USMLE: An In-Depth Guide

Discipline	Range %
Pathology	45-55
Physiology	30-40
Gross Anatomy & Embryology	10-20
Microbiology	10-20
Pharmacology	10-20
Behavioral Sciences	10-15
Biochemistry & Nutrition	5-15
Immunology	5-15
Histology & Cell Biology	5-15
Genetics	5-10

 

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USMLE Step 2 CK (Clinical Knowledge)

USMLE Step 2 CK is an exam assessing a medical student's application of clinical science knowledge to patient care (under supervision). The “CK” stands for “Clinical Knowledge.” Passing Step 2 is almost universally required to apply to medical residency.

There used to be another Step 2 exam required alongside CK — called USMLE Step 2 CS (Clinical Skills) — but Step 2 CS was discontinued temporarily during COVID and discontinued permanently as of 2021.

When do you take it? Typically, you take Step 2 CK at the end of your third year in medical school. This exam is meant to be taken right before applying to residency programs.

What’s the format? You’ll take Step 2 in a single 9-hour test session, divided into eight 60-minute blocks. This computer-based, multiple-choice test will feature no more than 318 health science questions — at most 40 questions per 60-minute block. There’s an optional 15-minute tutorial, and a minimum of 45 minutes allotted for break time.

We recommend you run the Step 2 CK interactive testing experience to get familiar with the Step 2 test software before your test date.

How is it scored? Step 2 is scored on a three-digit scale ranging from 1-300. In 2025, the minimum passing score was raised to 218 (bottom 3% of test takers). However, if you want to match into a competitive specialty, aim for a score of at least 250-255. Learn more about Step 2 scores here.

How many people pass? Domestic test takers pass Step 2 CK about 97% of the time — this stat includes repeat testers with a pass rate of 72%. Test takers from outside the U.S. have a pass rate of about 87% — including repeaters who pass about 63% of the time.

Because Step 1 is now pass/fail, scoring well on Step 2 is more important for residency applications than it used to be, and perhaps more stress-inducing. Check out our Step 2 Score Estimator to determine what score you should aim for to make it into the specialty of your choice.

What does it cover? Check out this table on what disciplines are covered on USMLE Step 2, plus how much each discipline could appear on the test. Check out our curated Step 2 Study Guide for more comprehensive guidance.

 

USMLE Step 3: Final Licensing Exam

USMLE Step 3 is a two-day exam which is the final step towards general medical licensure. Day one assesses your knowledge of basic medical, scientific, and even social principles essential for effective health care. Day two assesses your patient care and disease management skills.

When do you take it? You’ll take Step 3 during residency, generally at the end of PGY-1 or the beginning of PGY-2.

What’s the format? Step 3 is taken over two exam days:

• The first day includes an optional 5-minute tutorial, followed by 232 multiple-choice questions divided into six 60-minute blocks of 38-39 items. You get at least 45 minutes for break time. Day one typically takes 7 hours.
• The second day includes an optional 5-minute tutorial, followed by 180 multiple-choice questions, divided into six 45-minute blocks of 30 items. The second day then features a 6-minute tutorial on computer-based case simulations, followed by 13-14 case simulations (not multiple-choice), each of which is allotted 10 or 20 minutes to complete. You get at least 45 minutes for break time. There’s an optional survey at the end of the second day. Day two typically takes 9 hours.

We recommend you run the updated Step 3 interactive testing experience to get totally familiar with the Step 3 testing software prior to test day.

How is it scored? Step 3 is scored on a three-digit scale. Both multiple-choice items and case simulations contribute to your score. Case simulations are scored based on how appropriately you manage the case, not a single “correct” path. In 2024, the minimum passing score was raised from 198 to 200.

How many people pass? Generally, about 97% of domestic test takers and 90% of non-U.S. test takers pass Step 3. Repeat test takers have about a 75% pass rate for domestic testers and 64% pass rate for non-U.S. testers.

What does it cover? Below is a table of content specifications covered on Step 3, separated into what’s covered on multiple-choice questions versus the non-multiple-choice case simulations. Check out our Step 3 Study Guide for comprehensive assistance.

 

 

When Do You Take Each Step?

Here’s a basic timeline for when to take each USMLE Step:

• When to study for USMLE Step 1: Middle of 2nd year of medical school
• When to take USMLE Step 1: End of 2nd year in medical school or in summer after 2nd year, before clinical rotations
• When to study for USMLE Step 2 CK: Middle of 3rd year of medical school
• When to take USMLE Step 2 CK: End of 3rd year in medical school or beginning of 4th year, before applying to residency
• When to study for USMLE Step 3: During your intern year of medical residency (PGY-1)
• When to take USMLE Step 3: During residency, at the end of PGY-1 or beginning of PGY-2

International medical graduates (IMGs) don’t have a standard USMLE timeline like those attending U.S. medical schools. While many IMGs take Step 1 before applying for U.S. clinical rotations, the timing depends on your school structure and personal strategy. In some cases, you may delay Step 1 if your rotation plans allow it.

7-Year Rule

For most medical students, there’s a 7-year rule you must abide by. Most state medical boards require you to pass the USMLE Step 3 within 7 years of passing USMLE Step 1. If it’s been more than 7 years, you probably have to retake one or more of the exams.

There are several exceptions to this 7-year rule since every state board can make its own rules:

• California, Indiana, Iowa, Kansas, Louisiana, Nebraska, Ohio, Oklahoma, South Carolina, Virginia, West Virginia, and Wisconsin allow medical students 10 years to pass all the USMLE Step exams.
• If you’re an MD/PhD dual-program student, Alaska, Colorado, New Mexico, South Dakota, and Utah allow 10 years to complete all Steps. Georgia allows 9 years for MD/PhD students.
• The following states have no time limit for completing all Steps: Arkansas, Connecticut, Florida, Hawaii, Idaho, Kentucky, New Hampshire, New York, and the territory of Guam.

 

Tips for Exam Preparation

USMLE test prep is essential. If you pass a step, you typically cannot retake it. You can retake after a failure, but a failure is a huge red flag on residency applications. So you want to put your best foot forward from the get-go.

Below are some expert tips from MedSchoolCoach Tutors who have helped people like you pass the USMLE with competitive scores:

• Determine when you’ll take Step 1 early on. Consult your academic advisor or administration at the start of your 2nd year in med school. Check out more proven strategies for Step 1 in this free webinar.
• Give yourself at least 3 months to study, so you don’t have to cram at the last minute. We recommend a low-stress 6-month study schedule if you can fit it into your calendar, especially if you have a history of poor test-taking.
• Set yourself up for success by considering USMLE tutoring. MedSchoolCoach offers personalized tutoring services, and you can choose the tutoring service that works best for your unique circumstances.
• Decide on your test date, keeping in mind how long it takes to get your Step 2 scores back, as this may affect your residency application timeline. USMLE score reports are released 2-4 weeks after taking the test.
• Check out our free guidebook on getting ready for Step 1 and Step 2 CK, including what books and question banks best prepare you for test day.
• Take plenty of practice tests. Use AMBOSS or UWorld question banks. We would not recommend any other Qbanks because AMBOSS and UWorld are by far the best common question bank resources, which include comprehensive explanations of why individual answers are right or wrong. Learn more tricks for the USMLE Step 2 here.
• Try to find little bursts of time to do 5 practice questions at a time. It’s difficult to find time for Step 2 or Step 3 studies during rotations, so it’s best to seek out small time gaps and use them to your advantage. You could aim to complete 20 practice questions by noon and another 20 by 5:00 PM.
• Download our free guidebook on Mastering Step 3 to create an effective study schedule, maximize study resources, and balance your life and studying.

 

Costs and Registration

Registering for USMLE test dates requires payment of registration fees to NBME.

Here is how much it costs to take the different USMLE steps in 2026:

• Step 1: $695
• Step 2 CK: $695
• Step 3: $955

For exams taken outside the U.S., there is an additional fee that is not collected by USMLE:

• Step 1 outside the U.S.: An additional $210
• Step 2 CK outside the U.S.: An additional $235

To extend your eligibility period to take Step 1 or Step 2, it costs $70.

The NBME offers a Fee Assistance Program to medical students who demonstrate financial need. Only available to eligible U.S. test takers for Step 1 and Step 2 CK, NBME is offering a reimbursement — not a fee waiver — that likely covers the full cost of one exam.

 

FAQs

 

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USMLE refers to three distinct tests typically taken over the course of 3-7 years. Step 1 is pass/fail, while Step 2 and Step 3 are scored on a three-digit scale. Getting good USMLE scores is vital to your journey to becoming a physician.

Step 1 and Step 2 CK are usually required to apply to medical residency. Completing all three steps is generally required by state medical boards to obtain a license to practice medicine in that state.

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