The USMLE program has established rules to govern administration of the examinations to ensure that no examinee or group of examinees receives unfair advantage on the examination, inadvertently or otherwise. The rules include standard test administration conditions consistent with the principles on which the examinations are developed and scored. For example, examinations are designed to sample knowledge across specified content domains, and unauthorized access to examination content prior to testing violates that principle.

If there is a reason to believe that the integrity of the examination process is jeopardized, the USMLE parent organizations may invalidate all or any part of an examination. If information indicates that continued testing would jeopardize the security of examination materials or the integrity of scores, the USMLE parent organizations reserve the right to suspend or cancel test administration.

Testing Regulations and Rules of Conduct - Overview

Test center staff monitor all testing sessions for USMLE Steps. You must follow instructions of test center staff throughout the examination. Failure to do so may result in a determination of irregular behavior (see Score Validity and Irregular Behavior) and permanent annotation of your USMLE transcript.

Test center staff are not authorized to answer questions from examinees regarding examination content, testing software, or scoring. Test center staff are also not authorized to answer inquiries with regard to registration or retesting.

If staff observe you violating test administration rules or engaging in other forms of irregular behavior during an examination, the center staff will not necessarily tell you of the observation at the time of the examination. Test center staff are required to report such incidents to the USMLE program; each report is fully investigated.

The Rules of Conduct

If you violate these Rules of Conduct, you may be directed to leave the test center before you complete the examination. Also, evidence of violation of any test administration rule, including these Rules of Conduct, will result in actions being taken under USMLE policies and procedures on irregular behavior. If you are found to have engaged in irregular behavior, your score report and transcripts will include this finding, and you may be barred from taking the USMLE in the future.

When you apply to take the USMLE, you are agreeing to the following Rules of Conduct:

  1. You are the person named on the scheduling permit for the examination.
  2. You will not give, receive, or obtain any form of unauthorized assistance during the examination or during breaks.
  3. You will not have any formulas, study materials, notes, papers, or electronic devices of any kind in your possession while you are in the secure areas of the center.
  4. You will place in a locker or cubicle all personal belongings, including cell phones, watches, pagers, tablet PCs, iPods/media players, any device with transmitting or receiving capabilities (e.g., bluetooth), formulas, study materials, notes, papers, pens/pencils, and your purse or wallet, before you enter the testing room (or Orientation Room for Step 2 CS).
  5. During computer-based testing (Steps 1, 2 CK, and 3), you may use a telephone or other communication device while outside the secure testing area and only during an authorized break. You may not use it for any purpose related to test content. During Step 2 CS, you may not use a personal telephone at any time while you are in the testing center.
  6. During computer-based testing (Steps 1, 2 CK, and 3), you may use a telephone or other communication device while outside the secure testing area and only during an authorized break. You may not use it for any purpose related to test content. During Step 2 CS, you may not use a personal telephone at any time while you are in the testing center.
  7. You will not remove materials in any form (written, printed, recorded, or any other type) from the test center.
  8. All examination materials remain the property of the USMLE parent organizations, and you will maintain the confidentiality of the materials, including the multiple-choice items, and the case content for Step 2 CS and Primum CCS. You will not reproduce or attempt to reproduce examination materials through memorization or any other means. Also, you will not provide information relating to examination content that may give or attempt to give unfair advantage to individuals who may be taking the examination. This includes postings regarding examination content and/or answers on the Internet.

Continue to: Personal Items »

Personal Items

It is important that you read and understand the rules regarding personal possessions; the rules for Steps 1, 2 CK, and 3 differ from those for Step 2 CS.

Unauthorized possession of personal items while in the secure areas of the testing centers may lead to a finding of irregular behavior and permanent annotation of your USMLE transcript.

For Step 1, Step 2 CK, and Step 3, unauthorized items include, but are not limited to:

  • mechanical or electronic devices, such as cell phones, tablet PCs, pagers, calculators, watches of any type, recording or filming devices, iPods/media players, radios, any device with transmitting or receiving capabilities (e.g., bluetooth);
  • outerwear, such as coats, jackets, head wear, gloves;
  • book bags, backpacks, handbags, briefcases, wallets;
  • books, pens/pencils, notes, written materials, or scratch paper;
  • food, candy, gum, or beverages.

For the computer-based examinations, you may bring soft-foam earplugs into the testing room. However, they must be out of the packaging and ready for inspection by test center staff during check-in. Earplugs must be left at the workstation during all breaks.

For Step 2 CS, unauthorized items include, but are not limited to:

  • mechanical or electronic devices, such as cell phones, tablet PCs, pagers, calculators, watches of any type, recording or filming devices, iPods/media players, radios, any device with transmitting or receiving capabilities (e.g., bluetooth);
  • book bags, backpacks, handbags, briefcases, wallets;
  • books, pens/pencils, notes, written materials, or scratch paper;
  • medical equipment of any kind other than a standard stethoscope (without digital amplification, electronic, or any other enhancement);
  • earplugs of any kind.

For Step 2 CS, the entire testing session from orientation until the evaluation is completed, including all breaks, is considered a closed and secure testing session, and the entire test center, including the orientation room and the restrooms, is a secure testing area. Therefore, the rules regarding unauthorized possession during Step 2 CS apply to the orientation room and to all breaks.

For all Steps,if you bring personal items to the test center, you must store them in a designated locker outside the secure testing area or in the designated storage area for Step 2 CS. Keep in mind that the storage facilities are small and that all stored mechanical or electronic devices must be turned off. Personal items and their contents are subject to inspection. Any materials that reasonably appear to be reproductions of any USMLE examination materials will be confiscated. You are not allowed to make notes of any kind during an examination, except on the materials provided by the test center for this purpose. During Step 2 CS, making notes on the provided materials prior to the announcement to begin a case is also forbidden. Removal of those materials from the secure testing area is prohibited.

Continue to: Admission to the Test »

Admission to the Test

When you arrive at the test center, you must present your scheduling permit and the required identification described on your scheduling permit. Acceptable forms of identification include the following forms of unexpired identification:

  • passport,
  • driver's license with photograph,
  • national identity card,
  • other form of dated, unexpired, government issued identification,
  • ECFMG-issued identification card.

Important Note: Your name as it appears on your scheduling permit must match the name on your form(s) of identification exactly. Refer to your scheduling permit for limited exceptions. If the name listed on your scheduling permit is not correct, contact your registration entity immediately.

Your identification must contain both your signature and recent (no more than 10 years earlier) photograph. If it contains your photograph but not your signature, you can use another form of unexpired identification that contains your signature, such as a student/employee identification card or a credit card, to supplement your photo-bearing, governmentissued identification.

If you do not bring a printed copy of your scheduling permit and acceptable identification, you will not be admitted to the test. In that event, you must pay a fee to reschedule your test. Your rescheduled test date(s) must fall within your eligibility period.

Continue to: Step 1, Step 2 CK, & Step 3 »

Step 1, Step 2 CK, and Step 3

Test Centers and Testing Conditions

Prometric provides computer-based testing services for academic assessment, professional licensure, and certification. USMLE Step 1 and Step 2 CK are given at Prometric Test Centers around the world. USMLE Step 3 is given at Prometric Test Centers in the United States and its territories. These centers provide the resources necessary for secure administration of the USMLE, including video and audio monitoring and recording, and use of digital cameras to record the identity of examinees.


Use the Prometric Test Center Locator for directions to Prometric Test Centers.

Individual examinations are drawn from large pools of content-parallel test forms, which are in turn created from very large banks of test materials. Individual examinations vary within and across test centers, and within and across test days. Electronic encryption is employed to protect the security of item banks, test forms, and test responses. Physical security at test centers is maintained by proctoring and video surveillance and recording.

You should arrive at the Prometric Test Center 30 minutes before your scheduled testing appointment on your testing day(s). If you arrive after your appointment time, you may not be admitted. If you arrive more than 30 minutes after your scheduled testing appointment, you will not be admitted. In that event, you must pay a fee to Prometric to reschedule your test. Your rescheduled test date(s) must fall within your assigned eligibility period.

There are no waiting facilities for family and friends at the center; plan to meet them elsewhere after the examination ends.

Upon arrival at the test center, you must present the required identification, sign a test center log, be photographed, and store your personal items in your assigned locker. You will be scanned with a handheld metal detector and asked to empty and turn your pockets inside out before entering the testing room to confirm that you have no prohibited items. You will be asked to repeat this process each time you return to the testing room after a break. In addition, your identification document and fingerprint may be scanned electronically. (To learn more about this process, please read information about the Biometric Enabled Check In System). You will be provided with laminated writing surfaces and markers. You will be instructed to write your name and Candidate Identification Number (CIN) on one of the laminated writing surfaces provided. Your scheduling permit will be retained at the Test Center Administrator’s station. You may request access to the permit during the examination if it becomes necessary for you to rewrite the CIN on the laminated writing surface.

Test center staff will escort you to your assigned testing station and provide brief instructions on use of the computer equipment. Laminated writing surfaces and markers issued for USMLE Step 1, Step 2 CK, and Step 3 are to be used for making notes and/or calculations during the testing session. They should only be used at your assigned testing station, and only after you have begun your examination by entering your CIN. You must enter your CIN to start the examination. Depending upon the type of markers provided, you may also be provided an eraser. Otherwise, if you have filled the laminated writing surfaces and need additional space for making notes, raise your hand to ask test center staff for a replacement. You must return laminated writing surfaces to test center staff at the end of the testing session.

A brief tutorial is available before each exam. It is important that you run the sound check for the audio headphones in the tutorial so that if a problem is detected, it can be resolved before you start the exam.

Completing the Test

Each block lasts approximately 30 to 60 minutes and ends when its time expires or you exit from it. Once you begin a block of the test, no authorized breaks are provided during the block. During blocks, the block and daytime clocks continue to run even if you leave the testing room, (e.g., for a personal emergency). If you leave during a block, the test center staff will report that fact as an irregular incident. In addition, the "unauthorized break" screen, described in the examination tutorial, may appear on the monitor at your workstation during a testing block. As explained in the tutorial, the unauthorized break screen will appear after a defined period of inactivity (no mouse click or key entry). Thirty seconds before the appearance of the unauthorized break screen, an “inactivity time-out” warning will appear. If you do not click as instructed on the warning screen, the unauthorized break screen will appear after 30 seconds. You will then have to enter your CIN in order to continue with the examination. Each time you leave the testing room, you are required to sign out and sign in when you return. You must present your identification each time you sign in.

The test session ends when you have started and exited all sections or the total time for the test expires. You will sign out as you leave the test center, hand in the laminated writing surfaces, and receive a notice that you appeared for the test. If you encounter an error message at the conclusion of your exam, the notice that you appeared for the test may not print. However, please be assured that it does not affect your examination data or our receipt of the data. If your test is scheduled for multiple days, be sure to ask test center staff to return your scheduling permit to you at the end of your test day; you will need to check in on the following day(s). You can reprint your permit for the consecutive day(s), if test center staff do not return the permit to you.

After you start taking an examination, you cannot cancel or reschedule that examination. If you experience a computer problem during the test, notify test center staff immediately. The testing software is designed to restart the test at the point at which it was interrupted. In most cases, your test can be restarted at the point of interruption with no loss of testing time. However, in the rare event that a technical problem occurs that does not permit you to complete your examination, please send a written description of the incident to Test Administration Services at the NBME (refer to Test Administration Problems/Inquiries for details). Your problem will be investigated, and if necessary, arrangements will be made to allow you to test at a later date at no additional charge. This is the exclusive remedy for such problems.

If you start the examination but do not complete it for reasons other than a technical problem or expiration of time, you should promptly write to NBME Test Administration (see Contact Table) explaining, in detail, the reasons you decided not to finish the exam. The attempt may appear as an "incomplete" on your USMLE transcript (please refer to Examination Results and Scoring and Number of Attempts Allowed to Complete All Steps and Time Limits for further details).

How Break Time Works

Your entire testing session is scheduled for a fixed amount of time. The computer keeps track of your overall time and the time allocated for each block of the test. At the start of the testing session, you have a total of 45 minutes of break time. This allotment of time is available to you for authorized breaks between blocks and may also be used for computer transitions between blocks. Authorized breaks include any time taken between test blocks whether you remain at your seat or you leave the testing room. If you complete the tutorial or other blocks of the test early, the remaining time will be available as break time. It will not be available as testing time for other blocks of the test.

As you progress through the blocks of the test, you should use the features available in the testing software to monitor how many blocks remain and how much break time is left. If you take too much break time and exceed the allocated or accumulated break time, your time to complete the last block(s) in the testing session will be reduced. You should use the time summary feature (as explained in the tutorial) to keep track of the number of blocks completed and the number remaining.

When section time runs out, you will not be able to move to any new screens within that section. The computer will close the section. After you complete or run out of time for each block during the test, you must respond when the computer asks you whether you want to take a break or continue. After the test blocks, you may be asked to complete an additional block that contains survey questions about your testing experience.

Continue to: Step 2 CS »

Step 2 CS

The time you should arrive at the testing center is listed on the confirmation notice you will print after scheduling your appointment. If you arrive during the on-site orientation, you may be allowed to test; however, you will be required to sign a Late Admission Form. If you arrive after the on-site orientation, you will not be allowed to test. You will have to reschedule your testing appointment and will be required to pay the rescheduling fee. If you start to test, but do not complete the examination, the attempt may appear as an "incomplete" on your USMLE transcript.

At the time of check-in, you will be required to present your scheduling permit and unexpired identification (see Admission to the Test). You will be assigned a small storage cubicle in which you must place personal belongings. These cubicles are not secure, so do not bring valuables. In addition, please note the following:

NOTE: Behaviors that could constitute a real or potential threat to a standardized patient’s safety, such as careless or dangerous actions during physical examination, may impact your pass/fail determination, may result in a determination of irregular behavior and annotation of your USMLE record, and/or may result in the imposition of conditions on retesting.

Visitors from medical testing and academic organizations will on some occasions observe an examination in progress. They will be given no information regarding examinee identity or performance and will have no interaction with examinees.

  • You should bring your own stethoscope and white laboratory coat; all other equipment is provided at the center. Please be sure that all of the pockets of your laboratory coat are empty.
  • You should wear comfortable, professional clothing.
  • There are no waiting facilities for family and friends at the center; plan to meet them elsewhere after the examination ends.
  • Test center staff (wearing name tags) will direct you throughout the day. You should follow their instructions at all times.
  • There will be an on-site orientation to demonstrate the equipment available for you to use in the examination rooms, as well as to acquaint you with procedures and regulations.
  • Once you enter the secure area of the test center (beginning with the orientation), you may not leave that area until the examination has been completed. The examination lasts about eight hours. Two breaks are provided (one 30-minute break and one 15-minute break). A light meal is provided during the first break; however, you may bring your own food (provided that it does not require refrigeration or preparation). No special meals are available.
  • All examinees taking the Step 2 CS examination are required to type the patient note. Examinees are not permitted to handwrite the note, unless technical difficulties on the test day make the patient note-typing program unavailable.
  • You may not discuss the cases with other examinees at any time, and conversation among examinees in any language other than English is prohibited at all times. Proctors will monitor all examinee activity.
  • Should you wish to file a concern regarding your Step 2 CS testing experience, you may do so at the test center on your test day. If you do not file a report at the test center, and wish to report a concern, you must notify NBME Test Administration in writing within three weeks of your testing date(s).
  • The USMLE program retains the right to remove from the examination and/or to impose conditions upon retesting for any examinee who appears to represent a health or safety risk to the standardized patients or test center staff. This includes, but is not limited to, examinees who appear ill, are persistently coughing or sneezing, have open skin lesions, or have evidence of active bleeding. Examinees who are not feeling well are encouraged to seek medical advice prior to arrival at the center and should consider requesting a change in the date of their examination, if appropriate.