Scoring and Score Reporting

Examination Results and Scoring


Note: 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.

When you take Step 1, Step 2 CK, or Step 3, the computer records your responses. After your test ends, your responses are transmitted to the NBME for scoring. The number of test items you answer correctly is converted into a three-digit score. This score is used for score-reporting purposes.

Most Step 1, Step 2 CK, or Step 3 scores fall between 140 and 260. The mean score for first-time examinees from accredited medical school programs in the United States is in the range of 220 to 240, and the standard deviation is approximately 20. Your score report will include the mean and standard deviation for recent administrations of the examination. Visit the USMLE website for more information.

For Step 2 CS, examinees are assessed on their datagathering and communication skills (including spoken English) by the standardized patients, and on their ability to complete an appropriate patient note by physician raters. Performance on Step 2 CS is reported as pass or fail, with no numerical score.

USMLE score reports and transcripts (see Scoring: Score Reporting) show your scores (for Step 1, Step 2 CK, and Step 3) and whether you passed or failed (for all examinations). The same information is sent to medical licensing authorities upon your authorization for their use in granting the initial license to practice medicine.

Except as otherwise specified below, to receive a score on Step 1, Step 2 CK, and Step 3, you must begin every block of the test. If you do not begin every block, no results are reported, and the "incomplete" attempt appears on your USMLE transcript as "incomplete." If you register for but do not begin an examination, no record of the test will appear on your transcript.

Note: The USMLE program routinely monitors examinee performance on the Step examinations for unusual results. If such review raises concerns, e.g., about your readiness to test or your level of motivation in trying to pass the examination, you may be contacted by representatives of the USMLE program. Unusual performance patterns may result in your access to reapply and/or retest being delayed and/or your retesting being subject to conditions.

If you wish to become more familiar with the USMLE examinations, you should utilize the materials designed for this purpose (see Preparing for the Test ). You should not take a USMLE Step for "practice" or for purposes of becoming familiar with its format or structure.

If your Step 1, Step 2 CK, or Step 3 examination is incomplete, you may be given the option to request that your score be calculated and reported, with all missed test items or cases scored as incorrect. This score is likely to be lower than the score you would have achieved had you completed all sections of the examination. If this option is available to you, you will receive notification from the NBME. Not all examinees will receive notification regarding an incomplete attempt. If you have questions about the status of your exam, send an e-mail to testadmin@nbme.org for information.

If you do receive notification, contact the NBME in writing no later than 45 days after the date the notification was sent to you if you would like further information on having the score calculated and reported. If you decide to request calculation and reporting of your score, the score will appear on your USMLE transcript as though it were complete; it will remain the permanent score for the examination administration.

For Step 2 CS, if you leave the test early, or otherwise fail to carry out one or more of the cases, your performance may be assessed on those cases you completed. If this assessment were to result in a passing outcome no matter how poorly you may have performed on the missed case(s), then a "pass" would be reported. If this assessment were to result in a failing outcome even with the highest rating on the missed case(s), then a "fail" would be reported. Otherwise, the attempt may be recorded as an "incomplete."

If it is determined that you took a Step for which you were not eligible, results for that test may not be reported or, if previously reported, may be revoked (see Eligibility: Change in Status and the Score Validity and Irregular Behavior sections).

Some examination materials are included in the USMLE to enhance the examination system and to investigate the measurement properties of the examinations. Such materials are not scored.

Scoring for Multiple-Choice Items

Multiple-choice items are provided in blocks of approximately 45 to 60 minutes (see Test Lengths and Formats). Blocks of items are constructed to meet specific content specifications. As a result, the combination of blocks of items creates a form of the examination that is comparable in content to all other forms. The percentage of correctly answered items required to pass varies from form to form. However, examinees typically must answer 60 to 70 percent of items correctly to achieve a passing score.

Patient Note: Important Information

You will not receive credit for listing parts of an examination you would have done or questions you would have asked had the encounter been longer. Write only the information you elicited from the patient and describe only the physical examination that you did. Patient notes and videos of encounters may be reviewed for compliance.

Scoring for Primum CCS

The CCS scoring process compares your patient management strategy with strategies deemed by content experts to be appropriate. Actions resembling those identified by experts as being optimal will produce a higher score. You must balance thoroughness, efficiency, avoidance of risk, and timeliness in responding to the clinical situation. Dangerous and unnecessary actions will detract from your score.

Scoring for Step 2 CS

You must pass all three subcomponents (Integrated Clinical Encounter (ICE), Communication/ Interpersonal Skills (CIS) and Spoken English Proficiency (SEP) in a single administration to obtain the overall designation of passing on Step 2 CS. Additional score information is found in the Step 2 CS Content Description and General Information, available at the USMLE website.

Continue to: Passing Scores »

Minimum Passing Scores


The USMLE program provides score users with a recommended pass or fail outcome for all Step examinations. Recommended performance standards for the USMLE are based on a specified level of proficiency. As a result, no predetermined percentage of examinees will pass or fail the examination. The recommended minimum passing level is reviewed periodically and may be adjusted at any time. Notice of such review and any adjustments will be posted on the USMLE website. The recommended minimum passing level in place on the day you test will be the level used for scoring purposes.

A statistical procedure ensures that the performance required to pass each test form is equivalent to that needed to pass other forms; this process also places scores from different forms on a common scale.

For Step 3, your performance on the case simulations will affect your Step 3 score and could affect whether you pass or fail. The proportional contribution of the score on the case simulations is no greater than the amount of time you are allowed for the case simulations.

Continue to: Score Reporting »

Score Reporting


When your score is available, you will receive an e-mail notification from your registration entity. Follow the instructions in the e-mail notification for accessing your USMLE score report. Your score report will remain available for approximately 120 days from the date of your e-mail notification. Using password protection, you will be able to view, download, and print your score report. Once the score report is removed from the website, your scores will be provided to you only in the form of an official USMLE transcript. To obtain a transcript, you will be required to submit a request to your registration entity and to pay a fee.

Note: Updates and/or modifications to the test item pools may occur for each USMLE Step. When such changes occur, score reporting may be delayed. Please monitor the USMLE website for updates.

After taking Step 1, Step 2 CK, or Step 3, you should allow at least eight weeks after your test date to receive notification that your score report is available. For Step 2 CS results, you should refer to the Step 2 CS Schedule for Reporting Results on the USMLE website.

The NBME reports the results of the USMLE to LCME- and AOA-accredited medical school programs for their students, who are enrolled at the time of application, and graduates.

If you are a student or graduate of an LCME- or AOA-accredited medical school program and you do not want your Step 1, Step 2 CK, or Step 2 CS results reported to your medical school, you must send a signed request to the NBME. Your request must be postmarked or faxed at least two weeks before your scheduled test date. If you make this request, the score information provided to the medical school will list your name and the notation "record withheld at the request of the examinee." If you want your score reported to your medical school subsequently, you must submit a transcript request and pay the required fee.

The ECFMG may provide the results of the USMLE to international medical schools for their students and graduates. If you are a student or graduate of an international medical school and you do not want your Step 1, Step 2 CK, or Step 2 CS results reported to your medical school, you must submit a request for each exam administration using ECFMG’s Interactive Web Applications (IWA), available on the ECFMG website at www.ecfmg.org. Your request must be submitted at least 10 days before your scheduled test date. If you make this request, the score information provided to the medical school for that exam administration will list your name and the notation "withheld at the request of the examinee." If you want your score for that exam administration reported to your medical school subsequently, you must submit a transcript request and pay the required fee.

If you are a graduate of an LCME- or AOA-accredited medical school program, you must indicate on your Step 3 application your preference for reporting your Step 3 score to the school from which you graduated.

Continue to: Score Reports & Rechecks »

Examinee Score Reports


Note: The scoring process for USMLE Steps 1, 2 (CK and CS), and 3 is not expedited or accelerated for any individual or group.

For Steps 1, 2 CK, and 3, your score report includes a pass/fail designation, numerical score, and graphical performance profiles summarizing areas of strength and weakness to aid in self-assessment. These profiles are developed solely for your benefit and will not be reported or verified to any third party.

Performance on Step 2 CS is reported as pass or fail. Score reports include performance profiles, which reflect the relative strengths and weaknesses of your performance across the subcomponents of Step 2 CS.

Note: To avoid misinterpretation and protect your privacy, the USMLE program does not provide scores or pass/fail outcomes by telephone, e-mail, or fax to anyone.

Results for computer-based examinations (Steps 1, 2 CK, and 3) are typically available within three to four weeks after your test date. However, delays are possible for various reasons. In selecting your test date and inquiring about results, you should allow at least eight weeks to receive notification that your score report is available.

Results for Step 2 CS are available according to the Step 2 CS Schedule for Reporting Results, available on the USMLE website. Before selecting your test date, you should consult the reporting schedule.

Score Rechecks


For all Steps and Step Components, a change in your score or in your pass/fail outcome based on a recheck is an extremely remote possibility. However, a recheck will be done if you submit a written request and service fee to the entity that registered you for the examination. Your request must be received by your registration entity no later than 90 days after your result was released.

For Steps 1, 2 CK, and 3, standard quality assurance procedures ensure that the scores reported for you accurately reflect the responses recorded by the computer. When a request for a score recheck is received, the original response record is retrieved and rescored using a system that is outside of the normal processing routine. The rechecked score is then compared with the original score.

For Step 2 CS, score rechecks involve retrieval of the ratings received from the standardized patients and from the physician note raters. These values are then re-summed and reconverted into final scores in order to verify whether the reported pass/fail outcome was accurate. Encounters and patient notes are not re-rated; videos of encounters are not reviewed. Videos are used for general quality control and for training purposes and are retained only for a limited period of time.

Patient notes are carefully reviewed, in some instances by multiple physicians, before scores are released. As part of the quality control procedures for initial scoring, examinees who fail Step 2 CS solely on the basis of the Integrated Clinical Encounter (ICE) subcomponent and who are performing at a level that is near the minimum passing point have their patient notes rated by multiple physician note raters. Therefore, patient notes are not reviewed again when a recheck is requested.

Continue to: Transcripts »

Official USMLE Transcripts and Providing Scores to Third Parties


If you want your USMLE scores to be sent to a third party, you must submit a request and pay a fee. Your scores will be provided in the form of an official USMLE transcript.

Except as described in this Bulletin, USMLE results will not be reported to you or third parties without your request and payment of the transcript fee.

Note: Graphical performance profiles, which are included on your original score reports, are not included in your USMLE transcript.

Your USMLE transcript includes the following:

  • your name and other personal identification information, including your date of birth;
  • your complete examination history of all Steps and Step Components that you took;
  • your history of any examinations for which no results were reported;
  • indication of whether you have previously taken the former NBME Parts I, II, or III, Federation Licensing Examination (FLEX), or ECFMG Clinical Skills Assessment (CSA);
  • annotation(s) if you were provided with test accommodations as applicable (see Examinees with Disabilities Requesting Test Accommodations);
  • annotation(s) and information documenting classification of any scores as indeterminate (see Score Validity and Irregular Behavior);
  • annotation(s) and information documenting any irregular behavior (see Score Validity and Irregular Behavior); and
  • notation(s) of any actions taken against you by medical licensing authorities or other credentialing entities that have been reported to the FSMB Board Action Databank.

To obtain your USMLE transcript or have it sent to a third party, you must contact the ECFMG, FSMB, or NBME depending on which examinations you have taken and where you want your transcript sent. Contact the FSMB if you want your transcript sent to a medical licensing authority at any time. If you have not registered for or taken Step 3 and want your transcript sent to anyone other than a medical licensing authority, submit the request to the last entity that registered you.

Examination data (including performance information and recorded patient encounters) from USMLE examinations may be used by the USMLE program or made available to third parties for research. In such instances, the data will be confidential, and individual examinees will not be identified in any publication. If you do not wish your score to be made available for research purposes, you must advise the USMLE Secretariat in writing (see Communicating With USMLE).

Requesting USMLE Transcripts


Contact Information for Transcripts
Step(s)/Component(s) Taken Recipient of Transcript Contact
One or more USMLE Steps Medical licensing authority FSMB
All three USMLE Steps; or Step 1 and Step 2 CK and CS (if required), only when registered for or after taking Step 3 Any recipient FSMB
Step 1 and/or Step 2 CK and/or CS only, registered by ECFMG Any recipient other than a medical licensing authority ECFMG
Step 1 and/or Step 2 CK and/or CS only, registered by NBME Any recipient other than a medical licensing authority NBME

Continue to: Electronic Residency Application Service (ERAS®) »

Electronic Residency Application Service (ERAS®)


If you use ERAS, you may request electronic transmittal of your USMLE transcript to residency programs that participate in ERAS. If your program does not participate in ERAS, you must submit a transcript request and pay the required fee. Information on ERAS is available for students and graduates of LCME- and AOA-accredited medical school programs from the medical schools, and for students and graduates of medical schools outside the United States and Canada from the ECFMG. The Association of American Medical Colleges (AAMC) and ECFMG websites also include information on ERAS and/or links to the ERAS website.