Introduction
The United States Medical Licensing Examination (USMLE) is a three-step examination for the purpose of medical licensure in USA. The USMLE has following steps:

- USMLE Step 1
- USMLE Step 2
- Test of English as a Foreign Language (TOEFL)
- Clinical Skills Assessment (CSA)
- USMLE Step 3

USMLE Step 1, Step 2 and the CSA are conducted by Educational Commission for Foreign Medical Graduates (ECFMG). Step 1 and 2 can be taken in any order. The CSA can only be taken after passing step 1 and TOEFL.
USMLE Step 3 is conducted by Federation of State Medical Boards (FSMB) and can be taken only after passing Steps 1 and 2 and the CSA (must have a valid ECFMG Certificate). In some States USMLE Step 3 can be taken before starting the residency while in others it can be taken only after completing a required period of residency training, which could range from months to full course of residency. However USMLE Step 3 is not necessary for starting a residency. In order to start a residency one has to pass step 1, step 2 and CSA (have a valid ECFMG certificate).

Eligibility Reqirements for Medical Students for USMLE Steps 1 and 2
To appear in step 1 a medical student must have completed the Basic Medical Science component of medical curriculum of that medical school/college.
To appear in step 2 a medical student must be within 12 months of completion of the entire curriculum of that medical school/college.
Step 1 or 2 can be taken in any order, i.e., step 2 can be taken before step 1, but this strategy is to be strongly discouraged.

Eligibility Requirements for Medical Graduates for USMLE Steps 1 and 2
To appear in step 1 or 2 the graduates must possess their medical degree/diploma from a medical school listed in WHO directory.

Eligibility Requirements for the CSA
A medical student or graduate must have passed Step , Step 2 and TOEFL to be eligible to appear in CSA. However refer to ECFMG site for surrent inforamtion on CSA eligibilty as they are constantly changing.

Passing Scores
Minimum score to pass steps 1, 2 or 3 is frequently revised. However target should not be just to pass the step, as higher scores are needed to enter into a residency program. Maximum score in all the three steps is 99. Target should be at least a score in 90s in step 1 and high 80s in step 2. To enter a very good residency program a score in high 90s in both step 1 and 2 should be the target.
There is no scoring in CSA. One just has to pass CSA.
The minimum overall score required by ECFMG in TOEFL is 213 in the new computer-based testing (CBT) and 550 in the old paper-based testing

Scheduling for Steps 1, 2 and CSA

Steps 1 and 2 are conducted on daily basis. When you are applying for a step you have to indicate a 3 months eligibility period in the application form. ECFMG will send you a scheduling permit with a candidate number, which will allow you to schedule your test date during the 3 months period by calling a regional office. You can reschedule your test date any time, provided your new required date falls within the 3 months eligibility period and cancel your old schedule at least a week ahead of test date.

It is strongly advised that you should send your completed application with fee, at least 3 months before your desired test date. This is because processing of your application can take more than a month and moreover you should have sufficient time to get the test date of your choice. Ideally you should send your application by courier service like DHL or FedEx, as a postal delay can be disastrous for your planning.

CSA is conducted all year round only in Philadelphia. But before applying for CSA you should have passed step 1 and should have obtained the required score in TOEFL. Moreover you should also have submitted the TOEFL Score Acceptance Form with 40 US dollars to ECFMG. You should plan to send your application at least 4 months in advance of your desired test date, to give you sufficient time to handle the visa process.

For further information contact
Educational Comission for Foreign Medical Graduates
3624 Market Street
Philadelphia, PA 19104-2685
USA
Telephone
(215)386-5900
Fax
(215)387-9963
Website
www.ecfmg.org.
www.usmle.org.

When Should I Take USMLE ?

Usually 3 to 4 months of preparation is sufficient for both step 1 and step 2. For CSA one month of practice with the patients is enough. Try to take step 1 by the end of March or April and step 2 by the end of July. As score report usually arrives in a month so you can be able to apply for residency through ERAS by August. As the application process for residency usually starts in August so make sure that results of both steps are in your hand by this month. Although you can apply through ERAS till March but usually the interview slots are filled up by September. Thus applying late for residency will tremendously decrease your chances of getting an interview.
Also try to send your application for CSA before October. It is essential to appear in CSA by January 31st, otherwise you will loose your eligibility to remain in the Match (See Match later)
The biggest blunder most students commit is not to take TOEFL in time. As you can not apply to CSA unless you have passed TOEFL, it is utmost important that you take your TOEFL along with your step 1, ie., in March or April. This is because result of TOEFL arrives in almost 2 months and moreover you have than to send the TOEFL acceptance form to ECFMG, processing of which can take another month or so. So it takes almost 4 to 5 months from your first applying to TOEFL to its acceptance by ECFMG and only than you can be eligible to apply for CSA.