This AMA resource is designed to provide insight on questions that might arise as medical students prepare for medical school exams.
Who should read: Students in their first through fourth years of medical school.
Why it matters: Medical students face several critical exams throughout their training that are essential for graduation, residency applications and licensure.
The United States Medical Licensing Examination (USMLE®) is a three-step exam sponsored by the Federation of State Medical Boards and the National Board of Medical Examiners (NBME), passage of which is required for medical licensure in the U.S.
The Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) is the licensing exam administered by the National Board of Osteopathic Medical Examiners for graduates of osteopathic medical schools.
Both the USMLE and COMLEX exams demonstrate a student's readiness to practice medicine safely and effectively.
National Board of Medical Examiners (NBME) Subject Exams, often called shelf exams, assess students’ knowledge of clinical subjects during rotations. These exams are an important factor in evaluating clerkship performance.
Explore insights on these exams and AMA resources to help you prepare.
- What is the USMLE and how is it structured?
The USMLE is a three-step test, and successfully passing all steps is necessary to obtain a medical license in the United States. These exams assess ability to apply medical knowledge and clinical skills necessary for patient care.
- Step 1: Taken after completing the pre-clerkship curriculum, Step 1 assesses the basic sciences taught in the first and second years of medical school.
- Step 2 CK: Generally taken after concluding clinical rotations, Step 2 CK assesses knowledge and application of the basic clinical sciences taught during the core clinical rotations.
- Step 3: Generally taken after the first year of residency, this comprehensive exam tests more in-depth clinical knowledge and decision-making.
- What is the passing score for USMLE exams?
The minimum passing standards for the USMLE vary by exam:
- Step 1: Reported as pass/fail.
- Step 2 CK: Requires a minimum passing score of 218.
- Step 3: Requires a minimum passing score of 200.
- Where can I find USMLE tips and practice questions?
When planning your USMLE study strategy, consider which learning methods are most effective for you. Use comprehensive and subject-specific review books, formal prep courses, and print or online question banks. Seek guidance from your medical school’s academic support office, and use practice exams and other self-assessment tools.
For Step 1, practice questions should be a core part of your study plan. Since Step 2 is largely rooted in your knowledge of clinical medicine, use your performance on shelf exams to identify areas for improvement. For Step 3, complement question-based practice with real-world cases.
AMA provides test prep discounts on the USMLE and advice to support you, including:
- USMLE Step 1 FAQs on effective study strategies.
- USMLE Step 2 FAQs to help maximize your score.
- USMLE Step 3 FAQs covering timing and preparation.
- A 10% discount on the AMBOSS Library subscription and a Qbank with over 11,000 questions.
- 25% off any Sketchy Medical plan, a visual learning platform frequently used for USMLE prep.
- How much do med school exams cost?
General costs of registration fees for common exams include:
- Medical College Admission Test (MCAT): $355.
- USMLE Step 1: $695 for U.S. students; additional regional fee for testing outside the U.S. and Canada.
- USMLE Step 2 CK: $695 for U.S. students; additional regional fee for testing outside the U.S. and Canada.
- USMLE Step 3: $995, regardless of location.
- COMLEX Levels 1: $745.
- COMLEX Levels 2: $745.
- COMLEX Level 3: $950.
- What is the COMLEX and how is it different from the USMLE?
Osteopathic medical students are required to pass the COMLEX-USA Level 1 and Level 2 licensing exams to graduate with a doctor of osteopathic medicine (DO) degree.
The exam is a three-level sequence that tests knowledge and skills in two dimensions: Dimension 1 addresses the patient presentation and Dimension 2 addresses physician tasks.
- Level 1: Typically taken after the second year of medical school.
- Level 2: Usually taken during the third or fourth year of medical school.
- Level 3: Typically taken during residency.
Both the COMLEX-USA and USMLE exams cover similar subjects, but COMLEX-USA contains extra material related to osteopathic manipulative medicine (OMM). Although the USMLE isn’t part of the required path for DO licensure or graduation, many DO students take it to enhance residency opportunities.
- How do COMLEX scores factor into osteopathic residency applications?
For osteopathic medical students, COMLEX-USA scores play a role in determining or assessing options for residency programs during the residency selection process, though it varies heavily by specialty.
The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to accept performance data on both the COMLEX-USA and USMLE exams in candidate evaluation.
Where can I find COMLEX practice material?
Study strategies for COMLEX-USA include review materials and practice exams as well as test prep courses or study groups. Question banks such as those offered by UWorld and other test-prep vendors are a helpful methods of exam preparation.
AMA members receive a discount on COMLEX test prep materials. In addition, AMA and AMBOSS have teamed up to give student members an exclusive 10% off the AMBOSS Library and Qbank add-ons.
- What are shelf exams and when do students take them?
NBME Subject Exams, or shelf exams, are a key assessment of how students understand concepts covered during their clinical clerkship. Students take shelf exams at the end of each core clinical rotation during medical school. The required study time for a shelf exam is highly individualized.
Shelf exams are not required for licensure and are not directly reported to residency programs.
How are shelf exams scored and how do they affect my grades?
Most medical schools use scaled or percentile scores to compare student performance. Scoring methods differ by school, so check your institution’s policy or consult your advisor.
While residency programs generally do not see your individualized shelf exam scores, the value of academic and clinical performance matters when it comes time to residency selection. Good shelf exam performance showcases clinical knowledge and work ethic.
- How should I prepare for shelf exams?
Start preparing for shelf exams early in your rotation. If your schedule allows, incremental study is helpful for both shelf exams and clinical interactions.
Between question banks, practice questions, review books and online tools, there’s no shortage of study materials to prep for shelf exams. Take advantage of your medical school’s resources, review guides and lecture handouts highlighting locally emphasized content.
AMA members can save 10% on an AMBOSS Library subscription, a medical education reference designed to adapt to your learning style and clinical needs. AMBOSS’ NBME Shelf exam resource helps learners prepare for the end-of-clerkship exam, with more than 1,200 articles and over 3,500 challenging Qbank questions.
Test anxiety can be high for some medical students. Maintaining a deliberate wellness and time management routine can protect your study time and help you get on track. If your medical school test anxiety affects both your performance and your mental health, it’s important to engage in support.
