Overview
US physician licensing uses the USMLE (United States Medical Licensing Examination) as its core assessment pathway. All three Steps must be passed for full, unrestricted medical licensure in the United States.
USMLE Step 1
Step 1 tests basic science knowledge — anatomy, physiology, biochemistry, pathology, pharmacology, microbiology and behavioural sciences. Moved to pass/fail in January 2022, reducing its influence on residency applications but remaining essential to pass.
Recommended Resources
- First Aid for the USMLE Step 1 — essential annual reference text
- Anki — spaced repetition with Zanki/Anking decks
- Sketchy Medical — microbiology and pharmacology mnemonics
- Pathoma — pathology (Husain Sattar)
- UWorld Question Bank — gold standard question bank
USMLE Step 2 CK
Step 2 CK (Clinical Knowledge) tests clinical decision-making across all major specialties. Now the most important USMLE score for residency matching since Step 1 went pass/fail. High scores (250+) significantly improve Match competitiveness.
Recommended Resources
- UWorld Step 2 CK — primary question bank
- Amboss — excellent clinical correlations
- Divine Intervention Podcasts — free, high-yield
- Emma Holliday Ramahi Reviews (YouTube) — free specialty reviews
USMLE Step 3
Step 3 is taken during residency (typically PGY-1 or PGY-2). Tests clinical management including biostatistics and epidemiology. Two-day exam: Foundations of Independent Practice (FIP) and Advanced Clinical Medicine (ACM). Required for unrestricted licensure in most states.
ABMS Specialty Board Exams
After completing residency, physicians must pass their specialty board examination to become board certified. Examples:
| Specialty | Board | Exam Format |
|---|---|---|
| Internal Medicine | ABIM | Computer-based MCQ |
| Surgery | ABS | Written + Oral exam |
| Family Medicine | ABFM | Computer-based MCQ |
| Emergency Medicine | ABEM | Written + Oral exam |
| Anesthesiology | ABA | Written + Oral exam |
| Radiology | ABR | Core + Certifying exams |
| Psychiatry | ABPN | Written + Oral exam |
IMG-Specific Considerations
- All three USMLE Steps required for ECFMG Certification
- No attempt limits, but programmes track number of attempts
- Strong Step 2 CK score (250+) is critical for IMG Match competitiveness
- US clinical experience (externships, electives) important alongside exam scores