2007 USMLE Bulletin - Eligibility

Step 1, Step 2 CK, and Step 2 CS

To be eligible, you must be in one of the following categories at the time of application and on the test day:

• a medical student officially enrolled in, or a graduate of, a US or Canadian medical school program leading to the MD degree that is accredited by the Liaison Committee on Medical Education (LCME),
• a medical student officially enrolled in, or a graduate of, a US medical school leading to the DO degree that is accredited by the American Osteopathic Association (AOA), or
• a medical student officially enrolled in, or a graduate of, a medical school outside the United States and Canada and eligible for examination by the ECFMG.

Step 3

To be eligible for Step 3, prior to submitting your application, you must:

• obtain the MD degree (or its equivalent) or the DO degree,
• pass Step 1, Step 2 CK, and, if required based upon the rules referenced below, Step 2 CS,
• obtain certification by the ECFMG or successfully complete a "Fifth Pathway" program if you are a graduate of a medical school outside the United States and Canada (information on Fifth Pathway programs is available in ECFMG's Information Booklet, and
• meet the Step 3 requirements set by the medical licensing authority to which you are applying.

Who Is Required to Take Step 2 CS?

In order to be eligible to register for USMLE Step 3, the examination requirements for students and graduates of LCME-accredited medical school programs or AOA-accredited medical schools include passing Step 1 and Step 2. Such individuals must pass Step 2 CS as part of the examination requirements for Step 3 if they: (a) have medical school graduation dates in 2005 or later, or (b) graduated from medical school prior to 2005 but did not pass the CK component of Step 2 taken on or before June 30, 2005.

Step 2 CS replaced the Clinical Skills Assessment (CSA®) formerly administered by the ECFMG. Effective June 14, 2004, Step 2 CS became a requirement for ECFMG certification of international medical graduates who have not passed the CSA. To register for Step 3, ECFMG certificate holders must have taken and passed either the CSA or the Step 2 CS.

In order to register for Step 3, Fifth Pathway graduates must have taken and passed either the CSA or the Step 2 CS.

Individuals who have passed Step 2 prior to the implementation of Step 2 CS are not permitted to take Step 2 CK, except under the specific exceptions to the retake policy approved by the Composite Committee (see page 6), but are permitted to take Step 2 CS, provided they meet all other eligibility requirements.

Individuals who are not required to pass Step 2 CS for Step 3 eligibility but elect to take Step 2 CS and fail the examination are not eligible for Step 3 until such time as the individual's Step 2 CS performance of record (i.e., most recent performance) is a pass and the individual meets all other Step 3 requirements.

Graduates of Unaccredited Medical Schools in the United States and Canada

If you are eligible for licensure by a US medical licensing authority but are not in one of the eligibility categories listed on page 3, you may take the USMLE only upon specific request by that medical licensing authority. A licensing authority may sponsor you to take Step 1 and Step 2, followed by Step 3 if Step 1 and Step 2 are passed, if all the following conditions apply to you:

• You are a graduate of an unaccredited medical school in the United States or Canada;
• You are an applicant for initial medical licensure in the jurisdiction of the sponsoring licensing authority; and
• The sponsoring licensing authority certifies that you have met all of the requirements for licensure in the jurisdiction except for the examination requirement.

If these conditions apply to you, the medical licensing authority should submit the request to sponsor you to the USMLE Secretariat in advance of your application for the Step.

Sequence of Steps

If eligibility requirements are met, you may take Step 1, Step 2 CK, and Step 2 CS in any sequence.

Time Limit and Number of Attempts Allowed to Complete All Steps

Although there is no limit on the total number of times you can retake a Step or Step Component you have not passed, the USMLE program recommends to medical licensing authorities that they:

• require the dates of passing the Step 1, Step 2, and Step 3 examinations to occur within a seven-year period; and
• allow no more than six attempts to pass each Step or Step Component without demonstration of additional educational experience acceptable to the medical licensing authority.

For purposes of medical licensure in the United States, any time limit to complete the USMLE is established by the state medical boards. Most, but not all, use the recommended seven years as the time limit for completion of the full USMLE sequence. While medical schools may require students to pass one or more Steps for advancement and/or graduation, you should understand the implications for licensure. For states that establish a time limit for completion of all three Steps, the "clock" starts running on the date the first Step or Step Component is passed or, in some cases, on the date of the first attempt at any Step. General information regarding state-specific requirements for licensure can be obtained from the FSMB. For definitive information, you should contact directly the licensing authority in the jurisdiction in which you intend to seek licensure.

Special Notice for MD/PhD Candidates

The common pathway for MD/PhD students involves completing the first two years of medical school and then moving to graduate school studies and research for a three- or four-year period. Following completion of PhD course work and all or most of their research projects, these students return to complete their two clinical years, thus completing the medical degree in seven to nine years after first matriculating.

The USMLE program recognizes that the recommended seven-year time limit may pose problems for medical licensure for some students pursuing a combined degree (i.e., MD/PhD). It is for this reason that the USMLE program recommends to licensing jurisdictions that they be willing to consider exceptions to the seven-year limit for MD/PhD students who meet certain narrow requirements. The recommended requirements are as follows:

1. The candidate is working toward both degrees in an institution or program accredited by the LCME and regional university accrediting body and is a student in good standing, enrolled in the institution or program.
2. The PhD studies should be in a field of biological sciences tested in the Step 1 content. These fields include but are not necessarily limited to anatomy, biochemistry, physiology, microbiology, pharmacology, pathology, genetics, neuroscience, and molecular biology. Fields explicitly not included are business, economics, ethics, history, and other fields not directly related to biological science.
3. Candidates seeking an exception to the seven- year rule should be required to present a verifiable and rational explanation for the fact that he or she was unable to meet the seven-year limit. Although these explanations will vary considerably, each licensing jurisdiction will need to decide on its own which explanation justifies an exception.

Students who pursue both degrees should understand that while many states' regulations provide specific exceptions to the seven-year rule for dual degree candidates, others do not. Students pursuing a dual degree are advised to check the state-specific requirements for licensure listed by the FSMB.

Special Notice for International Medical Students and Graduates

ECFMG policy requires that applicants pass those USMLE Steps or Step Components required for ECFMG certification within a seven-year period. (You should refer to ECFMG's Information Booklet for complete details, as some exceptions may apply.) This policy applies only to ECFMG certification. The USMLE program recommends, although not all jurisdictions impose, a seven-year limit for completion of the three-Step USMLE program. You should contact the FSMB or the medical licensing authority of the jurisdiction where you plan to apply for licensure for state-specific requirements.

Retakes

If you fail or do not complete a Step or Step Component and want to retake it, you must reapply by submitting a new application and fee.

• You may take the failed or incomplete Step or Step Component no more than three times within a 12-month period.
• No Step or Step Component may be taken sooner than 60 days after your previous test date.
• For Step 1 and Step 2 CK: You may retake the examination no earlier than the first day of the month that begins at least 60 days after your previous test date.
• For Step 2 CS and Step 3: Your eligibility period for the retake will begin no earlier than 60 days after the date of your prior attempt.
• For Step 3: You may not reapply sooner than 60 days after your last attempt.

If you pass a Step or Step Component, you are not allowed to retake it, except to comply with the time limit of a medical licensing authority for the completion of all Steps or a requirement imposed by another authority recognized by the USMLE program for this purpose. The medical licensing or other authority must provide information indicating that you are applying to retake the passed Step or Step Component in order to comply with its requirement. If you are repeating a Step or Step Component because of a time limit, you may apply to retake the examination only after the applicable time limit has expired.

An exception to the policy of requiring the time limit to expire before applying to retake a previously passed Step or Step Component can be granted if, at the time of application and testing:

• you are currently enrolled in an LCME- or AOA- accredited medical school program leading to the MD or DO degree;
• you have previously passed Step 1 and/or Step 2 but have not passed Step 3;
• you are expected to graduate from the medical school program six or more years after the date
• you first passed Step 1 and/or Step 2; and
• you are otherwise eligible to retake the examination.

The number of attempts allowed to pass each Step or Step Component and the time allowed to complete all Steps vary among jurisdictions. To obtain specific information, you should contact the medical licensing authority in the jurisdiction where you intend to apply for medical licensure or the FSMB.

Official Performance of Record for Examinees Retaking a Previously Passed Step

In order to meet the examination requirements for Step 3 eligibility, you must achieve a passing performance on the most recent administration of the examinations intended to meet those requirements.

If you have not yet passed Step 3 and wish to retake a previously passed Step 1 or Step 2 examination in order to meet a time limit imposed by a medical licensing or other recognized authority, you should understand the implications for Step 3 eligibility of a failing performance on a retake. Specifically, if a failing performance on a retake is the most recent administration of that examination, that failing score will preclude Step 3 eligibility.

Formerly Administered Examinations

The NBME certifying examinations, Part I, Part II, and Part III, and the Federation Licensing Examination (FLEX) Components 1 and 2 are no longer administered. Use of the former NBME Parts or FLEX Components to fulfill eligibility requirements for Step 3 is no longer accepted. If you have passed all or a portion of these examinations and have never been granted a medical license by a US medical licensing authority, you may take any Step(s) for which you are otherwise eligible.

Change in Eligibility Status

If your eligibility for a Step or Step Component changes after you submit your application but before your scheduled test date(s), you must notify your registration entity promptly. Failure to notify your registration entity that you may no longer be eligible to take the examination may result in a determination of irregular behavior. If you take a Step or Step Component for which you are not eligible, scores for that examination may not be reported or, if previously reported, may be revoked.