Early in your medical school career, you will likely hear suggestions from teachers and older students that studying for your medical licensure exams is a rigorous ordeal. The most common licensure exam is the USMLE, and medical students often spend months, or even years, of their lives to study for all the steps of the exam.
Fortunately, this doesn’t need to be a huge roadblock to success in your medical career. If you’ve wondered what is the USMLE and you are looking for resources to make your studying more efficient, read on for some tips in mastering your medical licensure exams.
What is the USMLE?
The United States Medical Licensing Examination (USMLE) is a three-step exam for medical licensure in the United States. This test uses a combination of standardized questions and assessment scenarios to assess a medical student’s skills, abilities, and attitudes in real life, patient-focused situations.
To become licensed to practice medicine in the United States, a student must pass all three steps of the USMLE, and some steps consist of both multiple-choice and clinical evaluation portions. Although you can take the Step 1 and Step 2 exams in any order, you must pass both Step 1 and Step 2 exams before you are eligible to sit for the Step 3 exam. Generally, you must pass all three steps of the USMLE within seven years to become licensed, though there are exceptions in some cases.
The first task that will help you score highly on the USMLE is to get familiar with the test structure. The USMLE step tests are long, exhausting exams, so you should prepare for the mental stamina of these exams in addition to knowing the content.
Here is a brief overview of the USMLE step examination structures:
- Step 1 – This exam evaluates a student’s ability to apply basic science concepts that serve as the foundation of health, disease, and the practice of medicine. Test takers will complete up to 280 test multiple-choice questions over seven 60-minute blocks; the entire exam must be completed in one day and lasts approximately eight hours.
- Step 2 CK (Clinical Knowledge) – This exam evaluates a student’s ability to provide proper patient care in a clinical setting, with a special focus on disease prevention. Test takers will complete up to 318 multiple-choice questions over eight 60-minute blocks; the entire exam must be completed in one day and lasts approximately nine hours.
- Step 2 CS (Clinical Skills) – This exam evaluates a student’s ability to provide proper patient care through the use of real-world live patient simulations. Ordinarily, this exam involves 12 “patient encounters” over an eight-hour period where the test taker is responsible for evaluating, charting, and diagnosing the patient. However, due to COVID-19, the Step 2 CS testing process is temporarily suspended until at least June 2021.
- Step 3 – This exam evaluates a medical school graduate’s ability to practice medicine unsupervised. The exam is conducted in two parts and given over two non-consecutive days. The Foundations of Independent Practice (FIP) consists of approximately 232 multiple-choice questions given over six 60-minute blocks. The Advanced Clinical Medicine (ACM) consists of approximately 180 multiple-choice questions given over six 45-minute blocks and 13 computer-based case simulations of 10-20 minutes each.
To qualify to sit for any of the USMLE step exams, you must meet all the requirements both at the time of application and on the day of the exam. For example, if you are enrolled in a qualifying medical school at the time of registration but you withdraw before the day of your exam, you will no longer qualify and will not be allowed to test.
For Steps 1 and 2 CK exams, test takers must be:
- Enrolled in a US or Canadian medical school;
- A graduate of a US or Canadian medical school holding an MD or DO degree; or
- Enrolled or a graduate of an international medical school that is listed in the World Directory of Medical Schools as meeting Education Commission for Foreign Medical Graduates (ECFMG) requirements.
For the Step 3 exam, test takers must:
- Hold an MD or DO degree from a US or Canadian accredited medical school or an international medical school that meets ECFMG criteria;
- Pass the Step 1 and Step 2 CK exams; and
- Earn ECFMG certification if you graduate from an international medical school.
Preparing for the USMLE
As with many standardized tests, there is a plethora of resources available to help you study for the USMLE. However, not all resources are created equally – using resources that most closely resemble the actual tests in both structure and content will help you be well prepared.
You’ll also want to stay organized – there is a lot of ground to cover for these tests, so having a structured study plan will help ensure there are no gaps in your preparation.
Building A Study Plan
To ensure you will be properly prepared for all aspects of your exams, start with the following steps:
- Download and review the latest USMLE Test Bulletin of Information that includes general scheduling and retesting information, scoring specifics, and helpful links.
- Download and review the latest USMLE Content Outline to familiarize yourself with the specific topics tested on the exams.
- Download and review the latest USMLE Physician Tasks/Competencies document to familiarize yourself with the tasks that you may be expected to know for the various exams.
Once you have familiarized yourself with the general exam content, you should begin to build a specific study plan for your test based on how much time you have remaining until test day. If you haven’t yet scheduled your exam, it’s a good idea to give yourself at least three months of dedicated studying before test day. Some sources recommend 300-500 total hours of studying, depending on your score goals and familiarity with the content. By dividing the number of hours you’ll need by how many hours you can devote to studying each week, you can determine how many weeks you’ll need to be properly prepared.
Using your calendar of choice, outline a general study plan for each week remaining until test day. For each week, list:
- The blocks (day and time) you plan to set aside for studying throughout that week
- Your general focus area(s) of studying for that week
- Up to 3 short term goals you’d like to accomplish for that week to help you feel prepared leading to test day
Once you have your general study plan outlined, you can begin assigning specific content focus areas to individual study blocks by using study resources available for each test.
USMLE Step 1 Exam
The primary focus of the Step 1 exam is to assess a student’s basic science knowledge as applied to clinical scenarios. Questions on the exam are categorized by medical disciplines, core physician tasks, and individual organ systems. To help examinees as they begin to prepare for the exam, USMLE provides a helpful booklet that describes the overall content description and general information for the test, including percentage breakdowns for each test category.
To perform well on the Step 1 exam, you will need to:
- Be familiar with scientific terms and definitions.
- Learn the core medical concepts for each tested subject area.
- Integrate core concepts with other concepts to make deductions.
- Apply these interlinking concepts to clinical settings in the form of mini-cases.
To do this well, you’ll want to practice test-like questions and perform in-depth review to learn where you have the most opportunity for improvement. There are countless resources – some free and some paid – available in the form of flashcards, sample question banks, content review videos, and full-length practice sets. The National Board of Medical Examiners (NBME) provides some study resources on their website, and the USMLE also provides a Step 1 Sample Question set to get you started.
USMLE Step 2 CK Exam
The primary focus of the Step 2 CK exam is to assess a student’s ability to apply acquired medical knowledge to a variety of patient care scenarios, with a special focus on health advocacy and disease prevention. The USMLE also provides a Step 2 CK content booklet that outlines content breakdowns by category of disciplines, tasks, and systems.
The Step 2 CK exam focuses much more heavily on patient care, so students preparing for this exam should adjust their study habits accordingly. For example, the two most heavily tested competency topics are “Patient Care: Diagnosis” and “Patient Care: Laboratory/Diagnostic Studies”. These two categories account for approximately 30-40% of the exam questions. The Step 2 CK exam also tests legal, ethical, professional, and patient safety issues, which make up approximately 10-15% of the test and are not included on the Step 1 exam.
To perform well on the Step 2 exam, you should follow a similar study strategy to the Step 1 exam, but adjust the content focuses to mirror the most heavily tested topics. You can also download the Step 2 CS Sample Question set from the USMLE website to get a feel for the question style and patterns.
USMLE Step 3 Exam
The primary focus of the Step 3 exam is to assess a physician’s ability to provide unassisted comprehensive medical care to patients. This is the longest of the step exams and will be split over two days – a 7-hour multiple-choice exam on the first day and a 9-hour test on the second day consisting of multiple-choice questions and computer-based case simulations. The USMLE also provides a comprehensive Step 3 content booklet that lists a breakdown of what is tested throughout the exam.
To perform well on the Step 3 exam, you must become familiar with the computerized program that delivers the computerized case simulations. The USMLE provides a detailed tutorial and downloadable resources for Step 3 that include practice case simulations.
On to Test Day
As you continue throughout the process of preparing for the USMLE step exams, you can avoid frustrations, setbacks, and burnout by starting with a solid study plan. The entire preparation process can be a long journey, so start by finding some advocates who can encourage you along the way.
As you work through practice material, be sure to also set aside plenty of time for review and self-assessment. By continuously identifying and working to improve in your areas of opportunity, you can find the most efficient pathway to test day success.