Scheme of Examination for USMLE 2016

USMLE Step 1

The test checks the medical students'ability as to if they apply their theoritical knowledge practically. As of 2007, it covers the following subjects, in both systemic (general and individual anatomical characteristics) and procedural (functional, therapeutic, environmental, and abnormality) themes are as follows:

  • Anatomy
  • Physiology
  • Biochemistry
  • Pharmacology
  • Pathology
  • Microbiology
  • Behavioral sciences
  • Interdisciplinary topics, such as nutrition, genetics, and aging

US medical students take Step 1 at the end of the Basic Sciences portion of the curriculum. This is generally after the second year of medical school. This test has a duration of eight-hour and consists of in all 322 objective questions equally divided into 7 sections. This is purely a computer-based exam. As of summer 2008, some questions include audio and video. The time allotted for each section is one hour. The remaining hour is break time. You may choose to have a look at how the exam will be conducted during the 8 hours through a tutorial which is of 15 minutes duration and is optional. These 15 minutes will be included in your calculation of break time. A quality assurance survey is presented at the end, only if some time is left out of the actual 8 hours that are offered.

Scores are reported as a three digit score and a two digit score. But since July 1, 2011 only the 3-digit score is reported on USMLE transcripts. On January 1, 2010, the minimum passing score was raised from 185 to 188. The average score obtained by students in 2011 was 225 with a standard deviation of 22. If the student cleares the test in first attempt, he may not repeat the exam to get a higher score.

The Step 1 score is frequently used in medical residency applications as a measure of a candidate's likelihood to succeed in that particular residency (and on that specialty's board exams). Step 1 score is considered majorly important when it comes to judging of the score by residency program directors for choosing graduating medical students for their residency program. The average score in US was 213 for a Family Medicine and 249 for Plastic Surgery.

The Step 1 exam is widely viewed as the hardest and most important examination a medical student will take during his/her career.

USMLE Step 2

USMLE Step 2 is a test conducted to check the ability of a medical student as to how well he can put into use his medical knowledge, skills and understanding of clinical science which is required at the time of patient care under supervision. US medical students generally take this test when they are into their fourth year of graduation. Step 2 is further divided into two separate exams.

Step 2-CK

USMLE Step 2 CK is a theoritical test which is designed to test clinical knowledge. This is an objective type test consisting of 8 sections containing 44 questions each. The time duration for each section is one hour. The subjects included in this exam are clinical sciences like Medicine, Surgery, Pediatrics, Psychiatry and Obstetrics & Gynecology.

Step 2-CS

USMLE Step 2 CS is a test to assess the practicality in the medical field of the student. In this test, he is to attend patients and interact with them. These patients are simulated ones and are portrayed by actors. Each examinee faces 12 Standardized Patients (SPs) and has 15 minutes to complete history taking and clinical examination for each patient, and then 10 more minutes to write a patient note describing the findings, initial differential diagnosis list and a list of initial tests. Administration of this step started in 2004. The examination is only offered in five cities across the country:

  • Philadelphia
  • Chicago
  • Atlanta
  • Houston
  • Los Angeles

Before 2004, a similar exam, the Clinical Skills Assessment (CSA) was used to assess the clinical skills of foreign medical graduates.

USMLE Step 3

USMLE Step 3 is the final exam in the USMLE series designed to test how well can a student of the medical school put into practice his medical knowledge and understanding of biomedical and clinical science required for the unsupervised practice of medicine. This test, students in US, usually take at the end of the first year of residency. Foreign medical graduates can take Step 3 before starting residency in about ten US states. The city of Connecticut is often chosen for this test as it is free from havoc of simultaneous application for licensure, unlike New York. This step too is divided into two separate parts.

Step 3 is 16 hour examination divided over two-days. Each day of testing must be completed within eight hours.

The first day of testing includes 336 multiple-choice items divided into 7 blocks, each consisting of 48 items. The time allotted for each block to be completed id one hour.

On the second day, the paper consists of 144 objective type questions with options. These are contained in four sections, each section to be completed in forty-five minutes. Approximately 3 hours are allowed for these multiple-choice item blocks. The testing on this day also includes to solve twelve Clinical Case Simulations, where the examinees are required to ‘manage’ patients in real-time case simulations. Examinees enter orders for medications and/or investigations into the simulation software, and the condition of the patient changes. Each case takes 10 − 20 minutes.

Approximately forty-five minutes to one hour is available for break time on each of the two days of testing.