Step 1:
	Assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Step 1 ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning.
	QUESTION FORMAT
	Single One Best Answer Questions :
	Step 1 includes only single questions with one best answer. This is the traditional, most frequently used multiple-choice format. These items consist of a statement or question followed by three to eleven response options arranged in alphabetical or logical order. A portion of the questions involves interpretation of graphic or pictorial materials. The response options for all questions are lettered (eg, A, B, C, D, E). Examinees are required to select the best answer to the question. Other options may be partially correct, but there is only ONE BEST answer.
	Strategies for Answering Single One Best Answer Test Questions
	Read each question carefully. It is important to understand what is being asked. Try to generate an answer and then look for it in the option list. Alternatively, read each option carefully, eliminating those that are clearly incorrect. Of the remaining options, select the one that is most correct. If unsure about an answer, it is better to guess since unanswered questions are automatically counted as wrong answers.
	Example Question 1 A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure over the past 2 years. She has not yet started dialysis. Examination shows no abnormalities. Her hemoglobin concentration is 9 g/dL, hematocrit is 28%, and mean corpuscular volume is 94 µm3. A blood smear shows normochromic, normocytic cells. Which of the following is the most likely cause? A. Acute blood loss B. Chronic lymphocytic leukemia C. Erythrocyte enzyme deficiency D. Erythropoietin deficiency E. Immunohemolysis F. Microangiopathic hemolysis G. Polycythemia vera H. Sickle cell disease I. Sideroblastic anemia J. Thalassemia trait   (Answer D)
	Link for the sample test: http://www.usmle.org/Orientation/2007/menu.htm
	STEP 2 :
	Assesses whether you can apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision and includes emphasis on health promotion and disease prevention. Step 2 ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills that provide the foundation for the safe and competent practice of medicine.
	CK TEST QUESTION FORMATS :
	Single One Best Answer Questions :
	This is the traditional, most frequently used multiple-choice format. It consists of a statement or question followed by three to twenty-six options that are in alphabetical or logical order. The response options in this format are lettered (eg, A, B, C, D, E). Examinees are required to select the best answer to the question. Other options may be partially correct, but there is only ONE BEST answer.
	Strategies for Answering Single One Best Answer Test Questions
	Read each question carefully. It is important to understand what is being asked. Try to generate an answer and then look for it in the option list. Alternatively, read each option carefully, eliminating those that are clearly incorrect. Of the remaining options, select the one that is most correct. If unsure about an answer, it is better to guess since unanswered questions are automatically counted as wrong answers.
	Example Question 1 A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure over the past 2 years. She has not yet started dialysis. Examination shows no abnormalities. Her hemoglobin concentration is 9 g/dL, hematocrit is 28%, and mean corpuscular volume is 94 µm3. A blood smear shows normochromic, normocytic cells. Which of the following is the most likely cause? A. Acute blood loss B. Chronic lymphocytic leukemia C. Erythrocyte enzyme deficiency D. Erythropoietin deficiency E. Immunohemolysis F. Microangiopathic hemolysis G. Polycythemia vera H. Sickle cell disease I. Sideroblastic anemia J. Thalassemia trait   (Answer D)
	Matching Sets
	This format consists of a series of questions related to a common topic. All matching sets contain set-specific instructions, a list of lettered response options, and at least two questions. There will be between four and twenty-six response options. Each set is preceded by a box that indicates the number of questions in the set associated with the response options that follow. Examinees are directed to select one answer for each question in the set. Questions will be presented one at a time, with instructions and response options repeated for each subsequent question.
	Strategies for Answering Matching Sets
	Begin each set by reading through the option list to become familiar with the available responses. Read each question carefully. Within a set, some options may be used several times, while other options may not be used at all. Respond to each question independently. Of the remaining options, select the one that is most correct. For matching sets with large numbers of options, try to generate an answer to the question and then locate the answer in the option list. This is more efficient than considering each option individually.
	The response options for items 2-3 are the same. You will be required to select one answer for each item in the set. Example Items 2-3: Matching set A. Chronic lymphocytic leukemia B. Drug reaction C. Hodgkin disease D. Infectious mononucleosis E. Metastatic carcinoma F. Sarcoidosis G. Systemic lupus erythematosus H. Toxoplasmosis I. Tuberculosis J. Tularemia For each patient with lymphadenopathy, select the most likely diagnosis. 2. A previously healthy 30-year-old man has had fever, night sweats, pruritus, and an enlarging lump above his left clavicle for 3 weeks. Examination shows a 3-cm, nontender, rubbery, supraclavicular lymph node. An x-ray of the chest shows mediastinal lymphadenopathy. (Answer C) 3. A 41-year-old woman comes to the physician for a follow-up examination. She has taken aspirin for chronic headaches and phenytoin for a seizure disorder for 2 years. Examination shows mild epigastric tenderness and bilateral, 3-cm, nontender axillary lymph nodes. A lymph node biopsy shows hyperplasia. (Answer B)
	LINK: http://www.usmle.org/Orientation/menu.htm
	Step 3 :
	Assesses whether you can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care
	QUESTION FORMAT
	Strategies for Answering One Best Answer Questions (Single Items, Multiple Item Sets, and Cases)
	Read each question carefully. It is important to understand what is being asked. Try to generate an answer and then look for it in the option list. Alternatively, read each option carefully, eliminating those that are clearly incorrect. Of the remaining options, select the one that is most correct. If unsure about an answer, it is better to guess since unanswered questions are automatically counted as wrong answers.
	Single Items : This is the traditional, most frequently used multiple-choice format. These items usually include a patient vignette followed by four or five response options. The response options for all questions are lettered (eg, A, B, C, D, E). Examinees are required to select the best answer to the question. Other options may be partially correct, but there is only ONE BEST answer.
	Example Question 1 A 45-year-old African-American man comes to the office for the first time because he says, "I had blood in my urine when I went to the bathroom this morning." He reports no other symptoms. On physical examination his kidneys are palpable bilaterally and he has mild hypertension. Specific additional history should be obtained regarding which of the following? A. Chronic use of analgesics B. Cigarette smoking C. A family history of renal disease D. Occupational exposure to carbon tetrachloride E. Recent sore throats (Answer C)
	Multiple Item Sets : A single patient-centered vignette may be associated with two or three consecutive questions about the information presented. Each question is linked to the initial patient vignette, but is testing a different point. Questions are designed to be answered independently of each other. You are required to select the one best answer for each question. Other options may be partially correct, but there is only ONE BEST answer.
	Example Questions 2 to 4 A 38-year-old white woman, who is a part-time teacher and the mother of three children, comes to the office for evaluation of hypertension. You have been her physician since the birth of her first child 8 years ago. One week ago, an elevated blood pressure was detected during a regularly scheduled examination for entrance into graduate school. Vital signs on examination today are temperature 37.0°C (98.6°F), pulse 100/min, respirations 22/min, and blood pressure 164/100 mm Hg (right arm, supine). 2. The physical examination is most likely to show which of the following? A. An abdominal bruit B. Cardiac enlargement C. Decreased femoral pulses D. Thyroid enlargement E. Normal retinas (Answer E) 3. The most appropriate next step is to order which of the following? A.Complete blood count B. Determination of serum electrolyte and creatinine concentrations C. Determination of serum glucose concentration D. Determination of serum thyroxine concentration E. Urine culture (Answer B) 4. To assess this patient's risk factors for atherogenesis, the most appropriate test is determination of which of the following? A. Plasma renin activity B. Serum cholesterol concentration C. Serum triglycerides concentration D. Urinary aldosterone excretion E. Urinary metanephrine excretion (Answer B) End Of Set
	Cases : A single-patient or family-centered vignette may ask as few as two and as many as three questions, each related to the initial opening vignette. Information is added as the case unfolds. It is extremely important to answer the questions in the order presented. Time often passes within a case and your orientation to a question early in a case may be altered by the additional information presented later in the case. If you do skip questions, be sure to answer earlier questions with only the information presented to that point in the case.
	Each question is intended to be answered independently. You are required to select the ONE BEST answer to each question.
	Example Questions 5 to 7 A 24-year-old man comes to the office because of intermittent chest pain that began a few weeks ago. You have been his physician for the past 2 years and he has been in otherwise good health. He says he is not having pain currently. A review of his medical record shows that his serum cholesterol concentration was normal at a pre-employment physical examination 1 year ago. You have not seen him since that visit and he says he has had no other complaints or problems in the interim. He reminds you that he smokes 1 pack of cigarettes per day. When you question him further, he says that he does not use any alcohol or illicit drugs. Although the details are vague, he describes the chest pain as a substernal tightness that is definitely not related to exertion. 5. Which of the following findings on physical examination would be most consistent with costochondritis as the cause of his chest pain? A. Crepitance over the second and third ribs anteriorly B. Deep tenderness to hand pressure on the sternum C. Localized point tenderness in the parasternal area D. Pain on deep inspiration E. Normal physical examination (Answer C) 6. In light of the patient's original denial of drug use, which of the following is the most appropriate next step to confirm a diagnosis of cocaine use? A. Ask the laboratory if serum is available for toxicologic screening on a previous blood sample B. Call his family to obtain corroborative history C. Obtain a plasma catecholamine concentration D. Obtain a urine sample for routine analysis but also request toxicologic screening E. Present your findings to the patient and confront him with the suspected diagnosis (Answer E) Cocaine use is confirmed. The patient admits a possible temporal relationship between his cocaine use and his chest pain and expresses concern about long-term health risks. 7. The patient should be counseled regarding which of the following? A. Cocaine-induced myocardial ischemia can be treated with blocking agents B. Death can occur from cocaine-induced myocardial infarction or arrhythmia C. The presence of neuropsychiatric sequelae from drug use indicates those at risk for sudden death associated with cocaine use D. Q wave myocardial infarction occurs only with smoked "crack" or intravenous cocaine use E. Underlying coronary artery disease is the principal risk for sudden death associated with cocaine use (Answer B) End Of Case
	Link : http://www.usmle.org/Orientation/menu.htm

You must contact the appropriate registration entity as shown below for USMLE application materials.

Examination Type of Applicant Registration Entity to Contact Step 1 or Step 2 (CK or CS) Students and graduates of medical schools in the United States, and Canada accredited by the Liaison Committee on Medical Education or the American Osteopathic Association NBME Examinee Support Services 3750 Market Street Philadelphia, PA 19104-3190 Web site: http://www.nbme.org Telephone: (215) 590-9700 Fax: (215) 590-9457 Email: web mail@nbme.org Step 1 or Step 2 (CK or CS) Students and graduates of medical schools outside the United States and Canada ECFMG 3624 Market St. Philadelphia, PA 19104-2685 Application materials: Web site: http://www.ecfmg.org Telephone: (215) 386-5900 Fax: (215) 386-9196 Step 3 All medical school graduates who have passed Step 1 and Step 2 FSMB Department of Examination Services PO Box 619850 Dallas, TX 75261-9850 Web site: http://www.fsmb.org Telephone: (817) 868-4041 Fax: (817) 868-4098 Email: usmle@fsmb.org or Medical licensing authority

How to Request Test Accommodations

	Read the Guidelines carefully. - Share them with the professional who will be preparing your documentation.
	Read the instructions for completing the Applicant's Request for Test Accommodations.
	Complete the Step 1 and Step 2 Clinical Knowledge Applicant's Request for Test Accommodations or the Step 2 Clinical Skills Applicant's Request for Test Accommodations. - Be sure to sign the request form where indicated.
	If appropriate, have your medical school complete the Certification of Prior Test Accommodations form.
	Attach documentation of the disability and your need for accommodation. - Compare your documentation with the information listed in these guidelines to ensure a complete submission. - Incomplete documentation will delay processing of your request.
	Send your request for test accommodations and supporting documentation to the appropriate registration entity as noted below:

NBME - Students / Graduates of US & Canadian Medical Schools
Supervisor, Disability Services
National Board of Medical Examiners
3750 Market Street
Philadelphia, PA 19104-3190
(215) 590-9509


ECFMG - Students / Graduates of Medical Schools Outside the United States and Canada
Test Accommodations Coordinator
Educational Commission for Foreign Medical Graduates
3624 Market Street
Philadelphia, PA 19104-2685 USA
(215) 386-5900

FSMB - ALL Step 3 Applicants
Coordinator for Special Examination Services
Federation of State Medical Boards
PO Box 619850
Dallas, TX 75261-9850

Mail your request for test accommodations to the address above at the same time you mail your examination application to the address shown in the registration materials.

WANT TO DO :

USMLE Step 1 and Step 2 CK and Step 2 CS : TO PROTECT YOUR CONFIDENTIALITY, ALWAYS SEND YOUR REQUEST AND DOCUMENTATION TOGETHER TO THE ADDRESS BELOW. Do not include these materials with your examination application.

Address all requests and inquiries to the appropriate registration entity:

Students / Graduates of US & Canadian Medical Schools Students / Graduates of Medical Schools Outside the United States, Puerto Rico, and Canada Supervisor, Disability Services National Board of Medical Examiners 3750 Market Street Philadelphia, PA 19104-3190 (215) 590-9509 Test Accommodations Coordinator Educational Commission for Foreign Medical Graduates 3624 Market Street Philadelphia, PA 19104 USA (215) 386-5900

Test accommodations include but are not limited to the following:

	Assistance with keyboard tasks
	Audio rendition
	Extended testing time
	Additional break time
	Enlarged text and graphics
	Permission for assistive devices

Score Reporting

USMLE policy requires annotation of score reports and transcripts for Step administrations for which test accommodations were used. Score recipients who inquire about the annotation will be provided with information about the nature of the test accommodation only.

If you have a documented disability covered under the Americans with Disabilities Act (ADA) and require test accommodations, you must notify the USMLE in writing each time you apply for Step 1, Step 2 CK or Step 2 CS.

New Requests

Submit a completed Step 1 and Step 2 CK Applicant’s Request for Test Accommodations
or Step 2 CS Applicant's Request for Test Accommodations to the above address at the same time you send your examination application.

If you received test accommodations for a previous USMLE Step (Step 1, Step 2 CK, and Step 2 CS) and would like the identical accommodations, please submit the following form(s) to the above address at the same time you send your examination application. This form constitutes your official notification.

If you are requesting a change in accommodations or are previously approved for Step 1 or Step 2 CK but have not been approved for Step 2 CS, follow the instructions for New Requests above.

If you received test accommodations in Medical School submit a completed Certification of Prior Test Accommodations to the above address along with your Step 1, Step 2 CK and Step 2 CS Applicant’s Request for Test Accommodations.

	Original documents; keep the original and submit a copy
	Research articles, resumes, curriculum vitas
	Handwritten letters from physicians or evaluators
	Documentation previously submitted to Disability Services
	Documentation previously submitted to your registration entity
	Previous correspondence from Disability Services
	Multiple copies of documentation (i.e., faxed and mailed copies of a document)
	Staples, clips, binders, page protectors, folders, or similar items

	Legible copies
	All documents in English. You are responsible for providing certified English translations of foreign-language documentation
	Typed or printed letters and reports from evaluators
	Documentation from childhood if you are requesting accommodations based on a developmental disorder, i.e. LD, ADHD, Dyslexia
	Documentation of your functional impairment in activities beyond test-taking
	Documentation of your functional impairment beyond self-report

Students and graduates of LCME-accredited programs and AOA-accredited medical schools should apply for Step 1, Step 2 CK, and Step 2 CS by following the instructions at the NBME web site (http://www.nbme.org). Review and follow the application instructions, complete your application, and submit it to the NBME.

Students and graduates of medical schools outside the United States and Canada should apply for Step 1, Step 2 CK, and Step 2 CS by following the instructions at the ECFMG web site (http://www.ecfmg.org). Review and follow the application instructions, complete your application, and submit it to the ECFMG.

To request information on Step 3 eligibility requirements and application procedures, follow the instructions at the FSMB web site (http://www.fsmb.org), or contact the FSMB or the medical licensing authority to which you wish to apply.

Application procedures for Step 3 vary among jurisdictions. You should begin inquiries at least three months in advance of the dates on which you expect to take the test. After you obtain application materials, review and follow the application instructions to complete your application and submit it to the medical licensing authority or the FSMB as directed in the instructions.

When applying for Step 1 or Step 2 CK, you must select a three-month period, such as January- February-March or February-March-April, during which you prefer to take the examination. A Scheduling Permit with instructions for making an appointment at a Prometric Test Center will be issued to you after your registration entity processes your application and determines your eligibility. The Scheduling Permit specifies the three-month eligibility period during which you must complete the examination. During peak periods, allow up to approximately four weeks for processing of your application. On receipt of your Scheduling Permit, you are able to contact Prometric immediately to schedule a test date. Prometric schedules testing appointments for Steps 1 and 2 CK up to six months in advance of the assigned eligibility period. If your application is submitted more than six months in advance of your requested eligibility period, it will be processed, but your Scheduling Permit will be issued no more than six months before your assigned eligibility period begins. If you are unable to take the test within your eligibility period, contact your registration entity to inquire about a one-time contiguous three-month eligibility period extension. A fee is charged for this service.

Visit your registration entity’s web site for more information.If you do not take the test within your original or extended eligibility period and wish to take it in the future, you must reapply by submitting a new application and fee(s).

Step 2 CS is offered regularly throughout the year; however, there may be occasional, brief periods when all centers are closed. In planning the timing of your application, see below for information on how Step 2 CS eligibility periods are assigned. You should be aware that demand for test dates/centers at certain times during the year may exceed the number of testing spaces available. When you apply for Step 2 CS you are assigned a 12- month eligibility period that begins when processing of your application is completed. A Scheduling Permit with instructions for making a testing appointment is issued to you.

Your eligibility period will be listed on your Scheduling Permit. You must take the exam during your eligibility period. You can schedule a testing appointment for any available date in your eligibility period. Once your eligibility period is assigned, it cannot be changed. If you do not take the exam within your eligibility period, you must reapply to take the exam, including payment of the examination fee. Although you cannot change your assigned eligibility period, you can reschedule a scheduled testing appointment within your eligibility period (see Rescheduling). A fee is charged if a change is made during the 14 days before your scheduled appointment.

Step 3 eligibility periods are assigned immediately once your application has been processed and approved. Time for processing will vary depending on the particular medical licensing authority and the volume of applications. Check the FSMB web site for more detailed information on processing times. Upon complete processing of your Step 3 application and confirmation of eligibility, a Scheduling Permit will be issued to you with instructions for making an appointment at a Prometric Test Center. On receipt of your Scheduling Permit, you should contact Prometric immediately to schedule the test dates. The Scheduling Permit specifies the eligibility period (beginning immediately and extending for approximately 90 calendar days) during which you must complete the examination. If you are unable to take the test within your eligibility period, contact the FSMB to inquire about a one-time contiguous three-month eligibility period extension. A fee is charged for this service, and some restrictions may apply. Visit the FSMB web site (http://www.fsmb.org) for more detailed information. If you do not take the test within your original or extended eligibility period and wish to take it in the future, you must reapply by submitting a new application and fee(s). The USMLE Step 3 fee is non-refundable and non-transferable from one eligibility period to another or from one application to another.

Step 1 and Step 2 CK are administered in the United States and Canada and in more than 50 other countries. International testing locations are distributed among defined international testing regions. There is an additional international test delivery surcharge.

Your Scheduling Permit will be issued to you when the processing of your application is complete. You should verify the information on your Scheduling Permit before scheduling your appointment. Your Scheduling Permit includes the following:

	your name
	the examination for which you registered,
	your eligibility period,
	your testing region,
	your Scheduling Number,
	your Candidate Identification Number (CIN).

Note: Your Scheduling Number is needed when you contact Prometric to schedule test dates. It differs from your Candidate Identification Number (CIN), which is your private key, and is needed to test. Prometric does not have access to your CIN.

When applying for the USMLE Steps 1, 2 CK, and 3 or scheduling test dates, please keep the following in mind:

	You must have your Scheduling Permit before you contact Prometric to schedule a testing appointment. Appointments are assigned on a "first-come, first-served" basis; therefore, you should contact Prometric to schedule as soon as possible after you receive your Scheduling Permit.
	You may take the test on any day that it is offered during your assigned eligibility period,provided that there is space at the Prometric Test Center you choose.
	Prometric Test Centers are closed on major local holidays.
	USMLE Steps 1, 2 CK, and 3 are not available during the first two weeks of January.
	The busiest testing times in the Prometric testing network in the United States and Canada are May through July and November through December.
	The confirmed test day(s), date(s), and time;
	The address and telephone number of the Prometric Test Center where you will test;
	Your Prometric Confirmation Number(s).

After you schedule your testing appointment, you can print a confirmation of your appointment from the Prometric web site. Scheduling a testing appointment for a specific date at a Prometric Test Center is not a guarantee that the scheduled test time or location will remain available. The Prometric Test Center at which you are scheduled may become unavailable after you have scheduled your appointment. In that event, Prometric will attempt to notify you in advance of your scheduled testing appointment and to schedule you for a different time and/or center. However, on rare occasions, rescheduling your appointment for a different time or center may occur at the last minute. To avoid losses you would incur as a result, you should try to maintain flexibility in your travel arrangements. You are encouraged to confirm your testing appointment a week prior to your test date.

If you are unable to keep your testing appointment on the scheduled date(s) or at the scheduled location, you may change your date(s) or center by following the instructions on your Scheduling Permit for contacting Prometric. You will need to provide your Prometric Confirmation Number when you reschedule. To avoid a rescheduling fee, you must cancel or reschedule your appointment at least five business days before your appointment. If you are testing in the United States or Canada, you must cancel or reschedule by noon Eastern Time at least five business days before your appointment. If you are testing outside the United States or Canada, you must cancel or reschedule by noon local time of the Regional Registration Center for your testing region at least five business days before your appointment. If you provide less than five business days' notice, Prometric will charge you a fee to reschedule your test date(s). Your rescheduled test date(s) must fall within your assigned eligibility period.

Step 2 CS is administered at five test centers: Atlanta, Georgia; Chicago, Illinois; Houston, Texas; Los Angeles, California; and Philadelphia, Pennsylvania.

After your registration for Step 2 CS is complete, your registration entity will issue you a Scheduling Permit. The Scheduling Permit contains the following: