A Guide to USMLE Licensing Exam

USMLE Licensing Exam Step 1 Exam:

Carrying a weighty relevance to the specialties and location for which a residency applicant is competitive, step 1 of the USMLE Licensing Exam tests a candidate’s ability to apply basic science concepts in medical practice. Subjects tested range from interdisciplinary topics such as nutrition, genetics, and ageing to anatomy, behavioural sciences, biochemistry, microbiology, pathology, pharmacology and physiology.

Often referred to as the most onerous and cardinal test a medical professional will ever sit during his career USMLE Step 1 is a one day examination. It is administered in one, 8 hour testing session and divided into seven 60 minute blocks. Not exceeding 40, the number of questions per block on an examination are expected to vary. In the overall examination there are 280 questions.

The course is constructed by classifying scientific material in two dimensions: process and system. US medical students typically appear for the test after the second year of medical school. If the student passes the exam, he or she may not repeat it to obtain a higher score. Any failed attempt is permanently recorded.

USMLE Step 2 Exam:

Further divided in two sections, step 2 examination is typically attempted by US medical students during the fourth year of medical school. Emphasising disease prevention and health promotion step 2 tests a student or graduate’s provisional skills concerning patient care. They are required to showcase their skills and understanding of clinical science.

The subdivisions of USMLE Licensing Exam Step 2 are as follows:

  • USMLE Step 2 Clinical Knowledge – CK

Divided into eight 60-minute blocks, CK is administered in one 9-hour testing session. Candidates are tested on the basis of knowledge relevant to physician task and diseases. Topics include internal medicine, obstetrics and gynaecology, paediatrics, preventive medicine, psychiatry, surgery, other areas relevant to provision of care under supervision.

  • USMLE Step 2 Clinical Skills – CS

Using standardised patients, Step 2 CS gauges medical students and graduates ability to gather information,, perform physical examinations, and communicate their findings to patients and colleagues. It is conducted in the cities of Philadelphia, Atlanta, Houston, Los Angeles and Chicago.

USMLE Licensing Exam Step 3 Exam:

After passing the Step 2 which is a supervised tests, candidates undergo the final step to obtaining licensure- the USMLE Step 3. Unlike the former this is an unsupervised test conducted within the course of two days.  Candidates are tested on their ability to apply medical knowledge and understanding of biomedical and clinical science for unsupervised medical practice. A special emphasis is laid on patient management in ambulatory settings.

On the first day students are assigned 233 multiple choice items which are divided into 6 blocks comprising of 38-40 items. They are required to finish one block in an hour.  The second day of testing students undertake 180 multiple-choice items, divided into 6 blocks of 30 items with 45 minutes  allotted for completion of each block. This is followed by 13 case simulations, each of which needs to be finished within a maximum of 10 or 20 minutes.

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