USMLE : UNITED STATES MEDICAL LICENSING EXAMINATION

USMLE BASIC INFORMATION

The United States Medical Licensing Examination is jointly administered by the NBME and LCME. The fundamental purpose of the USMLE is to assess the suitability of a candidate to practise medicine in the United States.

USMLE step 1 assesses your knowledge of pre-clinical subjects. This is important from a pubic health standpoint to make sure that you understand the fundamentals of medicine, such as anatomy and physiology, and disease processes and pathology, and the microbiology of the pathogens that cause disease, and the pharmacology of the medications that you will be using. Many residency program directors give more importance to your step 1 scores as compared to your step 2 scores.

USMLE step 2 CK assesses your knowledge of clinical medicine. You will be tested on your knowledge of medical facts and also your ability to analyze and interpret clinical data. Clinical data includes history and exam findings and results of investigations.

USMLE step 2 CS tests your ability to perform a history and examination under simulated settings, it also tests your spoken English and communication skills, and it tests your ability to competently take patient notes.

The written parts of the USMLE ie step 1 and step 2 CK are administered through the internet. You can take these exams at test centres that are owned by Prometric. These centres are available around the world. Step 2 CS is available only in US centres. Step 3 is available at Prometric centres in the United States. You do not need step 3 to start in a residency program,

If you are a US graduate the first step is to register at the NBME's examination services website. You will need your SS number and your ID. Once you get your ID number and password, you can log into the NBME. Then click the 'Apply for USMLE' link. Have your credit card handy to pay the registration fee. You will then be able to print out the Certification of ID and Authorization Form. Once the photo is affixed and you sign it, you will need to turn it into your medical school's NBME representative. At this point you should register with Prometric for the exam itself.

The procedure for IMGs is different, please see the page on USMLE registration.

USMLE STEP 1

USMLE Step 1 assesses the candidate's level of knowledge in the basic sciences. Mastery of these sciences are crucial to properly understanding clinical medicine. Also future growth of scientific knowledge hinges on adequate knowledge of the basic sciences. For the USMLE step 1, basic sciences that are tested include Anatomy, Histology, Embryology, Physiology, Biochemistry, Pharmacology and Pharmacokinetics, Pathology and Microbiology.

The exam consists of 7 sections of 50 questions each.

To be eligible to take the USMLE step 1, you must be a medical student or a graduate of a medical school program that leads either to an MD degree or a DO degree. It is necessary that your medical school should be accredited by the LCME. LCME is the liaison committee on medical education.

If you are a medical student or a graduate of a foreign medical school, it is essential that your medical school is listed in the International Medical Education Directory.

If you have been dismissed from your medical school for some reason then you cannot take the USMLE.

If you are a US medical graduate or medical student at a school that is not credialled by the LCME, your exam candidacy must be sponsored by a state medical board.

Once you take the USMLE step 1, this starts the clock for the entire USMLE process, because you must finish all three parts of the USMLE within a seven year period of time.

If you fail USMLE step 1, you can re-take the exam any number of times. But be aware that many state medical boards will look disapprovingly at a candidate who has failed one of the steps of the USMLE, even if he or she cleared it later on in a subsequent attempt. Also , future employers may consider that as a disqualifying event.

USMLE Step 1 is vitally important because many residency program directors attach great importance to it, and use it as a yardstick to measure the candidate's intellectual acumen and ability to further his knowledge of medicine, in other words a low score will cast doubts on your 'trainability'. By all means try your best to get a decent score in the step 1 USMLE.

USMLE STEP 2 CK

USMLE Step 2 assesses a candidate's patient centered skills. It specifically measures your knowledge of disease processes and your ability to apply that knowledge in clinical settings. It tests your knowledge and skill in disease prevention and disease management.

USMLE step 2 focuses on your ability to function competently as a resident physician under the supervision of an attending physician. Needless to say this necessitates an adequate and appropriate knowledge of clinical sciences. This includes Internal Medicine, General Surgery, Orthopedic surgery, some Ophthalmology, Otolarnygology, Dermatology, Radiology etc, and also Pediatrics, Obstetrics and Gynecology. You are expected to have the necessary knowledge base, and then you are expected to know how to apply that knowledge to specific clinical situations that are commonly seen in an US general hospital.

The subject matter includes the following:

Infectious and Parasitic Diseases
Tumors and Neoplams
Disorders of the Immune system
Hematological disorders
Psychiatric disorders
CNS diseases
Respiratory Medicine
Nutritional diseases and Gastroenterology
Genitourinary diseases
Reproductive medicine
Diseases of pregnancy, childbirth and puerperium
Endocrinology and Metabolic diseases
Perinatology
Congenital diseases
Injuries and Trauma

You are expected to know the significance of information obtained in history taking and physical examination. You are expected to know what would be most appropriate tests and investigations to order in a given clinical setting. Be aware that knowing a battery of tests is not adequate, you have to know what test would be the most appropriate and cost effective, especially given the cost constraints faced by the health sector. Given the test results you are expected to know how to use the results to decide on an appropriate and safe plan of management.

Remember, one prime purpose of the USMLE is to determine if you can be safely trusted with the health and wellbeing of the American public. To this end, the USMLE strives to make sure that you are capable of the safe practice of medicine. Ethics and hippocratic principles are considered important in the practice of medicine in the United States. You are expected to know the current standards of acceptable physician behavior and conduct when it comes to issues such as confidentiality, boundaries etc.

USMLE STEP 2 CS

USMLE Step 2 CS is without any doubt the most feared part of the USMLE, especially for foreign trained doctors. No matter how competent you are, if you are not familiar with the system in a US clinic, you are at gross disadvantage and be forewarned that no matter how extensive your knowledge base may be, the failure risk is very high. The only way to properly prepare for USMLE step 2 CS is to get a observership at a US family practice clinic, where you can shadow an American physician, and learn the ins and outs of the system. There is no book or software or video or lecture program or any other magic wand that can substitute for this. This is a simple, cold hard fact of life. The better you understand this simple fact and the better you prepare for your CS exam day, the better you will do, and spare yourself unnecessary sorrow and humiliation.

The CS exam itself lasts for 8 hours.There is onsite orientation before the examination is due to start. Be sure to arrive on time. Remember, there is no waiting area for your spouse or family. There is no place to put your luggage. You will be provided with a locker where you can store valuables such as your cellphone, your watch etc. You are not allowed to carry any kind of gadgets into the examination area, and this includes wrist watches of all kinds. If you need a hearing aid or other medical assistive devices, seek permission in advance. Remember to bring a government issued photo ID such as a passport or driving license.

The testing area may look exotic and intimidating to someone who is not familiar with the US healthcare system. If you are familiar with an American Family Practice clinic, you will be right at home, and you may even find the entire process enjoyable. The exam area consists of a group of patient exam rooms, which are equipped with one-way mirrors. The proctors will observe you during the entire process. Outside each room there will be a computer station. You will also find a clipboard , a pen and a paper for taking notes. At the door of the room you will find some basic information about the patient such as vital signs and the reason as to why they are here. Do not get caught up with the fact that these are actors playing the role of patients. Do everything exactly as you would do in a real patient setting.

Remember, you have only 15 minutes for each patient encounter, and you have a total of 12 patient encounters. These are not rare and exotic cases, these are the common conditions you will see at an ordinary US family practice clinic. You may have heard of prior examines claim that the CS is a discriminatory test that aims to kick out IMGs. This is not true. The US healthcare system is in no way discriminatory, it is the most open system in the world, it is just that if you are not familiar with the system, you are at a fatal disadvantage.

You have to know how to introduce yourself properly. Remember to be friendly but professional. You already have the patient's name given on your clipboard. Make a friendly introduction such as "You must be Mrs.Jennings.. I am Dr.Wang.. How are you today?" A good opening line would be something like "So what brings you here to our clinic today?" Remember to shake hands. You must find the chief complaint immediately. Is it headaches? Is it back pain? Once you have the chief complaint, do a quick and focussed history that includes information such as timing, frequency, severity, duration etc. Always ask for allergies, current medications, past history etc, but be careful to tailor everything to fit into the minimal amount of time available. Before you examine the patient, be sure to ask permission, "Mrs.Jennings would you mind if I examine you quickly?" All you have is 15 minutes. Do a five minute history, then a five minute focussed physical examination and then for the last five minutes explain to the patient your impression, the differential diagnosis if any and the investigations that you would like to do. Make sure you answer any questions he or she may have. Be courteous, do not interrupt the patient. At the end be sure to thank the patient, something like "It has been very nice meeting with you Mrs.Jennings and thank you for allowing me to be your doctor." American culture attaches great importance to this kind of courteous behavior. And this is something to remember not just for your exams but also for your future practice as a doctor in the United States. Your patients will love you for it, they are more likely to forgive any errors you make and your staff will sing your praises to everyone they know.

And last but not the least, remember that at the end of the encounter you may be required to type the note on the computer. So if you do not know how to type, you better learn that also before you plunk down more money into the USMLE's already bursting coffers.

If you are an IMG, and you have a heavy accent you would be well advised to attend spoken English classes run by an American born and raised teacher. If there isn't any such classes available, one effective and low cost option is to regularly listen to Voice of America broadcasts and train yourself to speak clearly and coherently in US English.

USMLE SCORING

The computer records your answers during the USMLE STEP 1 and USMLE STEP 2 CK . Your answers are sent to the National Board of Medical Examiners for scoring. Your total number of correct answers are mathematically rendered into a three-digit exam score and also a two digit exam score.

Most exam scores will be in the 140-260 range. The mean score for graduates of US medical schools is 210-230, with a standard deviation of 20. The passing score is 188 on the three digit scale and 75 on the two digit scale. A score of 247 on the three point scale corresponds to 99 on the two point scale.

For USMLE Step 2- CS your ability to collect information from the patient, communication skills and your ability to put together a sensible and coherent patient note will be assessed. The result is reported as a pass or fail.

Especially if you are an IMG, you should definitely target a score of 220 and above. If you can manage a score above 240, you will have a decent shot at the speciality that you wish for. Of course there are other factors that influence a program director's decision.

A high USMLE score accomplishes one thing, it gets you an interview invitation. From there on, it entirely hinges on your interview skills and any contact you have at the residency program where you are applying. If you know someone who works there, like a current resident who can recommend you, or a faculty member who is related to you, that helps a lot. At the interview itself, the program directors and other faculty will mostly assess whether you will get along with them. And my 'getting along' it does not mean brown-nosing. It means you will fit into the system.

The US system works on the principle of responsibility from below up and authority from above down. As the lowest peon in the hierarchy, you will have significant responsibilities on your shoulders, minimal or no authority, and everyone whom you see is your boss in some form or other. You would need to be a better diplomat than the hapless UN representatives at at middle east summit. Life as a resident is incredibly stressful, you will have zero time for your family and everything else, you will be the whipping boy for the professor, the assistant professor, the nurse, the pharmacist, the patient , the patient's ex-husband and everyone else who crosses your path. The trick is to keep smiling, and not get anyone mad at you and survive those three to five years. You are not going to invent a cure for cancer while you are a resident. Your job as a resident is to survive, and not harm any patients and not get any of the faculty mad at you.

At the interview they will try to find out if you have sufficient tact, intelligence, patience and also clinical knowledge to do all that. Convince the program director that you 'enjoy' being busy and 'love' working long hours. Convince him how you are totally in love with the speciality, whether it be internal medicine or psychiatry. It does not hurt to drop hints that you are interested in clinical research, and any research projects that you have done before will be a big plus. Be prepared to discuss those projects intelligently.

But.. like they say, you can cross that bridge when you get there. Right now focus on getting a USMLE score of 240. That should be your objective. Remember, if you pass the USMLE with a low score such as 188, you can kiss all of your medical dreams permanently goodbye. If you fail the USMLE with a dismal score of 187, you are fine, because you can re-take the exam.

Program directors typically rely more on the three digit score, since the equivalence of the score remains the same regardless of the year when you tested whereas the relevance of the two digit score changes with time. For example, a score of 80 was enough to get you into an internal medicine residency fifteen or twenty years back, but right now you wont even get past the front door of a residency program with a score of 80.

Keep in mind that many program directors give more importance to step 1 than to step 2, because that is a pretty good indicator of the type of student you were when you were in medical school. Most students who did well in medical school will do really well in the step 1.

To summarize, aim high, work hard and focus on the USMLE until you ace it.

USMLE REGISTRATION

This USMLE information section is mainly for the benefit of foreign medical graduates who are wondering what to do first to get the USMLE process started.

The first step in the process is to go to this website www.secure2.ecfmg.org/emain.asp?app=iwa and obtain an ECFMG number. Click the link at the bottom of the page that says 'establish an account'. In order to do this, you will need a working permanent email address and you will need a government issued identification such as your passport. When you enter your information make sure that your name matches exactly what is given on your passport.

You will be issued an ECFMG identification number which will be emailed to you within a week or so. Now you can go back to the ecfmg website and log in using your identification number and password. If you already have an ID and a password and they are missing, contact ECFMG Applicant Information Services at (215) 386-5900 for help.

Once you have the ECFMG identification number and password , log into the IWA part of the ECFMG website and file your 'application for ECFMG certification.' Once this is completed and processed, you are ready to file an application for the USMLE examination itself, again on the same website.

The USMLE exam application has an online part, which when completed will take you to the certification of identification form, which will need to be sealed and stamped by the authorized person at your medical school after you fill it out. This form will need to be 'directly mailed' from your medical school to the ECFMG, and not mailed by you. It is no secret that this does not really work at many overseas medical colleges, you probably will need to get that bored and unmotivated guy at your medical school office to put his signature and imperial stamp on your little form (while giving you glances loaded with 'what is in it for me?' ) and then you probably will need to run to the post office and buy stamps and run to the corner store and buy an envelope, and finally it is ready to be 'mailed directly' to the ECFMG.

Remember, you need a printer attached to your computer throughout this process :) and you need a working credit card or a US bank account.

USMLE FAQ

How many times can I attempt the USMLE?

In theory you can attempt it multiple times, but USMLE rules mandate that you should finish all three parts within a seven year span of time.

If I fail, can I retake the USMLE ?

Yes, if you fail, you can retake the USMLE. But if you pass with a low score, you are stuck with it forever and you cannot retake the exam.

What is a passing score on the USMLE ?

On the three point scale, a passing score is 188. On the two point scale a passing score is 75

What kind of score do I need to get a good residency position?

You should aim for something in the vicinity of 240 if you want to make sure you get a good offer. Anything over 220 can still fly. Below 200 life will be really difficult for you.

United States Medical Licensing Examination™ (USMLE™ ) is a joint program of the FSMB and the NBME.

USMLE, FSMB and NBME are not affiliated with this site

The purpose of this website is to provide information that is useful to USMLE candidates around the world, given the huge amount of confusing information that is available. The information provided is not guaranteed to be correct, you are advised to check with the USMLE and the ECFMG for updated accurate information.

47,479 Questions and Answers

CLICK TO SEE SCREENSHOT OF PROGRAM

The Total Review Megacollection is a massive all-in-one software that includes 47,479 questions and answers. This includes Anatomy (4690 questions), Physiology (4599 questions), Biochemistry (4988 questions), Pharmacology (4477 questions), Microbiology (4915 questions), Internal Medicine (9484 questions), General Surgery (4992 questions), Obstetrics and Gynecology (4266 questions), and Pediatrics (5068 questions). There is also a free bonus section on neurology. Check it out now!

The TOTAL REVIEW software is now available for a one-time cost of $147. You can install it on one computer for unrestricted use. No monthly fees are required. And you don't need access to any website or special online facility.

"The USMLE steps 1 and 2 examinations expect the candidate to have extensive knowledge of the entire medical school curriculum."

It is not humanly possible to read everything and retain everything in your memory. You need a faster way to retain what you read. It is not realistic for you to single handedly create study notes for the entire medical school curriculum.

The Total Review gives you a sizable collection of the most important points that you need to know to ace the USMLE. It saves you the trouble of making notes yourself. It helps you overcome your biggest stumbling block, ie how to remember what you read. Get It Now!

"At this Point in YOUR life, You Cannot Afford to Fail

The Years are trickling by.."

No matter what horror stories you may have heard about the USMLE, one thing is for sure- no one who has put his heart and soul into preparing for the USMLE has ever done badly. You need to dedicate enough time, and you must make sure that every minute that you spend preparing does make a difference. If you spend an hour reading 5 pages from Ganong, but you cannot retain the most crucial ten sentences from those 5 pages, the hour was in effect wasted. This is precisely what you must be on guard against. Once you read a 'exam point', you must find a way to remember it. The USMLE-TR software helps you do precisely this. Imagine you are reading a page on the autonomic nervous system. You read it from end to end, and then your friend asks you "what type of fibers are pre-ganglionic autonomic efferents?" Now, if you can recall from that page that those fibers are B-type, you did a good job with your reading. But all too often, the stress of exam prep leads you to overlook those very points that must know cold. Pass this year with a high score.

"How Important is it to Have an Effective Studying Method that imprints information in YOUR Memory?"

Total Review enables you to undertake fast-revision, where you can go through thousands of points in a very short period of time, without worrying about whether you will remember it all. You WILL remember what you learn with Total Review. This is because Total Review uses a very simple neuropsychological learning technique: every point is presented as a question, this immediately puts your brain into 'learn' mode momentarily, and you see the answer a second later when you click the answer button. You will spend around 5 seconds on one exam point, ie you could learn over 700 exam points in an hour. And the "Ask the Question- Think a second - See the answer now" three step rapidfire process makes you learn automatically, even if you don't want to learn. And that is the core of this system- rapidfire revision and learning.

So when you see the question "What is the principal site of mesoblastic hematopoesis?" your brain says "I don't know" and Total Review says "yolk sac" , and your brain says "oh, ok!" and you will remember it at least for the rest of the year!

"You Owe It to Yourself.. Do not Miss out on this

Opportunity to Secure Your Future"

It took us over $150,000 to put together this gigantic collection of USMLE review materials. But we are not going to charge you $150,000 for it. We are not going to charge you even $9,000. Most the the indepth review courses that you attend (check out the prices on google) will cost you at least $10,000 without even including the cost of the flights.

Total Review despite the massive question-answer bank that includes 47,479 question and answer pairs covering everything for USMLE step 1 and USMLE step 2 is available for a modest $47. This comes to a mere 0.01 ¢ per question (one tenth of a cent) ! Get It NOW!

Total Review does have one shortcoming- it does not include pathology. We will include that in the next edition, but for now, Total Review has everything else from the core subjects.

We do realize that not everyone can afford $47, and if your financial circumstances are so extreme that it would be a hardship to pay that , email us and explain why and we may provide you with a discount coupon code to Total Review at our discretion. Please remember that we can only provide a very limited number of these discounts each year, because we do have to pay our authors and software engineers! Good luck with your preparation. You will make it.

"What if You Could Get an Edge Over Your Competitors in this

Life and Death Examination?"

Remember the time you aced an exam in school? Remember how you did something different from your classmates and it gave you an edge over them? TOTAL REVIEW gives you an edge over your competitors.

The experts advise you to read through volume after volume of textbook after textbook and then attend ten thousand dollar courses. Wouldn't it be better to be able to learn and memorize important exam facts easier and for much less expense in time and money? Download Yours Now.

"What would Happen if You Use Total Review Because You Want to Get the Residency Position that You Really Desire?"

Some folks scoff any any approach that is different from the usual 'hammer away until you drop' approach. We respect their opinion. We merely suggest that they should try out TOTAL REVIEW and then tell us how much information they were able to retain for every hour spent using it for the USMLE prep. Imagine for a second that you overcome such hesitations and started using TOTAL REVIEW, just like in the past you have embraced and effectively used new ideas and methods.

"Don't Wait to Buy This Unless You Want to Get Total Review NOW!"

Am I wasting money with this? The TOTAL REVIEW contains over 47479 questions and answers, that is not even including any bonus materials in it. For a mere $47 you are getting permanent access to all 47479 questions and answers, which gives you over 1000 questions and answers for every dollar you spend. You are getting 10 questions and answers for every cent that you spend. Compare that with a once week course that charges you $10000 (plus airfare).

"Don't Stand Up from that Chair Unless YOU are committed to buy YOUR Total Review Now!"

What other information do you want to decide to purchase your TOTAL REVIEW now. The more you sense any doubt in your ability to decide, the stronger grows your certainty that you want to get TOTAL REVIEW, the faster grows your single minded will to use TOTAL REVIEW to enhance your scores in the most cost effective and rapid manner possible. The more the recognition dawns on you that the importance of this lays in the enhanced memorization of crucial study points and faster and more efficacious studying and economization of financial resources available for exam prep you are more firmly committed to getting the TOTAL REVIEW. Get TOTAL REVIEW now.

Imagine the day your scores arrive. You have a wise decision that has improved significantly your chances of enhanced remembrance of study facts. You notice that your scores are higher than you expected. You feel that warm sensation of triumph, of hope realized and hard work rewarded. Now think back to the time when you made the decision to use TOTAL REVIEW in your exam preparation..now do you like what you chose?

"Don't Think About this for Too Long Unless You Want to Take a Quick Decision to Get Total Review Now."

TOTAL REVIEW was designed and built to help you memorize the maximum amount of medical facts and information in the least amount of time. Lifejackets make sense in the Lake Michigan. Get TOTAL REVIEW now.

TOTAL REVIEW is a great tool because it helps you memorize vast amounts of information that would otherwise be insurmountable. You can appreciate your ability to commit to get TOTAL REVIEW now or you could gain confidence from the decision in your mind to use TOTAL REVIEW today.

You are intelligent. You know what is best for you. You have always known what you want. Get TOTAL REVIEW now. You got into medical school beating thousands of competitors. You have come very far in life. Get your TOTAL REVIEW now. You see the value of TOTAL REVIEW in your overall exam strategy.

Get TOTAL REVIEW , AT JUST $ 47 FOR OVER 47,000 QUESTIONS AND ANSWERS.