What is USMLE?
The USMLE is a three-step examination for medical licensure in the United States and is sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners® (NBME®).
What is USMLE Step 1?

Step 1 assesses the examinee’s understanding and ability to 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. It is unlike any examination that Dutch medical students are exposed to during their medical educations in the Netherlands. Step 1 is a one day examination; the exam consists of seven 60-minutes blocks of 44 questions on various topics, often formulated in a different manner than the Dutch test formats. Step 1 is regarded as being the most challenging USMLE exam. Your Step 1 test score is a critical determinant when applying for a residency program in the US.

What is USMLE Step 2 CK?
Step 2 CK (Clinical Knowledge) focusses more on clinically applicable USMLE Step 1 knowledge from a medical doctor point of view. This exam tests knowledge on disease prevention, presentation, appropriate diagnostics and treatment. We advise to take the Step 1 and 2 CK in close proximity to each other, because you will need your Step 1 knowledge for the Step 2 CK exam.
What is USMLE Step 2 CS?
The Step 2 Clinical Skills (Step 2 CS) portion of the Step 2 exam assesses whether you can demonstrate the fundamental clinical skills essential for safe and effective patient care under supervision. You will be tested on three components: Integrated Clinical Encounter (ICE; consisting of data gathering & documentation), Communication and Interpersonal Skills (CIS; e.g. questioning skills, information sharing and professional skills) and Spoken English Proficiency (SEP).
What is USMLE Step 3?
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. It is the final examination in the USMLE sequence leading to a license to practice medicine without supervision. Be aware that the USMLE Step 3 is mostly not required by US institutions if you only conduct part of your residency or a fellowship in the US.
Why do the USMLE?
Dutch medical students and even medical graduates (despite being “BIG-registered”) are not allowed to practice medicine in the US. In order to practice in the US, medical pre-graduates will need to pass the USMLE. Also, studying for the USMLE is a great way to broaden, revive or summarize your medical knowledge prior to the start of your clinical rotations (‘’co-schappen’’) or residency.
What is ECFMG?

The Educational Commission for Foreign Medical Graduates (ECFMG), through its program of certification, assesses whether international medical graduates (IMGs) are ready to enter residency or fellowship programs in the US. The examination requirements for ECFMG Certification include passing Step 1 and Step 2 of the USMLE.

In order to take a USMLE examination, you will first need to establish an ECFMG account and apply for ECFMG certification through the Interactive Web Application (IWA) at the ECFMG website (https://secure2.ecfmg.org/emain.asp?app=iwa).

What is IWA and what is OASIS?
Interactive Web Application is ECFMG’s web-based application service. International medical students/graduates need to apply for ECFMG Certification by using IWA. Also, applying for USMLE Step 1, Step 2 CK, and Step 2 CS can only be done by using IWA. After you have registered for a USMLE exam, anything you want to change regarding your exam (e.g. access your USMLE scheduling permit; request extension of a USMLE Step1/2 CK eligibility period) needs to be addressed through IWA. On-line Applicant Status and Information System (OASIS) is an on-line service for ECFMG applicants and ECFMG-certified physicians. Through OASIS, international medical students/graduates may review their contact information and monitor the status of exam applications and medical education credentials. Also, you can manage your financial accounts to pay for the USMLE exams or pay for the translation of medical credentials. Through OASIS, you can access your USMLE results by opening your score report information.
Which USMLE step do I need?
If you want to do a clinical rotation (‘co-schap’) in the US and want to interact with patients instead of doing a clinical observership, you need to have passed the USMLE Step 1. If you want to do a fellowship or part of your residency in the US you will require USMLE Step 1, 2CK and 2CS (EFMCG certificate). Be aware that in order to do your full residency training in the US, you not only need to obtain your EFMCG certificate, but also do several observerships in the US to obtain recommendation letters which are needed for your application through ERAS, the residency application system.
Am I eligible for the USMLE?

To be eligible for Step 1, Step 2 Clinical Knowledge (CK), and Step 2 Clinical Skills (CS), mediscal students must be officially enrolled in a medical school located outside the United States and Canada that is listed in the World Directory of Medical Schools (World Directory: all Dutch medical faculties are enlisted) during the application period and at the time of your exam. In addition to being currently enrolled as described above, to be eligible for Step 1, Step 2 CK, and Step 2 CS, a medical school student must have completed at least two years of medical school. This eligibility requirement means that the student must have completed the basic medical science component of the medical school curriculum by the beginning of his/her examination eligibility period. We at USMLE SOS advise that you have obtained your bachelor degree (BSc) in Medicine, before applying for any of the USMLE exams.

An authorized official of the student’s medical school must certify his/her current enrollment status; instructions are provided at the time of application for examination. It is important that you contact the appropriate official at your faculty, not all service employees are registered by ECFMG. Also medical graduates will need confirmation from a registered official at the graduate’s medical school in order to apply for the USMLE.

How do I apply and how do I start?

In order to register for a USMLE exam as a foreign medical student/graduate, you must have your USMLE/ECFMG Identification Number and on-line services password. To obtain this, you will first need to establish an ECFMG account and apply for ECFMG certification through the Interactive Web Application (IWA) at the ECFMG website (https://secure2.ecfmg.org/emain.asp?app=iwa). You will need to confirm that you are officially enrolled in (or graduated from) a medical school located outside the USA and Canada.


After receiving your ECFMG Identification Number, you can apply for USMLE examination through IWA. There are two parts to the exam application:

  1. An on-line part of the application
  2. Certificate of identification form (Form 186) – signed and sent by an authorized official of your medical school
Are the USMLE exams expensive?

Below, you can find a table showing an example of the total costs of obtaining your ECFMG Certificate (consisting of USMLE Step 1, Step 2 Clinical Knowledge and Step 2 Clinical Skills).



Fee(s) in US dollars

Application for ECFMG Certification


Step 1


Step 2 CK


Step 2 CS


Translation of medical credentials after graduation of foreign medical school


Test preparation books (e.g. USMLE First Aid books, Master The Boards, Biochemistry)


30 day Q bank of UWorld (for both step 1 and step 2 CK)


American-style doctors’ coat


Additional test prep material for Step 2 CS (e.g. DVD with cases, 3 day Step 2 CS prep course in NYC)






Can I get external funding for the USMLE Step 1 exam?
At this moment, only some medical faculties in The Netherlands offer financial support for those applying for the USMLE (Step 1), including the medical faculties in Amsterdam.
Which USMLE Step 1 score is sufficient for my goals?

If you want to apply for residency training (or part of) in the US, your score is important. Several specialties are considered to be highly competitive and require you to have a near perfect score. The score needed for a specific residency differs between international medical graduates (IMG) and US medical graduates but also on the institution where you apply. Although these scores are not set in stone, they can be considered as guidelines. You can find the latest score requirements and other score statistics in the link below:


Where can I take the USMLE?

USMLE exams are offered at Prometric test centers located worldwide. Visit the Prometric website (https://www.prometric.com/en-us/clients/usmle/Pages/landing.aspx) to look for a test center in your area. In the Netherlands, the nearest test center is located in Amsterdam, about a 10 minute walk from Amsterdam Central Station (Westerdoksdijk 215). For the USMLE Step 2 CS one needs to travel to one of the 5 test centers in the US (Atlanta, Chicago, Philadelphia, Los Angeles and Houston).


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