USMLE - Not just a route to the USA

All doctors – those born in the UK and international doctors – need to be on the GMC register to practice medicine in the UK. Being GMC registered shows that you have the skills, experience, and capabilities required to work as a doctor in a medical setting. With it, you can begin your journey towards living in the UK while working for the NHS.

The General Medical Council accepts several routes towards registration, with the most common way for non-EEA doctors being PLAB or a postgraduate qualification. However, there are other routes; for example, the GMC also accepts USMLE as evidence of skills and knowledge. There are a couple of catches, though, so keep reading our guide to learn how to get GMC registration via USMLE.

What is USMLE?

USMLE (United States Medical Licensing Exam) is a three-part examination that grants US citizens and Non-US IMGs  access to practising as licensed physicians. Each of the three tests asks doctors to demonstrate their abilities in various ways, and passing all three is essential to be able to practice medicine unsupervised in the United States. It is owned by the National Board of Medical Examiners and The Federation of State Medical Boards, with its purpose being to create a single pathway to getting a medical license, ensuring that every doctor in the US practices medicine at the same high level.

More recently, the USMLE has also been recognised by the General Medical Council in the UK. It is seen as the US equivalent of PLAB. However, there are strict criteria to meet if you want to use it to attain GMC registration – most notably, you’ll need to have completed Step 2: Clinical Skills before March 2020.

Eligibility for USMLE

The three exams for USMLE include Step One, Step Two: Clinical Knowledge, and Step Three.

To be eligible for Step One and Step Two, this must apply to you:

• You are enrolled or have graduated from a US or Canadian medical school program.
• This program must lead to either an MD degree accredited by LCME (Liaison Committee on Medical Education) or a DO degree accredited by COCA (Commission on Osteopathic College Accreditation).
• Your medical school will have to be listed in the World Directory of Medical Schools if living outside the US.

To be eligible for Step Three, the following must apply to you:

• You have passed both Part One and Part Two: Clinical Knowledge of the USMLE exams.
• You have an MD/OD degree OR have an equivalent listed in the World Directory of Medical Schools.

It’s also recommended that you have at least one year of postgraduate training behind you before attempting Part Three of the USMLE examinations, as the experience will come in handy when performing the exam and trying to pass.

Note: you will not be eligible for any of the USMLE examinations if you have attempted any of the steps four times or more without passing. Another thing to note is that if your Step Two: Clinical Skills pass is over two years old, you’ll need to have been in medical practice for at least three years within the last five years for the GMC to recognise the qualification.

The USMLE Examinations

Passing the USMLE exams takes a lot of hard work. They are challenging for a reason – by passing all three, you can practice medicine independently anywhere in the US. Here is what to expect from each one.

Step One

Cost: $660 when applying through the NBME (National Board of Medical Examiners) or $1000 when applying through ECFMG (Educational Commission for Foreign Medical Graduates).

Step One is a multiple-choice examination that covers basic sciences related to medicine, diseases, and underlying health concerns. The questions vary widely to cover eighteen categories, including general principles, cardiovascular system, multisystem processes & disorders, and social sciences: communication and interpersonal skills.

The exam takes place over a day. It takes eight hours to complete and is split into seven blocks that last 60 minutes each. You will answer up to 40 questions per block, and the entire exam will never have more than 280 questions in total. Within that time, you’ll also get a 45-minute break and a 15-minute tutorial.

Step Two: Clinical Knowledge

Cost: $660 when applying through NBME, $1000 when applying through ECFMG.

The second exam is all about applying your medical knowledge. The questions focus on patient care, covering competencies like behavioural health, the immune system, and the general principles of foundational science.

Like Step One, it is a multiple-choice examination that takes place over a day. The exam lasts nine hours, with eight 60-minute blocks for answering questions. Each block has up to 40 questions, with the overall exam having no more than 318 questions.

Step Three

Cost: $915

Step Three is the final USMLE exam. Once complete, you can become an independent physician in the US. As such, the exam is long and strenuous, taking place over two days and requiring a broad and deep understanding of clinical knowledge.

Day one involves a multiple-choice exam consisting of 232 questions split into six blocks. You get sixty minutes per block, as well as a 45-minute break and a tutorial.

Day two lasts eight hours and includes 180 multiple-choice questions split into six blocks (thirty questions per block). You get 45 minutes per block. After those six blocks, you will answer 13 case simulations lasting between 10-20 minutes each.

Step Three covers a wide range of medical competencies. The questions provide common experiences physicians encounter, and they ask you to demonstrate your medical knowledge and skills to prove you can competently work as an independent doctor.

Now Cancelled – Step Two: Clinical Skills

It should be noted that there used to be another exam: Step Two: Clinical Skills. This was a clinical in-person examination that was suspended during the COVID-19 pandemic back in March 2020. It was initially to be relaunched after 12-18 months, but that is no longer the case. However, USMLE did post this on January 2021 :

“We intend to take this opportunity to focus on working with our colleagues in medical education and at the state medical boards to determine innovative ways to assess clinical skills.”

While this examination no longer exists, the GMC still requires it as part of the evidence of skills and knowledge. So, you’ll need to have passed Step Two: Clinical Skills before March 2020 to use USMLE to get GMC registered.

Before we go on to providing top tips for passing the USMLE, reasons to consider relocating to the UK as well as other routes to GMC Registration, this introduction explainer video gives a perfect summary of the points so far:

Tips for Passing the USMLE Examinations

As mentioned, passing the USMLE examinations is no walk in the park. To pass each exam, you need a strong grasp of medical science and broad clinical knowledge. If you’ve yet to take some of the examinations, here are some tips for passing:

Answer Sample Test Questions

On the USMLE website, you can find sample test questions to answer. Doing so is an excellent idea, as it will help you familiarise yourself with the content and how the questions are structured. USMLE also offers an interactive testing experience , which is worth doing!

Get to Know the Content

Obviously, it helps to learn the content involved in each step. By knowing all the disciplines you’ll be tested on, you can focus your revision on the areas you need more help with.

Read the Right Material

Studying will become a significant part of your life when prepping for a USMLE examination. Here are some excellent books fit for purpose:

• Master the Boards USMLE Step 2 CK, Seventh Edition: (Master the Boards Seventh Edition) by Conrad Fischer
• First Aid for the USMLE Step 1 by Tao Le
• MedEssentials for USMLE Step 1 by Kaplan
• USMLE Step 1 Lecture Notes by Kaplan

Don’t Rush

Remember, you don’t have infinite chances to pass the USMLE examinations, so don’t rush taking the test. You need a lot of experience and knowledge to pass. After all, the tests are there to ensure all doctors in the US are at the same high level! They are not easy, so give yourself plenty of study time before the exam date.

Using USMLE for GMC Registration

So, you want to move to the UK to work as an NHS doctor, and you want to use USMLE to do so. How exactly does that work? Assuming you have met all the criteria, here’s what you need to know for using USMLE for GMC registration.

What You’ll Need

• USMLE - You can use USMLE as part of your Evidence of Skills and Knowledge. Remember that this requires you to have passed Part Two: Clinical Skills before March 2020 .
• Proof of English Language Capabilities - The GMC accepts a pass in either IELTS or OET as proof of English language skills. However, you may not have to take either of these exams if you’re a US citizen, as the GMC accepts working in an English-speaking country during the past two years as adequate proof.
• Certificate of Good Standing - You will also need a certificate of good standing, which gets issued by a regulatory authority that you are registered with.

Cost

As of April 2023, it costs £433 to apply for GMC registration with a license to practice. Keep in mind that this price often changes slightly each year.

Applying for GMC Registration

To apply for GMC registration, you must register an account with GMC, ensuring you meet the eligibility requirements. Then, you’ll complete the application process, pay the fee (£433), provide the necessary evidence (such as your USMLE and Certificate of Good Standing), and finally, go through an ID check.

Are There Other Routes Other than USMLE?

Yes, if you’re from the US and want to move to the UK and work as a doctor, there are other ways to get GMC registered besides USMLE. This will suit those who took USMLE after March 2020, as you won’t be able to use that for GMC registration. Here are two of the most common methods:

PLAB

PLAB is a qualification given after completing two examinations: one written and one practical. You need to pass both to be awarded the qualification, allowing you to practice medicine at a junior level in the NHS.

Postgraduate Qualification

The GMC accepts Royal College postgraduate qualifications as evidence of skills and knowledge. It also allows specific international postgraduate qualifications – check here to see if yours is accepted.

Keep in mind that you’ll still need your certificate of good standing and proof of English language capabilities to get GMC registered.

Why Work as a UK Doctor?

Why switch from being a US doctor to being a UK one? You might be cautious about the temperamental weather (though no hurricanes, at least!) or the fact that the UK is over 4000 miles over the Atlantic Ocean. While it is undoubtedly a big move, there are plenty of reasons to make it.

To Be Part of the NHS

The UK’s healthcare system is quite different from the United States. In the UK, the NHS is a free healthcare system that was built on the belief that everyone should have access to free healthcare no matter what. You can be a part of that, providing much-needed care to those who need it most.

Of course, there is also the option of working as a private doctor in the UK if that’s what you prefer.

Development Opportunities

While working for the NHS, you will find structured training opportunities that will allow you to develop your medical career over the years. For example, you can take the traditional route of CCT (Certificate of Completion of Training) to get on the specialist register.

Great Benefits

Working for the NHS provides a range of benefits. When you start, you’ll get a minimum of 27 days of annual leave, which you can use however you like. On top of that, the UK has eight bank holidays, so, in total, you’ll get 35 days off work during your first year.

The NHS also offers paid sick leave, paid training, and many more employee benefits to make living much easier.

Excellent Transport Links

One significant benefit the UK has to offer is its excellent transportation links throughout the whole country. The rail network allows you to get from one major city to the next in a very short time. For example, you can take the Avanti West Coast train from Manchester to London to get there in just over two hours. On top of that, all UK cities and towns have their own bus system to get around affordably.

Easy Access to the Rest of Europe

While the UK is no longer part of the European Union, it is still geographically close to many beautiful European countries. You can easily reach incredible historical cities such as Paris, Berlin, Prague, Rome, and Barcelona. Basically, you have a wide range of cultures right on your doorstep!

Tips for Relocating to the UK from the US

Relocating to the UK from the United States can be quite a culture shock. While there are similarities – both countries speak the same language, for example – there are other things that you might not be used to. To make the transition smooth, you’ll want to familiarise yourself with the UK and its culture. Here are some tips to help you with that.

Finding Accommodation

Most IMGs choose to rent a flat or house when moving to the UK (rather than buying a home). You’ll usually need proof of income and a form of photographic ID to do this. To look for accommodation, the websites Rightmove, Zoopla, and OpenRent are very good and will let you refine your search by budget and location.

If you want to live cheaper, especially during your first few months in the UK, you could move into a house share. This will lower your rent while giving you the chance to meet new people. This might help you adapt to the new culture quickly, too.

Research the Area

While the UK is relatively small, it still has plenty of variety to offer. You can’t expect to find the busy atmosphere of London everywhere! Whether moving to a small town or a big city, take some time to research the place before relocating.

Be a Part of a Community

Being social upon arrival (and even before) will really help you fit into the UK. You’ll find plenty of friendly people in the UK, so branch out and look for people that you can connect with. Getting to know your co-workers is a good start. From there, you can ask about various social gatherings going on in the area.

Welcome the Changes

While the US and UK have many similarities, you’ll still come across a lot of differences in your day-to-day life. Embrace these! You might learn new lingo you’ve never heard before, such as “Skint,” “Knackered,” and “Chuffed”. If you don’t know what these slang words mean, ask those around you; they should be more than happy to educate you!

Bring Clothes for All Weather

The UK is an island, which means – yes – it gets a lot of rain. You might be surprised to learn that it doesn’t rain all of the time, though. In fact, the UK experiences a range of weather throughout the year (sometimes even on the same day), so be sure to pack clothes for all types of weather, including snow, wind, rain, sunshine, and everything in between.

USMLE for GMC Registration: FAQs

Do you still have some burning questions about USMLE for GMC registration? Hopefully, we can answer them here.

• Will Step Two: Clinical Skills Come Back?

USMLE stopped the Step 2: Clinical Skills examination for USMLE due to COVID restrictions. While originally, USMLE stated they wanted to bring it back within 12-18 months, they have since said they have no plans to do so. So, if you didn’t do USMLE Step Two: Clinical Skills before March 2020, you’ll need to use a different route to getting GMC registered, such as PLAB.

• Does USMLE Offer Test Accommodations?

Yes, the Americans with Disabilities Act means that USMLE ensures everyone can take the test by providing a range of accommodations where needed. These might include extended time allowance, assistance with keyboards, and an additional break during the examination.

• Do You Get a Score Report for the USMLE Exams?

Yes, you will receive a score report for each USMLE examination. You can find out how to interpret your score here .

• How Many Times Can You Take the Exams?

You were allowed to take the examinations up to six times before July 2021. However, that has changed, and now, you can only attempt each step up to four times. This was because it was rare for a candidate to continue to pass after the fourth attempt.

• Can You Retake a Step You Have Passed?

Generally, no, you cannot retake a step that you have previously passed. However, exceptions are made if you need to pass to comply with state board requirements. You may also be able to retake one because of a time limit issued by a medical licensing authority (such as the GMC).

USMLE: Important Points to Remember

• You can only use USMLE for GMC registration if you took Step Two: Clinical Skills before March 2020.
• It is recommended you take USMLE: Step Three only after completing a year of postgraduate training.
• You need to pass every part of the exam in 4 attempts (or less).
• If your clinical skills pass is over two years old, you’ll need to have been in medical practice for at least three years in the last five years to use it for GMC registration.

Summary

USMLE is one of the more unusual routes to GMC Registration however it is treated just as equally as the rest. The options to relocate to the UK and USA are both appealing and come with different pros and cons. Whichever option you choose you’ll be delighted with your decision as they are both amazing locations.

If you’re an IMG who is considering working in one or the other then please get in touch with our team or upload your latest CV . Having worked with thousands of doctors from around the world finding them their dream roles and ensuring their safe and timely relocation, our expert team will be happy to run through all of your options.