In many ways, licensing exams are gatekeepers for the medical profession. They assess a physician's ability to apply knowledge, concepts and principles to provide safe and effective patient care.
The United States Medical Licensing Examination (USMLE®) is a three-step test 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.
The USMLE has many secondary uses for medical schools and residency programs, including informing decisions on graduation, promotions and the ranking of residency applicants. And while it is the required exam for licensure of all allopathic physicians, it may also be taken in place of the COMLEX-USA for osteopathic physicians.
Check out these expert insights on the exams and how to prepare for them.
First, some useful USMLE background
The USMLE consists of three separate exams, known as steps. All states require passage of all three steps to obtain a license to practice medicine.
USMLE Step 1
The first of the USMLE tests assesses the basic sciences taught during the first and second years 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 second and third years of medical school.
Get answers to seven key questions about USMLE Step 1’s move to pass-fail, and learn more about USMLE Step 1.
USMLE Step 2
The next test assesses knowledge and application of the basic clinical sciences taught during the core clinical rotations, hence it is known as Step 2 CK. There had been a corresponding Step 2 test of clinical skills, but that was eliminated in 2021.
Most medical schools and residency programs require students to pass Step 2 CK to graduate and begin the first year of residency. Students will often take the Step 2 exam toward the end of their third year or the beginning of their fourth year of medical school.
Get more help with USMLE Step 2.
USMLE Step 3
Taken during residency, the final test in the series 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 it while your knowledge of these core areas is still fresh.
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.
Check out additional resources on USMLE Step 3.
The osteopathy equivalents
The COMLEX-USA can be taken by osteopathic medical students in place of the USMLE, though many DO students opt to take both. 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 three-level sequence that tests knowledge and skills in two dimensions. Dimension 1 addresses the patient presentation, while Dimension 2 addresses physician tasks. COMLEX-USA scores are reported as pass-fail for Level 1, numerically for Level 2-CE and Level 3, while Level 2-PE is scored as pass-fail. Score reporting typically takes eight to 10 weeks but can take up to 14 weeks during the initial three-four months of computerized testing.
Find out what COMLEX Level 1’s switch to pass-fail means for DO students.
Look here for more information on the COMLEX-USA, including registration, testing schedules, practice materials and answers to frequently asked questions.
Know where to look for help
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.
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 and Kaplan Medical’s USMLE Step 1 Qbook.
The USMLE also has multiple exam-preparation resources for students, including information on test format, practice questions and review materials. Additionally, most medical schools offer practice exams for students to measure where they are in their preparation.
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Note any special testing needs
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.
And don’t forget these study tips
Kaplan is the AMA's preferred provider to help you succeed with the USMLE or COMLEX-USA tests. Here is advice from Kaplan Medical on preparing for the USMLE or the COMLEX-USA.
Use study guides
For starters, find the types of study guides that work the best. Then, ask recent test takers about the study guides that worked well for them.
Get ready for your USMLE Step 1 and 2 exams with USMLE practice questions from the AMA. Take advantage of our full collection of sample USMLE questions, case studies and more to help you prepare for Step 1 and Step 2 of the USMLE.
Lastly, become an AMA member to get discounts on study guides and exam prep courses.
Save on Kaplan test prep
AMA members save 30% on Kaplan’s Qbank and High-Yield courses. If you’re an AMA member, Kaplan also provides free access to tools for pre-clinical studies, including Kaplan’s Lecture Notes series, Integrated Vignettes, Shelf Prep and more. Find more information by calling (800) KAP-TEST or visiting Kaplan Medical (AMA members only).
Get one month Until Your Test™ access to more than 2,200 questions in Kaplan’s Qbank review or the High-Yield course featuring on-demand online lectures. Use Kaplan’s innovative student tools available to prepare for and pass your medical licensing exams.
Create a calendar
First, create a week-by-week subject calendar and break down the calendar into study sprints, focusing on one subject during each sprint. Then assign specific tasks for each sprint—for example, watch video tutorials or review sample questions covering high-yield topics. Lastly, schedule a specific number of study hours each week, allotting extra time for more challenging topics.
Find the right study partner
Choose a motivating study partner—someone to supplement your expertise and hold you accountable. Then set up a regular weekly study session with your partner. Review what you have learned and what you need to learn.
Also, find a study-session location that enables extended periods of concentration and manage your time wisely:
- Incorporate exam preparation into class studies.
- Aim for five hours of focused exam preparation each week.
- Limit social media.
- Make sure cellphones are off during study times.
Check out these four essential tips for your final weeks of USMLE Step 1 study.
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