The United States Medical Licensing Examination is the three-Step exam series that every physician in the United States must pass to earn a license. This hub explains what each Step is, when students take it, and how it fits into the road to residency — with national pass-rate data and links to deep-dive strategy guides for Step 1 and Step 2 CK.
This is an unofficial, independent reference — not affiliated with or endorsed by the NBME, USMLE, LCME, NRMP, or AAMC. Passing standards, fees, and policies change: always confirm the current rules at usmle.org. National pass-rate figures below are from USMLE Performance Data (NBME), as summarized in AMA reporting.
The three Steps
Every medical graduate in the United States — US MD, US DO, and international medical graduate (IMG) — must pass all three Steps of the USMLE to become licensed to practice medicine. (DO graduates also complete the COMLEX series for osteopathic licensure; many take the USMLE Steps as well.) Each Step targets a different phase of training, and the stakes of each have shifted over time — most notably when Step 1 became pass/fail in January 2022.
Now reported pass/fail. Taken after the preclinical years, it tests basic-science foundations — anatomy, physiology, pathology, pharmacology, and more. A first attempt still matters: a failure is visible to residency programs.
Step 1 overview → Step 2 CKThe exam residency programs weigh most since Step 1 went pass/fail. A scored, three-digit exam of clinical knowledge taken during the clinical years. National mean: 249 (2023–24); passing standard raised to 218 in July 2025.
Step 2 CK overview → Step 3Taken during residency — usually intern year — Step 3 assesses readiness for unsupervised practice. A two-day exam; US MD first-time pass rate ran about 97% in 2023.
Step 3 overview →National snapshot
These are first-time pass rates for US MD and US DO takers — not eventual pass rates after retakes. The dip in Step 1 after 2021 reflects the pass/fail transition (January 2022) and the passing-standard increase from 194 to 196.
| Exam & population | 2021 | 2022 | 2023 | 2024 |
|---|---|---|---|---|
| Step 1, US MD first-time | 95% | 91% | 90% | 89% |
| Step 1, US DO first-time | 94% | 91% | 86% | 86% |
| Step 2 CK, US MD first-time | — | 98% | 98% | 98% |
| Step 2 CK, US DO first-time | — | 96% | 96% | 96% |
Source: USMLE Performance Data (NBME), as summarized in AMA reporting; Step 2 CK cycle figures for 2022–2024. Step 3, US MD first-time: ~97% (2023). Step 2 CK mean score: 249 (2023–24).
Go deeper
This hub is the overview. For dedicated preparation strategy, score analysis, and match data, our companion sites go deep on the two Steps that drive residency applications:
Full Step 1 strategy in the pass/fail era: study design, resources, practice-exam targets, failure-risk factors, and school-support considerations.
Open sistep1.pages.dev → Deep diveThe scored exam that matters most: score strategy, timing, and residency match data — including what the national data says about score competitiveness.
Open sistep2.pages.dev →Part of the SI MedEd family: SI MedEd portal · SI Med School · SI LCME Hub.