Common Questions

To apply for USMLE examinations, you must read the USMLE Bulletin of Information and submit an application through your registration entity.

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).

ECFMG
FSMB
NBME
 

A fee may be charged if you change your appointment, depending on how much notice you provide. See the appointment change fee schedule for more information.

Yes, water is permissible in a clear container. Explore other test-taker FAQs about Prometric.

The USMLE Bulletin can be found at USMLE.org/bulletin. You have the option of viewing the Bulletin online or downloading a PDF file.

Go to the website of your registration entity to submit a name change request and/or obtain the form for completing the change, or to request a change to contact information. Supporting document is required for a name change request.

Name change forms and documentation must be received and processed by your registration entity no later than 7 business days before your scheduled testing appointment.

NOTE: If you have a scheduling permit, a revised permit will be issued to you with your new name. You must bring your new permit for admittance to the test center or you will not be permitted to test.

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.

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 and Canada should contact the ECFMG for information on ECFMG Certification and Step 1 and Step 2 eligibility.

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 have already been granted a physician license by a US medical licensing authority, you may not be eligible to take the USMLE. Please contact the appropriate registration organization with questions about your eligibility.

The Educational Commission for Foreign Medical Graduates (ECFMG) provides such information. Through its Certification program, ECFMG assesses the readiness of graduates of medical schools outside the United States and Canada to enter residency or fellowship programs in the United States. The ECFMG® Certification Fact Sheet provides an overview of ECFMG Certification and preliminary information on entry into US programs of graduate medical education. For detailed information on these topics, including eligibility to take the USMLE, refer to the ECFMG Information Booklet. Both publications are available on the ECFMG website.

The USMLE program recognizes that the recommended seven-year time limit may pose problems for medical licensure for some candidates with a combined degree (i.e., MD/PhD). For this reason, the USMLE program recommends to licensing jurisdictions that they consider allowing exceptions to the seven-year limit for MD/PhD candidates who meet the following requirements:

- The candidate has obtained both degrees from an institution or program accredited by the LCME and a regional university accrediting body.

- The PhD should reflect an area of study which ensures the candidate a continuous involvement with medicine and/or issues related, or applicable to, medicine.

- A candidate seeking an exception to the seven-year rule should be required to present a verifiable and rational explanation for the fact that he or she was unable to meet the seven-year limit. These explanations will vary and each licensing jurisdiction will need to decide on its own which explanation justifies an exception. Students who pursue both degrees should understand that while many states' regulations provide specific exceptions to the seven-year rule for dual-degree candidates, others do not. Students pursuing a dual degree are advised to check the state-specific requirements for licensure listed by the FSMB.

If you are seeking licensure in a state where you do not meet the USMLE time limit, please contact the Office of the USMLE Secretariat for a possible exception to the policy around retaking a previously passed exam. Complete this form to contact the Office of the USMLE Secretariat for more information.

You may take the same examination no more than three times within a 12-month period. Your fourth attempt must be at least 12 months after your first attempt at that exam and at least six months after your most recent attempt at that exam.

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.

ERAS®, the Electronic Residency Application Service, is sponsored by the Association of American Medical Colleges (AAMC) and was developed to transmit residency applications via the Internet, including electronic transmittal of USMLE transcripts to residency programs which participate in ERAS.

Information on electronic transmittal of USMLE transcripts through ERAS is available for students and graduates of accredited medical schools in the United States and Canada from the medical schools.

ERAS is available to students and graduates of medical schools outside the United States and Canada through ECFMG.

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.

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

Writing surfaces and markers should be used only at your assigned testing station and only after you have entered your CIN in the computer to start your test session.

Report to the test center at least 30 minutes prior to your scheduled testing appointment

You must present one form of non-expired, government-issued, photo and signature bearing ID in order to test. 

Go to the website of your registration entity to submit a name change request and/or obtain the form for completing the change, or to request a change to contact information. Supporting document is required for a name change request. Name change forms and documentation must be received and processed by your registration entity no later than 7 business days before your scheduled testing appointment. NOTE: If you have a scheduling permit, a revised permit will be issued to you with your new name. You must bring your new permit for admittance to the test center or you will not be permitted to test.

No test preparation courses are affiliated with or sanctioned by the USMLE program. Information on such courses is not available from the ECFMG, FSMB, NBME, USMLE Secretariat, or medical licensing authorities.

The best preparation for the USMLE is a general, thorough review of the content reflected in the examination descriptions. You should also practice for your exams using the sample test materials. Self-assessment information and materials are also available. In addition, registered examinees who want the opportunity to become familiar with the Prometric test center environment may take a practice exam at the test center, for a fee. Register for a Practice Session. 

The list of current exam fees are located at https://www.nbme.org/examinees/united-states-medical-licensing-exam-usmle.

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

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

You cannot cancel your application after it has been submitted. Exam fees are non-refundable or transferable. 

The USMLE program routinely performs analyses as part of scoring to detect aberrant examinee response behavior. We do not provide specific information about the analyses performed. If you received a letter about an anomalous performance sanction, you met specific criteria which resulted in a restriction on access to the exam for 12 months.

No - if you received a communication about an anomalous performance bar on testing, this policy is unrelated to USMLE policies regarding score validity.

As explained in the USMLE Bulletin of Information, anomalous performance and/or unusual testing history may impact your access to the USMLE. If your performance raises concerns about your readiness to test or your motivation to pass, the USMLE program reserves the right to restrict your future access to its examinations and/or to impose conditions on future access.

The USMLE program uses scoring data from your administration to determine whether you meet criteria for anomalous performance. Given this decision is based on objective evidence, there is no valid basis on which to appeal.

The USMLE Bulletin of Information advises examinees not to test if you are ill, under unusual personal stress, unprepared for the examination, or otherwise not ready to test on your scheduled test date. If you had an issue on test day during the course of your exam, you were required to report it within 10 days of your exam date. If you reported an issue and still received a letter restricting your access to USMLE, we have concluded that your exam performance still fits the criteria for an anomalous performance sanction and the issue reported does not qualify you for a release of that sanction.

For all Steps, a highly rigorous process is used to ensure the accuracy of scores, including a parallel scoring method involving independent scoring systems. Therefore, a change in your score or in your pass/fail outcome based on a recheck is an extremely remote possibility. To date, the score recheck process has not resulted in a score change.

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.

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

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 biometric record contains some or all of the following information:

• a digitized representation of your fingerprint (the template), passport
   
• an image of your fingerprint, along with your name, address, telephone number (if provided)
   
• date of birth or age, identification document number
   
• a scanned copy of your identification document (such as your driver’s license, passport, etc.), which includes your digitized photograph

The biometrics record is paired with ID information and information about your testing appointment session.

Unless otherwise required by law, the personal information (including your fingerprint image and template) collected using biometrics is retained on behalf of the USMLE program sponsors in a secure, centralized database in the United States on test day and for a period of 5 years from the date of your most recent testing appointment with Prometric.

Access to your biometric information will be limited as described in the Privacy Notice for USMLE Candidates. Employees or agents of the USMLE sponsors who have access to the data are bound by confidentiality agreements. The data may be made available to third parties if required by law or as necessary to complete a testing fraud investigation directly related to the relevant candidate(s).

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

No.

Biometric Enabled Check-In Privacy Notice

For USMLE Candidates

Biometrics is part of Prometric’s identity management system and is designed to improve the security and integrity of the testing process. The USMLE program uses Biometric Enabled Check-In as part of standard test day procedures. This biometrics program is implemented by Prometric (whose corporate headquarters are located at 1501 South Clinton Street, Baltimore, MD 21224, U.S.A.) which acts on behalf of the USMLE program sponsors, as a data processor.

This Privacy Notice describes the privacy and security practices that have been established for the Biometric Enabled Check-In program.

About Biometric Enabled Check-In

The biometrics program converts a fingerprint to a digital image that is used for identity verification purposes. During the Biometric Enabled Check-In, you will place your finger on a scanner at the test center. The equipment will create a digitized representation of your fingerprint (a “template”). This representation template will be paired with other personal information you provide to your registration entity, allowing accurate identification during the testing process. As you move in and out of the test lab at the test center, you will use your finger to authenticate yourself at the scanners located in the test center.

Personal Information Collected as Part of the Biometrics Program

The biometric record contains some or all of the following information: a digitized representation of your fingerprint (the template), an image of your fingerprint, along with your name, address, telephone number (if provided), date of birth or age, identification document number, and a scanned copy of your identification document (such as your driver’s license), which includes your digitized photograph. The biometrics record is paired with ID information and information about your testing appointment session.

Purposes and Uses for the Personal Information

The personal information collected under the Biometric program is used:

To verify your identity on an ongoing basis throughout the test day

To identify and prevent testing fraud and maintain the integrity of the testing process by detecting and preventing test taking by unauthorized individuals

To improve security at test centers by detecting and preventing unauthorized access of individuals to secure areas

As required by law

Personal Information Disclosed to Third Parties

Your personal information (including your fingerprint template) may be provided to the following:

- Data processors, like Prometric, who process the data and who are bound by contracts to limit their use of the information to the purposes specified in this notice

- Third parties if required by law or as necessary to complete a testing fraud investigation directly related to the relevant candidate(s).

Information Storage

Unless otherwise required by law, the personal information (including your fingerprint image and template) collected using biometrics is retained on behalf of the USMLE program sponsors in a secure, centralized database in the United States on test day and for a period of 5 years from the date of your most recent testing appointment with Prometric. Upon expiration of that time period, all demographic information collected using biometrics and the fingerprint image and template are deleted. Although the U.S. and many other countries do not have comprehensive data protection laws, the USMLE sponsors and Prometric will treat your personal information such that it will receive appropriate protection through data transfer contracts and/or certification to the EU-US Safe Harbor Program.

Privacy and Information Security

Appropriate technical, physical and administrative safeguards have been implemented to help protect your personal information against unauthorized access or loss. Access to information collected under the Biometric Enabled Check-In program is limited to those employees or agents of the USMLE program sponsors who have a need to access it and who are bound by confidentiality agreements.

The USMLE program sponsors and Prometric are committed to protecting your privacy and will only use the personal information collected under the Biometric Enabled Check-In program for the purposes described in this Privacy Notice.

Questions

If you have concerns about the Biometric Enabled Check-In program, please contact us.

When you schedule your exam through Prometric, you will be asked whether you consent to the collection, use, processing and storage of your biometric information. Your consent will be effective until and unless you affirmatively withdraw that consent in writing to privacy@nbme.org or via www.prometric.com/datasubjectrequests.

Prometric may need to cancel and reschedule appointments at testing centers closed for reasons such as extreme weather, natural disaster, power outages, technical issues, or other circumstances, including social distancing guidelines. If your appointment is cancelled by Prometric, follow the instructions contained in the cancellation email to reschedule your examination.

To identify if a test center location is available for your appointment, see the Test Center Closures page on the Prometric website. If you need to reschedule your appointment, first confirm the site is available and then start the scheduling or rescheduling process.

If there is time left on your eligibility, contact Prometric to pay the late rescheduling fee to have your eligibility reset. If there is no time left on your eligibility, contact your registering entity.

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 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.

Describe the problem when contacting us. Someone will be in touch as soon as possible to assist you.

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 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.

If your exam is over multiple days only the first day of testing will be reflected on the score report.

Only exams taken will show on a transcript of your scores.

Your score report is provided only for your personal use. When you want a third party (e.g., residency programs) to receive an official record of your USMLE scores, request that your registration entity send the transcript (see Requesting a Transcript of USMLE Scores). Under some circumstances, medical schools may receive scores and pass/fail outcomes for their students.

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.

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.

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.

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: 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.

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.

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. 

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

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.

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: for Step 1 and Step 2, either NBME or ECFMG; for Step 3, FSMB. 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 4th of July or the last week of December.

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: 214
Step 3: 198

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.

In order to ensure that both the processing and scoring of USMLE examinations are done in a secure and accurate fashion, it is necessary to follow a number of quality assurance steps. These steps include monitoring reports from test centers about test delivery problems and about possible security violations. 

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.

For accredited medical schools in the United States and Canada, performance by medical school is reported by NBME only to individual schools and is available only from those schools. The Educational Commission for Foreign Medical Graduates (ECFMG®) has responsibility for reporting scores for students and graduates of international medical schools.

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.

To obtain your USMLE transcript or have it sent to a third party, you must contact FSMB or NBME and pay the associated fee.

Effective August 21, 2024, FSMB produces transcripts for all USMLE examinees (both domestic and international medical students and graduates). To have a transcript sent to a medical licensing authority at any time, submit your request through FSMB.

If you have taken both the NBME Parts exam and the USMLE, you must order your transcripts from NBME. NBME will provide transcripts for both exams in these instances.

Examinees participating in ERAS should continue to follow instructions from ERAS for sending their USMLE transcripts to U.S. training programs.

Information about requesting a score recheck is in the USMLE Bulletin of Information.

Your score report is provided only for your personal use. When you want a third party (e.g., residency programs) to receive an official record of your USMLE scores, request that your registration entity send the transcript (see Requesting a Transcript of USMLE Scores). Under some circumstances, medical schools may receive scores and pass/fail outcomes for their students.

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.

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 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.

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.

The primary purpose of USMLE is for licensure. The USMLE co-sponsors recognize that there are other uses for USMLE, such as residency selection, but an ideal system for evaluating candidates should be holistic. This system should feature various assessments of a candidate’s competencies and unique characteristics. In such a system, USMLE would serve as one objective measure and be weighted appropriately.

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.

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. 

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.

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.

You should function as a primary care physician and maintain responsibility for the patient in all management locations throughout each computer-based case simulation (CCS).

Do not assume that other members of the health care team (eg, nurses, medical consultants) will write or initiate orders for you when a patient is admitted to a facility or transferred for a surgical procedure. Responsibility for the primary care of the patient may include (but is not limited to) all of the following:

• Ordering laboratory tests, imaging studies, and diagnostic procedures
   
• Changing management locations as necessary
   
• Initiating and modifying treatment regimens
   
• Handling life-threatening emergencies
   
• Monitoring the patient's condition over simulated time
   
• Preparatory patient care that, if neglected, might jeopardize the patient (eg, in the preoperative setting, this may mean requesting IV fluids, a blood type and crossmatch, and antibiotics)
   
• Addressing health maintenance issues. Note: The nature of each case dictates whether or not health maintenance issues are relevant within the simulated time frame.

Your responsibilities for each patient are fulfilled when the case has ended.

Computer-Based Case Simulation (CCS) allows you to manage only one patient at a time. There is no option available to assess or treat anyone other than the patient. However, it is possible to order education or counseling for the patient's family or sexual partner. You manage one patient at a time by:

Reviewing the history

An initial history is given to you at the beginning of each case. Throughout the case, you may periodically ask how a patient feels by ordering an interval/follow-up history or monitor the patient by ordering a physical examination. Any information not included in the history or physical examination is normal or noncontributory for your patient.

Selecting physical examination components

Physical examination should be requested if and when you would do the same with a real patient. Requests for interval history and physical examination automatically advance the clock in simulated time.

Writing orders on the chart

The order sheet is the primary means for implementing your patient management plan. At any time, you may type requests for tests, procedures, and therapies directly on the order sheet.

Advancing simulated time to execute orders, obtain diagnostic information, and observe the effects of treatment by selecting the clock option

To see results of tests and procedures and to observe effects of treatment, you must advance the clock. When you do so, your orders are implemented, test results are returned, and therapies are initiated. As you advance the clock, the patient's condition may change based upon the underlying condition(s), your management, or both. Note that if a clock advance to a requested appointment time is stopped to review results from processed orders, the requested appointment is canceled.

Changing the patient's location

Change the patient's location by selecting the "Change Location" button. You can move the patient to and from home, office, emergency department, inpatient unit, and intensive care unit. Note: You will not be able to change the patient's location after the Case-end Instructions screen is presented.

You write orders by typing your requests on the order sheet section of the patient chart, one per line. You can place orders only in the order sheet section of the patient chart. You cannot place orders while you are in any other section of the chart (eg, Progress Notes, Vital Signs, Lab Reports, Imaging, Other Tests, and Treatment Record).

Order recognition

If the clerk recognizes the first three characters of the name or acronym (eg, "x-ray," "ECG"), you will be shown a list of options that match your entry. If the clerk does not recognize your order, you may have to type it differently. It is not necessary to type commands (eg, "administer," "give," "do," "get"); simply type the name of a test, therapy, or procedure. You must request drugs by specific trade or generic name. The clerk does not accept drug class names such as "antacids" or "beta-blockers."

Routes of administration

Once you have selected an order from the list presented, you must also specify route and type of administration by selecting those options during the order confirmation process. Assume that "continuous" administration also encompasses periodic administration (eg, every 4 hours) if that is appropriate for the treatment. Note that intravenous fluids are not available as a "One Time/Bolus" order in Primum CCS. Available routes of administration include epidural (EP), intra-articular (IA), intramuscular (IM), inhalation (IN), intravenous (IV), ophthalmic (OP), otic (OT), oral (PO), rectal (RE), sublingual (SL), subcutaneous (SQ), topical (TP), and vaginal (VA).

Dosage and administration rates

It is not necessary to specify dosages or administration rates; these will not appear on the order sheet, but you can assume these have been optimized for your patient's condition.

To taper a medication, simply discontinue (cancel) it by clicking on the order and confirming the cancellation.

Medications cannot be administered prn. When a medication is indicated for the patient, order it. When it is no longer indicated, cancel it.

Medication duration is assumed to be optimal.

Canceling an order

To discontinue a therapy or cancel a test or procedure, select it on the order sheet and respond "yes" to the prompt.

The patient's current medication(s)

There may be cases in which a patient is on a medication at the beginning of the case. In these situations, the patient's current medication will be displayed on the order sheet (eg, "oral contraceptive"). These orders appear with an order time of Day 1 @00:00. When current medications are displayed on the order sheet, you must decide whether to continue or cancel the medication, as you deem appropriate for the patient's condition; these orders remain active throughout the case unless canceled.

Reviewing orders

Information that has already been presented can be reviewed at any time on the patient chart in the Progress Notes, Vital Signs, Lab Reports, Imaging, Other Tests, and Treatment Record sections. Note: You can write orders only in the Order sheet section of the chart.

In a Computer-Based Case Simulation (CCS), after you write orders, you must advance the clock in simulated time to obtain results of diagnostic studies, monitor the patient's progress, or see the patient's response to therapies. Every diagnostic order placed on the order sheet will have a report time (the simulated time at which the result of that order will be displayed). Advancing the clock using the "With next available result" option will automatically advance the clock in simulated time to the next pending result

Advancing the clock in simulated time in a Primum CCS case is what "makes things happen." To see the results of tests and procedures and to evaluate the effect of therapies, you must advance the clock in simulated time.

There are various ways to advance simulated time in Primum CCS cases. At the top of the chart, select the "Obtain Results or See Patient Later" button. Under the Reevaluate screen, you can advance simulated time by using one of the following options:

• Select a date on the calendar for future evaluation.
   
• To reevaluate the patient on a specific future date, choose "On" under Reevaluate Case. Select a date on the calendar or enter a future day and time.
   
• To select a relative time in the future, choose "In" under Reevaluate Case (eg, reevaluate patient in 3 hours).
   
• To advance the case to the time when your scheduled test result will be available, choose "With next available result" under Reevaluate Case. If no results are pending, the case will advance to the next patient update message or to the end of the case.
   
• To end the case (once you are satisfied that you have completed all necessary patient management), choose "Call/See me as needed" under Reevaluate Case. This will instruct the patient to call you as needed for future visits. Do not assume this means that the patient will be monitored.

In general, any pending test results or messages from the patient, the patient's family, or another member of the health care team will give you an option to stop simulated time. If there are no pending test results or patient updates, advancing the clock may take you to the end of simulated case time. At that point, you will receive the Case-end Instructions screen and have an opportunity to finalize your orders.

You can change your mind at any point in the case by canceling orders and/or writing new orders. However, once you write an order and advance the clock to move forward in simulated time, you cannot go back. Therapies are initiated as soon as the clock is advanced in simulated time. Diagnostic orders and procedures cannot be canceled once the results are seen. As in real life, there is no opportunity to undo what has already been done.

Discontinue a therapy or cancel a test or procedure by selecting it on the order sheet and responding "yes" to the prompt. Canceling a medication, IV fluid, or therapy removes it from the order sheet. Canceling a test or procedure before a result is returned means the test/procedure has not been carried out.

Typically, consultants are not helpful since computer-based case simulations are designed to assess your patient management skills. However, requesting consultation at appropriate times may contribute to your score. In some cases, it may be necessary to implement a course of action without the advice of a consultant or before a consultant is able to see your patient. In other cases, a consultant may be helpful only if called after you have obtained enough information to justify referring the patient to his or her care.

After advancing the clock in simulated time, you will receive results of diagnostic studies you requested and reports of changes in the patient's condition.

You may obtain intermittent reports about the patient's condition through messages from the patient, the patient's family, or other health care providers. You may also directly request information about the patient's current condition by ordering an interval/follow-up history.

It is possible that a patient's condition might worsen despite ideal care on your part. It is also conceivable that a patient's condition might improve with less than ideal care or no care. The effect of an intervention may not be seen until an appropriate amount of simulated time has passed. You can monitor the effect of interventions you order by ordering a diagnostic test or physical examination component that will reflect a change or improvement in the patient's condition. You must order the diagnostic test or physical examination component at a point in simulated time when you would expect a clinical improvement.

Simulated time

Cases can last from a few minutes to several weeks of simulated time. You are not told how much simulated time will elapse in each case. It is your responsibility to manage simulated time based upon your understanding of the urgency of the case. To move forward in simulated time, use the Advance the Clock option.

Real time

Cases will be allotted varying amounts of maximum real time to complete each case. Before you begin each case in the examination, you will be informed of the maximum real time allotted. However, you may not need to use the entire amount of available real time. The real time you actually use may vary based on your actions. For example, if you accomplish a case's measurement objectives quickly, that case may end in just a few minutes. Alternatively, if you do not provide appropriate intervention but continue to advance the clock in simulated time, the case may also end before the maximum allotted real time. Please note that if during the examination, you do not use all the allotted real time for a case, the "remaining" real time is not added to the allotted real time for any other case. A case will end when you have demonstrated your skills sufficiently or you have run out of real or simulated time.

If you have finished all patient management, you can end the case by advancing simulated time. Use the clock as you normally would to receive results of pending tests and procedures. Once there are no longer any pending patient updates, tests, or procedures, use the clock to advance simulated time until the case ends.

Near the end of each case, you will be presented with the Case-end Instructions screen, which will notify you that the case will end shortly.

At that time, you will be given a few minutes to:

• Review all previously presented vital signs, test and imaging results, and patient updates using the chart tabs at the top of the screen.
   
• Write new orders to be done now or in the future.
   
• Cancel any pending tests or orders that you no longer wish to carry out or active therapies that you want to discontinue at that time.

After the Case-end Instructions screen is presented, you will NOT be able to:

• Order a physical exam or interval history
   
• Change the patient's location
   
• Receive the results for pending tests and diagnostic studies
   
• Schedule a follow-up appointment
   
• Advance the clock in simulated time

After finalizing patient care, you must select Exit Case to exit the case. You will then see an "END OF CASE" message.

In the event of a computer problem during a live examination, notify the proctor. A case may be restarted by testing center staff. Only one restart per case is permitted. If a case is restarted more than once, the restart restriction will prevent the interrupted case from being completed, and the next case will appear.

Circumstances and needs change. If you feel accommodations are necessary for you to access the USMLE, please review the guidelines and submit a request for accommodations.

There is no fee to submit a request for accommodations for the USMLE. 

• All examinees are seated in individual testing carrels which shield test takers from visual distractions.
   
• All test center chairs are ergonomic.
   
• The LCD computer monitors are 23-inches.
   
• The height of the table in the standard testing room is 30 inches from the floor to the top of the table.
   
• There are noise reducing headphones at each workstation and test takers can bring their own soft foam earplugs (without cords or strings).
   
• You will receive two double-sided laminated writing surfaces with a low odor erasable marker.

The workstations in the standard testing room are designed to provide a safe and reasonably quiet environment that is conducive to high-stakes, standardized test administration. Please note that noise and movement in the testing rooms are carefully monitored and controlled.

Please note that, for security purposes, no examinee-provided equipment may be connected via Bluetooth or plugged into a test center workstation. If you require specific equipment or have a question about what other options are available, please contact Disability Services.

• The USMLE is offered as a computer-based examination. All examinees may magnify the screen up to 2.2x, with the smallest text appearing in the Lab Values at 18 pt. font. The item stem and response sets are each considered 36 pt. font when fully magnified. A request for accommodation is not needed to access this feature.
   
• There is a reverse contrast feature (color inversion black on white or white on black) built into the system.
   
• There is a computer-based note taking feature and standard calculator incorporated into the exam.

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, ECFMG, 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.

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.

Please note that the separate testing rooms at Prometric test centers are not guaranteed to be “distraction-free” or any quieter than the standard Prometric testing area, which is designed to provide a reasonably quiet environment that is conducive to high-stakes, standardized test administrations. The separate room is typically located next to the check-in or proctors’ station, which can be busy. A window between the separate room and the check-in or proctors’ station is there for security measures.

Soft foam earplugs (without cords) are permitted in all testing rooms, and sound-reduction headphones are also available for all test-takers to minimize the distraction of ambient noises. Additionally, individual workstation carrels are provided in the general testing area to shield test-takers from visual distractions.

Supporting documentation is currently submitted to NBME electronically.  The maximum email file size is 15 MB (including text in body of email, headers, and all attachments). Files larger than 15 MB may require separate emails. All attachments should be in PDF, Word, or JPEG format. Please scan your documents into as few attachments as possible. Photographs of Personal Items may be in digital format such as JPEGs/JPGs. We are not able to access embedded or encrypted links.

There is no length requirement. To help develop your personal statement and ensure key information is included, please refer to the prompts provided within our guidelines.

While specific categories of information are requested (for example, documentation of your impairment from a qualified professional, and information on your use of accommodations on the MCAT), there is no specific amount of documentation required, and there is no specific piece of documentation that will guarantee an accommodation.  We will review all the documentation you choose to submit. Keep in mind, however, that the documentation must be sufficient to demonstrate the existence of your impairment(s) and whether accommodations are warranted considering the functional limitations that you experience because of your impairment(s).  For additional information on documentation, please review our guidelines.

We certainly understand that historical records may not always be obtainable. We recommend you submit whatever historical documentation you can reasonably obtain and provide as that will help us determine what accommodations, if any, would be appropriate. 

A scheduling permit is issued when an examinee has completed the registration process and is allowed to schedule their test date.  If you check the box for test accommodations on your exam application, a temporary hold will be placed on your scheduling permit. Checking the box does not initiate an accommodation request; you must still submit a request form and supporting documentation to Disability Services to initiate your request. Once a decision has been made, the hold will be released, and your scheduling permit will be issued to you several business days later.  Once you have received your scheduling permit you may schedule your exam at any time.

Please allow approximately 60 business days to process a request, starting from the time we receive your completed application and all supporting documentation and have confirmed that your registration is current and complete.

Your file is typically reviewed by one or more psychological or medical professionals, depending on the basis of your request. Some requests are also reviewed, at NBME’s request, by external professionals.

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. 

If additional documentation is needed, you will be notified by email within approximately two weeks of submitting your request.

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. 

Due to high volumes and time constraints, we do not speak to providers directly. If there are questions about our accommodation process, we recommend that your treatment provider review the General Guidelines to Request Test Accommodations as well as the additional Guidelines for Specific Impairments if needed.

We recommend you address the reviewer in writing with your specific questions or concerns, and you will receive a response within approximately two business days.

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.    

If you are seeking new or additional accommodations, please submit the request form along with any new supporting documentation that we have not previously reviewed. You should allow approximately 60 business days for processing. 

Your scheduling permit will remain temporarily on hold for the duration of the accommodation review process, and you will not be able to schedule an exam. As soon as a decision has been reached, we will email you a copy of your decision letter and release the hold on your permit. You will generally be able to schedule your exam within a few days of receiving the email that notifies you that the hold has been released on your scheduling permit. Your scheduling permit will contain information about how to schedule your exam with Prometric. For more specific questions please contact your specialist.

You may withdraw your request at any time by providing an email or dated and signed letter stating your desire to withdraw your request. We will then release any hold that may be on your scheduling permit so that you may schedule to test under standard conditions at your convenience. 

You can view available test dates and centers for standard appointments by navigating through the Prometric website to the USMLE section (https://www.prometric.com/test-takers/search/usmle) and selecting "Locate" on the left-hand side of the page. All questions regarding test centers and scheduling should be directed to Prometric (https://www.prometric.com/contact-us). If you are granted test accommodations, you may contact Prometric at the phone number listed on your scheduling permit with any questions about scheduling with your accommodations.

If your eligibility period has begun while your accommodation request is being processed and you have questions or concerns about whether you will be able to test within your eligibility period, please contact your Disability Services Specialist for more specific information regarding your eligibility period. 

To confirm, cancel, or reschedule your testing appointment(s), please follow the instructions on your scheduling permit.

If you had a standard exam appointment and were later approved for test accommodations and a new accommodated scheduling permit was issued to you, your previous exam appointment will automatically be canceled, please destroy your original scheduling permit as it is no longer valid. You may use your new accommodated scheduling permit to schedule a new appointment with the approved accommodations.  

If you are taking Steps 1 & 2 and your medical school is in the US or Canada, you should contact Customer Services and Resource Center. Telephone: (215) 590-9700, Fax: (215) 590-9460, or E-mail: usmlereg@nbme.org   

If you are taking Steps 1 & 2 and your medical school is outside of the US or Canada, you should contact ECFMG. Telephone: (215) 386-5900, or E-mail: info@ecfmg.org

If you are taking Step 3 and you are a graduate with an MD or DO degree, you should contact the FSMB. 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. 

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 medical emergency, you may get up and leave the secure testing area as needed. Please note that the clock will continue to run for the duration of the session and cannot be stopped and restarted.

Circumstances and needs change. If you feel accommodations are necessary for you to access the USMLE, please review the guidelines and submit a request for accommodations.

If your eligibility period has begun while your accommodation request is being processed and you have questions or concerns about whether you will be able to test within your eligibility period, please contact your Disability Services Specialist for more specific information regarding your eligibility period.