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The United States Medical Licensing Exam (USMLE) is the exam administered by the National Board of Medical Examiners (NBME). The Comprehensive Osteopathic Medical Licensing Exam (COMLEX-USA) is the licensing exam administered by the National Board of Osteopathic Medical Examiners for graduates of osteopathic medical schools.
Although the USMLE is the required exam for licensure of all allopathic physicians, it may also be taken in place of the COMLEX-USA for osteopathic physicians. The USMLE has many secondary uses by both medical schools and residency programs, including graduation decisions for medical students, promotions and the ranking of residency applicants.
USMLE Components and Scheduling
The USMLE currently consists of 3 separate exams, known as steps. All states require passage of all 3 steps in order to obtain a license to practice medicine.
Step 1 assesses the basic sciences taught during years 1 and 2 of medical school. Most medical schools require students to have taken and passed Step 1 before or shortly after starting clinical rotations. Students usually take Step 1 during the summer between their 2nd and 3rd years of medical school.
Currently, Step 2 has 2 separately administered components, Clinical Knowledge (Step 2-CK) and Clinical Skills (Step 2-CS). Step 2-CK tests knowledge and application of the basic clinical sciences taught during the core clinical rotations, and Step 2-CS tests a student’s basic clinical skills, including physical examination skills, clinical decision-making, note-writing ability and interaction and communication abilities with standardized patients.
Most medical schools and residency programs require the passage of both components in order to graduate and begin the 1st year of residency. Some schools also offer or require their own clinical skills exam, which can prove useful in preparing for Step 2-CS.
Students will often take the 2-part USMLE Step 2 exam toward the end of 3rd year or the beginning of 4th year. Since both exams test the knowledge and skills acquired during rotations in the core disciplines, it is helpful to have those rotations completed before taking the exam.
Step 3 is a more comprehensive exam and tests more in-depth clinical knowledge and decision-making. Because Step 3 covers the core disciplines, it is recommended that you take this exam while your knowledge of these core areas is still fresh. This is especially true for those in more specialized residencies. Additionally, for those seeking to obtain their medical license in order to moonlight during residency, or for military residents preparing for an operational tour, Step 3 can be taken as early as the beginning of internship year.
When deciding how to study for all steps in the USMLE, consider which learning techniques are most effective for you. Preparation materials for Step 1, Step 2-CK and Step 3 include comprehensive review books, subject-specific review materials, formal review courses, and written and electronic question banks.
- Step 1 consists of approximately 308 multiple-choice questions divided into 7 1-hour blocks given over an 8-hour period.
- Step 2-CK consists of approximately 350 multiple-choice questions divided into 8 1-hour blocks given over several hours.
- Step 3, given over 2 days, consists of approximately 450 multiple-choice questions. The 1st day features 256 questions divided into 6 blocks of 42-43 questions with each block running 60 minutes. The 2nd day consists of 198 multiple-choice questions divided into 6 blocks of 33 questions. In addition, there are 13 case simulations of 10-20 minutes each.
Most students need a combination of both review materials and practice questions to improve their content knowledge and familiarity with question format. Some of the most popular review books include First Aid for the USMLE, High Yield Comprehensive USMLE Review and Kaplan Medical USMLE Q Bank series.
The USMLE also has multiple exam preparation resources for students, including information on test format, practice questions and review materials. Additionally, most medical schools will offer practice exams for students to measure where they are in their preparation.
The AMA offers a discount on study prep materials for members.
Special Testing Accommodations
The NBME provides testing accommodations for students with documented disabilities. After registering for an exam, a student can submit a written request for testing accommodations to the NBME. This request must include a request form, a personal statement written by the applicant and all relevant and required documentation. A separate request form and information can also be found on the NBME website for women who need breastfeeding accommodations during the exam.
Administered by the National Board of Osteopathic Medical Examiners (NBOME), the Comprehensive Osteopathic Medical Licensing Exam (COMLEX-USA) can be taken by osteopathic medical students in place of the USMLE. The test is designed to assess the osteopathic medical knowledge and clinical skills considered essential for osteopathic generalist physicians to practice medicine without supervision.
The exam is a 3-level sequence that tests knowledge and skills in 2 dimensions. Dimension 1 addresses the patient presentation, while Dimension 2 addresses physician tasks. COMLEX-USA scores are reported numerically for Level 1, Level 2-CE and Level 3, while Level 2-PE is scored as pass/fail. Score reporting typically takes 8 to 10 weeks but can take up to 14 weeks during the initial 3 - 4 months of computerized testing.
Find more information on the COMLEX-USA, including registration, testing schedules, practice materials and answers to frequently asked questions.