Eligibility

Eligibility - Step 1, Step 2 CK, Step 2 CS

Sequence of Steps

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

To be eligible, you must be in one of the following categories at the time of application and on your 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 who meets the eligibility criteria of the ECFMG.

If you are dismissed or withdraw from medical school, you are not eligible for USMLE, even if you are appealing the school’s decision to dismiss you.

Eligibility - 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, Step 2 CS (see Step 2 CS - Who is Required?).
  • obtain certification by the ECFMG or successfully complete a "Fifth Pathway" program (see Step 2 CS - Who is Required? for Special Announcement Regarding Fifth Pathway Certificates and Step 3) if you are a graduate of a medical school outside the United States and Canada, and
  • meet the Step 3 requirements set by the medical licensing authority to which you are applying.

Note: The USMLE program recommends that for Step 3 eligibility, licensing authorities require the completion, or near completion, of at least one postgraduate training year in a program of graduate medical education accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the AOA. You should contact the FSMB for state-specific eligibility requirements for Step 3.

Note: A physician who received his or her basic medical degree or qualification from a medical school outside the United States and Canada may be eligible for certification by the ECFMG if the medical school and graduation year are listed in the International Medical Education Directory (IMED) of the Foundation for Advancement of International Medical Education and Research (FAIMER®). This applies to citizens of the United States who have completed their medical education in schools outside the United States and Canada but not to foreign nationals who have graduated from medical schools in the United States and Canada. Specific eligibility criteria for students and graduates of medical schools outside the United States and Canada to take Step 1 and Step 2 are described in the Information Booklet provided by the ECFMG.

Applications and other requests for services will not be processed if it is determined that doing so would be considered violative of any applicable federal laws or regulations.

Continue to: Step 2 CS - Who Is Required To Take It? »

Step 2 CS - Who Is Required To Take It?

In order to be eligible to register for USMLE Step 3, the current examination requirements for graduates of LCME-accredited medical school programs or AOA-accredited medical schools include passing Step 1 and Step 2. Such individuals must have passed 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. Note: After June 30, 2012, all graduates of LCME- and AOA-accredited medical schools will be required to take and pass Step 2 CS in order to be eligible for Step 3.

Special Announcement Regarding Fifth Pathway Certificates and Step 3

Currently, the USMLE program accepts either a valid Standard ECFMG certificate or a valid Fifth Pathway certificate (issued through December 31, 2009) from international medical graduates for purposes of meeting Step 3 eligibility requirements. The governing committee of the USMLE program and the USMLE parent organizations (the FSMB and NBME) have determined that the USMLE program will cease acceptance of Fifth Pathway certificates for the purpose of meeting Step 3 eligibility requirements, effective January 1, 2017. Individuals who hold valid Fifth Pathway certificates, and are otherwise eligible, may use their Fifth Pathway certificates to meet Step 3 eligibility requirements, and may apply for Step 3, through December 31, 2016.

Individuals holding Fifth Pathway certificates that are not accepted by the USMLE program for purposes of meeting Step 3 eligibility will be required to obtain ECFMG certification in order to be eligible for Step 3.

If you hold a valid Fifth Pathway certificate but have not completed the full USMLE sequence, you should remain mindful of the December 31, 2016 deadline, after which use of your Fifth Pathway certificate to meet Step 3 eligibility requirements will not be permitted.

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, eligible Fifth Pathway participants must have taken and passed either the CSA or the Step 2 CS (see the Special Announcement above).

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 Eligibility: Retakes), 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.

Continue to: Graduates of Unaccredited Medical Schools in the US and Canada »

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 under Eligibility: Step 1, Step 2 CK, and Step 2 CS / Eligibility: Step 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 program 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 at the address shown under General Inquiries in advance of your application for each Step.

Continue to: Time Limit and Number of Attempts Allowed to Complete All Steps »

Time Limit and Number of Attempts Allowed To Complete All Steps

The USMLE program recommends to medical licensing authorities that they:

  • require that the dates of passing the Step 1, Step 2, and Step 3 examinations 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.

Special Note: Multiple Attempts

The USMLE Program is introducing a limit on the total number of times an examinee can take the same Step or Step Component. When this limit takes effect, an examinee will be ineligible to take a Step or Step Component if the examinee has made six or more prior attempts to pass that Step or Step Component, including incomplete attempts.

The effective date for the six-attempt limit depends upon whether an examinee has taken any Step or Step Component (including incomplete attempts) before January 1, 2012.

Examinees who have NOT taken any Step or Step Component before January 1, 2012
If you have not taken any Step or Step Component before January 1, 2012, the six-attempt limit will go into effect for all exam applications that you submit on or after January 1, 2012.

Examinees who have taken any Step or Step Component before January 1, 2012
If you have taken any Step or Step Component (including incomplete attempts) before January 1, 2012, the six-attempt limit will go into effect for all exam applications that you submit on or after January 1, 2013. After that date, all attempts at a Step or Step Component will be counted toward the limit, regardless of when the exams were taken.

For purposes of medical licensure in the United States, any time limit to complete the USMLE is established by the state medical boards. Many require completion of the full USMLE sequence within seven years from the date the first Step or Step Component is passed or, in some cases, from the date of the first attempt at any Step or Step Component. While medical schools may require students to pass one or more Steps for advancement and/or graduation, you should understand the implications for licensure. General information regarding state-specific requirements for licensure can be obtained from the FSMB (www.fsmb.org). For definitive information, contact 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 candidates with 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 candidates who meet certain narrow requirements. The recommended requirements are as follows:

  1. The candidate has obtained both degrees in an institution or program accredited by the LCME and regional university accrediting body.
  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. A candidate 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.

Continue to: Retakes »

Retakes

For exam applications submitted on or after January 1, 2012, the following rules apply to all Steps and Step Components. You may take the same examination no more than three times within a 12-month period. Your fourth and subsequent attempts must be at least 12 months after your first attempt at that exam and at least six months after your most recent attempt at that exam. Attempts at that examination (complete and incomplete) prior to January 1, 2012 will be counted in determining whether these rules apply.

When you reapply, your exam eligibility period will be adjusted, if necessary, to comply with these rules.

If you pass a Step or Step Component, you are not allowed to retake it, except to comply with certain state board requirements which have been previously approved by USMLE governance. For example, you may retake a passed Step 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 authority must provide information showing that you are an applicant for licensure in that jurisdiction; have fulfilled all requirements for licensure in that jurisdiction; are eligible for licensure except for the out-of-date examination; and have completed the full USMLE sequence, including Step 3. Information regarding retakes allowed to comply with a requirement imposed by a recognized authority other than a medical licensing authority is provided at the time of exam application using ECFMG's Interactive Web Applications (IWA).

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 (see Special Note: Multiple Attempts under Time Limit / Max Attempts). 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 for eligibility requirements for Step 3.

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 recognized authority other than a medical licensing 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.

Continue to: Other Information »

Sequence of Steps

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

Other Information - 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. If you have been granted a medical license by a US medical licensing authority you are not eligible to take USMLE.

Other Information - 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 (see Indeterminate Scores and 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, and/or you may be subject to sanctions for Irregular Behavior.