The USMLE is structured as a multi-step examination with formats designed to assess both medical knowledge and clinical decision-making skills progressively. Step 1 and Step 2 CK primarily use multiple-choice questions (MCQs), testing foundational sciences and applied clinical knowledge, respectively, through scenario-based questions that evaluate diagnostic reasoning and problem-solving. Step 2 CS (historically) involved clinical skills assessment using standardized patient encounters to evaluate history-taking, physical examination, communication, and clinical reasoning, though its core elements are now integrated into Step 2 CK in some formats. Step 3 combines MCQs with computer-based case simulations (CCS), which assess a physician’s ability to manage patients independently over time, integrating diagnostic, therapeutic, and management decisions. Collectively, these question types ensure that candidates are evaluated on both theoretical understanding and practical application, from basic sciences to real-world patient care.