United States Medical Licensing Examination (Step 1, Step 2 CK, Step 3)
The USMLE is the three step exam sequence that MD physicians (and many DO physicians) pass to qualify for a U.S. medical license. Step 1 covers the basic sciences behind medicine, Step 2 CK tests clinical knowledge used in patient care, and Step 3 tests whether a doctor can apply that knowledge in unsupervised practice. Step 1 is reported pass or fail, while Step 2 CK and Step 3 report three digit scores.
Issued by USMLE, co-sponsored by the Federation of State Medical Boards (FSMB) and NBME · Official page
Who can apply
- Students and graduates of LCME or COCA accredited U.S. MD and DO programs register for all three Steps through NBME (MyUSMLE portal), for applications on or after Jan. 26, 2026
- Students and graduates of medical schools outside the U.S. that meet ECFMG eligibility requirements register for all three Steps through FSMB, for applications on or after Jan. 12, 2026
- International medical graduates need ECFMG Certification to be eligible for Step 3
- Four or more unsuccessful attempts at any Step makes an examinee ineligible for any Step; no more than three attempts at the same Step within 12 months
Exam
- Exam
- USMLE Step 1, Step 2 CK, Step 3
- Format
- Step 1: one day, 8 hour session; on or after May 14, 2026, fourteen 30 minute blocks of up to 20 questions each (previously seven 60 minute blocks, max 280 items). Step 2 CK: one day, 9 hour session; on or after May 7, 2026, sixteen 30 minute blocks of up to 20 questions each (previously eight 60 minute blocks, max 318 items). Step 3: two days; Day 1 (Foundations of Independent Practice) 232 multiple choice questions in 12 blocks of 30 minutes; Day 2 (Advanced Clinical Medicine) 180 multiple choice questions in 9 blocks plus 13 to 14 computer based case simulations.
- Questions
- Data unavailable
- Time
- Step 1 about 8 hours; Step 2 CK about 9 hours; Step 3 about 7 hours (Day 1) and 9 hours (Day 2)
Step 1 has been reported pass/fail for exams on or after Jan. 26, 2022. Current passing standards: Step 1 standard of 196 (score not reported), Step 2 CK 218 (exams on or after July 1, 2025), Step 3 200 (exams on or after Jan. 1, 2024). Since January 2026, registration, score reporting and customer service are handled by NBME and FSMB.
Official fees
| Fee | Amount | Notes | Source |
|---|---|---|---|
| Step 1 application fee (2026 and 2027) | $695 | Same for U.S. and international applicants | Official page |
| Step 2 CK application fee (2026 and 2027) | $695 | Same for U.S. and international applicants | Official page |
| Step 3 application fee (2026 and 2027) | $955 | Same for U.S. and international applicants | Official page |
| Region fee, Step 1 outside U.S. and Canada | $210 | Not a USMLE fee; charged for testing outside the U.S. and Canada | Official page |
| Region fee, Step 2 CK outside U.S. and Canada | $235 | Not a USMLE fee; charged for testing outside the U.S. and Canada | Official page |
Only fees published by the issuer or regulator are listed. Blank amounts mean no official figure was available to verify.
Renewal and continuing education
- Cycle
- Not applicable
- Requirement
- Each Step is passed once. License renewal and CME are set by each state medical board.
Timeline
2026 fees apply to three month eligibility periods ending in 2026; 2027 fees apply to periods ending in 2027, starting with Nov. 1, 2026 to Jan. 31, 2027.
Notes
National exam sequence accepted by all U.S. state medical boards, including Connecticut DPH.
Related careers
| Occupation | National median wage |
|---|---|
| Family medicine physicians | $244,180 |
| General internal medicine physicians | $256,560 |
| Obstetricians and gynecologists | $292,910 |
| Physicians, all other | $265,930 |
Sources
- USMLE Step Exams, accessed October 18, 2026
- USMLE Apply for Exams, accessed October 18, 2026
- FSMB USMLE Application Fees, accessed October 18, 2026
- USMLE 2026 Bulletin of Information, accessed October 18, 2026
- 2026 USMLE Service Transition Addendum, accessed October 18, 2026
- Step 1 Exam Content, accessed October 18, 2026
- Step 2 CK Exam Content, accessed October 18, 2026
- Step 3 Exam Content, accessed October 18, 2026
- USMLE Examination Results and Scoring, accessed October 18, 2026
Verification notes
questions is null because counts differ by Step and the new 2026 Step 1 and Step 2 CK formats state only a per block maximum (20), not a total cap. Step 3 eligibility prerequisites beyond ECFMG Certification for IMGs (for example degree and prior Steps) were not confirmed on a fetched page and are omitted. A 2026 Step 3 software change is linked on usmle.org but no format change details were published on the content page.
ConnectPrep is not affiliated with USMLE, co-sponsored by the Federation of State Medical Boards (FSMB) and NBME. Credential names may be trademarks of their owners.