Examination Day and Testing

Testing Regulations and Rules of Conduct

Testing sessions for the USMLE Steps are monitored by test center staff, in person and through audio and visual recording. Staff are required to report any violations of USMLE or test center rules. You must follow instructions from test center staff throughout the examinations; failure to do so may result in a finding of irregular behavior and permanent annotation of your transcript. Test center staff are not authorized to answer questions regarding registration, examination content or format, testing software, scoring, or retesting.

Rules of Conduct

Important! 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 the 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, and your score may be canceled.

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

  1. You are the person named on the scheduling permit for the examination.
  2. You will not seek, provide, or obtain any form of unauthorized assistance during the examination or during breaks.
  3. You will not have prohibited materials, including 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, fitness and tracking monitors, 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 will leave your testing station for breaks only when the break screen is visible on your monitor. It is a violation of the Rules of Conduct if you indicate on the center log that your break screen is visible when it is not.
  6. During computer-based testing (Steps 1, 2 CK, and 3), you may use a telephone or other communication device only when 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 test content from the test center by any means.
  8. You will maintain the confidentiality of the materials, including, but not limited to, 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 recording, memorization, or by any other means. Also, you will not provide information relating to examination content to individuals who may be taking the examination. This includes postings regarding examination content and/or answers on the Internet.
  9. You will not write on anything other than the note boards (computer-based examinations) or scrap paper (Step 2 CS) provided.

Continue to: Personal Belongings »

Personal Belongings - What You Can Bring Into The Testing Room

Personal items are prohibited in the secure areas of the testing center. For computer-based examinations (Step 1, Step 2 CK, and Step 3), the only items you are allowed to bring into the testing room are soft-foam earplugs without strings. Earplugs must be removed from the packaging and ready for inspection by test center staff during check-in and must also remain at your workstation during all breaks. Visit the USMLE website for more information.

For Step 2 CS, the entire test center, including the orientation room and the restrooms, is considered a secure testing area. The only items you are allowed to bring into the secure testing area are your white lab coat (pockets must be empty) and your personal stethoscope (there is limited supply at the test center). All other equipment, including pens, gloves, writing paper, and other medical equipment is provided by the test center. Visit the USMLE website for more information regarding the Step 2 CS examination experience and test center regulations.

For all Steps, if you bring personal items to the test center, you must store them in a small designated locker outside the secure testing area or in the designated storage area for Step 2 CS; electronic devices must be turned off. All personal items are subject to inspection.

Continue to: Admission to the Test »

Admission to the Test

Check-In Procedures
Step 1, Step 2 CK, Step 3

You should arrive at the test center approximately 30 minutes prior to your scheduled testing appointment. 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 and must pay a fee to reschedule your test. Your rescheduled test date(s) must fall within your eligibility period.

Step 2 CS

You should arrive at the test center at the time listed on the confirmation notice you will have printed after scheduling your appointment. There will be an on-site orientation to demonstrate the equipment available for you to use in the examination rooms and to review examination rules and procedures. If you arrive during the on-site orientation, you may be allowed to test after signing a Late Admission Form. If you arrive after the on-site orientation, you will not be allowed to test and must pay a fee to reschedule your test.

All Steps

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

  • passport
  • Driver's license with photograph
  • ECFMG-issued Identification Card
  • National Identity Card
  • other form of dated, unexpired, government-issued identification

Your name, as it appears on your scheduling permit, must match the name on your form(s) of identification exactly. Please review your scheduling permit for details and 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 a recent photograph.

If you do not bring your scheduling permit on paper or electronically (e.g., via smartphone) and acceptable identification, you will not be admitted to the test and will be required to pay a fee to reschedule your test. Your rescheduled test date(s) must fall within your eligibility period.

Security Procedures
For Step 1, Step 2 CK, and Step 3 ONLY

During check-in, test center staff will scan you with a handheld metal detector and ask you 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. Additionally, your photo ID and fingerprint may be scanned electronically and you must sign the test center log.

Before you enter the test room, test center staff will give you laminated writing surfaces and markers to use for making notes and/or calculations during the testing session. They should be used only at your assigned testing station, and only after you have entered your Candidate Identification Number (CIN) to start your test session. 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. Do NOT write on anything other than the laminated writing surface (e.g., your hand, other body part, tissue, etc.). Failure to comply may result in a finding of irregular behavior.

You will be instructed to write your name and CIN, as shown on your scheduling permit, on one of the laminated writing surfaces provided.

Test center staff will escort you to your assigned testing station and provide brief instructions on use of the computer equipment. You must enter your CIN to start the examination. A brief tutorial is available before each examination. 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 examination.

For Step 2 CS ONLY

During check-in, in addition to having your photo ID scanned electronically, you will be asked to place your personal belongings (e.g., pens, study materials, cell phones, etc.) in small bins, which are inaccessible for the duration of the examination day. Any personal belongings that you may need during breaks or during the examination, including your lab coat and stethoscope, can be placed at your seat in the orientation room.

Please note that every area of the testing center is under video surveillance at all times; examinees are escorted by proctors at all times, with the exception of restroom breaks.

All Steps

There are no facilities available for family and friends to wait at the center while you test; plan to meet them elsewhere after the examination ends.

Continue to: Break Time »

Break Time

Step 1, Step 2 CK, and Step 3

Your test session is scheduled for a fixed amount of time and the computer keeps track of the time allocated for each block and for breaks. At the start of the testing session, you have a total of 45 minutes of break time for authorized breaks and for computer transitions between blocks. Authorized breaks include any time you spend between test blocks, whether you remain at your seat or you leave the testing room. If you complete the tutorial or other testing blocks early, the remaining time will be added to your total break time.

Once you begin a testing block, no authorized breaks are provided during the block. During the 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 the block, the test center will file a report of the incident. Additionally, the unauthorized break screen, described in the examination tutorial, will appear on the monitor after a defined period of inactivity. After the unauthorized break screen appears, you will need to enter your CIN 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.

If you take too much break time and exceed the allocated or accumulated break time, the excess will be deducted from your total testing time. Use the time summary feature (explained in the tutorial on test day) to keep track of your time.

Step 2 CS

Your Step 2 CS administration will include 12 patient encounters. The examination session lasts approximately eight hours. Examinees get a minimum of 45 minutes in break time, which includes a 30 minute lunch period. During lunch, a light meal will be served. The test center is unable to accommodate special meal requests. However, you may bring your own food, provided that no refrigeration is required. The frequency and length of breaks, other than the lunch break, will vary slightly by testing center. Smoking is prohibited throughout the centers.

Continue to: Starting and Completing the Test »

Starting and Completing the Test

Step 1, Step 2 CK, and Step 3

The test session ends when you have started and exited all blocks or the total test time expires. You will receive a notice during checkout that you have appeared for the test. If your test is scheduled for multiple days, be sure to bring a copy of your permit with you each day or you may not be permitted to test.

After you start taking an examination, you cannot cancel or reschedule that examination. If you experience a computer issue during the test, notify test center staff immediately. The testing software is designed to restart the test at the point that it was interrupted.

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. Test Administration Services must receive your notice within 10 days of your testing date or it may not be possible to investigate your concerns. Your correspondence should include your name, your USMLE ID number, the examination name (Step 1, 2 CK, 2 CS, or 3), date of administration, and a detailed description of the difficulty experienced. Please allow at least 15 business days for your report to be investigated and evaluated. You will receive written notification of the investigation results.

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 Test Administration Services explaining, in detail, the reasons you decided not to finish the examination. The attempt may appear as an "incomplete" on your USMLE transcript.

For more information on how to report a test administration problem, visit the USMLE website.

Step 2 CS

Once you enter the secure areas of the test center, which includes the orientation area, you may not leave the area until the examination has been completed. All examinees taking the Step 2 CS examination are required to type the patient note portion of the exam. You are only permitted to handwrite your patient note if you were approved to receive an accommodation for a disability or in the event that technical difficulties make the patient note-typing program unavailable.

You may not discuss the cases with anyone, including other examinees, at any time (before, during or after your examination) and all conversation at the testing center among examinees must be in English.

NOTE: The USMLE program may prohibit an examinee from completing the exam and/or may impose conditions on retesting if the examinee appears to represent a health or safety risk to the standardized patients or test center staff. Such circumstances include, but are not limited to, an examinee performing careless or hazardous acts during the physical examination, exhibiting signs of illness (e.g., persistent coughing or sneezing) during the examination, or showing visibly open skin lesions or active bleeding.

If you do not feel well on the day of your examination, we strongly encourage you to consider rescheduling your examination.

NOTE: NOTE: The USMLE makes every effort to provide that your registration information is properly processed and that the Step examinations are properly prepared, administered, and scored. In the unlikely event that an error occurs in the preparation, processing, administration, or scoring of your USMLE examination or in the reporting of your USMLE scores, USMLE will make reasonable efforts to correct the error, if possible, or permit you either to retest at no additional fee or to receive a refund of the examination fee. These are the exclusive remedies available to examinees for errors in the registration process; in preparing, processing, or administering exams; or in determining or reporting scores.