USMLE Guide 2026: Step 1, Step 2 CK & Step 3 for FMGs and Medical Graduates

Dr. Amin ali
1 day ago
6 min read

Updated: 6 hours ago

Published January 6, 2026

The United States Medical Licensing Examination® (USMLE®) is a three-step exam that measures a doctor’s ability to practice medicine safely, effectively, and independently in the United States. Sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), and it sets a fair, clear standard for all physicians.

For medical students and foreign medical graduates (FMGs), the USMLE is a must-pass exam. It determines eligibility for U.S. residency programs, tests your medical knowledge and clinical skills, and opens doors to career opportunities worldwide.

This guide is your complete USMLE roadmap. You’ll learn everything about eligibility, exam steps, syllabus, preparation strategies, fees, scheduling, test centers, and top tips for success, so you can plan, study, and pass on your first try.

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What Is the USMLE?

The USMLE is a standardized, three-step examination required for medical licensure in the United States. It tests:

Step 1: Foundational medical sciences
Step 2 CK: Clinical knowledge and patient care
Step 3: Independent practice & decision-making

Governing Bodies:

Organization	Role
NBME	Exam development and assessment
FSMB	Licensure oversight
ECFMG	Certification of international graduates

Who Should Take the USMLE?

Eligible candidates include:

Medical students and graduates from accredited MD/DO programs in the U.S. or Canada
Foreign Medical Graduates (FMGs) from recognized schools listed in the World Directory of Medical Schools
Doctors aiming to practice or complete residency in the U.S.

Even if you don’t plan to practice in the U.S., preparing for the USMLE is globally recognized and can strengthen your medical career. Later in this blog, we’ll discuss which countries you could work in.

Check your school’s eligibility in seconds — click here or on the image!

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USMLE Exam Structure

Step Overview Table

Step	Focus	Format	Length	Scoring	When Taken
Step 1	Basic Sciences & Clinical Foundations	MCQs	~8 hrs, 280 Qs	Pass/Fail	After pre-clinical years
Step 2 CK	Clinical Knowledge	MCQs	~9 hrs, 316 Qs	3-digit score	During/after clinical rotations
Step 3	Independent Practice	MCQs + CCS	2 days	3-digit score	After Step 1 & Step 2 CK, usually during residency

Step 1: Foundations of Medicine

Purpose: Tests your understanding of basic sciences and their application to medicine.

Syllabus Overview (Weights Approx.):

Subject	Approx. %
Pathology	45–55%
Physiology	30–40%
Pharmacology	10–20%
Biochemistry & Nutrition	5–15%
Microbiology & Immunology	10–20%
Gross Anatomy & Embryology	10–20%
Behavioral Sciences	10–15%
Genetics	5–10%

Skills Tested: Mechanisms of disease, therapeutics, cellular & organ physiology, immunology, behavioral sciences, and ethics.

Step 2 CK: Clinical Knowledge

Purpose: Assesses diagnosis, patient care, and management.

High-Weight Areas:

Area	Approx. %
Internal Medicine	55–65%
Surgery	20–30%
Pediatrics	17–27%
Obstetrics & Gynecology	10–20%
Psychiatry	10–15%

Why It Matters: Step 2 CK scores are heavily considered by residency programs.

Step 3: Clinical Practice

Purpose: Tests readiness for independent practice.

Components:

Day 1: Foundations of Independent Practice
Day 2: Advanced Clinical Medicine & Case Simulations (CCS)

Skills Tested: Diagnosis, patient management, preventive care, patient safety, and clinical decision-making.

Eligibility For The USMLE

Step 1 & 2 CK:

Must be enrolled in or a graduate of an accredited MD/DO program (U.S./Canada)
FMGs/IMGs: Must have ECFMG certification

Step 3:

Must pass Step 1 & Step 2 CK
MD/DO degree
FMGs: complete ECFMG certification

Step-by-Step Registration Steps For FMGs

Registration for international candidates:

Create ECFMG account (Review the updates starting January 12, 2026 --> Moving to FSMB Portal)
Submit Step application
Submit Form 183 (school verification)
Receive Scheduling Permit
Book Prometric test date
Test within eligibility period

Rescheduling close to the test date may incur fees.

Important Changes of the Registration Portal

For International Medical Graduates (IMGs), USMLE Step 1 applications are currently submitted through ECFMG’s MyIntealth portal. However, a major system transition is scheduled for January 2026, when USMLE services for IMGs (Step 1 and Step 2 CK) will move from ECFMG to the FSMB (Federation of State Medical Boards).

To avoid delays, IMGs should either apply before the transition or wait until the new system is fully live.

Key Transition Dates to Know

December 31, 2025: Recommended deadline to submit ECFMG applications or service requests
January 8, 2026: MyIntealth portal temporarily unavailable
January 12, 2026: FSMB USMLE portal launches for IMGs; ECFMG services fully transition

For U.S. and Canadian Medical Students/Graduates

U.S. and Canadian medical students and graduates apply directly through the NBME (National Board of Medical Examiners). This process is not affected by the IMG transition.

Fees Overview

Fee Type	Step 1	Step 2 CK	Step 3
Exam Fee	~$1,000	~$1,000	~$935
ECFMG Certification	$150	—	—
Eligibility Extension	$70	$70	—
Change Testing Region	$85	$85	—
Score Recheck	$80	$80	—
Transcript / ERAS	$70–80	$70–80	—

Global Testing Centers

Step	Location	Notes
Step 1 & Step 2 CK	Worldwide Prometric Centers	Students can choose a center in their country once they have a scheduling permit
Step 3	U.S. & territories only	Step 3 is not available internationally; must be scheduled in the U.S.

Schedule up to 6 months in advance
Eligibility period: must test within your selected window. extensions possible with fees
Key Details for Usmle Step 3:
- Location: United States & Territories only (e.g., Puerto Rico).
- Test Provider: Prometric.
- Scheduling: Schedule via the Prometric website.
- When: Year-round, except for early January and major U.S. holidays, with peak times being May-July and Nov-Dec

Exam Day Rules

Arrive 30 minutes before your test
Bring your Scheduling Permit
Bring a valid government-issued photo ID matching your permit
Late arrivals may require rescheduling within the eligibility window
Follow Prometric security protocols (no electronic devices, personal items in lockers)

USMLE Preparation Timeline

Candidate	Step 1	Step 2 CK
U.S. Student	6–10 months	4–8 months
FMG/IMG	8–12 months	5–9 months

Concept-first learning + QBank practice
Self-assessment exams & performance tracking
Avoiding passive study & overloading resources
Focus on high-yield topics and weaknesses

Looking for an all-in-one USMLE resource and a fully organized plan to pass on your first attempt? Discover the Brocali USMLE program.

In Which Countries Is the USMLE Accepted or Recognized?

The USMLE is primarily a U.S. licensing exam, but its results are respected worldwide and, in some countries, can even exempt you from local licensing exams.

Country / Region	Recognition / Use of USMLE	Notes / Exemptions
United States	Required for medical licensure	Must complete residency after Steps 1–3
Canada	Recognized for residency applications	Local MCC exams usually still required
Israel	Can exempt from the Israeli licensing exam	Requires passing Step 1 & 2 CK and recognized MD degree
UAE	May waive local written exams	Exemption possible if all Steps passed
Qatar & Gulf countries	Helps with residency and hospital employment	Policies vary by hospital/region
Singapore	Recognized for clinical and teaching roles	May support registration in hospitals
Australia & New Zealand	Supports special licensing pathways	Can exempt parts of local exams (e.g., Competent Authority Pathway)
Ireland & UK	Recognized for research, fellowships, and some residency applications	Local exams (PLAB, others) usually still required
Global NGOs & Telemedicine	Preferred for international healthcare projects	Examples: Doctors Without Borders, Red Cross, UN programs

Recognition does not always mean full licensure. Always check local licensing requirements for language, clinical assessment, and residency rules.

How Brocali Supports USMLE Preparation

1. Organized Study Plan

Know what to study, when, and how.

Each Usmle subject is divided into Modules → Categories → Chapters.

Learn More

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2. Arabic Video Lectures

Over 580+ videos covering all USMLE subjects.

Each chapter has a short, focused video taught by a specialist doctor, breaking down concepts in a way that’s easy to understand and directly applicable to the exam.

Learn More