USMLE Examination Guide Part 1

Category: Exams.

Note: This article is for international medical graduates (IMGs) the United States Medical Licensing Examination (USMLE) is a three-step test for medical licensure. It is mandatory for every doctor who wants to practice in the US.

United States Medical Licensing Examination (USMLE) is a three-step test for medical licensure. It is mandatory for every doctor who wants to practice in the US.


The examination is conducted in three steps. Step 1 and Step 2 must be cleared to match for a residency, however, Step 3 can be attempted during the residency.

  • Step 1 tests the foundational aspects of the medical knowledge.
  • Step 2 tests the clinical knowledge and clinical skills of a doctor. Hence it is divided into the clinical knowledge (CK) and clinical skills (CS) parts.

It is not necessary that you attempt Step 1 before Step 2. In this article, we will discuss strategies to decide which step to attempt first.


Make sure that you have the following links saved:


Here is the list of actions items for you:

  • Register with to obtain an identifier (ID).
  • Decide which Steps examination you want to take first.
  • Apply to take the Step.
  • Prepare for the examination.
  • Request an extension if needed.
  • Attempt the examination.
  • Receive score.
  • Apply for matching (when both steps are passed)
  • Obtain a visa –once matched– to a residency program.
  • Travel to the US and join your job.
  • Be an amazing doctor!


  1. Register with ECFMG.Org and obtain a USMLE/ECFMG identifier. You cannot appear in a step without this identifier. Online application link is:

  2. Dr. Mobeen’s advice for deciding a Step to attempt:
    • If you spend the first four years studying foundational courses (physiology, pharmacology, pathology, etc.) and you are in one of these four years then attempt the step 1 first.
    • If you are in the final year (studying medicine and surgery) then attempt the step 2 first.
    • It is counterintuitive to attempt step 1 in the final year (imagine having to simultaneously study all four years of subjects and the final year’s subjects.) Chances are that you won’t be able to ace any of the two categories of subjects.
    • If you’re already a doctor – an HO or MO, etc., then my suggestion is to attempt step 2 first. The reason is that you’re more in tune with the clinical subjects and practices. Trying to recall step 1 material and ace it will frustrate you. Once you ace step 2, you will have enough confidence to take some time off to ace the step 1.
    • In my next articles and on our site ( I will propose some schedules that you can either follow as is or adjust according to your situation.
    • I will also outline exam prep material in the next articles of this series.
  3. Apply to take the test.

    • My recommendation is that you book a date for the exam once you have done at least two reviews of your course material, however, make sure you have registered to obtain your identifier before you are ready to appear for the exam.
    • To apply for a step go to this link:
    • At the time of writing this article, the fee for Step 1 is $895.00 (US Dollars.) You may also have to pay the international test delivery surcharge. See the page on the following link for further details:
    • At the time of writing this article, the fee for Step 2 CK is $895.00 (US Dollars), and fee for the step 2 CS is $1550.00 (US Dollars). These fees exclude the international test delivery surcharge.
    • There is a fee for rescheduling/extending your date. Again, take a look at the fees page for details:
  4. Preparing for the examination:

    • Your readiness means that you can review course material within a few days. To reach this point, a general suggestion is to study the material at least three times.
    • For Step 1, buy First Aid for USMLE and get it ring bound. Use a binder big enough to add new pages to take notes from other books, videos, and questions.
    • For Step 2, buy Ace The Boards from Kaplan and get it ring bound.
    • For your first review, go over the material in First Aid. If you feel that you need to clarify a concept then study from a bigger book (text book) to grasp the concept. Make notes on a page and add this page to First Aid. Indicate the page number and, if possible, the concept number on the notes page. This will help you correlate the notes to the concepts in the future. This phase should not be more than six months.
    • Your second review will be from this “new book” you have created during your first review. My recommendation is to use UW or Kaplan QBank with your second review. Make notes again from these resources and add them to this book you are making. Two months are sufficient for this phase.
    • Once finished with this review take  National Board of Medical Examiners (NBME) if necessary. Four to six weeks are sufficient for this phase.
    • The point to reduce the duration of review is to make sure that your recall has improved and your reflexes are built to answer questions rapidly. If you are not able to review your course within a few weeks then you are not ready yet.

In the next article, we will discuss the topics to study, reference books/videos/qbanks, study schedule; additionally we will also discuss strategies for studying.

Author: Mobeen Syed

Editors: Laraib Jumani and Humna Ali.



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