The USMLE is an examination program with three Steps, each complementary to the others. Step 1, Step 2 (Clinical Knowledge) and Step 3 examinations are composed of multiple-choice questions. Step 1 assesses whether an examinee understands and can apply key concepts of basic biomedical science, with an emphasis on principles and mechanisms of health, disease, and modes of therapy. Step 2 CK assesses whether an examinee possesses the medical knowledge and understanding of clinical science considered essential for the provision of patient care under supervision, including emphasis on health promotion and disease prevention. Step 2 Clinical Skills (CS) includes a 10-11 patient encounter, involving standardized patients who are actors portraying patients with medical conditions. Step 3 assesses whether an examinee possesses the medical knowledge and understanding of biomedical and clinical science considered essential for the unsupervised practice of medicine.
A passing grade on Steps 1, 2CK, 2CS and 3 of the USMLE will be required by all states for licensure. Certification of graduation from an approved medical school is also required. Policies regarding citizenship, graduate medical training, etc., differ among states and territories, as does the policy of reciprocity. Each State Board, in licensing its own physicians, sets the fee for licensure.