USMLE policy updates following Step 2 CS discontinuation

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.