The United States Medical Licensing Examination (USMLE) is the three-Step exam sequence that medical students and graduates take as part of getting a license to practice medicine in the United States. This guide is the starting point: what each Step is, how the exams are delivered since the 2026 format change, who applies where, how results work, and which of our detailed guides to read next. Everything on rules and numbers comes from usmle.org pages we read on October 31, 2026; confirm anything that affects a deadline or a fee on the official site.
The USMLE at a glance
| Step 1 | Step 2 CK | Step 3 | |
|---|---|---|---|
| Format now | One day, fourteen 30-minute blocks, one 8-hour session | One day, sixteen 30-minute blocks, one 9-hour session | Two days: multiple-choice blocks, plus case simulations on Day 2 |
| Questions per block | No more than 20 | No more than 20 | 18-20 (Day 1), 20 (Day 2) |
| Result | Pass/fail | Pass/fail (standard 218) | Pass/fail (standard 200) |
| New format began | Exams on or after May 14, 2026 | Exams on or after May 7, 2026 | Administrations on or after March 10, 2026 |
What each Step tests
- Step 1 assesses whether you can apply foundational science concepts to medicine. Its content outline classifies questions by discipline (pathology is the largest, at 45-55%) and by body system. See the complete Step 1 guide.
- Step 2 CK (Clinical Knowledge) assesses clinical science and patient care. Medicine is the largest clinical area, at 55-65% of questions. See the complete Step 2 CK guide.
- Step 3 assesses whether you can practice medicine without supervision. It adds Computer-based Case Simulations and gives biostatistics, epidemiology and the medical literature 11-13% of its multiple-choice items. See the complete Step 3 guide.
How the exams are delivered since 2026
In 2026 USMLE changed Step 1 and Step 2 CK from 60-minute blocks to 30-minute blocks of up to 20 questions, and set a minimum of 55 minutes of break time and a 5-minute optional tutorial. The session lengths stayed at 8 and 9 hours. Our guides explain the pacing implications and how the day adds up.
USMLE has also announced an updated timeline for designated testing dates, with a transition in January 2029. Check the USMLE site for how that will affect scheduling.
Who applies where
- Students and graduates of LCME- or COCA-accredited U.S. programs apply through NBME, using the MyUSMLE portal.
- Students and graduates of medical schools outside the U.S. apply through FSMB. For Step 1 and Step 2 CK your school must be listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements. For Step 3, international graduates must also hold valid ECFMG certification. See the ECFMG guide and our international graduates and visa guide.
- You must be enrolled in, or a graduate of, an eligible school both when you apply and on exam day.
- The listed application fee for 2026 and 2027 is $695 for Step 1 and Step 2 CK and $955 for Step 3. Exams taken outside the U.S. and Canada carry a regional fee ($210 for Step 1 and $235 for Step 2 CK, as listed). Fees change, so check before you apply.
Scoring and passing
Step 1 is reported only as pass or fail (the passing standard is 196 on the old three-digit scale). The Step 2 CK standard is 218, effective for exams on or after July 1, 2025, and the Step 3 standard is 200, effective January 1, 2024. USMLE reviews each standard about every four years. Read USMLE passing scores for the table, and results, rechecks and transcripts for score release timing, the 90-day recheck window and how to send a transcript.
The rules that can catch you out
- Attempts: four or more attempts at a Step, including incomplete attempts, without passing makes you ineligible for any Step. You may not take the same Step more than three times in 12 months. See attempt limits and retakes.
- Time limits: many state medical boards require all Steps within a set period, often called the seven-year rule. Your state board sets it.
- Security and accommodations: arrive early with matching ID, and request accommodations in advance. See exam security and accommodations.
The usual order, and how it fits residency
- Step 1, usually after the basic science years.
- Step 2 CK, usually during or after clinical rotations.
- Residency applications through ERAS and the NRMP Match.
- Step 3 requires passing Steps 1 and 2 CK and an MD, DO or equivalent degree. USMLE recommends at least one postgraduate training year before it.
The order is common practice, not a rule, except that Step 3 requires Steps 1 and 2 CK. Time your exams so that results are available when programs review applications, and check each program's own requirements.
Preparing
These are study suggestions, not official guidance.
- Start from the official content outline and the weights it gives each area.
- Choose a small set of tools. Our comparison of study resources covers question banks, videos, books and flashcards.
- Check readiness with an NBME self-assessment before you schedule.
- Practice in the new block format so test-day pacing is familiar.
Where to go next
- The three complete guides: Step 1, Step 2 CK and Step 3.
- FSMB and state licensure.
- The Step 1 exam page, Step 2 CK exam page and Step 3 exam page, and all USMLE guides.