What is the USMLE®?

The United States Medical Licensing Examination® (USMLE®) is the exam administered by the National Board of Medical Examiners (NBME). The Federation of State Medical Boards (FSMB) and the NBME sponsor the USMLE. The USMLE provides state medical boards with a common evaluation system for licensure applicants. 

As of August 2022, USMLE consists of three separate exams, known as steps.

• Step 1 assesses the basic sciences taught during preclerkship curriculum. 
• Step 2 CK assesses clinical knowledge and skills that can be applied to patient care under supervision. 
• Step 3 assesses in-depth clinical knowledge and decision-making to be able to care for patients independently. 

When is the exam taken? 

• Step 1 is generally taken upon completing the preclerkship curriculum.
• Step 2 CK is generally taken after concluding clinical rotations.
• Step 3 is generally taken after the first year of residency.

Test prep is valuable

Medical students should assess which USMLE exam preparation will work best for their needs. This may include a combination of preparation materials and other resources—such as formal course or subject-specific reviews and practice prep questions—to hone content knowledge as well as familiarity with the USMLE question format. 

Step 1 change to pass/fail score reporting

After substantial discussion from the medical education and licensing communities, Step 1 of the USMLE moved from numerical score reporting to pass-fail scoring only for tests completed on or after Jan. 26, 2022.

“Factors that drove this were a combination of things,” said Daniel Dent, MD, a professor of surgery and medical education at the UT Health San Antonio Long School of Medicine, in a 2022 AMA Moving Medicine video. “The stress of getting a particular score on a test was a concern.”

The previously used three-digit numeric score may have generally contributed to a negative impact on student well-being and diverted medical students from developing other critical competencies such as teamwork and communication skills.

Impact on IMGs

The change to pass/fail scoring may also uniquely impact international medical graduates (IMGs) or applicants from lesser-known medical schools who may rely on high numerical scores during the interview process.

The goal will be for these applicants to ensure their unique attributes are reflected in the other components of the application—which ideally more effectively and comprehensively convey important capabilities as an incoming trainee.

For the most up-to-date information on USMLE, refer to the official USMLE website.

AMA offers discounts on study prep materials for members, as well as a full collection of prep questions and case studies for steps 1 and 2, and step 3. Read more about the benefits of AMA medical student membership.

Other key AMA resources include:

• Study tips for USMLE® or COMLEX-USA®
• FREIDA™, the AMA Residency & Fellowship Database®
• AMA Ed Hub™:
  • Three Things Schools Should Do to Make Advancement Assessment Just
  • Medical Education and Training
• AMA Journal of Ethics:
  • A Critical Review of Standardized Patient Examinations as Part of the USMLE
  • The Role of State Medical Boards

Reviewed by: Sanjay V. Desai, MD, AMA chief academic officer and group vice president of medical education

Reviewed on: Aug. 5, 2022