United States Medical Licensing Examination or USMLE is a three-part test required for medical licensure in the United States. In other words, all medical students, foreign or local, are required to take the test if they want to practice medicine in the United States unsupervised.

The test has earned a notorious reputation for being one of the hardest tests in the world. Medical students who have gone through the three steps shudder at the thought of it. The reason? It is an extremely lengthy test that requires the study of more than ten different medical disciplines. Let’s take a brief look at what the different steps of the test constitute.

Three Steps of USMLE

USMLE is an extensive test broken into three steps. The first step, considered the most challenging out of all three, is 8-hour long and has eight sections. Each section or block has 40 multiple choice questions delivered on a computer. The 280 questions come from various medical subjects such as anatomy, biochemistry, behavioral sciences, microbiology, immunology, pathology, pharmacology, and physiology.

The Step 2 exam is a two-day test divided into two components. The first one is called USMLE Step 2 CK (clinical knowledge), and it tests a student’s understanding of clinical sciences like surgery, internal medicine, pediatrics and obstetrics, and gynecology. It is 9-hour long with a 45-minute break. The test is presented in eight blocks or sections, with a block containing no more than 40 questions.

The second component is called USMLE Step 2 CS (clinical skills), and unlike the first component, it is not a multiple-choice test. Instead, it requires students to examine and diagnose actors posing as patients practically. Students are required to use their clinical skills to diagnose and treat the patients successfully. The test runs for eight hours with a 50-minute break.

USMLE Step 3 is the final part of the test. It is also a two-day test, with the first-day test being 7-hour long and the second-day test 9-hour long. There are a total of 500 questions between the two days. The last step in the test determines whether a student is ready to practice medicine unsupervised in a professional setting.

Is USMLE the Hardest Test in the World?

It is difficult to say whether USMLE is the hardest test globally because one would need to evaluate hundreds of different tests from around the world. However, I am confident that USMLE is definitely ONE of the most challenging tests in the world.

Anyone who has looked into the test structure, the format, the volume of questions, the time duration, and most importantly, the syllabus would agree that USMLE is no walk in the park.

Let’s go through some of the significant reasons why USMLE is one of the most demanding tests in the world.

Extensiveness

The first and foremost reason why USMLE is so tricky is the extensive nature of the test. Think about it. The test has three distinct steps. Two of the three steps run for two days, and each step is at least eight hours long. On top of all that, you only get a 45 or so minute break between all that time.

Not only is this extremely taxing on the mind, but the sheer volume of questions is another factor to consider. Each step of the exam has several hundred questions, and there is no guarantee that successive questions will follow a theme. Questions can pertain to any subject out of the long list of subjects included in the test.

Substantial Syllabus

It is mind-boggling the range of subjects the USMLE exam tests. We don’t even need to take the whole test into account to understand the magnitude. Step 1 of the test alone has ten disciplines that students need to prepare:

• Behavioral Sciences
• Biochemistry & Nutrition
• Genetics
• Gross Anatomy & Embryology
• Histology & Cell Biology
• Immunology
• Microbiology
• Pathology
• Pharmacology
• Physiology

Step 2 and Step 3 have their own content specifications and involve 10s of more subjects. It is no revelation that managing such an extensive volume of subjects is extremely difficult.

Preparation time aligns with Medical School

You may think that preparing for the test is no big deal because you can study for hours on end each day. The only problem is you have to take USMLE step 1 towards the end of your second year of medical school. This means that on top of the already vigorous study routine of medical schools, you have to study separately for USMLE.

Add to this any jobs or internships you have going on, and you can just make out how difficult it would be to juggle all that. The second step of the test is usually taken by students in the fourth year of med school. The same step of problems applies to the second step as well. What about the third step? The third step is taken after the first year of residency, which means you’ll have to study for it while you are performing your residential duties.

Multiple-choice questions but very tricky

Most of us who have taken the SAT or GRE think that multiple-choice questions add a level of convenience to the test. This may be true for other standardized tests, but USMLE is different. Sure, you have to select given answers as in any MCQ test, but the answer choices are all extremely close to being correct. Moreover, the questions are purposefully designed to trick you into answering incorrectly, as all answer choices appear correct. The time constraint further exacerbates this fact. You only have a little over a minute to read the question, think about it, and then choose your answer.