Common Questions

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 imposed by 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have fulfilled all requirements for licensure in that jurisdiction; are eligible for licensure except for the out-of-date examination; and have completed the full USMLE sequence, including Step 3.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 imposed by a medical licensing authority, 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 AOA accredited 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.

USMLE results are reported on a 3-digit scale.

The current minimum passing scores are as follows:

Step 1: Reported as Pass/Fail only*
Step 2 CK: 218
Step 3: 200

Information on minimum passing scores for USMLE examinations is posted on the Scores and Transcripts page.

The USMLE Management Committee establishes the minimum passing score. The USMLE Management Committee reviews data for each component in the USMLE sequence approximately once every four years and decides whether to change the recommended minimum passing score.

*USMLE Step 1 score reporting is reported as pass/fail only for exams taken on or after January 26, 2022. On the three-digit score scale, the passing standard is 196. Future reviews of the Step 1 passing standard will not be reported in terms of a three-digit score.

The content-based standard used for setting the passing score means that as many as 100% of candidates could theoretically pass, or conceivably 0%. The number is not arbitrarily predetermined. Similarly, the pass rate can vary from one accredited medical school in the United States to another, and from one year to another. Recent performance data for first-time takers and repeaters for each Step are available.

Scores for USMLE Step exams are released on Wednesdays. Generally these will include scores for examinees who tested within four weeks before the release date. However, there are many factors that may delay an individual score release. Your registration entity will notify you by email when your score becomes available. When released, your scores will be posted to your registration entity's secure website. If you have not received your score within eight weeks of your test date, please contact us to determine the status of your score report.

Please note that new scores are not released during the week of July 8, 2026, the week of December 2, 2026, or the week of January 6, 2027.

USMLE scores and pass/fail decisions are not determined using a curve, which would necessitate a specific amount/percentage of examinees must fail. Rather, an exam score is determined by an examinee’s performance on the content seen during the test administration. Passing standards are set by the USMLE Management Committee, as a minimum threshold of performance that must be obtained by all examinees. The passing standards are periodically reviewed for each Step. Examinees who perform at or above the minimum threshold (i.e., passing standard) will pass the examination, regardless of the number or percentage of examinees that pass overall.

You must pass Step 1 and Step 2 before you are eligible to take Step 3. In LCME-accredited medical schools, although Step 1 and Step 2 can be taken in any order, most students will take Step 1 at the end of their second year and Step 2 in their fourth year; Step 3 is usually taken during the first or second year of postgraduate training.

Students and graduates of medical schools outside the United States must have a valid and unexpired ECFMG Certification to take Step 3. Contact the ECFMG for more information.

Most medical licensing authorities require completion of USMLE Steps 1, 2, and 3 within a seven-year period, which begins when you pass your first Step. Check the FSMB website for further information on such requirements.

If you pass a Step, 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 imposed by 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 because of a time limit imposed by a medical licensing authority, 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 COCA-accredited 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.

Complete this form to contact the Office of the USMLE Secretariat for more information.

No. The USMLE does not include “experimental” items in the sense of unreviewed questions or questions unrelated to the exam’s content blueprint. All items that appear on the exam - whether scored or unscored - undergo the same rigorous, multi-step review process by subject matter experts and editorial staff. They are also aligned with the USMLE blueprint and thus reflect the competencies assessed on the examination.

It is important that you read and understand the rules regarding personal possessions. 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 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. Electronic devices must be turned off. All personal items are subject to inspection and are prohibited in the secure areas of the testing center.

If you have a medical need for an item during your USMLE administration, see the list of approved personal items, https://www.usmle.org/step-exams/test-accommodations/pre-approved-items

Information about the cost of the exams is available on the websites of the appropriate registration entities. To learn more, visit the registration website of the appropriate organization (dependent on your medical school and the Step for which you are applying).

FSMB
NBME
 

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.

To report test day issues, such as computer problems or not completing your exam (for any reason), send a written description of the incident to Test Administration Services at testadmin@nbme.org . Test Administration Services must receive your notice within 10 days of your testing date or your concerns will not be investigated.

Your correspondence should include your name, your USMLE ID number, the examination name (Step 1, 2 CK, or 3), date of administration, and a detailed description of the difficulty experienced or the reason you decided not to finish the examination.

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 wish to appeal the results of the investigation, you may submit a written statement to the above office within 10 days of the date of the correspondence containing the results of the investigation. Please include a detailed explanation of the basis for your appeal. A group of senior staff will review the matter. Please be advised that the appeal process can take at least four weeks to complete and may not result in a change to the original decision.

You may check the status of your application(s) on your account or by checking the email notification sent to your email from your registration entity.

The deadline for and eligibility period extension is noted on the Extend Eligibility Period online request form.

The new score report format reflects both advances in the underlying science of assessment and changes to the USMLE examinations over time. USMLE score reports were virtually unchanged for nearly two decades. During that time, the USMLE exams experienced incremental changes, including changes to content sampling, item types, and review and modification of minimum passing scores. Simultaneously, measurement researchers, including those who support the USMLE program, continued to advance the science of subscore computational methods, data visualization, and score reporting.

The process used to design a new score report format included:

• The development of prototype score reports that better supported the intended inferences
   
• Approval of the prototypes by USMLE governance committees (composed of medical school faculty, members of state medical boards, and public members)
   
• Focus group studies with USMLE test-takers to identify preferences among prototypes and to evaluate their ability to make correct inferences (and not make incorrect inferences) from the prototype score reports

The examinee focus group results clearly demonstrated that the new score report format was viewed as a substantial improvement by USMLE test-takers. Results also showed that USMLE examinees were both able to interpret the information provided in the new score report format appropriately and were less likely to make incorrect inferences.

The Step 1 examinee score report underwent further modifications to account for the transition to reporting only a pass/fail outcome, which began for examinees taking Step 1 exams on or after January 26, 2022. The new Step 1 examinee score report format supports the transition to Step 1 pass/fail reporting while continuing to provide candidates who receive a failing outcome feedback on content areas requiring further study before they retake the exam.

Please view the sample score reports:

• Step 3 interactive (applies to Step 1 before pass-fail transition, Step 2 CK, and Step 3)
   
• Step 1
  • After Pass-Fail Transition – Pass
  • After Pass-Fail Transition – Fail

Step 1 before pass/fail transition, Step 2 CK, and Step 3: Your performance is compared to other examinees by comparing your three-digit score to that of a recent group of examinees (students from US and Canadian medical schools taking the examination for the first time). The blue bars represent the distribution of this group’s scores, with higher bars indicating more individuals with scores in that range. Your overall performance (three-digit score) is marked with an orange rectangle and solid line. The black rectangle and dashed line indicate the minimum passing score.

If your overall performance (indicated by the orange rectangle and solid line on page 1) is toward the right side of the chart and to the right of the tallest blue bar, your performance was higher than others. If your overall performance is toward the left side of the chart, or to the left of the tallest blue bar, your performance was lower than others.

Additional information about how your performance compares to others (including norm tables and summary data from recent administrations) is available in the Score Interpretation Guidelines. Performance data by group for each Step examination is available each year based on the performance of examinees in that year.

Step 1 after pass/fail transition: After Step 1 transitions to pass/fail score reporting, passing examinees will not see performance feedback on their score report. Examinees who fail will receive the visual described above to help assess how close they scored in relation to the passing standard.

Step 1 before pass/fail transition, Step 2 CK, and Step 3: Your score report shows both your overall performance (your three-digit score and pass/fail outcome) and an indication of whether your performance in each content area within the examination was higher, lower, or the same as your overall performance. For example, if your overall performance was strong and most of the content areas indicate that your performance fell in the “same” category, your performance across the examination was strong.

Step 1 after pass/fail transition: The Step 1 examinee score report for failing candidates who test on or after January 26, 2022 indicates whether the examinee scored below, about the same, or above a low-pass on each content area. A low-pass corresponds to performance that is above but near the passing standard. In other words, the low-pass represents performance that is sufficient to pass by a small margin. Examinees can use this information to identify areas of both strength and weakness.

Step 1 before pass/fail transition, Step 2 CK, and Step 3: The standard error of the estimate (SEE) indicates how you might perform if you were to retest repeatedly under the same conditions (without learning or forgetting). Approximately two-thirds (or 68%) of the time your score would fall within one SEE of your reported score (your score +/- 1 SEE); 95% of the time your score would fall within two SEEs of your reported score. This information may be useful if you are planning to retake the examination.

Step 1 after pass/fail transition: The SEE will not be provided on Step 1 score reports for examinations administered on or after January 26, 2022.

Step 1 before pass/fail transition, Step 2 CK, and Step 3: This indicates that your performance was consistent across the examination. Your performance in each content area was neither stronger nor weaker than your overall performance.

To interpret the boxes, you can use the chart and your three-digit score from the first page to determine your performance. You can then use the boxes next to each content area to determine whether your performance in each content area is the same as or different from your overall performance. If each box indicates that your performance was the same, you had no areas of performance that were meaningfully stronger or weaker than your overall performance on the examination.

The USMLE Management Committee establishes a passing standard for each individual Step examination. This standard reflects the level of performance an examinee must achieve to pass. The USMLE Management Committee reviews data for each Step examination approximately once every three years and decides whether to change the recommended passing standard.

Find more information on passing standards for USMLE examinations is posted here.

The Step examinations are highly integrative, and you should plan to review all content areas. In prioritizing which areas to review, you should take into account both the representation of that content area on the examination (based on the % items per exam next to the content area label) and your relative performance in that content area. Remediation strategies focused solely on relatively weak areas of performance are unlikely to be the most effective for failing examinees. In most cases, failing scores are best remediated through attention to all content areas.

Within each Step examination, the USMLE program creates various forms that are similar in difficulty and content. Scores on individual examination forms are made comparable through equating, a psychometric process that adjusts scores based on the difficulty of the questions. This can be thought of as small score increases applied to examinees who see somewhat more difficult sets of test questions, and small score decreases applied to test takers who see somewhat less difficult sets of test questions. This process ensures examinees who take different forms are held to the same passing standard. 

Your score reflects your relative mastery of the concepts and principles that constitute the basis of safe and effective patient care specific to each Step examination.

The average score and standard deviation for recent administrations are included on your score report. Detailed information about interpreting USMLE scores is available in the Score Interpretation Guidelines.

Please note that if your exam is administered over multiple days, only the first day of testing will be reflected on the score report and transcript.

Please see additional information about score reports here.

The "% Items Per Test" describes the breakdown of test questions on a typical examination by content area. For example, 30%–40% of each Step 3 test includes items within the Patient Care: Diagnosis content area. Though the amount of content in each area varies on each test, these percentages provide a guideline about how much content in each area is on the examination.

Tutorials that illustrate the USMLE Step 1, Step 2 CK, and Step 3 multiple-choice question and Step 3 computer-based case simulation (Primum® CCS) software, sample multiple-choice test questions for each Step, and sample Step 3 CCS cases are available under Prepare for Your Exam.

The requirements for using NBME web-based testing are outlined below and apply to exams delivered over both wired and wireless networks. Examinees may take a web-based exam on either PCs or Macs. Any combination of fixed desktops, institutional laptops, or examinee personal laptops may be used.

Hardware and OS (Operating System):

- Windows 10, Windows 11

- Mac OS versions 10.14: Mojave- 2018; 10.13: High Sierra- 2017; 10.12: Sierra- 2016; and 10.11: El Capitan- 2015.

- 1 GHz processor or higher

- 17” or larger color monitor recommended (Desktops)

- 13” or larger color monitor recommended (Laptops)

- 32-bit color setting enabled

- Please turn off Windows updates or virus scanner updates to avoid interruptions during practice session.

Browsers:

- Google Chrome (preferred)

- Edge1

- Safari 12 or higher

- Mozilla Firefox 1

Browser Settings:

- JavaScript, CSS, Cookies and Pop-ups all enabled

- If possible, disable toolbars, and Adware/Spyware programs to prevent slowness.

- TLS 1.2 or higher

Internet/Network Bandwidth:

- Broadband (DSL, Cable or T1)

- 256Kbps or higher per workstation

Important notes

- Other browsers and operating systems are not supported when using NBME web-based resources. Other browsers and operating systems have not been tested for their compatibility and some features may not work as expected. NBME is not responsible for any system issues that are related to the use of unsupported browsers or operating systems.

- You can use the multiple-choice question (MCQ) practice materials on your phone. Step 3 Computer-based Case Simulations (CCS) practice case software runs best in a Chrome browser. The optimal screen resolution is 1920x1080, precluding use on cell phones at this time.

The sample test questions and cases for all Step exams are web-based and do not require a download. The practice materials can be used on a variety of different devices and launch best using Google Chrome as your browser.

You can use the multiple-choice question (MCQ) practice materials on your phone. Step 3 Computer-based Case Simulations (CCS) practice case software runs best in a Chrome browser. The optimal screen resolution is 1920x1080, precluding use on cell phones at this time.

Step 1 pharmacology items continue to focus on examinees’ understanding of drug mechanisms rather than on pharmacotherapy. Step 1 examinees are not required to identify specific medications; Step 2 CK examinees, however, are asked to do this. See example Step 1 pharmacology item here. 

No new content was assessed in Step 1 exams administered after the exam was updated in October 2020. Examinees testing after the October 2020 update saw an increase in the number of items that assess knowledge of Communication and Interpersonal Skills; this content has been included on the Step 1 exam for many years.

You can see a representative Step 1 item assessing knowledge of Communication and Interpersonal Skills here.

All USMLE transcripts, including those submitted through the Electronic Residency Application Service® (ERAS®), will include the same information. A Step 1 exams taken since January 26, 2022 will appear on transcripts as a pass/fail outcome only, without a numeric score. A Step 1 exam taken on or before January 25, 2022 will appear on transcripts as a numeric score and a pass/fail.

January 26, 2022 was the effective date for the change. All Step 1 exams taken on or before January 25, 2022 received a numeric score and pass/fail outcome. All Step 1 exams taken on or after January 26, 2022 receive a pass/fail outcome only.

All scores for Step 1 exams taken prior to the date of the policy change will continue to be reported using the three-digit numeric score on all USMLE transcripts.

A comprehensive overview on CCS can be found at the practice materials page under the Step 3 CCS section. You can familiarize yourself with this portion of the Step 3 exam in the following ways:

- Watch an Instructional Video that illustrates how to run a case using the software.
- Practice with six CCS cases and receive case-related feedback by accessing the Step 3 Interactive Testing Experience
- Read the Feedback for Step 3 CCS Practice Cases to learn about the different types of management strategies and review examples of actions that would add to, subtract from, or have no effect on an examinee's score for each case.

Questions assessing basic science concepts are covered on Step 1. However, foundational science knowledge will often be needed to answer items on Step 2 CK, even if the question is focused on diagnosis or management. You can see examples of Step 2 CK items that require foundational science knowledge here.

These examples include an explanation of why and how foundational science is needed to answer a test item that is not primarily focused on basic science. Foundational science knowledge is needed both for licensure examinations and for lifelong learning that continues beyond assessment.

Examinees who tested before the exam was updated in November 2020 saw slightly more Diagnosis items than Management items on Step 2 CK, whereas examinees who tested after the update saw equal amounts of both types of test items. The proportion of items allocated within Organ Systems did not change. More detail is available here.

The USMLE Step 1 and Step 2 Clinical Knowledge (CK) are administered at Prometric centers around the world. Since Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care in the U.S., the exam is only administered in the U.S. and its territories. While the USMLE program welcomes examinees from all countries, there will be no changes to this policy in response to the U.S. Department of State’s current travel prohibition and restrictions preventing those from certain countries traveling to the U.S.
 

The total number of attempts allowed per Step is four (4). Examinees who have attempted any USMLE Step (including Step 2 CS) four or more times and have not passed are ineligible to apply for USMLE Steps.

The USMLE Composite Committee, the governing body of USMLE, considers all aspects of the examination as they work to ensure that the program fulfills its mission to support medical licensing authorities in the United States. The committee voted to change the number of allowed attempts to protect the integrity of the exam and to more closely match the USMLE attempt limits imposed by the majority of state medical boards.

As part of the review, the committee was also presented with information showing that it is uncommon for individuals with more than four repeated attempts on USMLE Steps to complete the examination sequence successfully, gain access to postgraduate training and ultimately receive a license to practice medicine in the United States.

Once you have been granted accommodations on a USMLE Step exam, simply submit to us the completed Subsequent Request for Test Accommodations form at the time you complete your Step exam registration. Please check the box for test accommodations on your exam application. For more information visit the Test Accommodations section.

Nursing/breastfeeding individuals may test under standard conditions and request to bring and use their breast pumps during standard breaks, or they may submit a request for additional break time to express milk. Breastfeeding a child may be done outside of the test center during authorized breaks. Please note that additional break time makes Step 2 CK a two-day exam and Step 3 a three-day exam.    

Why do I need to request to bring/use my breast pump? Disability Services needs to let Prometric know in advance so that Prometric can ensure it has the appropriate space available.    

We recommend advanced planning to help ensure that you can test on a date and time of your choosing. Start by completing your exam registration and choosing a three-month eligibility window through your registration entity (NBME or FSMB). Please note that this may be done approximately 1 year in advance of your anticipated testing window once the registration opens in September for the following calendar year. You must have a current and completed exam registration at the time you submit a request for accommodations.

After you have completed your Step exam registration, submit your accommodation request form and supporting documents to Disability Services at disabilityservices@nbme.org no later than the first three weeks of your three-month eligibility period. If your eligibility period expires before you have submitted your request form and supporting documentation, Disability Services will not be able to process your request. If your eligibility period has less than 60 days left at the time you submit your request to Disability Services, you will need to update your eligibility period so there is sufficient time to review your completed request for test accommodations. 
 

Next, we will review your submission for initial completeness and confirm receipt of your request within approximately 2 business days.  Once that request and all necessary supporting documentation have been submitted, you will receive a decision letter within approximately 60 business days.

Click here to learn more about the Test Accommodations request process.

We will begin processing your request once we have received your complete documentation, provided that your registration for the Step for which you are seeking accommodations is current, complete, and you have not tested with the related scheduling permit.

If we ask you for additional information regarding your request, the processing of your request will resume once we have received the requested information and/or we have received a communication from you that you do not intend to submit any additional documentation. 

You should submit documentation which confirms that you have a physical or mental impairment that substantially limits your ability to perform one or more major life activities that are relevant when taking an examination like the Step examinations, as compared to most people in the general population. The documentation should be sufficiently up to date to reflect your current level of functional impairment. For detailed information regarding documentation, please refer to the Guidelines for Requesting Test Accommodations and Additional Guidelines for Specific Impairments.

If you have a documented disability covered under the Americans with Disabilities Act (ADA) and require test accommodations, you must obtain information regarding procedures and documentation requirements from the Test Accommodations section of this website.

You must submit your application for the Step and your request for test accommodations with required documentation at the same time.

Examinees may submit a request for reconsideration of the original decision if the request for reconsideration is submitted within their current and active eligibility period window (the eligibility period for that step exam has not expired and the examinee has not taken the exam). Please visit the Test Accommodations section for additional information about requests for reconsiderations and click here to download the Reconsideration Request Form. 

If your medical school is in the US, you should contact NBME for questions about USMLE Step exam registration or eligibility. Telephone: (215) 590-9700, Fax: (215) 590-9460, or E-mail: usmlereg@nbme.org   

If your medical school is outside of the US, you should contact FSMB for questions about USMLE Step exam registration or eligibility. Telephone (817) 868-4041, or E-mail: usmle@fsmb.org 

For more information about applying for and scheduling your exam, please refer to the Bulletin of Information. 

Only complete, untested registrations will be cancelled as a part of the anomalous performance policy. If you have an outstanding incomplete registration, please contact your registration organization.