Massachusetts Medical Society: The U.S. Medical Licensing Exam

The U.S. Medical Licensing Exam

The U.S. Medical Licensing Exam (USMLE) is a three-step examination for medical licensure in the United States. The USMLE assesses a physician's ability to apply knowledge, concepts, and principles while demonstrating fundamental patient-centered skills that constitute the basis of safe and effective medical care. Step 1and Step 2 are only applicable to medical students. Step 3 is for residents.

Step 1

Assesses whether the student understands and can apply concepts of science that are basic to the practice of medicine. 


  • Anatomy
  • Behavioral sciences
  • Biochemistry
  • Microbiology
  • Pathology
  • Pharmacology
  • Physiology
  • Interdisciplinary topics such as nutrition, genetics, and aging

Knowledge Tested

  • Interpreting graphic and tabular material
  • Identifying pathologic and normal specimens (gross and microscopic)
  • Applying basic knowledge to clinical problems
    For more information and sample Step 1 test materials, visit:

Step 2

This section is divided into clinical knowledge and clinical skills components, assesses whether the student can apply medical knowledge, skills, and understanding that are essential for providing patient care under supervision.

Clinical Knowledge (CK) Content

  • Internal Medicine
  • Obstetrics and Gynecology
  • Pediatrics
  • Preventive Medicine
  • Psychiatry
  • Surgery
  • Other areas relevant to provision of care under supervision

Skills and Knowledge Tested

  • Arriving at a diagnosis
  • Making a prognosis
  • Explaining underlying mechanisms of disease
  • Identifying next steps in medical care, including preventive measures
  • Interpreting tables and laboratory data, imaging studies, photographs of gross and microscopic pathologic specimens, and results of other diagnostic studies
  • For more information and sample Step 2 CK test materials, visit:

Clinical Skills (CS) Content

Presentation categories include:

  • Cardiovascular
  • Constitutional
  • Gastrointestinal
  • Genitourinary
  • Musculoskeletal
  • Neurological
  • Psychiatric
  • Respiratory
  • Women's Health

Skills and Knowledge Tested

Fundamental clinical skills essential for safe and effective patient care under supervision, including:

  • Establishing rapport with people trained to portray real patients
  • Eliciting pertinent historical information
  • Performing focused physical examinations
  • Answering questions
  • Providing counseling when appropriate
  • Recording pertinent history and physical examination findings
  • Listing diagnostic impressions
  • Outlining plans for further evaluation
  • For more information on Step 2 CS, visit:

Step 3


Step 3 is only applicable to graduating medical residents. Unsupervised clinical encounters (initial, continued, and emergency care scenarios) and physician tasks, including:

  • History taking
  • Physical exam
  • Diagnostic studies
  • Formulating a diagnosis
  • Severity evaluation
  • Identifying disease mechanisms
  • Patient management


Step 3 examinees are tested using multiple-choice questions and Primum computer-based case simulations (CCS). During the CCS portion, the examinee provides care for a simulated patient and the computer records each step taken in caring for the patient and scores the examinee's overall performance.

As simulated time passes, the patient's condition changes based on the underlying problem and examinee interventions. The patient's simulated chart facilitates review of vital signs, progress notes, patient updates, and test results.

For more information and sample Step 3 test materials, visit:

Additional Resources

The most comprehensive and "official" information on the USMLE is found at Prior to applying for the exam, prospective examinees are required to review the latest USMLE Bulletin

The following two websites may also help:
Andreas Carl, M.D. offers a USMLE discussion forum, his own USMLE prep books, and recommendations for other helpful books and resources.
This online networking service helps USMLE aspirants communicate with one another. The site allows users to create profiles, participate in discussion forums, and organize study groups.

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The MMS has a number of resources and aptitude tests to help medical students make the best decision for their professional futures.

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