USMLE: Step 1, Step 2 CK and Step 3 Explained
USMLE is the three-step examination sequence used in the United States to assess whether a physician can apply the knowledge and skills needed for safe, unsupervised patient care. Students at US medical schools and international medical graduates both take the same examinations, but their eligibility is established through different routes.
Published 2026-02-18 · Updated 2026-09-12 · Last verified 2026-09-12 · Medically reviewed 2026-09-12
Answer in brief
The USMLE has three steps. Step 1 assesses foundational sciences and is reported as pass or fail. Step 2 Clinical Knowledge assesses clinical science and is numerically scored. Step 3 is usually taken during residency. Students at LCME-accredited schools register through the NBME; international medical graduates register through ECFMG.
The three steps
| Step | What it assesses | Usual timing |
|---|---|---|
| Step 1 | Foundational sciences applied to medicine; reported pass/fail | During medical school, commonly after pre-clinical study |
| Step 2 CK | Clinical knowledge and patient management; numerically scored | During the clinical years |
| Step 3 | Independent practice readiness | Usually during residency |
Eligibility routes
- Students and graduates of LCME-accredited MD programs register through the NBME.
- Students and graduates of medical schools outside the US and Canada register through ECFMG and must be listed appropriately in the World Directory of Medical Schools.
- Osteopathic students and graduates register through the NBOME route for COMLEX-USA and may also take the USMLE.
- Eligibility periods, attempt limits and identification rules are set in the USMLE Bulletin of Information for each testing year.
What this means for international medical graduates
For an IMG, USMLE performance is one component of ECFMG certification, which is required before entering an ACGME-accredited residency program. Certification also involves verification of the medical diploma and credentials and a clinical skills requirement, the form of which has changed over time.
Requirements change
Frequently asked questions
Is Step 1 still scored?
Step 1 results are reported as pass or fail. Step 2 CK remains numerically scored.
Do US MD students and IMGs take the same USMLE?
Yes, the examinations are the same. The registration route and eligibility verification differ.
Is the USMLE the same as a licence?
No. Passing the USMLE is one requirement. Licensure is granted by individual state medical boards, which set their own additional conditions.
When is Step 3 taken?
Most candidates take it during residency, though some IMGs take it earlier where state and programme rules permit.
Official sources
Requirements, fees and outcome data change. Check each source for its own publication date.
- 1.USMLE Bulletin of Information — United States Medical Licensing Examination
- 2.ECFMG Certification — Educational Commission for Foreign Medical Graduates
- 3.World Directory of Medical Schools — WFME and FAIMER
- 4.State medical board licensure requirements — Federation of State Medical Boards
Authorship and review
Reviewed for factual accuracy against publicly available primary sources. Requirements change; verify directly with the relevant school, accreditor, examination authority or licensing body.
Written by
MBBSinAmerica Editorial Team
Research and editorial desk
The editorial desk compiles US medical education information from accreditor publications, medical school websites, examination authorities and federal data releases, and records a source and verification date for every figure published.
Areas of expertise: LCME accreditation records, AMCAS and MD admissions processes, USMLE and ECFMG requirements, NRMP Match reporting.
Reviewed by
Medical Review Board
MD / MBBS reviewers with US graduate medical education experience · United States
Review panel members check that descriptions of degrees, examinations, accreditation and residency processes reflect the current published requirements of the responsible bodies, and that no page implies a guaranteed admission, examination or Match outcome.
Review date: 2026-09-12
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