USMLE | United States Medical Licensing Examination | Omkar Medicom

Two entities own and control the USMLE program:

• FSMB or the Federation of State Medical Boards, and
• NBME or the National Board of Medical Examiners.

Some members from the FSMB, ECFMG, NBME, and public constitute a committee to govern the rules of the USMLE.
This committee makes the directives of the program and form the rules for scoring and determine all significant policies and procedures.

USMLE was designed to fulfill the need for one single way to medical licensure for Doctors in the United States. Before the USMLE, there were different Licensing exams in the USA. So it was required to make one single Licensing exam which will be accepted by all States in the USA. This ensures that all Doctors had passed the same assessment standards – no matter in which school or which country they had trained.

USMLE has total 3 major steps.

• Step 1
• Step 2 (CK and CS), and
• Step 3

Step 1 of USMLE is taken to assess:

• Whether a medical student can perceive and can put in essential concepts of the medical sciences,
• With a specific emphasis on principles and mechanisms related to health, disease, and therapy modes.

A student can apply for USMLE Step 1 during or after completion of MBBS 3rd year. 

Usually 280 Questions from 7 subjects, mostly of Clinical Vignette format in MCQ pattern, are asked in the USMLE Part-1 exam. Subjects are:

• Pathology
• Pharmacology
• Physiology
• Anatomy
• Microbiology
• Biochemistry
• Behavioral Sciences

It is a 7-hour long exam. 192 is the minimum passing mark, and a non-US student must score 240 or above to clear the exam.

The actual cut off marks depend on the the relative difficulty of the items as determined by the test committee.

Clinical vignette Format  means:

• Patient-related cases and outline scenarios that have educational value for several other related persons.
• Any medical case that exemplify a certain key point or several points about diagnosis, management, or therapeutic decision. 

USMLE Step 2 has two divisions:

• USMLE Step 2 CK or Clinical Knowledge, and
• USMLE Step 2 CS or Clinical Skills.

USMLE Step 2 CK:
It is a one-day computer-based examination covering all of the clinical sciences of medical studies, which includes:

• Medicine,
• Surgery,
• Pediatrics,
• Obstetrics and Gynaecology,
• Psychiatry,
• Forensics,
• Emergency care,
• ENT,
• Ophthalmology,
• Tropical health,
• Ethics.

This is a MCQ type exam with around 350 question and a qualifying mark of 209.

The USMLE Step 2 CS or test of Clinical Skills is an examination held in only America throughout the year. Examinees will interact face-to-face with ten to 12 simulated patients. That is actors pretending to have specific health problem. Examinees have to rapidly assess a patient, communicate and interact with them, and write a note about the whole assessment and plans. This exam judge the practical communication ability of a medical student with a patient. 

On clearing Step 2 CS, a student can apply for Residency program to various universities in the US. If the universities find the student's resume attractive, then he/she will be called for an interview. Based on that interview and 3 Recommendation letters of Doctors (LOR) and other relevant documents, the university may grant the desired Residency program.

USMLE step 3:

• International students will apply for the USMLE part 3 if they plan to immigrate on a H-1B visa and work in the US as a doctor.
• This exam is only given in the United States.
• USMLE Part 3 is a 2 days exam. 
• A student can apply for Part 3 while doing the Residency program, that is the PG in the US which he/she is doing after clearing USMLE Part 2 CS.
• Minimum 1-2 years of Residency has to be completed (depending on State) before applying for Part 3.

• USMLE Step 2 CS is a practical exam to handle 10-12 simulated patients to check patient handling /diagnosing skills.
• The outcome of the CS exam is either Pass or Fail.
• However, Step 3 is the US licensing exam (with the same subjects as of Part 2 CK). So clearing Step 3 becomes easy to get into Residency than in the absence of Step 3.
• Ultimately every student has to clear Step 3 to be board certified doctor in the USA.
• Clearing the Step 2 CS is mandatory before applying for Residency.

The approximate total expenses that can occur in between USMLE Application till getting Residency in any University in the US:

• Step 1, 2, CK, CS fees as mentioned above
• USMLE Coaching or tutoring, if any, books, self-assessment, q-bank, and their extensions fees.
• ERAS, separate residency application fees per hospital
• Minimum 3 US-India round trips- 1st one for your Step 2 CS and 2nd and 3rd for Residency interviews (approx Rs 80 k to Rs 1 Lac per trip).
• Hotel expenses during CS and Interviews in the US (in some States in the US, hotel rates are quite high).
• Air travels within the US for interviews in different universities.
• Stay, food and travel during USCE and interviews
• USCE fees if any
• Visa application in India.
• Currency exchange charges / Forex card charges
• Phone bills
• Rs 9 – 11 Lac plus keeping Rs 3 – 4 Lac on the safe side for any unforeseen emergency. 
• So, keep a budget of a minimum Rs 15 Lac and study hard for USMLE. If you fail once, then your expense will go very high. A repeat at any stage is bound to cause an increase in total cost.
• This cost is excluding any paid USCE and USMLE coaching. The price of USCE may go up to $5000, including three proper LOR and Personal Statement (PS).

LOR is a Letter of Recommendation from a US doctor. 

USCE is US Clinical Experience. 

So, to be on the safe side, it is better to keep a budget of a minimum of Rs 19 Lac.