What is the USMLE? Steps, Scores and Requirements (2026 Update)

Updated November 2026 to reflect current USMLE rules.

The United States Medical Licensing Examination (USMLE) is the three-step exam every physician must pass to get a medical license in the United States. It is owned by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). US medical students and international medical graduates (IMGs) take the same exams.

The USMLE at a glance (2026)

• Step 1 – basic sciences applied to clinical problems. Pass/fail only since January 26, 2022.
• Step 2 CK (Clinical Knowledge) – diagnosis and management. Numeric score; the minimum passing score is 218 (since July 1, 2025).
• Step 3 – independent practice and management, taken during or after residency. Minimum passing score 200.
• Step 2 CS (Clinical Skills) – discontinued in 2021. It no longer exists.

USMLE Step 1

Step 1 tests how well you understand and apply the basic sciences: anatomy, physiology, biochemistry and genetics, microbiology and immunology, pathology, pharmacology, behavioral science, biostatistics and ethics. Most questions are clinical vignettes followed by one best answer.

It is a one-day, computer-based exam of up to 280 questions in seven 60-minute blocks (about 8 hours including breaks and the optional tutorial). Because Step 1 is now pass/fail, residency programs look more closely at your Step 2 CK score, clinical experience and letters of recommendation.

USMLE Step 2 CK

Step 2 CK tests the clinical knowledge you need for supervised patient care: internal medicine, surgery, pediatrics, obstetrics and gynecology, psychiatry, neurology, emergency medicine and preventive medicine. Questions focus on diagnosis, the next best step in management, and prevention.

It is a one-day exam of eight 60-minute blocks (about 9 hours in total). Step 2 CK is reported as a three-digit score, and it has become the most important exam score for residency applications.

USMLE Step 3

Step 3 is a two-day exam that tests whether you can practice medicine without supervision. Day 1 (Foundations of Independent Practice) is multiple-choice questions; Day 2 (Advanced Clinical Medicine) adds computer-based case simulations (CCS), where you manage virtual patients over time. Most doctors take Step 3 during their first or second year of residency.

What happened to Step 2 CS?

Step 2 CS was the in-person clinical skills exam with standardized patients. It was suspended during the COVID-19 pandemic and permanently discontinued in January 2021. Today, international medical graduates meet the clinical and communication skills requirement through an ECFMG Pathway, which includes a satisfactory score on the OET Medicine English test. Read more in our guide: USMLE Step 2 CS was discontinued – what replaced it.

What IMGs need for residency

To apply to US residency programs through the Match, international medical graduates need ECFMG Certification, which requires:

• Passing Step 1 and Step 2 CK;
• Meeting the clinical and communication skills requirement (an accepted ECFMG Pathway with OET Medicine, or a valid past Step 2 CS pass); and
• Verification of your medical diploma.

Rules change often, so always confirm the current requirements on the official USMLE and ECFMG websites before you register.

Start practicing

The best way to prepare is to practice exam-style questions every day. Browse our free USMLE question bank by subject — over a thousand questions with answers and explanations for Step 1 and Step 2 CK.

Written by Dr. Ray Makar, MD, author of the Repeated USMLE Questions eBook series.