USMLE (United States Medical Licensing Examination)

The USMLE is co-sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners. It has three steps, all computer-based and delivered at Prometric test centres:

• Step 1 covers the basic sciences. For exams on or after 14 May 2026 it is fourteen 30-minute blocks of up to 20 questions in one 8-hour session. Since 26 January 2022 it has been reported as pass or fail only.
• Step 2 CK (Clinical Knowledge) tests clinical science. For exams on or after 7 May 2026 it is sixteen 30-minute blocks in one 9-hour session. It is scored on a three-digit scale, with a minimum passing score of 218 for exams from 1 July 2025.
• Step 3 assesses readiness for unsupervised practice, with emphasis on patient management in ambulatory settings. The minimum passing score is 200.

The USMLE describes Step 1 as testing whether you can apply concepts of the sciences basic to medicine, and Step 2 CK as testing the clinical knowledge needed for patient care under supervision. Before the new formats, Step 1 was seven 60-minute blocks and Step 2 CK eight 60-minute blocks.

Every doctor seeking a US medical licence takes the USMLE. For international medical graduates, Step 1 and Step 2 CK form the medical science examination requirement for ECFMG Certification, and you must hold ECFMG Certification to be eligible for Step 3. To be eligible for Steps 1 and 2 CK, your medical school must be listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements.

A Step 1 and Step 2 CK pass, dated within seven years, is also accepted by Ireland's Medical Council in place of PRES Level 2.

1. Open a MyIntealth account and submit the Application for ECFMG Certification, including verification of your medical diploma and transcript.
2. Apply for Step 1 or Step 2 CK through the FSMB USMLE portal. Since January 2026, FSMB manages USMLE registration, score reporting and customer service for international graduates, and checks your eligibility with ECFMG.
3. Schedule with Prometric and sit the exam.
4. After ECFMG Certification, apply for Step 3 through FSMB.

The USMLE lists fees of US$695 for Step 1, US$695 for Step 2 CK and US$955 for Step 3. Testing outside the US and Canada adds a region fee of US$210 for Step 1 and US$235 for Step 2 CK, and the India testing region adds 18% tax. ECFMG charges separately for the certification application.

Results are typically available within four weeks, but the USMLE advises allowing at least eight weeks.

• Attempt limit. Four attempts per Step, including incomplete ones. After four unsuccessful attempts at any Step, you cannot apply for any Step.
• Attempts too close together. No more than three attempts at a Step in 12 months.
• State time limits. Many state boards require all Steps within a set number of years. Check the FSMB website.

See our USMLE guide for international medical graduates.