What Is the USMLE? Complete Guide for Medical Students
Explore the three steps, eligibility requirements, key timelines and more.
If you’re on the path to becoming a licensed physician in the United States, you will need to pass one of the most important series of assessments in medical education: the United States Medical Licensing Examination, or USMLE. Whether you’re just starting your MD program admissions journey or approaching the USMLE Step 1, understanding what the USMLE step exams involve and how they’re structured can help you prepare with confidence.
This blog post covers everything you need to know, from USMLE exam prep recommendations and eligibility criteria to fees and registration processes. Read on to gain a deeper understanding of what it will take to succeed on the USMLE steps and earn your license to practice independently in the U.S.
What Is the USMLE?
So, what is the USMLE? The United States Medical Licensing Examination is a three-step assessment series that every physician must pass to obtain a license to practice medicine in the United States. The USMLE is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). Together, these organizations provide state medical boards with a standardized system for evaluating licensure applicants.
Each of the three USMLE steps builds on the last. No single step can independently determine your readiness to practice medicine; rather, the series as a whole assesses your knowledge and clinical ability at each stage of your medical education journey.
Eligibility Criteria for the USMLE
Before registering for any USMLE step, you must confirm that you meet the USMLE eligibility criteria. To be eligible, you must fall into one of the following categories at the time of application and on exam day:
- A medical student enrolled in, or a graduate of, a U.S. or Canadian medical school that grants an MD degree accredited by the Liaison Committee on Medical Education (LCME)
- A student enrolled in, or a graduate of, a U.S. medical school that grants a DO degree accredited by the Commission on Osteopathic College Accreditation (COCA)
- A medical student enrolled in, or a graduate of, a medical school outside the U.S. and Canada that is listed in the World Directory of Medical Schools and meets the requirements of the Educational Commission for Foreign Medical Graduates (ECFMG)
St. Matthew’s University School of Medicine (SMUSOM) MD program participants would fall into the third category, as we are listed in the World Directory of Medical Schools. This means that students and graduates of our MD program are eligible to sit for the USMLE exams.
“Medicine is not only a science; it is also an art. It does not consist of compounding pills and plasters; it deals with the very processes of life.”
Paracelsus, 16th-century Swiss physician
USMLE Steps Explained
The USMLE consists of three steps. Here is a breakdown of what each one involves.
USMLE Step 1
USMLE Step 1 assesses your understanding and application of the sciences fundamental to the practice of medicine, with a particular focus on the principles and mechanisms underlying health, disease and treatment. In short, it tests everything you’ve learned during the Basic Science portion of your MD program journey.
As of January 26, 2022, Step 1 moved from numerical score reporting to a pass/fail format. This change was made in response to concerns from the medical education community that the three-digit numerical score was contributing to student stress and potentially distracting from the development of other key competencies, including communication and teamwork skills.
USMLE Step 2 CK
USMLE Step 2 CK (Clinical Knowledge) assesses your ability to apply medical knowledge and clinical science to patient care under supervision, including an emphasis on health promotion and disease prevention. This step is closely tied to the skills you develop during your clinical rotations, making it an assessment of real-world readiness in a clinical environment.
USMLE Step 3
USMLE Step 3 is the final step in the series. It assesses whether you can effectively apply a wide range of medical knowledge to the unsupervised practice of medicine, with a specific emphasis on patient management in ambulatory settings. Unlike the first two steps, Step 3 can only be taken in the United States and is completed across two testing days.
When Do Medical Students Take Each USMLE Step?
The timing of each step aligns with the key stages of your medical education:
- Step 1 is typically taken upon completing the pre-clerkship curriculum (basic sciences), usually at the end of the second year of your MD program.
- Step 2 CK is generally taken after completing clinical rotations, near the end of an MD program.
- Step 3 is typically taken during the first or second year of postgraduate residency training.
In order for SMUSOM students to sit for the USMLE Step 1 exam, they must successfully complete the Basic Science curriculum and such other prerequisites as the school may establish at its discretion. Similarly, in order to sit for the USMLE Step 2 CK exam, MD students must successfully complete the Clinical Medicine curriculum and any related prerequisites.
To learn more about what a medical residency involves and where Step 3 fits into that journey, visit our dedicated blog post.
Want to Learn More About Preparing for the USMLE?
Explore our Doctor of Medicine program, your pathway to licensing success!
USMLE Exam Pattern and Format
Step 1 is a one-day exam administered in an 8-hour testing session. From May 14, 2026 onward, the format includes fourteen 30-minute blocks with up to 20 questions per block. The total number of possible questions is capped at 280. A 45-minute break is included.
Step 2 CK is a one-day exam administered in a 9-hour testing session. From May 7, 2026 onward, the format includes sixteen 30-minute blocks with up to 20 questions per block. The total number of possible questions is capped at 318. A 55-minute break is included.
Step 3 is the final examination in the USMLE sequence and is a two-day test. The first day of testing includes 232 multiple-choice items divided into 12 blocks of 18-20 items. There are approximately 7 hours in the test session on the first day, including 55 minutes of break time.
There are approximately 9 hours in the test session on the second day. This includes 180 multiple-choice items, divided into 9 blocks of 20 items, followed by 13 to 14 case simulations, each of which is allotted a maximum of 10 or 20 minutes of real time. A minimum of 45 minutes is provided for break time.
USMLE Scoring System
The USMLE scoring system differs across the three steps.
Step 1 reports results as pass or fail only, following the 2022 change in scoring policy.
Steps 2 CK and Step 3 continue to use a three-digit numerical score. A strong numerical score on Steps 2 and 3 can carry significant weight during the residency application process, particularly for international medical graduates (IMGs) who may rely on these scores as key indicators of their academic ability and clinical knowledge.
“The good physician treats the disease; the great physician treats the patient who has the disease.”
Sir William Osler, Canadian physician and “The Father of Modern Medicine”
USMLE Fees and Cost Breakdown
The USMLE exam fees are fixed, but vary by step. It is worth budgeting for all three steps as part of your overall cost of medical education.
As of April 2026, USMLE application fees are as follows:
| Exam Step | Application Fee |
|---|---|
| Step 1 | $695 USD |
| Step 2 CK | $695 USD |
| Step 3 | $955 USD |
USMLE Registration Process
The USMLE registration process differs depending on where you studied medicine:
- U.S. and Canadian medical students and graduates register through the National Board of Medical Examiners (NBME)
- International medical students and graduates register through the Educational Commission for Foreign Medical Graduates (ECFMG)
To register for the USMLE, begin by creating an account on the relevant platform (NBME or ECFMG). Once your eligibility has been verified, you can apply for the specific step you are ready to sit for and submit your required documentation. Upon approval, you will receive a scheduling permit, which allows you to book your exam date through the Prometric website, selecting a test center and time that works for you.
Early registration is strongly recommended. For detailed, up-to-date guidance on how to register for USMLE, visit the official USMLE website.
How Long Does It Take to Complete the USMLE?
Medical licensing authorities in the U.S. generally require that doctors complete the USMLE Steps 1, 2 and 3 within a 7-year span, beginning when you pass Step 1. For successful St. Matthew’s University MD program participants, USMLE Step 1 occurs in the second year of med school, Step 2 CK occurs in the fourth year of med school, and Step 3 usually occurs within the first two years of residency. This is a 4-5 year period.
How to Prepare for the USMLE?
Preparation is everything when it comes to all three steps of the USMLE. Here are some practical approaches to get you started:
- Start early: Give yourself three to four months of focused study time before each step.
- Use official materials: The USMLE website offers free preparation resources, including practice questions and interactive test simulations for all three steps.
- Identify your weak areas: Take practice tests regularly and use the results to guide targeted revision.
- Combine resources: A mix of question banks, subject-specific reviews and formal study courses tends to work best for most students.
- Lean on your instructors: At SMUSOM, our faculty and student services team actively support students through both the preparation and registration processes for Steps 1 and 2 CK. For Step 3, take advantage of the resources available to you in residency.
Explore St. Matthew’s University School of Medicine
Understanding what the USMLE exam involves is an important part of planning your path to becoming a licensed physician. At St. Matthew’s University School of Medicine, USMLE preparation is built into the fabric of our MD program, with dedicated faculty support, structured curricula and student services designed to help you succeed at every step.
Since 1997, SMUSOM has helped more than 2,300 students earn their MD degrees. Graduates go on to earn residency placements at high rates and practice in the U.S., Canada and internationally. Our 10-semester program begins with five semesters of classroom and lab-based learning on our Grand Cayman campus, followed by five semesters of clinical rotations at affiliated teaching hospitals and medical centers in the U.S, and select elective rotation sites in Canada.
Learn more about the SMUSOM student experience and pathway to residency in this graduate testimonial video:
Then contact us to learn more or register for an upcoming admissions event. We also encourage you to explore the application process!
FAQs about the USMLE
Step 1 is scored on a pass/fail basis. Steps 2 CK and 3 use a three-digit numerical score, with passing scores set by the USMLE program. Examinees typically need to answer around 60% of questions correctly to pass, though the exact threshold varies by step and exam form. For Step 3, performance on case simulations also contributes to your overall score.
Yes, the USMLE is open to international medical graduates (IMGs). To be eligible, your medical school must be listed in the World Directory of Medical Schools and you must meet ECFMG requirements. International students register through the ECFMG rather than the NBME.
At SMUSOM, MD program participants/graduates are eligible to sit for the USMLE steps, provided they meet all academic and other prerequisites established by the school.
The USMLE is widely regarded as a rigorous series of exams. Each step requires months of dedicated preparation. That said, students who follow a structured study plan, use quality resources and take advantage of available faculty support are well-prepared to succeed.
Candidates are permitted a maximum of four attempts per step. This is a lifetime cap. If you fail to pass a step after four attempts, you are no longer eligible to apply for that exam.
For Prospective Students
SMUSOM is committed to supporting prospective students throughout the admissions process. Please click the following links for detailed information about each topic: