step-1 This step assesses whether you can understand and apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy.
    Step 1 has approximately 336 multiple-choice test items, divided into seven 60-minute blocks, administered in one eight-hour testing session. 
  • Step-2 (CK) This step assesses whether you can apply medical knowledge and understanding of clinical science for the provision of patient care under supervision, and includes emphasis on health promotion and disease prevention.
    Step 2 has approximately 370 multiple-choice test items, divided into eight 60-minute blocks. The exam (including breaks) is administered in one nine-hour testing session.
  • Step-2 (CS) The exam consists of 11-12 encounters with standardized patients (SP). The cases are developed around common situations typical of an ambulatory clinic setting. Students will have 15 minutes to interview the SP and 10 minutes to record pertinent history and physical findings, diagnostic impressions, and follow-up if necessary.
    Why a clinical skills exam? There is considerable concern that as many as 25% of medical school graduates report never having been observed by a faculty member while interviewing a patient. Also, while a multiple-choice exam can adequately test medical knowledge, it does not measure well skills such as interviewing and physical exams.
  • Step-3 This step 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. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care. Step 3 has approximately 480 multiple-choice test items, divided into blocks of 35 to 50 items. You will have 45 to 60 minutes to complete each of these blocks. There are approximately nine computer-based case simulations, with one case in each block. You will have 15 to 25 minutes to complete each of these blocks. Step 3 is administered in two eight-hour testing sessions. more


The content outlines provided in this section are not intended as a curriculum development or study guide. They provide a flexible structure for test construction that can readily accommodate new topics, emerging content domains, and shifts in emphases. The categorizations and content coverage are subject to change. Broadly based learning that establishes a strong general foundation of understanding of concepts and principles in the clinical sciences is the best preparation for the examination.

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Pakistani Foreign Medical Students and Graduates