usmle exam for foreign doctors

USMLE Exam For Foreign Doctors [2023 Comprehensive Guide]

In this article, we provide you with all the beneficial information you require related to the USMLE exam for foreign doctors in 2023. Let's get started!

June 14, 2022

You will need to undertake the United States Medical Licensing Examination (USMLE) if you are applying for a Post Graduate Medical Residency Training program or seeking licensure in the United States. In this article, we provide you with all the beneficial information you require related to the USMLE exam for foreign doctors in 2022.

Let’s get started with our free USMLE practice test to enhance your chance of passing your actual exam with a high score on your first attempt.

usmle exam for foreign doctors

USMLE Exam

The USMLE, or United States Medical Licensing Examination, is the exam that must be passed in order to obtain a medical license in the United States. The USMLE was created by two non-profit organizations, the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), to provide a single national examination for allopathic physician licensure that could be used by all state medical boards. (Osteopathic physicians should use COMLEX-USA.) This guarantees that all practicing allopathic physicians, regardless of their previous training or the state in which they practice, have met the same assessment standards.

The USMLE’s purpose is to provide a uniform standard of testing for medical licensing in the United States. It is a requirement for graduates who earned their certifications both in the United States and abroad. Those who had their training outside of the United States are assessed to the same requirements as United States medical school students and graduates, ensuring that all physicians, regardless of their previous training, have met the same standards.

The USMLE is designed to evaluate essential skills for providing safe and effective patient care. It tests your patient-centered skills and focuses on your ability to apply knowledge, concepts, and principles.

The exam is formed of three multiple-choice tests, including Step 1, Step 2 Clinical Knowledge, and Step 3, which are covered in more detail in the format section below.

Requirements for foreign doctors in the US

As an international medical graduate, you must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG).  To become certified, you must pass the USMLE Steps 1 and Step 2, meet the ECFMG’s eligibility requirements, and ensure that your teaching institute is listed in the World Directory of Medical Schools.

After that, you can apply for a position in Post Graduate Medical Residency Training (residency). This can be done either before or after passing the USMLE Step 3 test. Because obtaining residency is competitive, some applicants choose to complete Step 3 first to improve their chances of acceptance, while others wanted to wait if their Step 1 and Step 2 scores are good. The third step is usually completed after the first year of your graduate residency program.

Either way, you can not take Step 3 of the USMLE until you have been certified by the ECFMG, so get that completed first. You can apply for a license to practice medicine in the state of your choice once completing your residency and pass Step 3.

If you are applying for a medical license to practice clinical medicine in an unsupervised setting (i.e. outside of postgraduate training programs), you will also need to obtain ECFMG certification after passing Step 1 and Step 2 of the USMLE and passing Step 3 of the USMLE.

USMLE Format

The USMLE consists of three multiple-choice exams, as said before: Step 1, Step 2 Clinical Knowledge, and Step 3. A Clinical Skills section was once included in Step 2, however, this has now been discontinued.

USMLE Step 1 Questions

  • Length / Time: One-day exam. Seven 60-minute blocks, totaling roughly eight hours including breaks.
  • The total number of questions: roughly 280 multiple choice questions.
  • Assessment area: Your ability to apply crucial basic science concepts to clinical scenarios, focusing on the underlying principles and mechanisms of health, disease, and modes of therapy.

USMLE Step 2 Clinical Knowledge Questions

  • Length / Time: One-day exam. Eight 60-minute blocks, totaling roughly nine hours including breaks.
  • The total number of questions: is roughly 318 multiple choice questions.
  • Assessment area: With a focus on health promotion and disease prevention, your ability to apply your medical knowledge, skills, and understanding of clinical science is considered vital for patient care.

USMLE Step 3 Questions

Step 3 is separated into two sections: Foundations of Independent Practice (FIP) and Advanced Clinical Medicine (ACM), take two days to complete. It examines your ability to use medical knowledge and understanding of biomedical and clinical science in ambulatory settings, with a focus on patient management.

Day 1 – FIP:

  • Length / Time: One-day exam. Six 60-minute blocks, totaling roughly seven hours including breaks.
  • The total number of questions: is roughly 232 multiple choice questions.
  • Assessment area: Your knowledge of basic scientific and medical principles is essential for effective care.

Day 2 – ACM:

  • Length / Time: One-day exam. Six 45-minute blocks (for the multiple choice questions) and thirteen stimulation blocks (each lasting no more than 10 or 20 minutes), totaling roughly nine hours including breaks.
  • The total number of questions: roughly 180 multiple choice questions and 13 computer-based case simulations (CCS).
  • Assessment area: Your ability to manage patients using your understanding of health and disease.

USMLE Timeline

Although there is no specific timeline for taking the various stages of the USMLE, there are several limitations and recommendations to keep in mind when deciding when to take each step.

Step 1 and Step 2 can be taken in any order, however, students in LCME-accredited medical schools are recommended to take Step 1 at the end of their second year and Step 2 in their fourth year.

Only after passing Step 1 and Step 2 of the USMLE could you take Step 3. Before trying Step 3, it is advised that you have completed, or be close to completing, at least the first year of postgraduate training in a recognized United States graduate medical education program.

Most licensing authorities require that you must complete Step 1, Step 2, and Step 3 of the USMLE within seven years of passing the first step.

Registration

Prometric Centers administer the USMLE Step 1, Step 2 Clinical Knowledge, and Step 3 computer-based examinations. Step 3 is only administered in the United States and its territories. You may find your nearest Prometric Center on their website.

The registration process varies depending on where you studied/graduated from and which stage of the USMLE you are taking. The different registration procedures are as follows:

usmle exam for foreign doctors

  • Step 1 and Step 2 Clinical Knowledge:
  • Step 3:
    • All medical school graduates (who have passed Step 1 and Step 2) – apply through the FSMB website.

Regardless of where you studied/graduated from, the application and scheduling process for each element of the USMLE remains the same once you have registered through the appropriate route. The steps for you to take are as follows:

  • Select your eligibility period during which you want to test.
  • Check your emails for your scheduling permit that will be sent to you.
  • Visit the Prometric website to schedule your USMLE exam.

Fees

The USMLE fees for the different stages of the exam are as follows:

Step 1 & Step 2 Clinical Knowledge

The following are the USMLE fees for students/graduates of LCME or COCA accredited medical schools in the United States or Canada in 2021–2022.

Step 1645
Step 2 Clinical Knowledge645
Eligibility Period Extension70

For students/graduates of medical schools outside of the United States or Canada, the USMLE fees are as follows:

Application for ECFMG150
Step 1$975 + $180 international test delivery surcharge, if testing outside of the United States or Canada
Step 2 Clinical Knowledge$975 + $200 international test delivery surcharge, if testing outside of the United States or Canada
Eligibility Period Extension90
Step 1/Step 2 Testing Region Change$85 per region change

Step 3

For USMLE Step 3, the application fee is non-refundable and non-transferable from one application to another or from one eligibility period to another.

The fee for the exam in 2022 is $895.

The Difficulty of The USMLE

With three different examinations to study for (though not all at the same time) and the complexity of each element, passing the USMLE may be a long and difficult process.

Since post-graduate residency programs are so competitive, it’s crucial that you do well on the USMLE. When you consider the importance of the exam and how hard it is, you can see why you need to study well.

USMLE practice questions will be very useful in aiding your exam preparation. Including these in your study plan will help you get more familiar with the types of questions you’ll be asked at each step of the exam and give you opportunities to practice applying your knowledge and skills.

USMLE Pass Rate for International Students

For each step of the USMLE in the last two examination years, the number of candidates from non-United States or Canadian schools, as well as the percentage of candidates who passed, is shown below:

Step 1

Examinees from Non-US/Canadian Schools2020 Number Tested2020 Percent Passing2021* Number Tested2021* Percent Passing
1st Takers117420.87169520.82
Repeaters**13750.522580.45
Total131170.8319,210.77

* Data for examinees who tested in 2021 and reported through February 2, 2022.

** ‘Repeaters’ represents exams given but not the number of examinees.

Step 2 Clinical Knowledge

Examinees from Non-US/Canadian Schools2019 - 2020 Number Tested2019 - 2020 Percent Passing2020 - 2021* Number Tested2020 - 2021* Percent Passing
1st Takers91230.9124310.91
Repeaters**11720.5913680.62
Total102950.87137990.88

*Data for Step 2 Clinical Knowledge are provided for examinees who tested during the period of July 1 to June 30 whose scores were reported through February 2, 2022.

** ‘Repeaters’ represents exams given but not the number of examinees.

Step 3

Examinees from Non-US/Canadian Schools2020 Number Tested2020 Percent Passing2021* Number Tested2021* Percent Passing
1st Takers71920.998910.91
Repeaters**9130.5713110.62
Total81050.86112020.87

* Represents data for examinees who tested in 2021 and reported through February 2, 2022.

** Repeaters represent exams given but not the number of examinees.

USMLE Validity Abroad

Although the USMLE was created to assess medical licensure in the United States, it is only accepted in a few countries outside of the United States. If you’re considering working in a country other than the United States, check what exams and qualifications are required, as the USMLE may not be the best route, even if it is accepted. However, if you pass the USMLE and are unable to obtain a post-graduate residency or no longer choose to work in the United States, there may be other options available to you.

Jobs for Foreign Doctors without USMLE

As a foreign medical graduate, you cannot apply for residency in the United States without passing the USMLE (Step 1 and Step 2). Similarly, you will be unable to apply for medical licensure in the United States unless you complete all elements of the USMLE (including Step 3). All practicing physicians in an unsupervised setting (that is outside of postgraduate study) must have a license, which is required if you want to work in this capacity.

If you don’t want to complete the USMLE, you can still work in non-clinical roles. Your options will likely be limited, and you may find that some jobs still require medical licensure. Even if your objective is to work in a non-clinical role, passing the USMLE can help you land a job and broaden your career options.

Job comparison

As stated previously, without passing the USMLE, you would be limited to non-clinical positions. There are a variety of non-clinical job opportunities available, but they are generally competitive and need experience, additional training, or certification.

Research roles, pharmaceutical roles for unlicensed physicians, and business roles are some of the topics you might want to look into more. This will enable you to compare potential opportunities available without the USMLE to those available if you pass the exam and are eligible for residency and/or licensure.

Salary comparison

If you chose not to take the USMLE, the salary you can earn will be determined by the type of job you land and the level at which you’ll be working. If you’re thinking about going this route, do some research on the specific field you want to work in to find out what kind of salary you can expect.

In comparison, post-graduate training (residency) at a United States hospital is a paid job, with first-year residents earning around $45,000 USD on average.

Conclusion

This article brings you a lot of beneficial information about the USMLE exam for foreign doctors. You can apply for a license to practice medicine after passing each step of the USMLE – Step 1, Step 2 Clinical Knowledge, and Step 3 – with flying colors. This creates opportunities for you to practice in an unsupervised setting (i.e. outside of postgraduate training).

Don’t forget to take our free USMLE practice test to get familiarized with the format as well as the questions of the actual exam to strengthen your knowledge and skills, as a result, enhancing your chance to pass the USMLE exam with a flying score on your first attempt. Good luck to you!

[Sassy_Social_Share]