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United States Medical Licensing Examination

Three-step examination for medical licensure in the United States.

The USMLE assesses a physician's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care.

Three steps that put you into the medical industry in the US

9 issues you need to know about USMLE Step 1 Exam

The United States Medical Licensure Exam (USMLE) Step 1, commonly called “the Boards,” is a standardized test that assesses a med student’s ability to apply basic science fundamentals to the practice of medicine. The entire exam has three steps, but the below applies only to Step 1. Students generally take Step 1 following their second year of medical school. The test is administered by the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB).

Below are answers to some of the most common questions about Step 1.

  • 1. What is the Step 1 exam format?

    The Step 1 exam is a computer-based test taken in a single day over an eight hour period. It’s a multiple choice question test that includes seven sections of 46 questions each for a total of 322 questions. One hour is allotted for each of the seven sections. That’s an average of one minute and 18 seconds per question.

    Test takers are allowed 45 total minutes during the test for personal breaks. If you finish any section before the allotted hour is up, you can add that time to your personal break total. Six breaks total are allowed. There is an optional 15 minute tutorial period at the beginning of the exam. If you choose to skip the tutorial you can add the 15 minutes to your total break time.

    During the test, you are only allowed to bring soft foam earplugs into the examination room. Nothing else is allowed – no bags, electronics, phones, or even jackets are allowed. Be sure to check with the exam monitor prior to entering the test room for complete details.

  • 2. How do I apply for Step 1?
    Student or graduates of a medical school in the United States and Canada must apply for the USMLE Step 1 exam with the NBME. Students or graduates of medical schools outside of the U.S. or Canada register with the Educational Commission for Foreign Medical Graduates (ECFMG). Tests are administered by appointment year round.
  • 3. How much does the test cost?
    As of 2015, Step 1 costs $590.
  • 4. What is covered on the exam?

    Step 1 mainly covers basic scientific principles including anatomy, behavioral sciences, biochemistry, microbiology, pathology, pharmacology, and physiology. Interdisciplinary topics covered include genetics, aging, nutrition, immunology, molecular and cell biology, epidemiology, and medical ethics.

    Some questions test your understanding of basic facts and definitions. But the majority deal with your ability to solve problems using basic scientific principles. For example, you’ll be asked to interpret graphs, identify gross and microscopic pathology and normal specimens, and apply concepts and principles relevant to individual organ systems.

  • 5. When should I take the test?
    Most people take the test between their second and third years in medical school, after finishing basic science courses and before a clinical clerkship. Many have success taking it within two months of finishing basic courses because material is still fresh in their minds, combined with an extra month or two of studying.
  • 6. What is needed to pass?
    A score of 192 is needed to pass the Step 1 exam. The average score in 2013 was 228 with a standard deviation of 21.
  • 7. When do I get my USMLE test results?
    Scores for Step 1 are released each Wednesday. It usually takes three to four weeks for scores to be released. You will receive an email from the entity you registered with (NBME or ECFMG) when your score is available. It will also be posted to that entity’s website. If you don’t receive an email within two months, it’s recommended that you contact the registration entity directly. The current pass rate is about 85%.
  • 8. I passed Step 1 but am not thrilled with my score...

    I passed Step 1 but am not thrilled with my score. Can I retake it to raise my score?

    Unfortunately, the answer to this is no.

  • 9. I didn’t pass the first time. Can I retake the exam?
    Yes. You may take the USMLE Step 1 exam a maximum of three times within a 12-month period. Your fourth attempt must be at least 12 months after your first attempt, and at least six months after your most recent attempt.

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United States Medical Licensing Examination

Three-step examination for medical licensure in the United States.

Are you ready for becoming a physician in the US?

Primevest facilitates you all the way in the journey of USMLE and opens your doorway to the medical industry.
Primevest enhances your chance of passing USMLE

Your five steps to begin your medical career.

  • 1.Eligibility
    Candidate who was trained outside US and Canada must be a medical student officially enrolled in, or a graduate of, a medical school who meets the eligibility criteria of the ECFMG. If you are dismissed or withdraw(n) from medical school, you are NOT eligible for USMLE, even if you are appealing the school’s decision to dismiss you or are otherwise contesting your status.
  • 2. Sign up with PrimeVest
    Primevest International provides consultancy services to facilitate candidates to apply, schedule and arrange professional examinations.Candidates may simply focus on exam review and preparation while Primevest will assist with the sometimes tedious and time consuming pre and post examination procedures.Contact us for more information.
  • 3. Apply for the exams
    Primevest International Education provides consultancy services to facilitate candidates to apply, schedule and arrange professional examinations. We also assist with candidates for the practice licenses required in the US. Please contact us for details.
  • 4. Exam prep

    Modes of study

    • Face-to-face lectures
    • High definition live lectures
    • Video lectures

    Program Outline

    Step 1

    • General Principles
    • Hematopoietic and Lymphoreticular Systems
    • Central and Peripheral Nervous Systems
    • Skin and Related Connective Tissue
    • Musculoskeletal System
    • Respiratory System
    • Cardiovascular System
    • Gastrointestinal System
    • Renal/Urinary System
    • Reproductive System
    • Endocrine System
    • Immune System

    Step 2 CK

    • General Principles
    • Infectious and Parasitic Diseases
    • Neoplasms
    • Immunologic Disorders
    • Diseases of the Blood and Blood-forming Organs
    • Mental Disorders
    • Diseases of the Nervous System and Special Senses
    • Cardiovascular Disorders
    • Diseases of the Respiratory System
    • Nutritional and Digestive Disorders
    • Gynecologic Disorders
    • Renal, Urinary, and Male Reproductive Systems
    • Disorders of Pregnancy, Childbirth, and the Puerperium
    • Disorders of the Skin and Subcutane Tissues
    • Diseases of the Musculoskeletal System and Connective Tissue
    • Endocrine and Metabolic Disorders
    • Congenital Anomalies
    • Conditions Originating in the Perinatal Period
    • Symptoms, Signs, and Ill-defined Conditions
    • Injury and Poisoningli

    Step 2 CS

    1) Integrated Clinical Encounter (ICE)

    • Data gathering – patient information collected by history taking and physical examination
    • Documentation – completion of a patient note summarizing the findings of the patient encounter, diagnostic impression, and initial patient diagnostic studies

    2) Communication and Interpersonal Skills (CIS)

    • Fostering the relationship
    • Gathering information
    • Providing information
    • Helping the patient make decisions
    • Supporting emotions

    3) Spoken English Proficiency (SEP)

    • Clarity of spoken English communication within the context of the doctor-patient encounter

    Step 3

    • General Principles
    • Disorders of the Nervous System and Special Senses
    • Disorders of the Respiratory System
    • Cardiovascular Disorders
    • Nutritional and Digestive System Disorders
    • Behavioral/Emotional Disorders
    • Disorders of the Musculoskeletal System
    • Disorders of the Skin/Subcutaneous Tissue
    • Disorders of the Endocrine System
    • Renal and Urinary Disorders
    • Diseases/Disorders of the Female Reproductive System
    • Pregnancy/Labor and Delivery/Fetus and Newborn
    • Disorders of Blood
    • Disorders of the Male Reproductive System
    • Disorders of the Immune System
  • 5. Take the test

    Step 1

    Step 1 assesses students’ understanding and applicability of important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy.

    Step 1 ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning. Step 1 is constructed according to an integrated content outline that organizes basic science material along two dimensions: system and process.

    Step 1 is a one-day examination. The testing day includes 322 multiple-choice items divided into 7 blocks of 46 items; 60 minutes are allotted for completion of each block of test items. On the test day, examinees have a minimum of 45 minutes of break time and a 15- minute optional tutorial. The amount of time available for breaks may be increased by finishing a block of test items or the optional tutorial before the allotted time expires.

    Step 2

    Step 2 assesses whether the candidate can apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision and includes emphasis on health promotion and disease prevention. Step 2 ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills that provide the foundation for the safe and competent practice of medicine.

    Step 2 Clinical Knowledge (CK)

    Step 2 CK is constructed according to an integrated content outline that organizes clinical science material along two dimensions: physician task and disease category.

    Step 2 CK is a one-day examination. The test items are divided into blocks, and test item formats may vary within each block.

    The number of items in a block will be displayed at the beginning of each block. This number will vary among blocks, but will not exceed 45 items. The total number of items on the overall examination form will not exceed 355 items. Regardless of the number of items, 60 minutes are allotted for the completion of each block.

    Step 2 Clinical Skills (CS)

    Step 2 of the USMLE assesses the ability of candidates to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision, and includes emphasis on health promotion and disease prevention. Step 2 ensures that due attention is devoted to the principles of clinical sciences and basic patient- centered skills that provide the foundation for the safe and effective practice of medicine.

    Step 2 CS uses standardized patients to test medical students and graduates on their ability to gather information from patients, perform physical examinations, and communicate their findings to patients and colleagues.

    Step 3

    Step 3 assesses whether the candidate can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. It is the final examination in the USMLE sequence leading to a license to practice medicine without supervision.

    The examination material is prepared by examination committees broadly representing the medical profession. The committees comprise recognized experts in their fields, including both academic and non-academic practitioners, as well as members of state medical licensing boards. Step 3 content reflects a data-based model of generalist medical practice in the United States.

    The test items and cases reflect the clinical situations that a general, as-yet undifferentiated, physician might encounter within the context of a specific setting. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care.

    Step 3 is a two-day examination. You must complete each day of testing within 8 hours.

    Day One

    The first day of testing includes 336 multiple-choice items divided into 7 blocks of 48 items each. There will be 60 minutes of time allowed for completion of each block of test items. Items with an associated pharmaceutical ad or abstract are included in some of these multiple choice blocks. Those blocks that include these item types will contain 46–47 items per block. The timing will remain the same for all blocks.

    There is a maximum of 7 hours of testing on the first day. There is also a minimum of 45 minutes of break time and a 15-minute optional tutorial. Note that the amount of time available for breaks may be increased by finishing a block of test items or the optional tutorial before the allotted time expires.

    Day Two

    The second day of testing includes 144 multiple-choice items, divided into 4 blocks of 36 items. These blocks will take 45 minutes. The total time allotted for these blocks is 3 hours. The second day also includes a Primum® Tutorial and instructions for which approximately 15 minutes are allowed. This is followed by 12 case simulations, for which 4 hours are allotted.

    A minimum of 45 minutes is available for break time. There is an optional survey at the end of the second day, which can be completed if time allows.The timing and structure of the Step 3 testing days may change without notice.

Are you eligible for the USMLE?

Find out now by calling Primevest consultant
Want to know more if USMLE suitable for you?Call us for more details
What Primevest offers?

  • 1.Over 10 years exam prep experience
  • 2.Both online and offline modes of study
  • 3.Thousands of successful cases
  • 4.Quality question bank
  • 5.Customized programs for Chinese students
  • 6.Promising passing rates
  • 7.Hassle free exam application process

It’s All About You
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Our bespoken learning models allow more flexibility and utmost results.


USMLE Preparation Strategies

Once you’ve decided whether you’re going to enroll in a prep course, and which question bank and books you’ll be using to study, you can also begin to practice the following preparation strategies:

  • Start preparing for the USMLE Step 1 the moment you set foot into medical school by using board books as you are taking courses in each subject. For example, while you are studying microbiology, review “Clinical Microbiology Made Ridiculously Simple.”
  • Before any official studying begins, make a schedule that includes breaks and time to eat, as well as days for taking full practice tests. If your schedule isn’t working, change it so you can get to all of these activities — each one is important!
  • Take a practice test early to see where you stand.
  • Complete as many practice questions as you can. Go through your question bank — then go through it again.
  • Be sure to do as many full-length practice tests as possible in a test-like setting to ensure you are finishing blocks in the allotted 60 minutes and preparing your body for a long test day. Prometric Test Centers allow you to take a USMLE practice test for a fee that ranges from $75 to $266, depending on where you are taking it. This practice session is worth every penny. Schedule it at least a month before your actual test date so you have adequate time to sharpen your skills if the test doesn’t go as you hoped.
  • Study what you don’t know. It’s easy to fall into the trap of studying the subjects you’re already confident in, but if you’ve mastered a subject, spend time focusing on areas in which you are struggling.
  • Study with a friend, and use humor and other potential mnemonics to help with memorization. Remember, the amygdala (emotion) is connected to the hippocampus (memory).
  • Take breaks in your study day. Get outside. Exercise.
  • If you are retaking the test, focus your preparation on the areas in which you did not excel. Fortunately, the score report from your previous test provides graphical performance profiles for each testing category that will allow you to see where you need the most work.

Strategies for taking USMLE

When the test day arrives, here are some tips to help you approach the USMLE Step 1 with assurance that you will be successful:

  • Know how to get to the test site, and do a practice run. There is nothing worse than feeling rushed on the morning of the test.
  • Get to the test site at least 30 minutes early, and be sure to have a current picture ID with your signature, along with a printed copy of your scheduling permit.
  • Bring a lunch, snack, and ear plugs.
  • Answer every question. Wrong answers do not count against you.
  • Think of the exam as seven mini-tests — that is, seven blocks of 44 questions each.
  • Focus solely on the block you are in, complete it, clear your mind, and move to the next block.
  • Be sure you have checked all the questions in a block before hitting “end.” Once a block is ended, you cannot re-enter it to review your answers.
  • Gain extra break time by skipping the optional 15-minute tutorial. At this point, you should be so familiar with how the test works that you won’t need the tutorial — but an extra break will be welcome.
  • Decide your plan for breaks ahead of time, and practice the strategy. For example, you could try the following plan:
    • Complete two blocks
    • Take a 10-minute stretch/bathroom break
    • Complete two blocks
    • Take a 30-minute lunch break
    • Complete two blocks
    • Take a 10-minute stretch/bathroom/snack break
    • Complete one block

Or you could decide to complete four blocks, take a quick lunch break, and return to complete the final three blocks. Whatever strategy you choose, perform it over and over on practice tests to simulate the real test environment and train your body to become accustomed to the challenge of a long test day.

Get a great night’s sleep the night before the exam. Anecdotally, students and admissions counselors report that this night of sleep is one of the most important (and easily accomplished) steps you can take to enhance test performance.

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