In most medical schools, the medical degree requires four years of study. The first two years, called the pre-clinical years, are spent primarily in the classroom and laboratory studying the basic sciences. The third and fourth years are spent learning from direct patient care in the clinical setting under the supervision of experienced physicians. The clinical clerkships are spent in a variety of settings including family medicine, obstetrics/gynecology, internal medicine, surgery, pediatrics, neurology and psychiatry. Students also pursue specialized elective clerkships in their final year of medical school. During medical school, students are required to take two steps of the US Medical Licensing Exam (USMLE). Step 1 is taken at the end of the second year and must be passed before starting the third year clinical clerkships. Step 2 is taken toward the end of the fourth year, and many schools require successful completion for graduation.