USMLE Preparation

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Welcome to the UTRGV USMLE page!

The USMLE is a benchmark that must be passed by all medical students in the United States. In order to become a full practicing physician, you must first pass all four United States Medical Licensing Exams. This website is intended as a starting point in your preparation for getting past the first hurdle, Step 1. It contains study tips, suggestions, resources, and advice. Please remember, however, that no single approach to studying is right for everyone.

USMLE – What is it for?

To become a licensed physician in the United States, individuals must pass a series of examinations conducted by the National Board of Medical Examiners (NBME). These examinations are the United States Medical Licensing Examinations, or USMLE. Currently there are four separate exams which must be passed to be eligible for medical licensure:

  • Step 1 is taken after the completion of the second year of medical school;
  • Step 2 Clinical Knowledge (CK), usually taken by December 31st of Year 4
  • Step 2 Clinical Skills (CS), usually be taken by December 31st of Year 4
  • Step 3, typically taken during the first (intern) year of post graduate training.

Requirements other than passing all of the above-mentioned steps for licensure in each state are set by each state’s medical licensing board. For example, each state board determines the maximum number of times that a person may take each Step exam and still remain eligible for licensure. In Texas, individuals are limited to three attempts at each Step exam. Some states allow more attempts, some allow fewer. Our goal is for all of our students to be eligible for licensure in every state.

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.

Step 2 Clinical Knowledge (CK) 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.

Step 2 Clinical Skills (CS) A clinical skills examination was part of the original design of USMLE. The NBME was charged with including a test of clinical skills using standardized patients when such an examination was shown to be valid, reliable, and practical. NBME research and the work of other organizations administering clinical skills examinations demonstrate that clinical skills examinations

measure skill sets different from those measured by traditional multiple-choice questions. Mastery of clinical and communication skills, as well as cognitive skills, by individuals seeking medical licensure is important to the protection of the public.

The clinical skills examination began in June 2004 and is a separately administered component of Step 2. USMLE Step 2 CS is currently administered at five regional test centers (CSEC Centers) in the United States: Philadelphia, PA; Atlanta, GA; Chicago, IL; Houston, TX; and Los Angeles, CA.

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.

UTRGV Policy Regarding USMLE

Step 1 Examination

Scheduling of Step 1: Students are required to take Step 1 of the USMLE prior to the start of the beginning of Year 3 orientation. Students who delay taking Step 1 until after the start of Year 3 orientation cannot begin the Year 3 clerkships until after the first clerkship or at the midpoint of Year 3.

Failure and Retaking of Step 1:

Students who fail USMLE Step 1 on their initial attempt will be removed from the Year 3 curriculum (at the end of their current clerkship) and be assigned to Independent Study, to prepare for and retake Step 1. Students must retake Step 1 between August 1st and August 31st. Students who pass on their second attempt can rejoin the Year 3 curriculum at its midpoint. Students who fail their second attempt will continue to be assigned to Independent Study. Students must complete their third attempt to pass Step 1 between March 1st and March 31st. Failure to pass, after the third attempt will result in automatic dismissal from the School of Medicine. After academic dismissal, a student may apply for readmission to the SOM through the standard admissions process. Policy Regarding USMLE Step 2 Clinical Knowledge and Clinical Skills Examinations Passage of Step 2 Clinical Knowledge (CK) and Step 2 Clinical Skills (CS) are required for graduation.

Initial attempts to pass both Step 2 exams (CK and CS) must be completed by October 31st of the year preceding graduation. To ensure that a student who matches to a residency will be able to start the PGY1 year on time, any student who will not be able to obtain a passing score on USMLE Step 2 CK and/or Step 2 CS before the final date for submission of the NRMP rank order list will be withdrawn from the residency match by the Office for Student Affairs. At the discretion of the Associate Dean for Student Affairs and the Senior Associate Dean for Education and Academic Affairs, such students will be allowed to walk with their class at commencement and will receive a diploma with a later date, if it is anticipated that they will have met all graduation requirements within a reasonable time after commencement. Passing scores must be documented no later than April 15th of the year the student expects to graduate. Failure to document a passing score for either Step 2 exam by April 15th will result in a delay in graduation. 


How important is your Step 1 score?

Residency positions are becoming more and more competitive. In the last few years, U.S. allopathic medical schools have increased their class sizes to improve Americans’ access to healthcare. The number of residency positions during this same time period, however, has remained relatively constant thus making it more and more difficult for medical students to be successful in their residency matches.

What does this mean for you? It means that Step 1 has become an even higher high stakes exam. For better or worse, residency programs place a great deal of importance on Step 1 scores when assessing applicants. Grading systems in medical schools are not consistent and thus not comparable. Step 1 has therefore become the one objective measure common to all residency program applicants that program directors feel they can rely on to help them compare and assess applicants. 

The more competitive the specialty (i.e., Plastic Surgery, Dermatology, Orthopedics), the more likely that programs will use Step 1 scores to screen residency applicants for interviews. A very good performance on Step 1 can help when it comes to securing a top-rate residency, and a poor score can hurt by limiting your options. A failure on Step One can likewise all but eliminate the possibility of some residencies altogether. Bottom line - although Step 1 is only one of many criteria that will be used in evaluating your residency application, it is in your best interest to do all you can to maximize your chances of doing well, regardless of what type of specialty training you may choose to pursue.

How do I prepare for Step 1?

Several things have been proven to help students prepare to do their best of Step 1:

  1. LEARN the material you are currently studying in your classes.
    Approximately 70% of the questions on the exam are likely to use or combine information in ways that you have not seen before. It is the purpose of the testing agency to see how adept you are at taking partial information and, based on that, figuring out an answer you consider to be a high probability response. You can’t do that with MEMORIZED material, but you can do it using material that you have LEARNED.
  2. KNOW how to approach multiple choice questions and PRACTICE, PRACTICE, PRACTICE.Some people seem to instinctively know how to answer multiple choice questions correctly, others of us not so much. There are test-taking skills that you can learn to help you answer these kinds of exam questions.

    If you always feel that your performance on multiple choice tests doesn't equate with your mastery of the material, you might think about having your test taking analyzed.

    Jolley Test Prep and other assessment services offer online diagnostic testing of your ability to take multiple choice tests and measures variables such: as the amount of time spent on different types of questions; correlations between the length of a question and the likelihood of answering it successfully; performance on questions which rely on strict definitions or precise interpretation of technical vocabulary; and the extent to which you are able to narrow down your choices to two good answers; and the extent to which your second choices are correct.

    They also offer a full-length Mock Board Exam. For details and how to order a test, please go to
  3. ALLOW enough time to prepare, but not too much. Although you will have approximately 8 weeks from the time Year 2 ends to the deadline for taking Step 1, the vast majority of our students throughout the years reported that they spent between four to six weeks of intense study following the end of Year 2 preparing for Step 1. Please note, however, there is no hard and fast rule regarding amount of study time and everyone works at a different pace. Many students who have taken longer than 6 weeks to prepare later said they felt they took too much time, and lost ground with their studying (they peaked before actually taking Step 1).
    Just remember everyone works at a different pace and your preparation should be individualized to your study style and needs.

  4. MAKE a study schedule and stick to it. This is a critical step in successful Step 1 preparation.
  5. STUDY smart. Spending 10 hours a day passively reading study guides or old notes is much less effective than spending half that amount of time in active study. Explain concepts out loud to a study partner, practice answering questions by explaining why the right answers are right and the wrong answers are wrong. If concept mapping works for you do it. If there are other methods that work for you, use them.


Providing the following information does not represent an endorsement from UTRGV SOM or the Office of Student Affairs!

Some students find the structure and discipline of a review course very helpful as part of their Step 1 preparation. Unfortunately, some programs schedule their courses at times of the year that don’t coincide with most first-time takers’ preparation efforts.  Nevertheless, here is some information on review courses that are available.

Question Banks

Mock Exams

Live Courses