usmle steps explained: Steps, Eligibility, Registration, Fees &Tips for Indian Med Students

What is usmle exam

The United States Medical Licensing Examination (USMLE) is a three-step exam required for medical licensure in the United States, assessing a candidate’s ability to apply medical knowledge and patient-centered skills.

Purpose

The USMLE exam is designed to evaluate a medical student’s proficiency in applying medical knowledge, principles, and concepts, as well as their ability to demonstrate essential patient-centered skills for safe and effective patient care.

The USMLE consists of three separate exams, known as " USMLE Steps"

USMLE Step 1: Assesses basic sciences knowledge.

USMLE Step 2 CK: Assesses clinical knowledge and skills.

USMLE Step 3: Tests clinical decision-making and patient management, often taken during or after the first year of U.S. residency.

Importance

Passing all three steps usmle steps of the usmle exam is a requirement for obtaining a medical license in the United States.

USMLE is not exclusively for MBBS students; it is a comprehensive examination accessible to a diverse range of medical graduates, including MDs, DOs, and IMGs

How to Become a U.S. Doctor as an IMG From India

To become a doctor in the U.S. as an International Medical Graduate (IMG) from India, you need to pass the USMLE exams, obtain ECFMG certification, complete a U.S. residency program, and obtain state medical licensure.

Step 1: Register for ECFMG Certification

The first step for any IMG is to register with the Educational Commission for Foreign Medical Graduates (ECFMG). This organization evaluates and certifies the qualifications of international medical graduates who wish to practice medicine in the U.S.

Create an account and apply through the ECFMG portal.
Ensure your medical college is listed in the World Directory of Medical Schools and recognized by ECFMG.
Submit your medical school transcripts and degree certificates for verification.
Prepare for and pass the Occupational English Test (OET) exam, which is required to demonstrate English proficiency.
Once your documents are verified and OET test is cleared, you can apply for the USMLE Step 1 and Step 2 CK. No, ECFMG certification is not required for USMLE Step 1 and Step 2 Clinical Knowledge (CK). ECFMG certification is a requirement for applying to US residency programs, and it’s earned after passing Step 1 and Step 2 CK. To become ECFMG certified, international medical graduates (IMGs) need to pass Step 1 and Step 2 CK, among other requirements. It is best to complete the certification before the residency Match application starts, as some programs filter candidates based on ECFMG certification status.

Step 2: Take the USMLE Exams

The United States Medical Licensing Examination (USMLE) is a three-step exam series that all aspiring physicians must pass to obtain a license to practice in the U.S.

USMLE Step 1 assesses your understanding of the basic sciences relevant to medical practice. It’s important to dedicate time to a thorough study plan, and many candidates take a structured Step 1 prep course.
USMLE Step 2 CK (Clinical Knowledge) evaluates your clinical knowledge and application in real-world scenarios. Just like Step 1, preparation through a review course and question banks is highly recommended.
USMLE Step 2 CS (Clinical Skills) has been permanently discontinued.

USMLE Step 3 focuses on clinical decision-making and can be taken before applying to residency, provided you meet the eligibility criteria. However, many take it during or after the first year of residency.

Step 3: Apply for a U.S. Residency Program

After completing USMLE Step 1 and USMLE Step 2 CK and receiving your ECFMG certification, the next phase is applying to residency programs in the U.S.

Submit your application through MyERAS (Electronic Residency Application Service).
Register for the National Resident Matching Program (NRMP), which matches applicants with available residency positions.
Prepare a strong application, including letters of recommendation, a personal statement, US clinical experience (if possible), and your usmle exam scores.
Once you match with a residency program, you can begin your postgraduate training in the U.S.

Step 4: Obtain Your Medical License

After completing at least one year of residency and passing USMLE Step 3, you can apply for a license to practice medicine in a particular state. Each state has its own licensing board and requirements, so it’s important to research the specific state where you plan to practice.

Who is Eligible to take the USMLE Examinations?

USMLE Step 1 and USMLE Step 2 CK

To be eligible, you must be in one of the following categories at the time you apply AND on the day of your examination:

A medical student officially enrolled in, or a graduate of, a US or Canadian medical school program leading to the MD degree that is accredited by the LCME, OR
A medical student officially enrolled in, or a graduate of, a US medical school leading to the DO degree that is accredited by the Commission on Osteopathic College Accreditation (COCA), OR
A medical student officially enrolled in, or a graduate of, a medical school that is outside the US and Canada, listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements, and that meets other eligibility criteria of the ECFMG.

USMLE Step 3

Eligibility requirements for Step 3 are:

Passing scores on usmle Step 1 and usmle Step 2 CK, AND
An MD degree or the DO degree from an LCME- or COCA-accredited US or Canadian medical school, OR the equivalent of the MD degree from a medical school outside the US and Canada that is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements and obtain ECFMG Certification, AND
Meet all other eligibility criteria as listed in the USMLE Bulletin of Information.

The USMLE program recommends that, for Step 3 eligibility, applicants should have completed, or be near completion of, at least one postgraduate training year in an accredited US graduate medical education program that meets state board licensing requirements.

usmle registration process

Registering for the USMLE Step 1 as an International Medical Graduate (IMG) involves several key steps.

Verify Medical School Eligibility

Confirm Accreditation: Ensure your medical school is listed in the World Directory of Medical Schools with an ECFMG note, indicating it meets eligibility requirements.

Obtain a USMLE/ECFMG Identification Number

Request ID: Visit the ECFMG website and navigate to the Interactive Web Applications (IWA) section to request a USMLE/ECFMG Identification Number.

Complete the Application for ECFMG Certification

- Submit Application: Log in to IWA using your Identification Number, complete the Application for ECFMG Certification, and pay the associated fee.

Form 186: After submitting your application, you’ll need to complete and notarize Form 186 through NotaryCam, which involves an online verification process.

Apply for USMLE Step 1 Examination

Access Exam Application: Once your ECFMG Certification application is accepted, log back into IWA to access the USMLE Step 1 application.
Choose Eligibility Period: Select a three-month eligibility period during which you plan to take the exam.
Pay Examination Fee: Submit the required examination fee as specified on the ECFMG website.

Schedule Your Exam

Receive Scheduling Permit: After your application is processed, ECFMG will issue a scheduling permit.

Book Exam Date: Use the scheduling permit to book your exam date with Prometric, the official testing service.

usmle from india

Indian MBBS students can take the USMLE to practice medicine in the United States, with many doing so after completing their second year of medical school. The USMLE is a three-step exam, and Indian students can take it in India for Steps 1 and 2, but Step 3 must be taken in the USA.

Eligibility and Process:

Eligibility: To be eligible for the USMLE, you typically need to be enrolled in or a graduate of a medical school recognized by the Medical Council of India (MCI).

ECFMG Registration: You must create an account with the Educational Commission for Foreign Medical Graduates (ECFMG).

USMLE Application: Complete the USMLE Step application form and pay the necessary fees.

Form 183: Fill out Form 183, which requires a signature and stamp from your medical school dean, and mail it to the address listed on the form.

Scheduling Permit: After submitting Form 183, you’ll receive an email from the ECFMG containing your scheduling permit.

Exam Scheduling: Book your exam date through Prometric, the testing agency.

USMLE Steps:

Step 1: Focuses on basic sciences like anatomy, physiology, biochemistry, pathology, microbiology, and pharmacology.

Step 2 CK: Focuses on clinical knowledge, including internal medicine, surgery, pediatrics, OB-GYN, and psychiatry.

Step 3: You can take Step 3 even before applying for residency, only in the United States.

Preparation:

Start Early: Many recommend starting preparation in the second year of MBBS.

Study Materials: Utilize resources like First Aid, Pathoma, and UWorld Q-bank.

Thorough Review: Read First Aid and Pathoma thoroughly, and complete UWorld Q-bank.

Practice Questions: Solve a large number of practice questions to familiarize yourself with the exam format.

Where Can You Take the USMLE in India?

Steps 1 and 2 CK are offered in:

Chennai
Hyderabad
Ahmedabad
Bangalore
Kolkata
Allahabad
Mumbai
New Delhi

Step 3 is available only in the United States.

What is the total cost for USMLE 2025?

The total cost of USMLE journey (United States Medical Licensing Examination) varies depending on which steps you take and where you take them. The fees for each step in 2025 are as follows:

Step 1: $1020.
Step 2: CK (Clinical Knowledge): $1020.
Step 3: $915 for 2024 and $925 for 2025.

In addition to these fees, additional costs may be associated with taking the USMLE, such as study materials and travel expenses.

Final Words

This comprehensive us medical licensing exam guide is tailored for Indian MBBS students aiming for a successful usmle journey — from usmle registration to post-residency licensing. Whether you’re exploring usmle exam in india options or deep into your usmle preparation, this usmle guide offers clarity, steps, and tips to move forward.