The USMLE organization, the single group responsible for certifying all American physicians, has added the USMLE Step 4 for all current and future medical residents.

usmle_This new Step will include 3 parts:

1) A written section similar to Step 3 but labeled Step 4CBK (Clinical and Book Knowledge) and will include a $550 registration fee and a $350 testing fee.

2) A Step 4CSK (Clinical Skills and Knowledge) that includes a $550 registration fee and a $2000 testing fee.

3) And finally a Step 4E (essay), like the MCAT, that will require students and residents to go to one of 2 convenient testing centers, located in Oklahoma City and Salt Lake City, and write an essay on anything they want, for a $7,000 testing fee (plus travel expenses).  Each test, they added, must be taken separately.

“Step 4E [essay] is really a capstone on the future physician’s medical training.  They had to write a long, critical essay when they took the MCAT, now a final essay when they leave medical education,” Sam Silver M.D. a USMLE board member said in a statement.  “Like the MCAT, the written portion will be graded differently, this time using symbols found above the numbers on a standard qwerty keyboard,  from ~ to !@#$%^&*()_ and +.”

Dr. Silver also said the other parts of the test Step 4CBK will be given a number grading scale and Step 4CSK a pass/fail with a projected 99.9% of testers passing.  Giving a final 3-part combined score of 35P^, where the ^ is the essay.  Other Scores of 24P# and 22P( are possible.  When asked why have a test when everyone passes anyway, he responded: “We have Step 2 CS, which most people pass, and that is a vital step in the licensing process.”  He also reiterated that this announcement was in no way related to the ginormous debt the USMLE has accrued over the years.



  • Show Comments

  • Steve Kaiser

    Good luck Alex Trzebucki

  • scottie

    You omitted mention of the 5% discount for non-refundable pre-payment of all Step 4 fees before the first day as an MS-1

  • Tandis R

    @mariamhk1 NICE, freaking fantastic, I’m so ecstatic about this addition, God Bless USMLE

  • Ahlam

    as if it already isnt too much!

  • G.G.MD.

    You win the internet.

  • Jack Killian Jamesy

    Please Don’t give them ideas!

  • Abel Romero Corral

    Dont give this guys ideas!!!

  • Austin Peat
  • Payal Patel

    Thanks for almost killing me Pradhita…

  • Andres E Martiny


  • Dominique Woods

    Ha! Clever

  • Dominique Woods

    Ha! Clever

  • Justin Hamlin

    What’s funny is, it’s so believable that people think it’s real.

  • Melanie Bernstein

    This post gives me anxiety. I think I need an ativan!

  • Matthew Garringer

    I like how people think this js serious

  • Alhareth Aljuboori

    Not funny at all

  • Kent Meldrum

    I think the essay should be written on script pads for realism.

  • Michael Yerukhimovich


  • Tenille Smith

    Omg. I panicked! Essay!?! $7000?!!? Hahaha

  • Aron Trocchia

    This has to be a fu&&$ joke.

  • Natalie Bruno

    F this. F. THIS EXAM.

  • Lorna Kaiser

    Hahaha xD Usmle only thing that’s missing is I don’t when it comes to the Govt

  • Maria Carlota Miranda

    After i almost has a heart attack thinking this was serious; my husband says: “i don’t get it” Obviously he’s not a doctor.

  • Heath Foreman

    Omg… Considered having a heart attack…. This is a horrible joke!

  • Tiffany McBurney Pothapragada

    Wow…there are some seriously scary med students on this feed…you ever think before you type?

  • Vivek Halappa

    Do not feed them any crazy ideas to them

  • Debbie Lavigne

    This is a satirical site folks…… bre a th.

  • John DeCaro

    No comment

  • Gabe Medrano

  • Anwaar Saeed

    Funny, sad, & ridiculous at the same time. A result of failing economy ……..

  • John Park

    So good

  • Yenna Bea

    I think it’s a hoax there is nothing else on the Internet or usmle site regarding this

  • Kirk Merrikh

    Obviously 7k.. No its definitely not due to bankruptcy.. Are we that gullible?

  • Mohsin Jamal

    Thats Blasphemy

  • Elena Morgan

    Not funny!

  • Ahsan Mujtaba Rizvi

    This is bullshit, in 5 years they’ll be crying that they don’t have enough doctors. This is why you idiots !!

  • Tasha Chase

    Don’t make me come over there -_-

  • Lacramioara Pirvan

    3 usmle steps not enough. Another exam for doctors.

  • Clayton Hines

    Usmle makes way too much damn money off us to be close to chapter 7

  • Kal El

    Good thing I’m from salt lake, but take more money from me, why don’t you.

  • Kyle Kelly


  • Anthony Franklyn

    Tasha Chase

  • Elizabeth Cullen

    Ah, I see that they have been taken over by the American Board of Pathology.

  • Mara SantaMaria

    Ryan Gardner

  • Patrick David

    I quit. Im done. Someone please pay back my loans

  • Thomas Buretta

    “Convenient” testing centers in Salt Lake City and OKC… lmao!

  • Aaron Charniak

    Or just increase the price and decrease the passing rate… Again

  • Vanessa Rivera

    Sounds like a load of garbage and a way to rip med students and residents off even more. I have a $2600 board exam to take. I don’t want to spend close to $10K for yet another USMLE. Ridiculous.

  • Julie Shapiro Levine

    OMG. Almost freaked until I saw it was gomer

  • Lance Chapman

    Omg I had a moment of panic until I read the comments

  • Farah Nasraty

    Allison Michelle

  • Benjamin Srivastava

    I seriously had a nightmare about this

  • Tien Thang Lai


  • Theresa Hall

    Charles DeCarlo

  • Eric Schauberger

    Good thing I’m a DO and our licensing board, which is not redundant at all to the usmle, would never add a step for money. Of course if they did, our essay would require discussion on how we planned to use OMM to cure disease.

  • Laila Samiian

    This is a farce

  • El B Tea

    Omg I have been complaining about this all week!

  • Marcos Molina-Sotomayor

    money making machine

  • David Morse

    I love the ‘two convenient testing centers’ bit:)

  • Kevin McMullen


  • Shannon Hopkins

    I’m figuring this has to be satire… (My first newsfeed post from this site).

  • Melissa Smith

    Ann Ann Schwartz

  • Gregory Thomas

    No need for a step 4, we have MOC now.

  • Jessica Rayhanabad Moradkhani

    Such a joke!

  • Priyanka Baweja


  • David Grier

    Don’t give them any ideas!

  • Meg Mettler


  • Mitchel Leavitt


  • Justin Chaltry

    I honestly wouldn’t be surprised…

  • Steve Fortson

    Seems like the reasoning used to justify the previous steps

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