Become a Doctor in the USA: How to Pass the USMLE

November 27, 2024

8 min read

If you are on your way to becoming a medical professional in the USA, you will have to pass the USMLE. It can be an overwhelming and stressful task, but you can do it with the right preparation.

What Is the United States Medical Licensing Examination (USMLE)

USMLE is the exam administered by the National Board of Medical Examiners (NBME). The Federation of State Medical Boards (FSMB) and the NBME sponsor the USMLE, which provides state medical boards with a common evaluation system for licensure applicants. Medical Specialists need this exam to work legally in the USA.

The USMLE is needed both for U.S. Medical Students enrolled in accredited allopathic (MD) medical schools in the U.S. who need to pass the USMLE to get medical licensure to become physicians and for medical specialists who graduated from medical schools outside the USA and Canada. It might be especially complicated for people from other countries as they are not familiar with the exam structure and are more likely to study medicine in different languages. So basically it is needed to confirm that the medical education of a specialist is enough to work in hospitals and become licensed physicians.

What makes the USMLE exams a bit more complicated is that this test includes 3 exams (steps). The preparations for each of these exam parts are a bit different. Let’s overview the USMPLE program in detail.

Steps of the Usmle: From Medical Schools to Doctor License

💉 Step 1 (Basic Sciences): Focuses on foundational sciences, including anatomy, physiology, pathology, pharmacology, microbiology, biochemistry, and behavioral sciences.

💉 Step 2 CK (Clinical Knowledge): Tests your ability to apply knowledge in clinical scenarios and unsupervised practice.

💉 Step 3 (Patient Management): Assess your ability to manage patients in a clinical setting, which licensure requires.

How Are the Steps Allocated

💊 Step 1 Basic Sciences

Eligibility requirements: Typically taken after completing basic sciences (first two years of medical school).

Commonly taken by U.S. medical students at the end of second year

💊 Step 2 Clinical Knowledge

Eligibility requirements: Typically taken after completing clinical rotations or clerkships (third or fourth year of medical school for U.S. students).

International applicants take it after Step 1 to proceed with their ECFMG certification and U.S. residency applications.

💊 Step 3 Patient Management

Eligibility requirements: To pass it, you might have completed the Step 1 and Step 2 exams and finished an MD degree (or its equivalent). International applicants should have an active ECFMG certification.

Typically it is taken during or after residency training to gain full licensure.

There is no specific required gap between the steps, but your readiness and career timeline dictate the progression. Some states or programs may require passing all steps within a certain timeframe (e.g., 7 years).

How Long Does the USMLE Preparation Take?

💉 Step 1: 6–12 months of preparation.

💉 Step 2 CK: 4–6 months (after clinical rotations).

💉 Step 3: 2–4 months (after Step 2 CK and some clinical experience).

Step 1. Basic Sciences

The United States Medical Licensing Examination Step 1 is a big step on the journey of every medical student, especially for international specialists who want to work in the USA.

It pulls together everything learned in the first two years of medical schools and tests your knowledge and your ability to stay sharp and focused during an intense 8-hour exam. Think of it as a preview of the long, demanding days ahead as a physician, where staying steady under pressure is key to providing great care.

What is the Pass/Fall System

The USMLE Step 1 officially became pass/fail in 2022, aiming to reduce burnout and improve students’ mental health. Previously, Step 1 scores heavily influenced residency applications, often making or breaking chances for competitive specialties like dermatology. This pressure led to intense stress, with students skipping classes to cram for the exam.

With more weight now placed on Step 2 CK, students still face significant pressure to perform. While the long-term impact of this change remains to be seen, Step 1’s content remains challenging, requiring dedicated preparation to pass.

Resources to Prepare for Step 1.

As there are a lot of previous generations of students who already passed the exam, there are a lot of recommendations for high-quality content for the preparation. The American Medical Association provides resources, tools, and study materials to help medical students prepare for the USMLE. Use them!

✔️ Books

First Aid for the USMLE Step 1 (2024 edition) — The gold standard for Step 1 preparation.
Pathoma: Fundamentals of Pathology — Exceptional for pathology, with a concise book and accompanying video lectures.
SketchyMedical — Best for memorizing microbiology, pharmacology, and biochemistry through visual storytelling and mnemonics.
Kaplan USMLE Step 1 Lecture Notes — A comprehensive set of books covering all subjects.
Goljan’s Rapid Review Pathology — Detailed pathology explanations and high-yield information.

✔️ Question Banks

Use question banks for regular training on exam questions.

UWorld — The most recommended QBank for Step 1 with Over 3,500 high-quality questions with detailed explanations.
AMBOSS — Another excellent QBank with integrated references and medical library access.
NBME Tests — Official exams that simulate the Step 1 format.

✔️ Flashcards

Use Anki Pro flashcard decks for the memorization of material. Study with them daily to make sure you use a spaced repetition system and don’t let information get forgotten. Useful decks:

✔️ Training Exams

NBME Self-Assessments — Official tests that closely mimic the real Step 1. Use them to benchmark progress and predict your score.
UWorld Self-Assessments — High-quality tests with detailed performance analysis. Take them closer to your real exam date for accurate assessment.

Step 1 is not considered the hardest one, especially if you study in the USA where professors help you to study step by step during your day-to-day studies. Hopefully, you passed it. What is next?

Step 2. Clinical Knowledge

United States Medical Licensing Examination Step 2 focuses on clinical reasoning and the application of medical knowledge in patient care. It covers internal medicine, surgery, pediatrics, obstetrics and gynecology, psychiatry, and more. Includes patient care, diagnosis, prognosis, and preventive care. For sure you study all these disciplines during medical school classes.

So it is a bit more practical than Step 1 and goes deeper into real situations. How do you prepare for it?

Resources to Prepare for Step 2.

✔️ Books

First Aid for the USMLE Step 2 CK — High-yield review book specifically designed for Step 2 CK, Great for consolidating key concepts.
Master the Boards: Step 2 CK — Focused on testable concepts and high-yield facts. Ideal for quick reviews and management-focused preparation.
Step-Up to Medicine — Comprehensive coverage of internal medicine topics. Excellent for understanding clinical reasoning in depth.

✔️ Question Banks

UWorld Step 2 CK — The most recommended resource for Step 2 CK.
AMBOSS — Offers a high-quality qbank questions bank with integrated references. Useful for supplementing UWorld if additional questions are needed.

✔️ Anki Pro Decks

✔️ Practice Examination

NBME Tests — Official preparation exams that simulate the Step 2 CK format.
UWorld Self-Assessments — Highly accurate predictors of your performance on the actual exam.

So, not 2 out of 3 parts are passed! Time for the more practical stage — step 3.

Step 3 Patient Management

Preparing for the United States Medical Licensing Examination Step 3 requires a different approach compared to Step 1 and Step 2 CK, as it tests your ability to manage patients independently in a clinical setting. It focuses on clinical decision-making, doctor-patient conversation, patient-centered skills, and applying medical knowledge in real-world scenarios. There are a lot of practice questions that check do you know all the essential information on how to behave in real clinical situations and do you have enough skills to do it.

It’s a two-day examination:

Test Day 1 (Foundations of Independent Practice – FIP):
- Multiple-choice questions (MCQs) test foundational knowledge in biostatistics, epidemiology, and clinical reasoning.
Test Day 2 (Advanced Clinical Medicine – ACM):
- MCQs and Computer-based Case Simulations (CCS) testing patient diagnosis, management, and follow-up care.

Resources to Prepare for Step 3

✔️ Books

Master the Boards: Step 3 — Concise and high-yield resource focused on management and testable concepts.
Step-Up to Medicine — Comprehensive for internal medicine topics, covering the most commonly tested areas.
First Aid for the USMLE Step 3 — A solid overview of high-yield topics, though not as detailed as other resources.

✔️ Question Banks

UWorld Step 3 QBank — Essential resource with high-quality clinical vignettes and detailed explanations. Has both MCQs and CCS cases.
AMBOSS — A supplementary QBank with strong clinical content and an integrated library.

✔️ CCS Test

UWorld CCS Cases — Offers an interactive platform to train CCS scenarios and skills.
CCS Case Software from USMLE — Official tool to familiarize yourself with the CCS interface and case flow.

✔️ Practice Examination

NBME Step 3 Tests — Official tests to gauge readiness and identify weak areas.
UWorld Self-Assessments — Provides performance analytics and predicted scores.

General Tips

Passing the USMLE is a long journey but only one part of your way to becoming a professional doctor in the USA. It is very important, but you don’t have to overwork yourself and become stressed out because of it. Your study efforts will bring you to your goals. Take care of yourself, medical students are already stressed enough (usually more than other students). Work in small steps and stay confident. You are ready for your exam day! Good luck!

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