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USMLE policy updates following Step 2 CS discontinuation

Posted: July 21, 2021

Step 3 Eligibility Requirements Reinstated; New Information Added to USMLE Transcripts; Attempt Limits Set at Four

The United States Medical Licensing Examination® (USMLE®) Composite Committee, the governing body of USMLE comprised of medical educators, regulators, and members of the public, recently met to determine how the discontinuation of the Step 2 Clinical Skills examination (Step 2 CS) will impact certain USMLE policies. The Composite Committee’s role is to ensure that the program fulfills its mission to support medical licensing authorities in the United States by providing them with meaningful information from assessments of physician competencies —including medical knowledge and skills—that are important to the provision of safe and effective patient care. The decisions surrounding these policies reflect that mission.

The policy decisions made regarding Step 3 eligibility requirements, reporting Step 2 CS results, and attempt limits are described below. 

Step 3 Eligibility Requirements

During the Step 2 CS suspension, the USMLE program announced temporary Step 3 eligibility requirements. Since the Step 2 CS exam has been discontinued, these temporary requirements are no longer needed.

Step 3 eligibility requirements will conform with criteria established before Step 2 CS became part of the USMLE
. The requirements, which can be found here, are:

  • Passing scores on Step 1 and Step 2 Clinical Knowledge, and
  • An MD degree or DO degree from an LCME- or COCA-accredited U.S. or Canadian medical school, or 
  • The equivalent of the MD degree from a medical school outside the U.S. and Canada that is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements, and obtain ECFMG Certification
  • Meets all other eligibility criteria as listed in the USMLE Bulletin of Information.

Reporting Step 2 CS Results

As a medical licensing examination, the USMLE program has the responsibility to produce transcripts that report to state medical boards a complete exam history for each examinee. Accordingly, all Step 2 CS results will continue to be reported on the USMLE transcript.  

To facilitate the interpretation of transcripts with either Step 2 CS fails or no Step 2 CS attempts, the following statement will be included on all transcripts:

“The USMLE Step 2 CS examination was last administered on March 16, 2020. Examinees with a failing outcome may not have had an opportunity to retest. The USMLE defines successful completion of its examination sequence as passing Step 1, Step 2 CK, and Step 3.”

Attempt Limits

Beginning with applications submitted on or after July 1, 2021, examinees will be limited to four attempts per Step exam rather than the six allowed under the current policy. This policy decision is designed to protect the integrity of the exam and more closely match the attempt limits imposed by state medical boards for USMLE in the majority of states.

Once the change to the attempt limit policy is effective, examinees who have attempted a USMLE Step four or more times and have not passed will be ineligible for other USMLE Steps.

If you have any questions about these policies, please contact the USMLE program by using the form available here.    

Want to Know More About the Decision to Discontinue Step 2 CS?

Listen to a New Podcast
: In the March 4, 2021 episode of USMLE® Connection, David Johnson, the Chief Assessment Officer at the Federation of State Medical Boards, and Chris Feddock, Executive Director for the Clinical Skills Evaluation Collaboration, discuss the discontinuation of the Step 2 CS exam, the reasons behind the decision, and next steps.


Step 2 CK – Delay in score reporting

Posted: July 19, 2021

Most Step 2 Clinical Knowledge (CK) scores are reported within 3-4 weeks of testing. However, because of necessary annual modifications to the test item pools, there will be a delay in reporting for some examinees who test beginning on or after the week of June 28, 2021
If you need to receive Step 2 CK scores before August 25, 2021, the USMLE program recommends that you take the exam before June 28, 2021.
The target date for reporting Step 2 CK scores for most examinees testing the week of June 28, 2021, through Friday, August 13, 2021, will be Wednesday, August 25, 2021.


USMLE Step 1 updates on score reporting and standard setting

Posted: June 29, 2021

Two United States Medical Licensing Examination® (USMLE®) Step 1 changes may coincide in early 2022. First, Step 1 score reporting will transition to pass/fail only for administrations on or after January 26, 2022. Second, as part of best practices for licensing and certification examinations, the USMLE program reviews the minimum passing score of each Step exam every three to four years. The standard review process for the Step 1 minimum passing score is currently underway, which includes substantial input from licensing authorities, medical educators, and subject matter experts. If any change to the minimum passing score is determined appropriate by the USMLE Management Committee, it will become effective for examinees who take Step 1 on or after January 26, 2022. While the timing may overlap, the standard review process is unrelated to the upcoming transition to pass/fail score reporting.

Pass/Fail Score Reporting
The pass/fail reporting change is in alignment with the Invitational Conference on USMLE Scoring (InCUS) recommendations, which were based on a broad range of input from state medical board members, physicians, medical educators and examinees. To support this transition, USMLE Step 1 score reports for administrations on or after January 26, 2022 will be updated in the following ways:
  • Passing outcome reports will only display the notification of “Pass.” This change is intended to reduce the overemphasis of USMLE Step 1 scores on secondary uses while retaining the ability to use the exam for its primary purpose of medical licensure eligibility.
  • Failing outcome reports will display “Fail” and have 1) a visual illustration showing the distance between the examinee’s overall score and the minimum passing standard and 2) content area feedback that shows whether the examinee scored lower, about the same, or higher than examinees with a low pass (ie, above but near the passing standard) for each content category. This additional information is intended to guide study plans for future exam attempts.
Sample score reports for USMLE Step 1 examinations taken on or after January 26, 2022 are available here. USMLE transcripts will be similarly revised to display only a “Pass” or “Fail” for Step 1 exams taken on or after January 26, 2022. USMLE transcripts for Step 1 exams taken January 25, 2022 or earlier will continue to report a numeric score along with a “Pass” or “Fail” outcome.
Minimum Passing Score Review
The USMLE program reviews the minimum passing score for each Step examination every three to four years with extensive input from faculty and subject matter experts. This ensures that the standard is aligned with the potentially changing expectations within medicine.
Based on its routine schedule, the review of the Step 1 minimum passing score was originally scheduled to occur in December 2020 but was postponed as a result of the COVID-19 pandemic. Instead, the review will occur in December 2021, and any change to the minimum passing score will be made effective with Step 1 administrations beginning on or after January 26, 2022. This review is consistent with USMLE’s standard operating procedures and is not connected to the upcoming transition to pass/fail score reporting. For reference, the last reviews of the minimum passing scores for Steps 1, 2 CK and 3 resulted in changes that ranged between 0 and 2 points.

Four types of data are considered:

  • Results of content-based standard-setting exercises conducted with three independent groups of physicians;
  • Results of surveys of various stakeholders (e.g., samples of examinees, state licensing representatives, medical school faculty) concerning the appropriateness of current pass/fail standards for Step examinations;
  • Trends in examinee performance;
  • Score precision and its effect on the pass/fail outcome.
Changes to the minimum passing score, if any, are determined by the USMLE Management Committee. This committee is comprised of a diverse national group of medical professionals from undergraduate and graduate medical education as well as state medical boards. Two public members and a resident member also serve on the committee.
An additional announcement that reports the outcome of the minimum passing standard review, whether there is a change or not, will be made on December 9, 2021.


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