What it is
To become a licensed physician, medical students take a multi-step licensing exam sequence during and after medical school. MD students take the USMLE (from the NBME and FSMB); DO students take COMLEX-USA (from the NBOME), and many DO students also take the USMLE. These are among the highest-stakes exams in any profession, taken across years of training.
Format & structure
- USMLE (MD path)Step 1 (foundational sciences — now Pass/Fail), Step 2 CK (clinical knowledge), and Step 3 (patient management, taken during residency)
- COMLEX-USA (DO path)Level 1 (now Pass/Fail), Level 2-CE, and Level 3 — parallel to the USMLE, with osteopathic principles included
- When they're takenAcross medical school and into residency, in sequence
How it's scored
USMLE Step 1 and COMLEX Level 1 are now Pass/Fail (Step 1 changed in 2022) — a shift meant to reduce score pressure early on. Step 2 CK and Step 3 (and COMLEX Levels 2–3) still report numeric scores, which residency programs weigh heavily. Passing all steps is required for licensure.
Registration & cost
Register through the official bodies — the USMLE (via the NBME/ECFMG) or the NBOME for COMLEX — as directed by your medical school. Fees are substantial (hundreds of dollars per step). Your school guides you through eligibility and scheduling.
Test dates & timing
Each step is scheduled at a Prometric center (and some have specific windows). Steps are taken in sequence over years — typically Step/Level 1 after preclinical years, Step/Level 2 in clinical years, and Step/Level 3 during residency.
How to prepare
- Plan months per stepStudents devote dedicated study blocks (often 6+ weeks) using question banks and review resources
- Practice-question heavyLarge question banks with rationales are the standard method
- Integrate across systemsThese reward applying knowledge to clinical scenarios
- Use your school's guidanceMed schools structure prep and timing
Strategies & tips
- Since Step 1 is Pass/Fail, focus Step 2 CKPrograms now weigh Step 2 CK numeric scores more heavily
- Build clinical reasoningAll steps test application, not just recall
- Manage the marathonThese are long exams — build stamina with full practice
- Sequence carefullyTiming each step around rotations and residency matters
How scores are used
Passing all steps is required for medical licensure, and the scored steps (especially Step 2 CK / COMLEX Level 2) are major factors in residency selection. State medical boards require the full sequence (plus training) to license a physician.
Accommodations & support
Accommodations for documented disabilities are available through the USMLE/NBOME — apply well ahead, as review takes time.
Frequently asked questions
- Is Step 1 still scored?No — USMLE Step 1 (and COMLEX Level 1) are now Pass/Fail; the later steps are scored.
- USMLE vs COMLEX?USMLE is for MD students; COMLEX-USA is for DO students (many DOs take both).
- When are they taken?Across medical school and residency, in sequence.
- Why do the later scores matter so much?Residency programs use Step 2 CK / COMLEX Level 2 scores in selection.
- How long is prep?Often months of dedicated study per step.
Key facts
- USMLE (MD)Step 1 (Pass/Fail) · Step 2 CK · Step 3
- COMLEX (DO)Level 1 (Pass/Fail) · Level 2-CE · Level 3
- ProvidersNBME/FSMB · NBOME
- TakenAcross med school & residency
- Required forMedical licensure
Where to learn more
Confirm current details with the official sources: