The USMLE® Guide

Daniel Stein

Bio: Many medical students dream of a doctor's career in the USA. Therefore they have to pass the USMLE (United States Medical Licensing Examination). Daniel Stein passed the USMLE himself and answers the most important questions about this special exam.

December 1, 2019 |

The USMLE® (United States Medical Licensing Examination) is an examination required to be taken by all american medical students to become doctors as well as foreign medical students/doctors to practice medicine in the USA. The USMLE entails three STEP examinations testing applicants’ knowledge through multiple-choice questions, clinical cases and patient care. This guide helps you cover most questions around the USMLE including each STEP explained, the financial aspect, and much more.

What is the STEP 1 examination about?

It is considered to be the most important examination as your score determines what speciality you will most likely work in (More about that topic below). It comprises computer-based multiple-choice questions in the form of case reports on Anatomy, Behavioral Science, Immunology, Microbiology, Biochemistry, Pharmacology, Physiology and Pathology.

You will face 7 ‘one-hour’ blocks each with 40 multiple-choice questions. The score ranges between 0 to 300, and to pass the USMLE you have to exceed 194. Once you pass, you are stuck with the score for the next 7 years.

What is the STEP 2 CK examination about?

It also comprises multiple-choice questions even though its focus is on patient scenarios in the following areas: internal medicine, obstetrics and gynaecology, paediatrics, preventive medicine, psychiatry, surgery, and other areas. It includes about 318 questions, broken down into 8 one-hour blocks of 40 questions each. The passing score is 209 and only plays a minor role in your overall resident matching selection.

What is the STEP 2 CS examination about?

Other than the other STEP examinations, this entails a practical part in which you encounter 12 standardized patients within 8 hours. It is essential to have you present your English and communication skills, your approach to taking patient history, and the right way of responding to patient questions. This examination does not come with a score and only a pass/fail decision.

What is the STEP 3 examination about?

Participation requires passing STEP 1, STEP 2 and having worked at least a year as a US resident. Within a two days examination, multiple-choice questions require your understanding of the clinical approach to patients, diagnosis, treatment, prognosis and pathophysiology in the fields of surgery, OB/GYN, internal medicine, psychiatry, ethics and epidemiology. For applicants outside the US, it enables you to apply for a permanent visa for yourself as well as your family.

What is the resident matching program?

The resident matching program simply means the field of residency you apply for in the US after completing STEP 1 and STEP 2. This can be internal medicine, surgery or any other medical field. Each field requires a certain score (e.g. 240 for gynaecology) to maximise your chance to get matched (= selected).

Could you explain the scoring?

Only STEP 1 and STEP 2 CK make use of a score that ranges between 1 to 300. If you fall below the passing score (STEP 1: 194; STEP 2: 209), you fail, and you can retake the examination until you pass. If you manage to pass, your score stays with you for the next 7 years no matter how good or bad it is.

Keep in mind, only your STEP 1 score determines which residency program you will get in to, the STEP 2 score only plays a minor role and will, in most cases, not be considered for your placement.

Can I fail it?

Yes. Each STEP examination can be retaken as many times as you want as long as you score below the passing score. Once you pass, your score sticks with you for the next 7 years. For some, failing is considered to be better than getting a bad score as it might disable you from doing the medical field you always wanted to.

Does it cost me anything?

Yes. The USMLE is a costly undertaking and should make you think twice before taking the USMLE. Every STEP examination requires a fee to be paid ranging between around 950 to 1600 dollars. This does not include any retakes in case you fail the exam, as well as it does not contain any travel expenses – STEP 1 and STEP CK can be taken all around Europe whereas STEP 2 CS and 3 demand you to travel to specific examination centres in the US.

Taking clerkships in the US and sending out application letters, will add up to the overall costs, and should not be underestimated.

When can I take the exam?

Anytime. You can be a first-year medical student or a 70 years old doctor from outside the US. Dates can be found on their official webpage, and they are quite ubiquitous, too, giving you the chance to take it whenever you want during the year.

American students take STEP 1 after their second year and STEP 2 CS/CK after their fourth (and last) year. STEP 3, as explained before, is similarly taken by all residents after their first year of residency in the US.

Do I have a time window in which I need to finish all STEP examinations?

Yes. From the day you passed your first STEP examination, you have 7 years to finish the others. But be aware, this also means that even if you finish all STEP examinations, you need to apply for residency within those 7 years otherwise you need to do all STEP examinations again. Once you do your residency and want to reapply for a different field (let’s say from internal medicine to surgery), you are only able to do this within those 7 years without having to redo the STEP exams again.

How do I study for it and how long will it take to be prepared for it?

Every student is individual, and your success depends on many different factors. Most students start studying for it after their second year when they finished all required subjects, and use their summer break to fully prepare themselves. Every student I asked, used First Aid USMLE STEP 1 comprising everything you need to know to pass, and a so-called Q-Bank containing multiple-choice questions perfectly tailored to your needs to be ready for the exam.

You can also do an exam simulation that is simulating the entire STEP 1 in length and difficulty. You will receive a score at the end giving you an idea where you stand, and if already taking the exam is the right decision.

I finished STEP 1 and STEP 2, what’s next?

After finishing STEP 1 and 2 exams, you have to apply for a job. Instead of sending out letters to 1 or 2 hospitals, it is recommended to send out at least 50 letters to optimize your chances for matching a resident program.

Your letter should include all your achievements you can think of, certificates, degrees and letters of recommendations. Hospitals recommend including at least 2 letters of recommendation obtained from US clerkships. They usually do not care about any other kind of recommendation. After sending out all your documents, you need to wait for anyone to invite you for an interview. If everything works well, the hospital hires you and you can finally start as a resident!

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