USMLE Exam 2024: Syllabus, Eligibility & Scoring

What is the USMLE Exam?

United State Medical Licensing Examination, or USMLE, is a necessary milestone to pass for acquiring a medical license to practice in the US. It's a three-step process that examines a physician's ability to provide safe and effective patient-centric care. Owned by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), the USMLE program analyzes the application of knowledge and concepts to offer comprehensive medical care to patients. 

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For assessment purposes, the one-national assessment program includes expert test committees with Liaison Committee on Medical Education (LCME) accredited alumni, biomedical scientists, and educators. These specialists in the medical field have drafted the USMLE exam syllabus. With the highest professional assessment standards, the USMLE exam checks the physicians' eligibility to get an allopathic medical license.

How to Register for USMLE? 

The registration process for the USMLE exam is straightforward. The program offers three entities for submitting the application. These comprise the National Board of Medical Examiners (NBME), the Federation of State Medical Boards (FSMB), and the Education Commission for Foreign Medical Graduates (ECFMG). 

The candidates must enroll for the test through two channels, i.e., NBME and ECFMG, for Step 1 and Step 2 of the USMLE exam if the students have graduated from LCME or  Commission on Osteopathic College Accreditation (COCA)-accredited medical programs in the US or Canada, they've to opt for NBME. However, for foreign graduates attempting the exam from outside the US or Canada, ECFMG is the right channel to apply through. 

For Step 3, i.e., the final milestone, USMLE requires registrations through the Federation of State Medical Boards (FSMB). 

USMLE Exam Pattern & Eligibility 

The USMLE exam is designed to analyze the abilities and comprehension of students at different stages during medical education. For this reason, all the aspiring students need to participate in the three steps, I.e., Step 1, Step 2 (Clinical Clinical Knowledge and Skills), and Step 3. 

USMLE Step 1  Exam

Eligibility Criteria for USMLE Step 1  Exam

• An enrolled or a graduate medical student in the US or Canadian medical program pursuing an MD degree with LCME  accreditation, or
• An enrolled or a pursuing graduate student in the US medical school leading to a COCA-authorized D.O. degree, or
• An enrolled or pursuing graduate student in a foreign medical school (outside the US and Canada), which the World Directory of Medical Schools recognizes as meeting eligibility conditions of ECFMG.  

Appearing Stage during Medical Education: After the second year 

Test Pattern

The first test, i.e., USMLE Step 1, aims to analyze the candidates' mastery of sciences and competence for lifelong learning. In this one-day examination, the students must answer multiple-choice questions in seven 60-minute blocks. The applicants have to sit for the eight-hour testing duration with 15 minutes allowed break before every block. 

Minimum Passing Score for Step 1: Reported as Pass/Fail (For candidates appearing after January 26, 2022)

USMLE Step 2 Exam

Appearing Stage during Medical Education: After the fourth year 

Eligibility requirements for Step 2: Same as Step 1 

Test Pattern

Step 2 analyzes the candidates' ability to apply prompt medical knowledge depending on the patient's condition. The one-day examination with eight 60-minute blocks checks the applicant's understanding of the patient-centric concept application. During the nine-hour testing duration, the appearing students have to answer multiple choice questions on surgery, pediatrics, etc. 

Minimum Passing Score for Step 2 CK: 214 

USMLE Step 3 Exam

Qualification Requisites for Step 3

• Passing scores in both the previous steps 
• An MD degree or D.O. degree from an LCME or COCA-authorized US or Canadian school for medical studies, or the equivalent of the M.D. degree from a foreign medical school mentioned in the World Directory of Medical Schools fulfilling ECFMG eligibility requirements and obtain certification of ECFMG, 
• Meeting other eligibility essentials as released by USMLE from time to time. 

Appearing Stage during Medical Education: After the first year of residency 

Test Pattern

Step 3 is the pivotal test for candidates to clear for practicing medicine in the US. It checks the performance of the graduates in the biomedical and clinical science domains. It aims to understand the applicant’s knowledge of unsupervised medicine practice, focusing on ambulatory patient management services. 

The expert panel prepares the test to gauge the candidates’ ability through data-based situational questions. 

Minimum Passing Score for Step 3: 198 

Depending upon their medical knowledge, the candidates can appear for the Step 1 and 2 tests in any sequence they want. However, both exams have to be cleared before attempting Step 3. Moreover, since these exams consider the comprehensive expertise and understanding of the subject, a re-test isn’t allowed once passed.

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Syllabus 

All USMLE examinations are designed based on a content outline created by medical experts from all domains. Depending upon the requirement in the medical field, the team adjusts the content structure along with the USMLE examination pattern. 

The exhaustive content outline makes the USMLE syllabus include 18 major areas to prepare for in different subjects. Most of the test items or questions in Steps 1 and 2 revolve around analyzing the medical knowledge and the physicians' competency. The USMLE Step 3 exam syllabus carries comprehensive medical content for the physicians to deliver expert clinical assistance in the actual practice of medicine. 

USMLE Step 1 exam syllabus 

General Principles 

It consists of the following:

• Biochemistry and molecular biology 
• Biology of cells 
• Human development and genetics 
• Biology of tissue response to disease 
• Pharmacodynamic and pharmacokinetic processes: general principles 
• Microbial biology 
• Normal age-related findings and care of the healthy patien

Blood & Lymphoreticular/Immune Systems 

• Normal processes
• Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis

Behavioral Health & Nervous Systems/Special Senses 

• Normal Processes involving psychodynamic and behavioral factors, adaptive responses, etc 
• Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis including psychotic, childhood, sexual, and gender identity disorders, etc. 

Musculoskeletal, Skin & Subcutaneous Tissue 

• Normal processes involving embryonic development, fetal maturation, skin defenses, organ structure, etc 
• Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis of infectious disorders, bone metastases, etc

Cardiovascular System 

• Normal processes involving development, organ structure, cell tissue function, repair, and changes in life 
• Abnormal Processes, including neoplasms, heart failure, ischemic heart diseases, etc

Respiratory System  

• Normal processes involving airway structure and function, pulmonary mechanisms, cell structure, etc. 
• Abnormal processes, including upper respiratory infections, tonsillitis, malignant and benign neoplasms, and more

Gastrointestinal System 

• Normal processes involving anatomy of the alimentary canal, intestines, endocrine, and neural regulatory functions, etc
• Abnormal processes include bacterial, viral, and fungal infections, etc.

Renal/Urinary Systems

• Normal processes that comprise kidney functions, renal mechanisms in acid-base balance, repair and regeneration, etc. 
• Abnormal processes including infection in specific locations, tubular interstitial diseases etc. 

Reproductive & Endocrine Systems 

• Female structure, hormonal system, reproductive system etc. 
• Diseases and management related to breasts, reproductive systems, neoplasms, fertility, menopause, menstrual disorder etc.

Multisystem Processes & Disorders 

• Normal processes consisting of nutritional processes, water metabolism, intracellular accumulations etc.
• Abnormal processes involving Kawasaki diseases, parasitic disorders, neoplasms and related disorders. 

Biostatistics & Epidemiology/Population Health 

• Population health, including measures of disease frequency, survival analysis, demographic changes
• Study designs and types of selection studies 
• Measures of association
• Principles of testing 
• Correlation and regression 
• Distribution of data 
• And more

Social Sciences: Communication and Interpersonal Skills 

• Communication and interpersonal skills involving patient interviewing, consultation, and interaction

Use of interpreter or surrogate

USMLE Step 2 Syllabus 

The USMLE Step 2 syllabus contains two more specifications on top of the USMLE Step 1 syllabus. It includes: 

Pregnancy, Childbirth & the Puerperium 

• Normal processes involving pregnancy fertilization, implantation, etc.
• Abnormal processes involving prenatal care, obstetric complications, labor, delivery, etc.

Legal/Ethical Issues & Professionalism/Systems-based Practice & Patient Safety 

• Issues related to medical ethics involving consent to treatment informed and refusal etc. 
• Physical-patient relationship 
• System-based thinking and culture 
• Quality improvement
• Patient safety 
• Health care economics 

USMLE Step 3 Syllabus

The USMLE 2 exam syllabus carries different components to understand the physicians' ability to perform unassisted medical functions. In addition to the complete syllabus from Steps 1 and 2, the scenarios and setting-based questions consist of specifications, including the site of care, such as: 

• Ambulatory assistance, ie. In-office/health center, home care, outpatient hospice, and ambulatory surgical center. 
• Inpatient facilities, ie. Hospital, ICU, acute rehab facility, etc 
• Emergency department 
• Clinical Encounters critical to patient-physical interactions

USMLE Scoring 

The USMLE exam provides a recommended pass or fails result with all the Steps. The passing level is periodically reviewed by the expert team consisting of scientists and medical educators. 

In each Step, the passing percentage varies every year. However, each candidate must correctly answer 60% of the items to surpass the passing mark. In addition, the performance of case simulations in Step 3 determines the potential to pass the test. 

The USMLE exam scoring committee undertakes various steps to ensure the accuracy and veracity of the scores by: 

• Electronic delivery of scores to NBME 
• Analysis for aberrant examinee response behavior 
• Final quality assurance procedures 
• Availability of score reports on a secure website 

The scores are usually available after two to four weeks before the date. The notification is sent to each candidate's registered email address.