What Are the Different Types of USMLE® Questions?

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  • Written By: M. Walker
  • Edited By: Allegra J. Lingo
  • Last Modified Date: 06 November 2019
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Medical doctors who wish to practice in the US must take the United States Medical Licensing Examination (USMLE®), which features various types of USMLE® questions. All three sections of the professional exam feature multiple-choice and matching questions, while Step 2 also features practical test questions and patient examinations. USMLE® questions contain only one best answer, and many feature vignettes or fictional patient descriptions to accompany each question.

USMLE® questions in Step 1, which is usually taken after the first two years of medical school, are individual, multiple-choice questions with only one best answer. Each possible answer is lettered from A to K, and all of the answers are arranged in alphabetical order or in a logical sequence. The number of answer choices for any given question on Step 1 ranges from three to 11. A few of the USMLE® questions in this test section will rely on graphs, pictures, or other data, while others will be sequential or reliant upon the same vignette.


Step 2 of the USMLE® test contains both a clinical knowledge section and a clinical skills section. The clinical knowledge questions are similar to those in Step 1 in that they are multiple-choice, contain only one best answer, and feature alphabetized and lettered answers. These USMLE® questions, however, contain between three and 26 choices, and some questions are also matching. The matching answer choices can be used multiple times or not at all, so process of elimination is not a viable strategy for this portion of the test.

Clinical skills (CS) are also tested in Step 2 with 12 patient encounters, each of which lasts for about 15 minutes. These encounters will measure the test taker's ability to empathize with patients and proceed appropriately through a history and physical exam. Although not all sessions will have time for a physical exam, students should structure their encounters according to what they deem the best course of action, which should be based on the patient’s history or chief complaints. Step 2 CS also features telephone-based patient encounters and 10-minute patient note write-ups, which should contain relevant information from each encounter and proposed treatment ideas.

The last of the three USMLE® sections is Step 3, which features multiple choice, patient-focused exam questions. These can come in an array of formats, including typical individual questions, sequential question groups, and multiple question sets, which center around a single vignette. The general content focus of Step 3 is more clinical, focusing on applied skills and clinical judgment, rather than basic science facts.


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