The United States Medical Licensing Examination (USMLE) is a three-step examination required for medical licensure in the United States. It is jointly administered by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) and is mandatory for all physicians U.S. graduates and international medical graduates (IMGs) seeking to practice medicine in the U.S.
Step 1 and Step 2 Clinical Knowledge (CK): You are eligible if you are officially enrolled in, or a graduate of:
- A U.S. or Canadian medical school accredited by the Liaison Committee on Medical Education (LCME) granting the MD degree, or by the American Osteopathic Association (AOA/COCA) granting the DO degree.
- An international medical school listed in the World Directory of Medical Schools that meets ECFMG criteria.
For U.S./Canadian students, your medical school must certify your enrollment or graduation. For IMGs, you must register through the Educational Commission for Foreign Medical Graduates (ECFMG) and meet ECFMG eligibility requirements (e.g., valid medical school diploma and ECFMG-recognized credentials).
Step 3: Eligibility is more restrictive and requires:
- An MD or DO degree from an LCME- or COCA-accredited school, OR
- ECFMG Certification (for IMGs), which requires passing Step 1 and Step 2 CK, plus meeting English language proficiency (OET Medicine), AND
- At least one year of postgraduate training in an ACGME-accredited program in the U.S. or, in some cases, a full medical license from a U.S. state.
Important note: Starting July 1, 2025, graduates of Canadian medical schools will be treated as IMGs and must obtain ECFMG Certification to be eligible for USMLE Step 3 and U.S. residency programs.
There is no age limit, but each step has a maximum of six attempts within defined timeframes. Always verify current requirements on the official USMLE (usmle.org) and ECFMG (ecfmg.org) websites, as policies occasionally change.