Eligibility for the USMLE Steps

Impact of Change to Accreditation Body for Medical Schools in Canada Effective in July 2025

Currently, medical education programs in Canada leading to the MD degree are accredited by both the Liaison Committee on Medical Education (LCME) and the Committee on Accreditation of Canadian Medical Schools (CACMS). Effective July 1, 2025, CACMS will become the sole accrediting body for medical education programs in Canada.

Accreditation by LCME establishes eligibility to take the USMLE and to enter U.S. residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). In the absence of LCME accreditation for Canadian medical education programs, Canadian medical school graduates will establish their eligibility for USMLE and ACGME-accredited residency programs through ECFMG Certification.

This means that individuals who graduate from Canadian medical schools on or after July 1, 2025 will be considered international medical graduates (IMGs) for the purpose of entry into graduate medical education (GME) programs in the United States, and, in order for these graduates to enter ACGME-accredited residency programs, the ACGME will require that they either obtain ECFMG Certification or hold a full and unrestricted license to practice medicine in the U.S. licensing jurisdiction in which the ACGME-accredited program is located.

ECFMG Certification is the standard for evaluating the qualifications of IMGs entering the U.S. health care system and includes requirements for medical schools, examination requirements (which include USMLE Step 1 and Step 2 CK among other requirements), and verification of medical education credentials directly with the issuing institution. For more detailed information, please visit the ECFMG website.

Individuals who will graduate from Canadian medical schools on or after July 1, 2025, will be able to apply for ECFMG Certification beginning in late spring 2025, prior to the start of the 2026 residency application cycle in the United States. Additional details and a definitive date when these individuals can begin applying for ECFMG Certification will be provided in a future update. In the interim, these individuals should continue to apply for USMLE exams as planned and based on current policies and procedures.

Individuals who will graduate from medical schools in Canada on or after July 1, 2025, and who plan to pursue U.S. GME should monitor the ECFMG and USMLE websites for detailed information on applying for ECFMG Certification and USMLE.

Who Is Eligible to Take the USMLE?

Step 1 and Step 2 CK

To be eligible, you must be in one of the following categories at the time you apply AND on the day of your examination:

• A medical student officially enrolled in, or a graduate of, a US or Canadian medical school program leading to the MD degree that is accredited by the LCME, OR
• A medical student officially enrolled in, or a graduate of, a US medical school leading to the DO degree that is accredited by the Commission on Osteopathic College Accreditation (COCA), OR
• A medical student officially enrolled in, or a graduate of, a medical school that is outside the US and Canada, listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements, and that meets other eligibility criteria of the ECFMG.

Step 3

Eligibility requirements for Step 3 are:

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

The USMLE program recommends that, for Step 3 eligibility, applicants should have completed, or be near completion of, at least one postgraduate training year in an accredited US graduate medical education program that meets state board licensing requirements.

Change in Eligibility Status

If your eligibility for a Step changes after you submit your application but before your scheduled test date(s), you must promptly notify the organization that registered you for your examination. If you take a Step for which you are not eligible, results for that examination may not be reported or, if previously reported, may be canceled, at the discretion of the USMLE program.

  If you are dismissed or withdraw(n) from medical school, you are not eligible for the USMLE, even if you are appealing the school’s decision or are otherwise contesting your status. If you are on a leave of absence, please check with the organization that registered you for your examination before submitting your application; if you have already registered, check before testing.

Failure to notify the organization that registered you for your examination of your changed status may result in a determination that you engaged in irregular behavior and placement of a permanent annotation on your score reports and transcripts.

Graduates From Unaccredited Medical Schools in the US or Canada

If you graduated from an unaccredited medical school in the US or Canada and are eligible for initial licensure as a physician by a US medical licensing authority, you may take the USMLE only upon specific request by that medical licensing authority. The medical licensing authority should submit the request to sponsor you to the USMLE Secretariat in advance of your application for each Step.

Number of Attempts and Time Limits

 If you have attempted a Step four or more times, including incomplete attempts, and have not passed, you are ineligible to apply for any Step in the USMLE sequence. Attempts at the formerly administered Step 2 Clinical Skills count toward the limit.

Many state medical boards require that all Steps of the USMLE sequence be successfully completed within a certain time frame.

Information regarding state-specific requirements for licensure can be obtained on the FSMB website. Note: Combined degree (e.g., MD/PhD) students should reference the USMLE website for more specific information regarding exceptions to time limits.

Retaking Failed Examinations

You may not take the same Step more than three times within a 12-month period. Your fourth attempt must be at least 12 months after your first attempt at that examination and at least six (6) months after your most recent attempt at that examination. This includes incomplete attempts.

Retaking Previously Passed Steps

If you pass a Step, you are not allowed to retake it, except to comply with a time limit imposed by a US medical licensing authority for completion of all Steps or by another authority recognized by the USMLE program. Visit the USMLE website for more information. 

If you have not yet passed Step 3 and need to retake a previously passed Step 1 or Step 2 CK examination to meet a time limit imposed by a US medical licensing authority or another authority recognized by the USMLE program, you should understand that if you fail a retake, you will no longer be eligible to take Step 3. 

To meet the examination requirements for Step 3 eligibility, you must have achieved a passing performance on the most recent administration of the examinations intended to meet those requirements.
 

Previously Licensed Physicians

If you have already been granted a physician license by a US medical licensing authority based on other licensure examinations including but not limited to, the Federation Licensing Examination (FLEX), Medical Council of Canada Qualifying Examination, NBME certifying examinations, or National Board of Osteopathic Medical Examiners COMLEX-USA, or by exception — you may not be eligible to take the USMLE. Please contact the appropriate registration organization with questions about your eligibility.

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