The United States Medical Licensing Examination® (USMLE®) is a three-step examination for medical licensure in the United States and is sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners® (NBME®). Physicians with an M.D. degree are required to pass this examination before being permitted to practice medicine in the United States; see below for requirements of physicians with a D.O. degree.

The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care. Examination committees composed of medical educators and clinicians from across the United States and its territories create the examination materials each year. At least two committees critically appraise each test item or case, revising or discarding any materials that are in doubt.


The USMLE, formally the United States Medical Licensing Examination, is a famously challenging, three-step exam series that is required for anyone who wants to practice medicine in the United States. The first two steps of the series are typically taken while a student is still in medical school, while the third step takes place after graduation.

The exams are sponsored by two organizations: the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). The USMLE exams, particularly Step 1, are often referred to colloquially as “The Boards.”

USMLE scores are used in three major ways:

Most U.S. medical schools require students to pass Step 1 to graduate — and some also require that they pass Step 2/Clinical Knowledge (CK) and Step 2/Clinical Skills (CS) to receive their degree.

The scores from the first two steps (Step 1, Step 2 CK, and Step 2 CS) play an important part in assessing medical students for residency training positions in the U.S.

Passing the last step (Step 3) is required in order to be admitted into U.S.-based specialty boards, such as the American Board of Internal Medicine, but is also required by state medical boards that license doctors to practice in their specialty. (Boards are governing bodies that certify doctors at the state level, as well as in more than 150 specialties.)