The United States Medical Licensing Exam is a three-part exam designed by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) to test the potential of incoming doctors to see if they measure up to the rigorous standards required to practice medicine in the US. It was created in the early 1990s to replace and consolidate the different exams, which offered different medical license paths, including the NBME Part Examination program and the FSMB’s Federation Licensing Examination (FLEX) program.
The USMLE is required to acquire medical licensure in the United States by all graduates of American medical schools and international medical schools. The first stage of the USMLE, ‘Step 1,’ is designed to assess the foundational knowledge of medical doctors typically obtained during the first two years of US medical school. It checks if you have a firm understanding of the topics taught and if you can apply the knowledge in your practice of medicine, especially the principles underlying health, disease, and modes of therapy.
The exam has been the subject of more than a few debates due to its format and scoring, and as a result, it has undergone quite a few changes since its inception.
Exam Format and Structure
The USMLE Step 1 is a one-day exam that takes place over an eight-hour testing session but is divided into seven 60-minute blocks, with an allocated break time of at least 45 minutes. The exam is computer-based and is made up of a total of 280 multiple-choice questions, with each block containing no more than 40 questions. There is also a 15-minute optional tutorial time given at the start of the exam that candidates can skip past and have the extra time added to their break. Examinees who require extra break time for medical conditions like diabetes or for nursing mothers who need to feed their offspring can apply by submitting the form found on the USMLE website.
As mentioned above, Step 1 tests your knowledge of the basic sciences learned during your pre-clinical years in medical school. American students typically take the Step 1 exam after their second year of med school when the topics are still freshly taught. Clinical vignettes will test your understanding of anatomy, behavioral sciences, biochemistry, microbiology, pathology, pharmacology, and physiology, as well as interdisciplinary topics like genetics, aging, immunology, nutrition, and molecular and cell biology. Problems related to epidemiology, medical ethics, and empathy are also addressed.
Important Dates
The USMLE Step 1 exam is offered year-round at Prometric test centers, so there isn’t a fixed date for the test. Instead, applicants are allowed to pick a three-month window during which they can take the exam on a day of their choice. Once registered, you will receive a scheduling permit that will allow you to book a specific date within that period on the Prometric website. Test centers fill up quickly, especially during popular times (e.g., summer or just before residency application deadlines). Applying and scheduling early increases your chances of securing your preferred test date and location; however, you may not be allowed to pick a date more than six months ahead.
Steps to Schedule the USMLE Step 1
1. Apply for Eligibility: To begin, you must register and receive your Scheduling Permit for Step 1 through the appropriate registration body, the National Board of Medical Examiners (NBME) for students of US or Canadian accredited medical schools, or the Educational Commission for Foreign Medical Graduates (ECFMG) for international students or graduates of a medical school listed in the World Directory of Medical Schools to schedule an appointment with Prometric. It is important that you register with the appropriate body to ensure that your application is routed to the right place for verification and proper processing based on your educational background.
2. Select an Eligibility Period: The next step is to create a profile on the appropriate platform by submitting personal details and information on your academic background. After registering, you’ll be asked to pick a three-month window in which you plan to take the exam. Keep in mind that your application won’t be processed until you pay the required registration fee: $680 for American and Canadian students and $1197 for international medical graduates. Allow adequate time to screen your application, including processing your payment, verifying your credentials, and issuing your scheduling permit. For international medical graduates (IMGs), credential verification through ECFMG might take longer.
3. Receive Scheduling Permit: Once your application is approved, you’ll get an email with your scheduling permit. This document will contain your unique scheduling ID and eligibility period for the test.
4. Schedule on Prometric: Use the permit to book a test date on the Prometric website. Test center slots fill quickly, so book early. If you miss your eligibility period, you may request a one-time extension for a fee of $100; if you don’t take the exam within the extended period, you’ll need to reapply. You are permitted to reschedule or change your appointment at no cost if you make the request 46 days before your chosen date.
Tips for Scheduling
1. Plan and Apply Early: Popular eligibility periods (e.g., summer or before residency deadlines) tend to fill up quickly. So, you must decide when to take the exam and select the eligibility period accordingly. Submit your application at least 6-8 weeks before your desired period begins to account for processing time.
2. Gather All Necessary Documents Beforehand: You will need to submit proof of Medical School Enrollment/Graduation. U.S./Canadian students can obtain their certification from their school. International Medical graduates, however, must apply to their schools to submit their credentials to the ECFMG. You will also need a Government-Issued Photo ID; the details on the ID must match the name on your application because missing or incorrect documents can delay your application.
Pro Tip: Double-check that all names and details match exactly across your documents and application.
3. Budget for Fees and Additional Costs: When budgeting for how much you might spend during your exam, you should make allowances for unexpected billing. This ensures you’re prepared for any unexpected changes or delays.
4. Choose the Right Eligibility Period: Pick a period that aligns with your preparation timeline to help reduce stress. Do this by considering your study schedule, major holidays, and academic/residency deadlines. Avoid scheduling too close to important commitments to allow flexibility if unforeseen delays occur.
5. Be Strategic About Exam Day: Choose a convenient center, especially if you live in a country that struggles with traffic and logistics. Having to travel far or too early in the morning might cause delays or unneeded stress. You should also visit the test center beforehand to familiarize yourself with the location.
6. Check for Test Accommodations (if needed): Examinees with disabilities under the ADA or medical needs requiring extra time/breaks can apply for special considerations by submitting the necessary forms early. The forms are available on the USMLE website.
7. Prepare Your Environment: On Test Day, you should only come to the testing center with the required items: Scheduling permit (printed or electronic) and ID. Avoid prohibited items like electronics, notes, and large bags to avoid delays or disqualification. You can find the full list of prohibited items at the Prometric test-day rules and plan accordingly.
8. Stay Informed: Follow announcements on the USMLE website to keep abreast of policy changes or updates. We recommend using a high-quality question bank like CanadaQBank for USMLE to prepare for the exam. It provides over 3000 classic simulated MCQs that cover all the subject areas tested, e.g., anatomy, pathology, microbiology, etc. It also supplies detailed answers and explanations for all the questions. The Qbank can be used in Timed or Untimed mode to familiarize you with the exam settings and will give you a detailed breakdown of your performance, showing you the subjects and topics you both excel at and struggle with. This will allow you to streamline your preparations and focus more time on your weak areas.
