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.

The policy change was effective for all applications submitted on or after July 1, 2021.