What is the USMLE Exam? All About the USMLE Exam

If you’re anything like me when I was starting med school, you have heard the terms USMLE and boards but know very little about them; other than that they are something to be feared. Whether you are just starting your first year of medical school, closing in on your USMLE test date, or anywhere between, this post is meant to shed a little light on this nebulous task that is “THE USMLE” (aka boards).

So, here’s what is the USMLE exam, when they (yes the USMLE has 3 parts!) are, what their purpose is, and some quick tips on how to approach them.

The USMLE, or, United States Medical Licensing Exam, comes from an organization that puts out three sets of exams that serve a couple of purposes. The first and primary goal of the USMLE is to act as a stopgap between milestones during medical training and assess if you should be allowed to proceed further in your medical studies and anticipated career. Second, the USMLE also serves the purpose of assessing all medical students with a standardized set of tests to evaluate where you stand amongst your peers.

The three sets of USMLE exams are organized in steps with Step 1 traditionally taken between years 2 and 3 of medical school, Step 2 CK/CS taken during year 4, and Step 3 taken during your first year of residency. In recent years, however, some medical schools are shifting to varying curriculum structures that sometimes cause medical students to take the USMLE Step 1 exam close to or at the same time as USMLE Step 2 CK. Passing each Step of the USMLE satisfies goal number 1 above and is done by getting a passing score: currently 194 for Step 1, 209 for Step 2 CK, and 196 for Step 3. While currently USMLE Step 1 remains a scored exam, in the near future it will actually be shifting to a pass/fail. As of now, there are no plans to change the scoring of USMLE Step 2 CK or USMLE Step 3.

The USMLE exams are broken down to test your grasp on pre-clinical sciences (Step 1), the application of this knowledge to real patient scenarios (Step 2), and the ability to use all of that to practice medicine without supervision (Step 3). Steps 1 & 2, as those are the ones taken during medical school, tend to be the most stressful and have an effect on residency acceptance.

USMLE Step 1

The first and most important of these USMLE exams and the one that everyone is usually referring to when talking about boards. This bear of a test is your first taste of the USMLE (and probably first taste of full-day written exams) and is the most scrutinized when applying for residency. This is with good reason, however, because all subsequent exams and medical knowledge build off of this base.

Tip- I had classmates who started buying board studying material during orientation. I would not suggest that, don’t be that guy. The best thing you can do for yourself in preparation for boards during the first year of medical school is to learn what is being presented to you as best as you can. This will build a solid base that you’ll be thankful for come time to put everything together and begin USMLE studying. Give yourself ample time to study for Step 1, but also don’t forget to make your own health a priority. Don’t psych yourself out, this test is hard enough and you will do more harm than good by stressing.

USMLE Step 2

Step 2 used to be broken into two parts, clinical knowledge (USMLE CK) and clinical skills (USMLE CS). The CS was a day of 12 simulated patient encounters where a student would perform an H&P and write a SOAP note. Graded as pass/fail, Step 2 CS was actually permanently canceled in 2021 amidst the coronavirus and mounting criticism that it was unnecessary and time-consuming.

Today, USMLE Step 2 CK is the only exam taken during Step 2 of the USMLE. This is a written exam following the same multiple-choice format of Step 1 that tests your ability to apply knowledge from Step 1 and your clinical rotations to real-life situations.

Tip- With Step 2, make sure you approach each rotation and shelf exam with the intent of learning as much as you can. Hopefully, you’ve learned through life experience by now that time put in beforehand makes tasks less daunting down the road– and the same is true about boards. It’s daunting, but you can do it!

USMLE Step 3

Step 3 is the culmination of your medical school experience in combination with the USMLE. This exam is different in that you take it once you have already begun residency. Because of this, the stress and the average scores tend to drop dramatically. This is another written exam, but unlike Steps 1 & 2, it takes place over two days of testing.

Tip- The average dedicated study time you should commit to each step is: One month for Step 1, one week for Step 2, and one day (or just show up) for Step 3. Not as much of your future hinges on the USMLE Step 3 test, but it would be more than a huge headache if you were to completely neglect to prepare and fail the exam. You’ve made it this far, don’t ruin your hard work. As my dad used to say in reference to baseball “Don’t run to first base, run through it”-except in this case you’re running through home.

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