USMLE For Nigerian Doctors | A Complete Guide

usmle for nigerian doctors

USMLE for Nigerian Doctors” is a key term 80% of Nigerian Doctors search for.

While there are other means of practicing abroad, the USMLE route is well-loved for many reasons.

But as a Nigerian medic, how do you go about USMLE? What’s it all about? What is the examination like? How much does it cost?

Never to worry, these are typical questions that we will fully cover in this guide.

In this post, we will give you all the information necessary to make your American Journey a success.

But before we start, here are posts you may like;

What is USMLE?

The popular acronym ‘USMLE’ stands for the United States Medical Licensing Examination.

USMLE is an examination that provides the qualifying license for doctors to do residency and fellowships in the United States of America.

The popularly known USMLE is sponsored by the National Board of Medical Examinations(NBME) and the Federation of State Medical Boards(FSMB).

The examination consists of three parts, known as steps. The names of the three steps are:

  • USMLE Step 1
  • USMLE Step 2 CS and USMLE Step 2 CK
  • USMLE Step 3

Each year, qualified medical educators and physicians from the United States come to set questions for the medical licensing examination, USMLE.

There are also committees assigned to revise and review materials before each examination.

In all, you can liken the USMLE to be a ticket without which you can’t do residency nor fellowship in the USA. Understood right?

What is the Purpose of USMLE?

Challenges are certain to arrive at your doorstep if you decide to be a Physician. One of them is the USMLE.

You can skip it if you want to practice elsewhere. But if your choice is the US, then USMLE is a MUST.

 But what’s the essence of USMLE? Why is it so important for you as an immigrant? Let’s check it out.

The USMLE is very crucial for any doctor wanting to practice in the US.

The examination’s aim isn’t to test your theoretical skills in medical courses like other tests do. Instead, its major purpose is to access doctors’ capability to apply the concepts and knowledge of the medical practice.

Recall, it’s majorly about the application of concepts!

Asides the major purpose of USMLE, here are other key points to show why USMLE is important;

Importance of USMLE to Americans

  • The majority of medical schools in the US make it a requirement for students to pass the USMLE Step 1 before graduation. Some others deem it necessary that before collecting degrees, doctors should pass the USMLE Step 2 CK and Step 2 CS.
  • Before taking doctors into the US residency program, the scores from USMLE Step 1 and 2 are necessary. Hence, so many doctors strive to ace their USMLE with high scores because their residency placement solely depends on it.
  • Writing and passing Step 3 is a requirement for admission into the US-based medical specialty boards. For example, the American Board of Cardiology.

Importance of USMLE to Foreign Medical Graduates

Like we said earlier, there’s no other way, whatsoever, by which a Nigerian doctor can practice in the US without USMLE!

This exam is important to get residency or fellowship before working as a doctor in the US.

So now you’ve known its importance, lets head over to the eligibility and format of USMLE.

Eligibility for USMLE for Nigerian Doctors

Checking every requirement for USMLE is pertinent before thinking of application. The primary conditions to be fulfilled are filed into three categories:

  • You must be an official medical student already in, or a graduate of a US or Canadian medical school. The medical school program must lead to MD degree and must be accredited by the Liason Committee on Medical Education(LCME), OR
  • You must be an official medical student already in, or a graduate of a US medical school. The medical school program must lead to DO degree and should be accredited by the American Osteopathic Association(AOA), OR
  • You must be an official medical student already in, or a graduate of a medical school outside the US and Canada. The school must be listed in the World Directory of medical schools and meet the ECFMG eligibility requirement.

Since you’re a Nigerian Medic, your concern is the third requirement above.

Do well to check all the medical schools in Nigeria that meet the ECFMG requirement. We will show you the full list in this guide.

Other Eligibility Conditions on USMLE for Nigerian Doctors

  • To be eligible for Step 3, you should take and pass the Step 2 CS firstly. If whatsoever, you fail the Step 2CS, be it having to meet a state medical board or any other, you are not eligible for Step 3 unless you pass step 2 CS.
  • If, in any way, you are withdrawn from medical school, you lose your eligibility and can not apply for USMLE.
  • If you are on leave of absence, you are expected to report your status to the organization that registered you. Failure to do so may have it that you are involved in random acts and may affect your score reports and transcripts.

Step 3 Eligibility – USMLE For Nigerian Doctors

  • You must have passed Step 1, Step 2 CK, and Step 2 CS before applying for Step 3.
  • Additionally, you must have MD or Do from a US or Canada medical school accredited by LCME or AOA OR
  • have the equivalent of MD degree, that is, your MBBS degree, outside the US and Canada. The school must be listed in the World Directory of medical school and also fulfill the ECFMG requirement.

Its recommended that you have finished or nearly finished at least one postgraduate training year in the US accredited medical school program that falls in line with the State board licensing requirements.

What do the Exams look like? – Format of USMLE Exams

USMLE Step 1

The First step of the US medical licensing exam tests your knowledge in the following courses; Anatomy, Biochemistry, Physiology, Microbiology, Pathology, Pharmacology, and Behavioral sciences.

Furthermore, it covers interdisciplinary topics like immunology, Aging, genetics, nutrition, Molecular, and Cell Biology.

The USMLE Step 1, to the Nigerian exam, covers both 2nd and 3rd MBBS professional courses.

The First step assesses your;

  • Ability to put into application essential concepts and knowledge of the Basic Medical Sciences.
  • Foundation for the practice of medicine and surgery
  • Application of scientific Principles to medicine both now and in times to come.

How is USMLE Step 1 Structured?

The examination is taken under one day. It’s a marathon series that consists of 8 sessions known as Blocks. Each block has 60 minutes.

The total number of questions in the exam does not exceed 280. But the number of questions per block varies.

Facts about USMLE Step 1

  • Medical students in the US take Step 1 after completion of the Basic sciences section of the curriculum.
  • The exam is considered a one time deal in that any failed attempt is permanently recorded. If for instance, you wish to write again for higher scores, and then get a lower one, this recent score is permanently recorded.
  • It has a huge impact on residency placement.
  • In February 2020, there was an announcement by the USMLE program that Step 1 will be Pass/Fail System. This decision played out in a bid to reduce the overemphasis on Step 1 to get a medical license. But the rule won’t take place yet till January 1, 2022.

USMLE Step 2

USMLE Step 2 aims to assess medical students’ s/doctors’ ability to apply medical concepts, knowledge, skills, and understanding of clinical studies.

It ensured that your application of medical knowledge is in path with quality patient care and health promotion.

Furthermore, Step 2 makes sure that doctors give due attention to the Principles of clinical sciences and key patient-centered skills.

There are two exams written in Step 2; the USMLE Step 2 Clinical Knowledge(CK), and Clinical Skills(CS).


Just like step 1, the USMLE Step 2 CK is a one-day examination. It’s also a marathon series having eight blocks of 60-minutes each. The test formats of each block vary, and the 8 hours are administered under a 9-hour testing session.

The examination categorizes clinical science material into two aspects; physician task and disease category.

Step 2 CK of the USMLE tests your knowledge and application on the following subjects: Paediatrics, Preventive medicine, Psychiatry, Surgery, Internal medicine, Obstetrics, and gynecology.

As you can see, the subjects in Step 2 CS are the normal courses Nigerian medics do in school.


The Step 2 Clinical Skill examination is solely patient-centered. It assesses the medical doctor’s ability to draw essential information from patients, undergoes patient examination, and relate their findings to patients and fellow health workers.

You can liken the Step 2 CS to an exam that assesses how well you can relate in a hospital environment, conduct proper tests, and show good sociable skill to patients.

Step 2 CS consists of the following: Integrated Clinical Encounter(ICE), Community, Interpersonal Skills(CIS), and Spoken English Proficiency(SEP).

Utilization of the Step 2 CS commenced in 2004. Before then, a similar examination, the Clinical Skills Assessment(CSA), was used to assess foreign doctors’ clinical skills.

Presently, the Step 2-CS is suspended for 12-18 months due to the COVID-19 pandemic.

Step 3 – USMLE For Nigerian Doctors

The final exam in the USMLE is Step 3. US medical doctors usually write it after the first year of residency.

This step majorly focuses on the assessment of medical doctors’ ability to apply medical knowledge and skill for unsupervised medical practice.

It further assesses one’s ability to practice medicine under ambulatory conditions.

The following areas of medicine are tested in this step; pregnancy, neonate illnesses, parasitic diseases, Central nervous system, eye/ear/nose/throat, respiratory system, and digestive system.

The examination further tests your knowledge of the musculoskeletal system, emotional disorders, subcutaneous tissue, endocrine/metabolic disorders, kidneys tract, reproductive system, injuries, blood-forming organs, and health maintenance issues.

Unlike the other ones, Step 3 is a two-day exam. On the first day of this exam, you’ll write 233 multiple-choice questions in 6 hours under the administration of 7 hours. The total size hours are split into six blocks, each containing 60 minutes/1-hour.

On the second day, you will get to write 180 multiple choice questions, divided into six blocks, but containing 45 minutes each.

But that’s not all. There are also 13 case simulations given 10 to 20 minutes each for you to solve.

Cost of USMLE Examinations

If you’ve been taking little research on USMLE, you should know this: the USMLE might scratch your pocket.

The USMLE charges for US or Canadian Medical students in 2023 are different for foreign medical Graduates. Here’s the USMLE fees:

 USMLEUS or CanadaOutside US and Canada
Step 1$1000$1000 + $195 surcharge
Step 2 CS$1000$1000 + $220 surcharge
Step 3$895$895
List comparing the cost of USMLE in US to that in Nigeria

The additional fees allocated to international medical students is due to ECFMG certification plus the International Test delivery charge.

Earlier, I converted the fees to Nigerian naira but due to the inconsistencies of dollar rate, you’d have to convert them yourself using the present rate.

Now you can see that the USMLE for Nigerian Doctors is something to be properly planned. It costs much, and you can’t fail, except you wish to be generous and give USMLE more money.

Please, the fee above excludes other expenses you have to make. For example, accommodation, flight tickets and other things you’ll have to pay for.

How to Apply for USMLE for Nigerian Doctors 2024

To begin your application, you will have to go through ECFMG on Interactive Web Applications(IWA). But this method differs from US Graduates who apply through NBME on NBME licensing services(NLES).

Note that there are three months’ eligibility periods of application of Step 1 and Step 2 CK. Read more through the ECFMG official site.

For more references, here are the bodies in charge of applications and their contact details;

USMLE StepContact Details
Steps 1 and 2Name: ECFMG
Location: 3624 Market Street, Philadelphia, PA 19104-2685. Website: Telephone: (215) 386-5900
Step 3Name: FSMB
Location: 400 Fuller Wisee Road Euless, TX 76039-3856. Website:
Telephone: (817) 868-4041

USMLE Test Centres for Nigerians

Step 1 and Step 2 CK exams are written at Prometric test centers worldwide.

The centers in Africa are; Kenya, Ghana, South Africa, and Uganda. Formerly, as a Nigerian, you could take your tests in your country, but things changed. Now the closest center is Ghana.

The other ones that are the Step 2 CS and Step 3 are taken in the US.

USMLE Scoring System

All steps use a three-digit score except Step 2 CS. Step 2 CS uses the pass/fail system.

 Presently, these are minimum cut-off Mark for the USMLE 2023:

  • USMLE Step 1: 194
  • Step 2 Ck: 209
  • Step 3: 196.

It’s pertinent to know that the Pass/fail method of scoring for Step 1 will take place no earlier than January 1, 2022. So from now till 2022, Step 1 will be scored using digits.

Factors to Consider before Thinking of USMLE as a Nigerian

1. Finances

Before anything else, you should check your financial ability. From research, a good tip is to save up your housemanship and NYSC salary to add up to the funding for the exam.

We’ve given you an estimate of the total amount for all USMLE Exams. Please note that there will be extra expenses like accommodation, certifications, flights, etc.

2. Information-wise

Information is rapidly changing the world. You can’t act on what you don’t know. Before getting started on USMLE as a Nigerian, you must get enough information.

Belong to a group of friends with similar interests, ask questions, get mentors, regularly check on MedicsDomain for more guides on USMLE.

3. Knowledge

The USMLE Exams is not something to joke with. It’s important to check whether you’re educationally sound. Did you understand those concepts you learned in medical school?

You should first read through and make sure you’re sound before engaging in thorough USMLE preparations.

If you’re still a student, you may not have time to go through your texts as much as you want, you should learn deeply about your courses.

But if you’re not ready educationally, then commit to becoming better. The First step scores matter a lot, and your residency placement largely depends on it.

Check yourself. Are you free to begin intense preparations, or are you occupied? Are you willing to commit to Intensive reading? These are typical questions to ask to put you in check.

Frequently Asked Questions on USMLE for Nigerian Doctors

1. Is USMLE for Nigerian Doctors Difficult?

The medical licensing exam will be challenging, the earlier you know this, the better for you. It’s not a regular semester test but a critical and more complex qualifying exam.

People say the USMLE is the hardest in terms of stamina and difficulty. Here are some points to prove that:

 Approach to answering Questions is Different.

Back in Nigerian medical school, you can ascertain that questions do come on a theoretical basis. But that’s not the same for USMLE. The exam uses a different approach, and thus you may not be too familiar with them.

Preparation is hectic

Despite your academic feats in Nigerian medics school exams, you will need to prepare your life for the USMLE. It’s not something to take likely. You are competing with US and international medical Graduates, so the preparation needs to be intense.

The average time of preparation for the Exams is about 3-5 months.

Questions are Long and Require more Reasoning.

A typical Nigerian medical school might ask a question on Radial nerve like:

Saturday Night Palsy is caused by which of the following nerve?

A. Median nerve B. Axillary. C. Radial D. Ulnar

But, here’s an example of how USMLE Step 1 looks like:

An 18-year old teenager arrives at the emergency department with his mom because he noticed he couldn’t extend the fingers of his right hand. Three weeks earlier to the presentation, he had suffered a right fibula fracture while riding a bicycle and was given a pair of crutches to use while his leg gets better.

He further revealed that he lost the set of crutches given to him and used his friend’s own who happens to be a taller person. With further questioning, he further revealed that the new crutches have been exerting a lot of pressure in his Axilla.

With a physical examination, he is said to have a wrist drop and decreased sensation over his posterior forearm and dorsal hand. What is your diagnosis, and which nerve is injured?

From the above, you can easily see that USMLE questions are longer than those you’re used to.

But wait!

USMLE for Nigerian Doctors is not as difficult as it seems if you commit to consistent preparations and intensive reading.

2. When is the Best time to write USMLE for Nigerian Doctors?

Some people do advice during medical school, while others say after school is best. Whatever anyone says, our pick is that the best time to write USMLE is anytime you’re ready for it.

3. How does USMLE affect my life?

If your interest is in a competitive specialty, the USMLE can influence your career options for years to come. If successful, you can train at top-notch hospitals in the US. Fail it, and you may never practice in the US.

Final Thoughts on USMLE for Nigerian Doctors

Usmle has much power in making your medical career dreams fruitful. And how you take, it affects whether you’ll be successful.

In conclusion, You’ve come to grasp a good knowledge of USMLE for Nigerian doctors.

We hope this in-depth guide was helpful in your American Journey.

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Anaso Emmanuel
Anaso Emmanuel

My name is Anaso Emmanuel and I’m the founder of MedicsDomain; an SEO Expert, Content Writer and an Enthusiastic learner. To the outside world, I’m an ordinary Medic but secretly I use this blog to help aspirants get into medical school, provide insightful guides and connect with others like me.