Testing Regions and International Test Delivery Surcharges for USMLE Step 1 and Step 2 CK

When you apply for Step 1 or Step 2 CK, you must select one of the testing regions from the list below where you will take the exam. Test centers offering Step 1/Step 2 CK were located in the countries listed below for each testing region. However, the availability of test centers is subject to change without notice. Before selecting your testing region, visit the Prometric website or contact Prometric for current information on the availability and location of test centers for Step 1 and Step 2 CK.

If you select a testing region other than the United States and Canada, you must pay the appropriate international test delivery surcharge for each exam for which you apply. This surcharge is in addition to the examination fee.

(effective April 1, 2019)

Examination Content for USMLE

The United States Medical Licensing Examination  (USMLE) is a three-step examination for medical licensure in the United States. A medical student officially enrolled in, or a graduate of, a medical school outside the United States and Canada is eligible to take the step 1 and step 2 of USMLE. To be eligible for step 3, you must obtain the MD degree (or its equivalent) or the DO degree and pass Step 1, Step 2.

Below are the examination content for each step, just list out for your reference.

Step 1  Step 2 Clinical Knowledge (CK)  Step 2 Clinical Skills (CS)  Step 3

Step 1

Step 1 includes test items in the following content areas:

• anatomy,
• behavioral sciences,
• biochemistry,
• microbiology,
• pathology,
• pharmacology,
• physiology,
• interdisciplinary topics, such as nutrition, genetics, and aging.

Step 1 is a broadly based, integrated examination. Test items commonly require you to perform one or more of the following tasks:

• interpret graphic and tabular material,
• identify gross and microscopic pathologic and normal specimens,
• apply basic science knowledge to clinical problems.

Step 2 Clinical Knowledge (CK)

Step 2 CK includes test items in the following content areas:

• internal medicine,
• obstetrics and gynecology,
• pediatrics,
• preventive medicine,
• psychiatry,
• surgery,
• other areas relevant to provision of care under supervision.

Most Step 2 CK test items describe clinical situations and require that you provide one or more of the following:

• diagnosis,
• a prognosis,
• an indication of underlying mechanisms of disease,
• the next step in medical care, including preventive measures.

Step 2 Clinical Skills (CS)

Step 2 CS assesses whether you can demonstrate the fundamental clinical skills essential for safe and effective patient care under supervision. There are three subcomponents of Step 2 CS: Integrated Clinical Encounter (ICE), Communication and Interpersonal Skills (CIS), and Spoken English Proficiency (SEP).

Integrated Clinical Encounter (ICE)

• Data gathering – patient information collected by history taking and physical examination
• Documentation – completion of a patient note summarizing the findings of the patient encounter, diagnostic impression, and initial patient workup

Communication and Interpersonal Skills (CIS)

• Questioning skills
• Information-sharing skills
• Professional manner and rapport

Spoken English Proficiency (SEP)

Clarity of spoken English communication within the context of the doctor-patient encounter

Step 3

Step 3 is organized along two principal dimensions: clinical encounter frame and physician task. Step 3 content reflects a data-based model of generalist medical practice in the United States.

Clinical Encounter Frame

• 20%–30% Initial care
• 50%–60% Continued care
• 15%–25% Emergency care

Physician Task

• 8%–12% Obtaining history and performing physical examination
• 8%–12% Using laboratory and diagnostic studies
• 8%–12% Formulating most likely diagnosis
• 8%–12% Evaluating severity of patient’s problems
• 8%–12% Applying scientific concepts and mechanisms of disease
• 45%–55% Managing the patient
  • health maintenance
  • clinical intervention
  • clinical therapeutics
  • legal and ethical issues

* Percentages are subject to change at any time. See the USMLE website for the most up-to-date information.