Examination Day & Testing

Readiness to Test on Exam Day

You should not feel compelled to test on a particular day if you are ill, under unusual personal stress, unprepared for the examination, or otherwise not ready to test. Contact the organization that registered you for your examination for further details regarding rescheduling your examination.

Testing Regulations and Rules of Conduct

Administrations of the USMLE Steps are monitored by test center staff, in person and through audio and visual recording. Test center staff is required to report any violations of the 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 that you have engaged in irregular behavior and a permanent annotation on your transcript. Test center staff is not authorized to answer questions regarding registration; examination content or format; or testing software, scoring or retesting.

caution warning icon If you violate these Rules of Conduct, you may be directed to leave the test center before completing your 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 Regarding Irregular Behavior. If you are found to have engaged in irregular behavior, your score report and transcripts will include this finding, you may be barred from taking the USMLE in the future, and your score may be canceled.

Rules of Conduct

When you submit your application to take the USMLE, you agree 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 at any time, including 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 test center.
  4. You will place in a locker all personal belongings, including cell phones, watches, pagers, tablets, 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 and/or wallet, before you enter the testing room.
  5. You will leave your testing station for breaks only when the break screen is visible on your monitor. 
  6. You may use a telephone or other communication device only when outside the secure testing area and during an authorized break. You may not access your locker or use your cell phone on an unauthorized break.
  7. You will not remove examination 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 Primum CCS. You will not reproduce or attempt to reproduce examination materials through recording, memorization or any other means. Also, you will not provide information relating to examination content to anyone, including those who may be taking or preparing others to take the examination. This includes postings regarding examination content and/or answers on the internet. 
  9. You will not write on anything other than the laminated note boards.

BOI stop icon, prohibited symbol STOP IT! Report Cheating on USMLE

The USMLE program takes examination security seriously. Irregular behavior includes but is not limited to:

The USMLE program takes examination security seriously. Irregular behavior includes, but is not limited to:

  • Registering for or taking an exam when ineligible

  • Seeking, providing, or obtaining unauthorized access to exam content, including solicitation via social media or web forums

  • Altering exam scores or other official USMLE information

  • Having unauthorized items in the testing area

  • Having or attempting to have someone else take your exam

  • Writing on anything other than the laminated note boards provided

The penalties for irregular behavior may include:

  • Cancellation of your exam scores
  • Ban on future USMLE testing
  • Permanent annotation on your USMLE transcript
  • Report to the FSMB’s Physician Data Center and other entities with a legitimate interest
  • Possible legal action

caution warning iconContact the USMLE program via STOPit app if you have information and/or evidence that someone may have violated a USMLE rule. Visit the Apple or Google Play Store for a free download. Use access code: USMLE-TIP.



STOPit SolutionsApple Store BadgeGoogle Play Store Badge


Personal Belongings—What You Can Bring into the Testing Room

You are permitted to bring your locker key and ID into the testing room. A list of approved personal items that may be permitted in the secure testing area (e.g., cordless soft-foam earplugs without strings, water in a clear or transparent container with a lid or cap and all labels removed, certain medicines or medical devices, etc.), subject to inspection by test center staff, is available on the USMLE website. Generally, other personal items are not allowed in the secure testing area. Exceptions to this policy may be made in certain limited circumstances.

For all Steps, if you bring personal items to the test center that are not permitted in the secure testing area, you must store them in a small, designated locker outside the secure testing area. Electronic devices must be turned off; turning down the volume is not sufficient. All personal items are subject to inspection.

See also the Personal Item Exceptions section.

Admission to the Test

You should arrive at the test center at least 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.

When you arrive at the test center, you must present a paper or electronic copy of your scheduling permit and a valid, unexpired government-issued photo identification. Please review your scheduling permit for additional identification requirements. Acceptable forms of unexpired identification include:

1.    Passport
2.    Driver’s license with photograph
3.    National identity card
4.    Other form of unexpired, government-issued identification

Your name, as it appears on your scheduling permit, must exactly match the name on your form(s) of identification. The only acceptable differences are variations in capitalization; the presence of a middle name, middle initial or suffix on one document and its absence on the other; or the presence of a middle name on one and middle initial on the other. The name on your identification must appear in the Latin alphabet (i.e., in “English language letters”). If the names on your identification and scheduling permit differ, contact the organization that registered you for your exam immediately. Your identification must contain both your signature and a recent photograph. Please review your scheduling permit for additional details. 

If you do not bring your scheduling permit in paper or electronic (e.g., via smartphone) form and acceptable identification on each day of your exam, 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.

During check-in, test center staff will scan you with a handheld or walk-through device designed to detect prohibited items and ask you to empty your pockets and turn them inside out before entering the testing room to confirm that you have no prohibited items. All examinees will be required to remove eyeglasses for close visual inspection by the test center administrator. These inspections will be done at check-in and upon your return from breaks. Jewelry, except for wedding and engagement rings, is prohibited. Hair accessories such as ornate clips, combs, barrettes, and headbands must be removed for inspection by proctors. Religious headwear is subject to visual inspection only; removal is not required.

Additionally, your photo ID and fingerprint may be scanned electronically, and you must sign the test center log during the initial check-in process and again at checkout, at the end of your test day. 

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. You will be instructed to write your name and candidate identification number (CIN), as shown on your scheduling permit, on one of the laminated writing surfaces provided. Writing surfaces and markers should be used only at your assigned testing station and only after you have entered your CIN in the computer 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 (e.g., skin, clothing, tissue, etc.) other than the laminated writing surface. Failure to comply may result in a finding that you engaged in irregular behavior.

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. You must run the sound check for the audio headphones either before the examination begins or during the tutorial, so that problems can be resolved before you start the examination.

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

The USMLE program reserves the right to terminate your administration if you engage in any activity that may compromise the validity, integrity, or security of the USMLE, including possessing or using prohibited items.

Break Time

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 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, you may not leave the room (except in the event of an emergency). If you leave the room for a personal emergency and you are not on an authorized break, the block and daytime clocks will continue to run, and the test center will report the incident to the USMLE program. 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, test center staff will record the time in and out. You must present your identification each time you return from a break. 

If you exceed your 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 your test day) to keep track of your time. 

Starting and Completing the Test

Once you enter your CIN and launch the examination, you cannot cancel or reschedule that examination. The test session ends when you have started and exited all blocks or the total test time expires. You will receive a printout at checkout indicating that you have taken your Step exam. 

Unanticipated Testing Conditions

The USMLE program recognizes that unanticipated situations may arise that may affect performance on your examination. Examples may include significant technical malfunctions that prevent you from continuing to test or other significant and sustained interruptions. The USMLE program maintains sole discretion concerning what, if any, situation warrants further review and/or remediation.

If you experience a situation as described above, you may elect to stop testing. Whether or not you elect to stop or continue testing, if you want the USMLE program to review your case, you must:

  1. Promptly report any interruption you feel may adversely affect your exam performance to test center staff on the day of your exam; and 
  2. Email the USMLE program at testadmin@nbme.org within 10 calendar days following the date of the examination. Your correspondence should include your name, your USMLE ID number, the examination name (Step 1, Step 2 CK or Step 3), the date of administration, and a detailed description of what occurred. Making a comment in the post-examination survey does not qualify as written notification to USMLE. Please be advised, the USMLE program will not review cases if the difficulty experienced is a result of inadequate preparation for the exam. If you choose to stop testing, your exam may be scored. 

Please allow at least 15 business days for your report to be investigated and evaluated. You will receive a response in writing. Score reporting for your exam may be placed on hold until the USMLE program has completed its review. 

After completing its review, the USMLE program, in its sole discretion, will determine if the attempt will be scored (whether in full or by removing the impact of the issue on your score) or not scored. If the attempt is not scored, it may not appear on your transcript, or it may appear on your transcript as an incomplete. 

If you fail to notify both the test center staff on exam day and the USMLE program within 10 calendar days following the day of your examination, you thereby waive any claim or right to any recourse against the USMLE; the test center; or their employees, agents or representatives arising out of or relating to that claim.

caution warning icon 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 test center staff and/or other test takers. Such circumstances include, but are not limited to, an examinee exhibiting signs of illness (e.g., persistent coughing or sneezing) during the examination, showing visibly open skin lesions or active bleeding, or excreting other bodily fluids.

If you do not feel well on the day of your test, we strongly encourage you to consider rescheduling your examination. If you become ill during your exam, follow the steps described above.

The USMLE makes every effort to ensure that your registration information is properly processed and that the Step examinations are properly built, administered and scored. In the unlikely event that an error occurs in the exam construction, processing, administration, scoring or score reporting of your examination, the USMLE program will make reasonable efforts to correct the error and/or provide a valid score, if possible. In some cases, you will be offered a retest of all or part of the exam at no cost to you or receive a refund of the exam fee. These are the exclusive remedies available to examinees impacted by errors in the registration process; in constructing, processing or administering exams; or in scoring or score reporting. The USMLE program, in its sole discretion, will determine which of these remedies, if any, are available.