USMLE Exam: Guide for Medical Students

Want to become a doctor in USA? Then you must take the USMLE exam. It's the main test for all medical students and Indian MBBS graduates who wish to work as a doctors in the US. In this guide, we explain all steps, fees, and how to apply for the USMLE.

The USMLE exam (United States Medical Licensing Examination) is a crucial test for individuals seeking to become licensed physicians in the United States. The USMLE exam is primarily designed for medical students and graduates who wish to practice medicine in the United States. The USMLE test checks if the person has the right knowledge and skills to work safely and professionally as a doctor. The USMLE assesses medical knowledge, clinical concepts, and patient-centered skills.

The USMLE exam has three steps - Step 1, Step 2 CK (Clinical Knowledge), and Step 3. Each step is different and tests different things. For example, Step 1 checks basic medical science knowledge, Step 2 CK looks at clinical knowledge, and USMLE Step 3 checks if the person can apply that knowledge in real-life patient care.

This exam is not easy and needs good preparation. Many international medical graduates (IMGs) also take the USMLE to get a chance to work in the USA. Doing well in the exam helps in getting a residency in the USA, which is a big step toward becoming a doctor there. After clearing USMLE Step 1 and Step 2 CK, the next big step is getting into residency. Learn more about how to get medical residency in US.

USMLE Exam: Key Highlights

Other Medical Exams: 

USMLE Full Form 

The USMLE full form is the United States Medical Licensing Examination. The test is owned by two entities: the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). It is one of the top 10 toughest exams in the world.

The USMLE plays a crucial role in ensuring that doctors meet high and consistent standards before they are permitted to practice. It demonstrates that a physician possesses the requisite medical knowledge, practical skills, and clinical judgment to deliver safe and effective care.

USMLE is governed by a committee that includes members from the ECFMG, FSMB, NBME, and the public. The USMLE has three examinations, called "Steps". It is a computer-based test and suitable for medical graduates who wish to practice medicine in the United States. 

If you are exploring higher education in the medical field post-MBBS, consider the Masters of Medicine & Health Sciences in USA.

What is USMLE Exam? 

The USMLE is part of a physician's pathway to licensure in the USA. The exam includes a three-step assessment process: USMLE Step 1, Step 2 CK, and Step 3. Step 1 tests basic medical sciences, Step 2 CK assesses clinical knowledge, and Step 3 evaluates the ability to apply medical skills in unsupervised practice.

Examinees who pass each Step of the USMLE show that they have a solid understanding of medical knowledge, clinical concepts, and essential patient-focused skills. This proves they are qualified to earn a medical license and practice medicine in the United States.

USMLE Step 1:

Step 1 assesses the examinee’s understanding of basic medical sciences and their application to the practice of medicine. The test includes approximately 280 multiple-choice questions (MCQs), divided into seven 60-minute blocks. The duration of the test is approximately eight hours. 

USMLE Step 2 CK (Clinical Knowledge):

Step 2 CK assesses the examinee’s ability to apply medical knowledge, clinical skills, and understanding of clinical science. The test includes approximately 318 multiple-choice questions (MCQs), divided into eight 60-minute blocks. The duration of the test is approximately nine hours.

USMLE Step 3:

Step 3 assesses the examinee’s ability to apply medical knowledge and understanding of biomedical and clinical sciences necessary for the unsupervised practice of medicine.

The exam is spread over two days:

• Day 1 – Foundations of Independent Practice (FIP): It includes approximately 232 multiple-choice questions (MCQs), divided into six 60-minute blocks.
• Day 2 – Advanced Clinical Medicine (ACM): It includes approximately 180 MCQs (six 45-minute blocks) and 13 computer-based case simulations (CCS), each lasting up to 10 or 20 minutes.

USMLE Exam Dates 2025 

The USMLE exam has no fixed dates. The USMLE test dates 2025 are available year-round. Candidates choose a three-month eligibility period during registration and can schedule their exam on any available date within that window.

Step 1 and Step 2 CK can be taken at Prometric centers in India and abroad, based on slot availability. Students usually take Step 1 after the second year of MBBS, and Step 2 CK after clinical rotations or the final year.

Step 3 must be taken only in the US and spans two consecutive days. It is available only to those who have cleared Step 1 and Step 2 CK and received ECFMG certification.

Popular months like May-August and November-January fill up quickly, so it is best to book at least 6–8 weeks in advance. Always use the Prometric website with the scheduling permit to check and secure a preferred slot.

USMLE Eligibility for Indian Students

Medical aspirants who are planning to take the USMLE test must fulfill the eligibility requirements to apply for the test. The USMLE test eligibility for Step 1, Step 2 CK, and Step 3 is as follows:

USMLE Step 1 and Step 2 CK Eligibility

• Medical students or graduates from a US or Canadian MD program accredited by the LCME are eligible to apply for USMLE Step 1 and Step 2 CK.
• Candidates or graduates who have a US DO program accredited by COCA.
• A student or graduate from an international medical school listed in the World Directory of Medical Schools and meeting ECFMG eligibility requirements can apply for the USMLE.

USMLE Step 3 Eligibility

• Candidates need to achieve passing scores on Step 1 and Step 2 CK.
• Candidates must fulfill all the eligibility criteria as listed in the USMLE Bulletin of Information.
• Candidates must have an MD or DO degree from a US or Canadian medical school accredited by LCME or COCA, OR an equivalent MD degree from an international medical school listed in the World Directory of Medical Schools, and must also obtain ECFMG Certification.

Before applying for USMLE, you must understand how MBBS (MD) in USA for Indian Students works, as the US doesn't offer an undergraduate MBBS; it is a postgraduate MD program.

USMLE Application Process

Each USMLE Step (Step 1, Step 2 CK, Step 2 CS, and Step 3) requires a separate application form. The application process depends on your medical school location and which Step you are registering for.

How to Apply for USMLE from India – Step by Step

If you are an MBBS student in India and want to go to the USA for residency, you need to take the USMLE exam. Below are the steps on how to register for USMLE from India.

Step 1: Get Your USMLE/ECFMG ID

• First, go to the ECFMG website.
• Click on “I want to apply for ECFMG Certification.”
• Fill in your details like full name (same as passport), email, date of birth, etc.
• After 4 to 5 working days, you’ll get your USMLE/ECFMG ID and password on email.
• This ID is very important. You’ll need it for all the next steps.

Step 2: Login on IWA Portal

• Now go to the IWA (Interactive Web Applications) login page.
• Use your ECFMG ID and password to login.
• Fill the form carefully. Name, DOB, and passport details should match.
• If anything is wrong, it can delay your process badly.

Step 3: Apply for ECFMG Certification

• Once you're logged in, click on “Apply for ECFMG Certification”.
• Fill the application and pay around USD 160 (INR 13,000).
• After this, you need to complete Form 186, which is an identity form.
• This is done online through a video call using NotaryCam.

Step 4: Apply for USMLE Step 1 (or Step 2 CK)

• When ECFMG cert is accepted, go back to IWA and click on “Begin New Application”.
• Select the exam – Step 1 or Step 2 CK.
• Choose your eligibility period (3 months) when you want to give the exam.
• Select India as your exam location.
• Pay the exam fees:
• Step 1 = USD 1,020 + USD 195 (India surcharge) = USD 1215 total
• That’s around INR 1 Lakh to INR 1.05 lakh in Indian rupees.

Step 5: Send Form 183 from Your College

• After payment, you will get access to Form 183.
• Download and take it to your Dean’s office (in college).
• They must sign, stamp, and seal it in a college envelope.

Then courier it to ECFMG office in the USA:

Step 6: Wait for the Scheduling Permit

• After sending Form 183, wait 2 to 3 weeks.
• Once ECFMG approves, they’ll send you a scheduling permit on email.
• This permit is used to book your test date.

Step 7: Book Your Exam Date on Prometric

• Go to Prometric.com, search for USMLE exam.
• Click your exam (Step 1 or Step 2 CK), and select India center (like Hyderabad, Bengaluru, etc.).
• Enter your details and use the scheduling permit to book the date.
• You must take the test in the 3-month window you selected.

Some Important Things

• Keep your passport ready – not expired.
• Make sure all names and details match exactly in all forms.
• If you miss your 3-month slot, you’ll have to pay and apply again.
• You can reschedule your test date, but extra fee may apply.

USMLE Exam Fees in India 2025

USMLE fees range from USD 1020 for Step 1 and Step 2 CK to USD 895 for Step 3. Additional charges apply for rescheduling, score rechecks, and region changes.

USMLE Exam Centre 2025

The USMLE exam is held at Prometric test centres in the US and some other countries. International students can take Step 1 and Step 2 CK at approved centres outside the US. But Step 3 must be taken only in the United States, as it is the final step for getting a medical license.

USMLE Exam Centre in India

A total of 9 USMLE exam centres are available in India. These test centres are located in major cities like Chennai, Hyderabad, Ahmedabad, Bangalore, Kolkata, Allahabad, Mumbai, and New Delhi.

USMLE Exam Pattern

The USMLE (United States Medical Licensing Examination) is a three-step exam required for medical licensure in the United States. Step 1 and Step 2 CK are administered at Prometric centers worldwide, while Step 3 is taken in the USA. Check details on USMLE paper pattern below, 

USMLE Step 1 Exam Pattern

Step 1 consists of multiple-choice questions (MCQs). Questions involve interpreting images, graphs, or tables created by expert committees of doctors, educators, and researchers from across the US

The exam covers 18 major content areas, primarily organized by organ systems and foundational sciences.

USMLE Step 1: Test Section Weightage

USMLE Step 2 CK Exam Pattern

USMLE Step 2 CK is a one-day exam. The duration of the test is 9 hours. The test includes 8 blocks, each lasting 60 minutes. Each block has up to 40 questions, with the total not exceeding 318 questions. The exam includes:

• Standard MCQs
• Sequential case questions
• Scientific abstracts 
• Items with audio or video findings

USMLE Step 2 CK Test Section Weightage

USMLE Step 3 Paper Pattern 

Step 3 is the final exam in the USMLE series that assesses whether a candidate is ready to practice medicine without supervision. Step 3 content mirrors the types of clinical challenges seen in actual practice.

Questions are based on 18 major content areas and include a broad mix of patient demographics (age, gender, culture, occupation). 

USMLE Step 3: Test Section Weightage

USMLE Exam Syllabus 

Candidates can check the USMLE Step 1 syllabus and, USMLE Step 2 syllabus. Here is a brief USMLE syllabus with main topics and key subtopics:

1. General Principles of Foundational Science

• Biochemistry: Gene expression, protein synthesis, enzymes, energy metabolism.
• Cell Biology: Cell cycle, apoptosis, cancer biology.
• Human Genetics: Inheritance patterns, pedigree analysis, gene therapy.
• Tissue Responses: Inflammation, healing, fibrosis.
• Pharmacology: Pharmacokinetics, drug actions/interactions.
• Microbiology: Bacteria, viruses, fungi, parasites, prions.

2. Immune System

• Immune Cells: T cells, B cells, NK cells, APCs.
• Immune Response: Antigen processing, MHC I/II, cytokines, complement system.
• Disorders: Immunodeficiencies, hypersensitivity types, transplant rejection.
• Diagnostics & Vaccines: ELISA, immunoglobulins, vaccine actions.

3. Blood & Lymphoreticular System

• Hematology: RBC, WBC, platelet production, coagulation.
• Disorders: Anemias, leukemias, lymphomas, bleeding/clotting disorders.
• Infections: Lymphadenitis, viral hemorrhagic fevers, malaria.
• Drug Effects: Anticoagulants, chemotherapy, transfusion reactions.

4. Behavioral Health

• Normal: Coping, adherence, stress responses.
• Psychiatric Disorders: Psychotic, mood, anxiety, personality, childhood disorders.
• Substance Use: Alcohol, opioids, cannabis, stimulants.
• Psychosocial Issues: Grief, adjustment, sexual/gender identity.

5. Nervous System & Special Senses

• Neuroanatomy: Brain, spinal cord, cranial nerves.
• Sensory & Motor Systems: Vision, hearing, balance, proprioception.
• CNS Biology: Neurons, glia, neurotransmitters.
• Disorders: Meningitis, encephalitis, neurodegeneration.

6. Skin & Subcutaneous Tissue

• Normal Processes:
• Embryonic & neonatal development
• Structure, barrier & thermal regulation
• Eccrine function & repair across lifespan
• Infectious Disorders:
• Bacterial: Impetigo, cellulitis, anthrax, MRSA
• Viral: Herpes simplex, herpes zoster, measles
• Fungal: Dermatophytosis, candidiasis, onychomycosis
• Parasitic: Scabies, cutaneous larva migrans
• Inflammatory & Autoimmune Disorders:
• Psoriasis, dermatitis, pemphigus, erythema multiforme
• Neoplasms:
• Benign: Nevi, lipoma, seborrheic keratosis
• Malignant: Melanoma, BCC, SCC, Kaposi sarcoma
• Other Disorders:
• Hair/nail/sweat gland disorders
• Oral lesions (aphthous ulcers, leukoplakia)
• Drug reactions & congenital skin diseases

7. Musculoskeletal System

• Normal Processes:
• Organ & cell structure of bones, joints, muscles
• Exercise physiology
• Infectious Disorders:
• Osteomyelitis, discitis, septic arthritis
• Autoimmune/Inflammatory:
• Rheumatoid arthritis, spondyloarthritis, myositis
• Degenerative/Metabolic:
• Osteoarthritis, osteoporosis, gout, rhabdomyolysis
• Neoplasms:
• Osteosarcoma, ganglion cysts, bone metastases
• Trauma & Congenital:
• Fractures, dislocations, scoliosis, Osgood-Schlatter
• Drug Effects:
• Statin-induced myopathy, steroid effects

8. Cardiovascular System

• Normal Physiology:
• Heart structure, conduction, circulation, regulation
• ANP secretion, vascular resistance, endothelium
• Infectious/Inflammatory:
• Myocarditis, bacterial endocarditis
• Arrhythmias:
• A-fib, V-tach, torsades, bradycardia, AV blocks
• Vascular Disorders:
• Aneurysms, thrombosis, varicose veins
• Hypertension & Dyslipidemia:
• Essential/secondary HTN, hyperlipidemia
• Neoplasms:
• Cardiac myxomas, metastatic tumors
• Congenital Defects:
• ASD, VSD, Tetralogy of Fallot
• Drug-Induced:
• Effects from adriamycin, cocaine, CCBs

9. Respiratory System

• Normal Anatomy & Physiology:
• Airways, gas exchange, surfactant, ventilation
• Defense mechanisms and flora
• Infectious Disorders:
• URI, pneumonia (bacterial, viral, fungal)
• TB, bronchitis, sinusitis
• Obstructive & Restrictive Diseases:
• Asthma, COPD, interstitial lung diseases
• Neoplasms:
• Lung cancer types, mesothelioma, nasal polyps
• Vascular & Structural Disorders:
• Pulmonary embolism, edema, ARDS
• Congenital & Drug-Induced Issues:
• Diaphragmatic hernia, oxygen toxicity

10. Gastrointestinal System

• Normal Physiology:
• GI anatomy, motility, hormones, absorption
• Liver, pancreas, salivary glands, and defense
• Infectious Disorders:
• C. difficile, E. coli, hepatitis A–E, parasites
• Autoimmune/Inflammatory:
• Celiac, IBD (Crohn’s, ulcerative colitis)
• Neoplasms:
• Oral, esophageal, gastric, colorectal cancers
• Disorders by Region:
• GERD, ulcers, IBS, appendicitis, hemorrhoids
• Liver: Cirrhosis, hepatitis, portal hypertension
• Pancreas: Pancreatitis, cysts, insufficiency
• Congenital & Drug-Induced:
• Pyloric stenosis, Meckel’s diverticulum
• NSAID ulcers, acetaminophen hepatitis

11. Renal & Urinary System

Normal Processes

• Embryonic development and perinatal changes
• Kidney structure/function: glomerular filtration, hemodynamics, acid-base balance
• Hormones: renin, aldosterone, vasopressin
• Micturition, tubular reabsorption/secretion

Abnormal Processes

• Infections: pyelonephritis, cystitis, tuberculosis
• Immunologic disorders: IgA nephropathy, lupus nephritis
• Neoplasms: Wilms' tumor, renal cell carcinoma
• Renal failure: AKI, CKD, ESRD
• Calculi: renal/ureteral stones
• Congenital anomalies: horseshoe kidney, hydronephrosis
• Drug effects: NSAIDs, aminoglycosides, lithium

12. Pregnancy, Childbirth & the Puerperium

Normal Processes

• Fertilization, implantation, embryonic development
• Labor and delivery
• Lactation, puerperium

Abnormal Processes

• Prenatal care: screenings, Rh isoimmunization
• Obstetric complications: ectopic pregnancy, gestational diabetes, preeclampsia
• Labor complications: shoulder dystocia, cord prolapse
• Puerperal issues: postpartum hemorrhage, uterine atony
• Neonatal disorders: SIDS, respiratory distress, hypoglycemia
• Drug effects: teratogens, prenatal radiation

13. Female Reproductive System & Breast

Normal Processes

• Ovulation, menstrual cycle, puberty
• Breast development and function

Abnormal Processes

• Infections: PID, vaginitis, STIs
• Neoplasms: cervical, ovarian, endometrial cancers
• Menstrual disorders: amenorrhea, PCOS, dysmenorrhea
• Fertility: ART, tubal factors, Turner syndrome
• Menopause, sexual dysfunction
• Drug effects: SSRIs, hormone therapy

14. Male Reproductive System

Normal Processes

• Spermatogenesis, puberty
• Genital and prostate function

Abnormal Processes

• Infections: prostatitis, STIs
• Neoplasms: testicular and prostate cancer
• Sexual dysfunction: ED, premature ejaculation
• Congenital disorders: hypospadias, Klinefelter syndrome
• Drug effects: finasteride, antipsychotics, alcohol

15. Endocrine System

Normal Processes

• Structure and hormones of pituitary, thyroid, adrenal, pancreas
• Hormone synthesis and metabolism

Abnormal Processes

• Diabetes mellitus (types 1, 2, complications)
• Thyroid disorders: hypo/hyperthyroidism, thyroid cancer
• Adrenal disorders: Addison's, Cushing’s, pheochromocytoma
• Pituitary disorders: prolactinoma, gigantism, SIADH
• Congenital/endocrine neoplasia (MEN syndromes)

16. Multisystem Processes & Disorders

Normal Processes

• Nutrition and metabolism
• Electrolyte/water balance
• Intracellular storage disorders

Abnormal Processes

• Infections: Lyme, TB, rickettsial diseases
• Inflammatory: SLE, vasculitis, sarcoidosis
• Paraneoplastic syndromes
• Amyloidosis, hemochromatosis
• Environmental: radiation, chemical exposure

17. Biostatistics, Epidemiology/Population Health & Medical Literature

• Study design and selection
• Screening principles and interpretation
• Diagnostic test evaluation
• Error types and bias
• Statistical measures: sensitivity, specificity, predictive values
• Epidemiologic measures: incidence, prevalence, mortality rates
• Critical appraisal of clinical studies
• Risk assessment and decision analysis

18. Social Sciences

• Medical ethics and jurisprudence
• Consent, confidentiality, advance directives
• Cultural competence and health disparities
• Public health systems and preventive medicine
• Health economics: insurance types, access to care
• Patient safety and quality: root cause analysis, error reduction
• Communication and teamwork in healthcare settings

Thinking about long-term goals? Here's what you can expect to earn after residency. Check the average doctor salary in USA.

USMLE Results & Scoring 

The USMLE exam results are reported as either ‘Pass’ or ‘Fail’ for each Step. There is no fixed percentage required to pass or fail. The USMLE sets a minimum passing standard each year, and this standard is reviewed regularly and may change over time. So it is important to check the USMLE website for updates.

Usually, you need to answer about 60% of the questions correctly to pass, although this can vary slightly depending on the exam version and the specific Step you are taking.

USMLE Scores Timeline

The USMLE test scores are usually released 2 to 4 weeks after the test. In some cases, results may take up to 8 weeks due to extra checks or delays. The USMLE sends an email notification when the score is available on the official portal. Candidates can check and download their scores for up to 365 days after the scores are released. 

How to Send USMLE Scores?

Candidates can request a transcript via FSMB to send their scores to others, such as ERAS or a third party. All candidates need to pay a fee to send their scores to others. One can request that the results not be used in research reports, but he/she must inform USMLE 30 days in advance.

Score Recheck

Candidates can request a score recheck within 90 days of getting their result, but score changes are extremely rare.