- Steps 1 & 2
- Step 3
- Step 2 CS - Who's Required
- Graduates of Unaccredited Medical Schools
- Attempts/Time Limits
- Other Information
Eligibility - Step 1, Step 2 CK, and Step 2 CS
Sequence of Steps
If eligibility requirements are met, 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 you apply 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(n) from medical school, you are not eligible for USMLE, even if you are appealing the school’s decision to dismiss you or are otherwise contesting your status.
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 from an LCME- or AOA-accredited US or Canadian medical school, or from a medical school outside the US and Canada that is listed in the IMED,
- pass Step 1, Step 2 CK, and Step 2 CS,
- obtain certification by the ECFMG or successfully complete a "Fifth Pathway" program (see Special Announcement Regarding Fifth Pathway Certificates and Step 3 below) 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
thee 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
FAIMER’s IMED will merge with the Avicenna
Directory of the World Federation for Medical Education
(WFME)to create a new, combined directory called the World Directory of Medical Schools. The World Directory is
expected to become available in early 2014. During the transition to
the World Directory,
IMED and the Avicenna
Directory will remain open to ensure continuity of
and the Avicenna Directory will
close when the World
Directory is fully operational. International medical
students and graduates should monitor the ECFMG website for detailed
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, state, or local laws or regulations.
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 accepting 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, remember the December 31, 2016 deadline, after which you will not be permitted to use your Fifth Pathway certificate to meet Step 3 eligibility requirements.
Who Is Required To Take Step 2 CS?
All graduates of LCME- and AOA-accredited medical schools are required to take and pass Step 2 CS in order to be eligible for Step 3.
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 Step 2 CS (see Special Announcement).
Individuals who 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 were 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 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 in advance of your application for each Step.
Number of Attempts Allowed To Complete All Steps and Time Limits
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.
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 of time limits for licensure. General information regarding state-specific requirements for licensure can be obtained from the FSMB. For definitive information, contact the licensing authority in the jurisdiction in which you intend to seek licensure.
The USMLE Program limits the total number of times an examinee can take the same Step or Step Component. An examinee is 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.
All attempts at a Step or Step Component are counted toward the limit, regardless of when the exams were taken.
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). For this reason, the USMLE program recommends to licensing jurisdictions that they consider allowing exceptions to the seven-year limit for MD/PhD candidates who meet the following requirements:
- The candidate has obtained both degrees from an institution or program accredited by the LCME and regional university accrediting body.
- 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 the biological sciences.
- A candidate seeking an exception to the sevenyear 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. These explanations will vary and 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 and Step Components required for ECFMG certification within a seven-year period. (You should refer to ECFMG’s Information Booklet for complete details.) 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 statespecific requirements.
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.
When you reapply for Steps 1, 2 CK, or 2 CS, your exam eligibility period will be adjusted, if necessary, to comply with these rules. When you reapply for Step 3, you must wait to submit your application until any time limits have expired.
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 ECFMG requirements is provided at the time of exam application using ECFMG's Interactive Web Applications (IWA).
If you are repeating a previously passed 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 this policy can be granted if, at the time of application and testing:
- you are currently enrolled in an LCME- or AOAaccredited 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.
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 of a failing retake performance on your Step 3 eligibility. 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. The former NBME Parts and FLEX Components are no longer accepted to fulfill eligibility requirements for Step 3. 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.
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 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.