FAQs

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Step 1 and Step 2 application materials are available for students and graduates of LCME- and AOA-accredited medical schools from the National Board of Medical Examiners® (NBME®) website. Step 1 and Step 2 application materials are also available for students and graduates of medical schools outside the United States and Canada from the Educational Commission for Foreign Medical Graduates (ECFMG®).

Step 1 and Step 2 applications must be submitted to the NBME if you are a student or graduate of a medical school in the United States and Canada, or to the ECFMG if you are a student or graduate of a medical school outside the United States and Canada. You must complete current, official USMLE applications and submit them to the ECFMG or NBME in accordance with the application instructions.

To request information on eligibility requirements and application procedures for Step 3, you should contact the medical licensing authority with which you intend to apply for Step 3 or the Federation of State Medical Boards (FSMB). Application procedures for Step 3 vary among jurisdictions. Therefore, you are advised to begin inquiries well in advance of the dates on which you expect to take the examination. Depending on the licensing board, application materials are available from the FSMB or medical licensing authority. See also USMLE Bulletin: Applying for the Test and Scheduling Your Test Date

Thomson Prometric, a division of The Thomson Corporation, provides scheduling and test centers for USMLE. Computer-delivered USMLE is delivered at Prometric test centers, Step 1 and Step 2 CK at Prometric test centers in the United States and around the world, and Step 3 at Prometric test centers only in the US and its territories. To take computer-delivered USMLE, you must do the following:

1. Access application materials from the appropriate registration entity. (See also How do I apply for USMLE?)
2. Complete your application materials and submit them to the registration entity.
3. Obtain a Scheduling Permit verifying your eligibility and authorizing you to schedule the examination.
4. Follow the instructions on your Scheduling Permit to schedule your test date at a Prometric test center. Center locations are available at www.prometric.com
5. Bring your Scheduling Permit and identification as described on your Scheduling Permit to the Prometric test center on the scheduled date and time and take the examination. See also USMLE Bulletin: Applying for the Test and Scheduling Your Test Date and Testing.

USMLE Step scores are made available to you by your registration entity - for Step 1 and Step 2, either NBME or ECFMG; for Step 3, FSMB. You must contact your registration entity if you have questions about obtaining your scores.

Scores ready for release are released on a weekly basis on Wednesdays. Generally these will include examinees tested three to six weeks before the release date. However, there are many factors that may delay an individual score release. Usually these will be quickly resolved and the score released in the next weekly cycle. If you have not received your score within eight weeks of your test date, please contact your registration entity to determine the status of your score report. Please note that during 2008, no new scores for computer-delivered Step examinations will be released during the week of July 2 and during the week of December 24.

In order to assure that both the processing and scoring of USMLE examinations are done in a secure and accurate fashion, it is necessary to follow a number of quality assurance steps. These steps include monitoring reports from test centers about test delivery problems and about possible security violations. For Steps 1 and 2 CK, these processes are completed for a majority of examinees in three to four weeks. For Step 3, because it is a two-day examination containing computer simulations, the processes are a bit more complex. For Step 3, most examinations are processed, scored, and reported in four to six weeks.

Requests for a change in address must be made as follows:

• Step 1 and Step 2 NBME applicants - Update your address online on the NBME Licensing Examination Services Website by logging into your account and choosing the "Change Contact Information" option.
• Step 1 and Step 2 ECFMG applicants - Update your address online by accessing OASIS on the ECFMG website or download Form 182 from the ECFMG website and submit the completed form to ECFMG.
• Step 3 applicants - you must include your full name, new and old address, date the address change is to take effect, social security number or USMLE ID number, your signature, and "ATTENTION Exam Department" to
  FSMB
  Department of Examination Services
  PO Box 619850
  Dallas, TX 75261-9850
  Fax (817) 868-4098

Step 1 and Step 2 NBME applicants - Log in to your account on the NBME Licensing Examination Services website and select the Name Change option. Print the associated form(s) and submit it with the required documentation listed on the form. If you have a Scheduling Permit, an updated scheduling permit will be issued to you with your new name. You should discard your old scheduling permit once you receive the new one. You must bring your new Scheduling Permit for admittance to the test center. Your name on your new scheduling permit must exactly match your name on the identification you are required to present at the test center. Name change forms and documentation must be received by NBME no later than 7 business days before your testing appointment or you will not be able to test.

Step 1 and Step 2 ECFMG applicants - Download Form 182 from the ECFMG website and return the completed form to ECFMG with appropriate documentation, as described in Form 182. If your name of record with ECFMG is changed while you are registered for an examination, you can obtain a new scheduling permit by accessing IWA on the ECFMG website. You must bring the new scheduling permit to the test center on your exam date. The name on your scheduling permit must match exactly the name on the forms of identification you present at the test center. Name changes must be received by ECFMG and processed no later than 7 business days before your testing appointment, or you will not be able to test.

Step 3 applicants- send documentation noting the name change and your full new and old names, your address, social security number or USMLE ID number, your signature, and "ATTENTION Exam Department" to
FSMB
Department of Examination Services
PO Box 619850
Dallas, TX 75261-9850
Fax (817) 868-4098

Tutorials that illustrate the USMLE Step 1, Step 2 CK, and Step 3 multiple-choice question and Step 3 computer-based case simulation (Primum® CCS) software, sample multiple-choice test questions for each Step, sample Step 3 Primum cases, and orientation materials for Step 2 CS are available at this website:

• Step 1
• Step 2
• Step 3

All applicants can download sample test and orientation materials from the USMLE website. FSMB applicants will also receive these materials on a CD from their registration entity. Once registered, ECFMG applicants can request a CD using the appropriate form, available on the ECFMG website. NBME applicants can request that a CD be sent to them, by sending an e-mail to webmail@nbme.org. The materials on the CD and on the website are identical.

Click here for frequently asked questions about the sample test materials. If you cannot find the answer to your question, you may either send your inquiry to USMLEtech@nbme.org or call (215) 590-9700 between 8:30 AM and 4:00 PM Monday through Friday, eastern time. See USMLE Bulletin: Preparing for the Test.

The Bulletin is at the Bulletin section of this website.

If you have a documented disability covered under the Americans with Disabilities Act (ADA) and require test accommodations, you must obtain information regarding procedures and documentation requirements in advance of applying for each Step. This information is available from your registration entity (ECFMG or NBME) if you are applying for Step 1 and Step 2 and from the FSMB if you are applying for Step 3, and from the Test Accommodations section of this website.

• Test accommodations information for ECFMG Step 1 and Step 2 applicants
• Test accommodations information for NBME Step 1 and Step 2 applicants
• Test accommodations information for Step 3 applicants

Your application for the Step and your request for test accommodations with required documentation must be submitted at the same time.

You must pass Step 1 and Step 2 before you are eligible to take Step 3. In LCME-accredited medical schools, although Step 1 and Step 2 can be taken in any order, most students will take Step 1 at the end of their second year and Step 2 in their fourth year; Step 3 is usually taken during the first or second year of postgraduate training. Students and graduates of medical schools outside the United States and Canada should contact the ECFMG for information on ECFMG Certification and Step 1 and Step 2 eligibility. Most medical licensing authorities require completion of USMLE Steps 1, 2, and 3 within a seven-year period, which begins when you pass your first Step. Check the FSMB website for further information on such requirements.

Any limits are established by the individual medical licensing boards, and they can vary from three to six times, while a few states have no limit. Once again, you should check this with the FSMB or the individual licensing authority in the state where you intend to apply for licensure. See USMLE Bulletin: Time Limit and Number of Attempts Allowed to Complete All Steps

See USMLE Bulletin: Retakes.

Generally no, although this should be specifically checked with individual medical licensing authorities or the FSMB.

If you pass a Step, 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. See USMLE Bulletin: Time Limit and Number of Attempts Allowed to Complete All Steps.

The Educational Commission for Foreign Medical Graduates (ECFMG) provides such information. Through its program of certification, ECFMG assesses the readiness of graduates of medical schools outside the United States and Canada to enter residency or fellowship programs in the United States. The ECFMG® Certification Fact Sheet provides an overview of ECFMG Certification and preliminary information on entry into US programs of graduate medical education. For detailed information on these topics, including eligibility to take the USMLE, refer to the ECFMG Information Booklet. Both publications are available on the ECFMG website. Students and graduates of medical schools outside the United States and Canada can also contact ECFMG for information.

To obtain your USMLE transcript or have it sent to a third party, you must contact the ECFMG, FSMB, or NBME. Which entity you contact depends on which Steps you have taken and where you want your transcript sent. Contact the FSMB if you want a transcript sent to a medical licensing authority at any time. If you have not registered for or taken Step 3 and you want a transcript sent to a third party other than a medical licensing authority, the request should be sent to the same entity that registered you for Step 1 and/or Step 2, the ECFMG or the NBME. Once you register for or take Step 3, all requests for USMLE transcripts must be sent to the FSMB. See USMLE Bulletin: Official Transcripts and Providing Scores to Third Parties.

ERAS®, the Electronic Residency Application Service, is sponsored by the Association of American Medical Colleges (AAMC) and was developed to transmit residency applications via the Internet, including electronic transmittal of USMLE transcripts to residency programs which participate in ERAS.

Information on electronic transmittal of USMLE transcripts through ERAS is available for students and graduates of accredited medical schools in the United States and Canada from the medical schools.

ERAS is available to students and graduates of medical schools outside the United States and Canada through ECFMG; instructions are included at www.ecfmg.org.

Tutorials that illustrate the USMLE Step 1, Step 2 CK, and Step 3 multiple-choice question and Step 3 computer-based case simulation (Primum® CCS) software, sample multiple-choice test questions for each Step, sample Step 3 Primum cases, and orientation materials for Step 2 CS are available at this website:

• Step 1
• Step 2
• Step 3

See also How can I prepare for the test?

The sample test questions are only available for the Windows (PC) operating system because the exams are administered on a PC-only platform at test centers. The sample test questions may run on a Mac that has PC-emulation software, such as Virtual PC, installed, however, we do not test the installation or the application running with PC-emulation software, and cannot advise you about Mac applications. If you use a Mac and do not have access to PC-emulation software, you may be able to contact someone who can arrange for the sample test questions to be installed on computers that can be accessed by Mac users or students who do not have personal PCs (i.e., in learning resource centers or libraries).

Windows XP does not automatically update the desktop for you. Just press F5 to refresh your screen and the folder will appear.

The regional language setting must be set to English, otherwise it will cause the FRED software to produce error #6. To fix this problem please do the following and then attempt to open the materials again:

1. For Windows XP (home or Professional): Go to the Start menu/ Settings/Control Panel. Select the "Regional and Language" icon from Control Panel. Select the Advance Tab and in the "Language for non-unicode programs" field, select ENGLISH(United States) from the drop down list.
2. For Windows 2000: Go to the Start menu/ Settings/Control Panel. Select the "Regional Options" icon from Control Panel. Select the General Tab and in the "Settings for the current user" field, select ENGLISH(United States) from the drop down list.

This practice session uses the Courier font that is installed by default with all Windows operating systems. If you do not see anything in the center of the screen, your Courier font has either been removed or become corrupted in some way. You can reinstall fonts from your original operating system disk or from any number of locations on the Internet. Once a Courier font is installed you should see everything on your screen.

The problem you describe is a Microsoft Windows problem. It is not a problem with the USMLE Practice Materials. Please visit the Microsoft website for a knowledge base article about this issue.

This error occurs if the machine is missing the "MS Sans Serif" font, or the font exists but the machine is configured to use "TrueType fonts only."

Please check the "True Type fonts only" option, to see if it's selected. To do this, go to your Window's "Start" button, then Settings, then Control Panel, then Fonts. Click on the "Tools" menu option and click on "Folder Options." Select the "TrueType Fonts" tab, and uncheck the "Show only TrueType fonts in the programs on my computer" box.

If this is already unchecked, check to see if the MS Sans Serif font is installed on the computer. Scroll down the list of fonts and verify that "MS Sans Serif" is installed (sserife.fon). If it is not installed, you should find it on your Windows CD.

This error occurs when an older version of the FRED practice materials is already saved on your PC. You must uninstall the old version before attempting to install the new version.

Please uninstall the old materials by going to your Windows Start button, then to Settings, then the Control Panel. From the Control Panel window chose Add/Remove Programs. On the list of currently installed programs, locate anything having to do with FRED and chose to remove those items. Once the uninstall is complete, you should then reboot your computer. After you have rebooted, go to the USMLE website and download the most current materials.

You should rename the file located in C:\Windows\System32\ComDlg32.OCX to ComDlg32.OLD. Once this is done, reinstall the FRED software (this action will copy the correct version of the comdlg32.ocx file to the above directory automatically).

Both scores reflect your overall performance on the examination. The number of test items you answered correctly is converted to two equivalent scores, one on a 3-digit score scale and one on a 2-digit score scale. Both scales are used for score reporting purposes.

On the 3-digit scale, most scores fall between 140 and 260. The mean score for first-time examinees from accredited medical schools in the United States is in the range of 200 to 220, and the standard deviation is approximately 20. Your score report includes the mean and standard deviation for recent administrations of the Step.

Score information for each Step, including performance data by group, is posted each year for the previous year's examinees:

• Scores and Transcripts Page

The 2-digit score is not a percentile.The 2-digit score is derived from the 3-digit score. It is used in score reporting to meet requirements of some medical licensing authorities that the passing score be reported as 75. The 2-digit score is derived in such a way that a score of 75 always corresponds to the minimum passing score.

The profiles appear only on the second page of your individual Step score report. They are provided as an assessment tool for your benefit and will not be reported or verified to any third party. The profiles summarize relative areas of strength and weakness to aid in self assessment. Please consult page 2 of your score report for further information on what the profiles mean and how to interpret them.

Percentiles are not provided in connection with USMLE scores. The calculation and provision of data to be used to rank or make comparisons among examinees is inconsistent with the primary goal of USMLE, which is to provide a series of assessments and recommendations for minimum passing requirements to the state licensing authorities to support decisions about initial licensure.  Furthermore, normative data such as percentiles are easily misinterpreted because, as the examinee group changes across time, the correspondence between percentile values and examinee ability can change.  For these reasons, USMLE does not report percentiles. 

Under current procedures, the scores for each administration of a USMLE Step are equated so that a given three-digit score represents essentially the same level of examinee performance for that Step, and this holds true across years. In other words, a score of 200 on one administration of a Step indicates a comparable level of examinee performance as a score of 200 on any other administration of the same Step. This equivalence holds even if the pass-fail standard is changed, which permits comparing performance across time.

It is important also to remember that the two-digit score, also reported for USMLE, is not a percentile and is not fully equated like the three-digit score. The two-digit score is a total test score that is designed to meet the requirements of some state licensing authorities. The two-digit score scale is one on which a 75 is always the minimum passing score. A given two-digit score may represent a different level of performance if the two administrations were subject to different pass/fail standards.

The 3-digit score is calculated using statistical procedures that ensure that scores from different years are on a common scale and have the same meaning. Performance data from previous years are available: Scores and Transcripts Page.

The USMLE program recommends a minimum passing score for each Step. Currently, the passing scores as set by the USMLE program are 185 for Step 1, 184 for Step 2 CK and 184 (187 starting 5/1/2008) for Step 3 on the 3-digit scale, or 75 on the 2-digit scale. Each of these corresponds to answering 60-70% of the items correctly. Performance standards for USMLE are based on a specified level of proficiency. As a result, no predetermined percentage of examinees will pass or fail the examination. The passing scores are reviewed periodically and may be adjusted without notice prior to score reporting. See Minimum Passing Scores on USMLE Step Examinations and USMLE Bulletin: Scoring and Score Reporting.

The content-based standard used for setting the passing score means that as many as 100% of candidates could theoretically pass, or conceivably 0%. The number is not arbitrarily predetermined. Similarly, the pass rate can vary from one accredited medical school in the United States to another, and from one year to another. Recent performance data for first-time takers and repeaters for each Step are available: Scores and Transcripts Page.

For accredited medical schools in the United States and Canada, performance by medical school is reported by NBME only to individual schools and is available only from those schools. The Educational Commission for Foreign Medical Graduates (ECFMG®) has responsibility for reporting scores for students and graduates of international medical schools.

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