New Rules on Repeating USMLE Examinations: Time between Examination Attempts

The USMLE Program sets rules on how quickly examinees can repeat the same Step or Step Component. These rules will change for exam applications submitted on or after January 1, 2012.

For exam applications submitted before January 1, 2012, the current rules apply. The current rules are:

  • For the computer-based examinations (Step 1, Step 2 CK, and Step 3), you may take the examination no more than four times within a 12-month period.
  • For Step 2 CS, you may take the examination no more than three times within a 12-month period.

For exam applications submitted on or after January 1, 2012, the following rules apply to all Steps and Step Components. You may take the same examination no more than three times within a 12-month period. Your fourth and subsequent attempts 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. Attempts at that examination (complete and incomplete) prior to January 1, 2012 will be counted in determining whether these rules apply.

When you reapply, your exam eligibility period will be adjusted, if necessary, to comply with these rules.

Example: An examinee takes and fails her first attempt at Step 1 on January 15, 2011, her second attempt at Step 1 on April 15, 2011, and her third attempt at Step 1 on September 15, 2011. In January 2012, the examinee submits an application for a fourth attempt at Step 1, requesting the March-April-May eligibility period. The earliest date that is both 12 months after her first attempt on January 15, 2011 and six months after her most recent attempt on September 15, 2011 is March 15, 2012. Since the March-April-May eligibility period requested by the applicant begins before this date, the applicant is assigned the next eligibility period that begins after March 15, 2012, April-May-June.

USE CAUTION IN SELECTING REVIEW COURSES: Orientation, Practice, and Self-Assessment Materials Available through USMLE, NBME, and Third Parties

The United States Medical Licensing Examination® (USMLE®) program recognizes the importance of providing all examinees the opportunity to learn about the design and content of its examinations and to have some exposure, before examination day, to samples of testing formats and materials. USMLE provides orientation and practice materials for all USMLE Steps and Step Components. These materials, which are available at no cost on the USMLE website, include:

  • Informational materials on the overall USMLE program and content descriptions for each of the USMLE examinations,
  • Tutorials that illustrate the USMLE Step 1, Step 2 Clinical Knowledge (CK), Step 3 multiple-choice question software and the Step 3 computer-based case simulation (Primum® CCS) software,
  • Sample multiple-choice test questions with answer keys for each Step,
  • Sample Step 3 Primum cases with feedback, and
  • Orientation materials for Step 2 Clinical Skills (CS).

In addition, the National Board of Medical Examiners® (NBME®) provides, for a fee, self-assessment services to help the examinee evaluate his or her readiness to take USMLE. These services help individuals become familiar with questions like those that have appeared on USMLE and provide performance feedback on the individual’s areas of relative strength and weakness. See to obtain additional information and to purchase self-assessment services.

Beyond these USMLE and NBME services, there are a variety of commercial test preparation materials and courses that claim to prepare examinees for USMLE examinations. Examinees who are considering using such services should fully understand the nature of these services, the sources of any content being used, and the basis for any claims being made. None of these third-party materials or courses are affiliated with or sanctioned by the USMLE program and information on such materials and courses is not available from the Educational Commission for Foreign Medical Graduates (ECFMG), the Federation of State Medical Boards (FSMB), NBME, USMLE Secretariat, or medical licensing authorities.

Please note that it is unlawful for any test preparation program or any individual to use, disclose, distribute, or provide access to questions or answers from actual USMLE exams. An examinee who is involved with any enterprise that disseminates USMLE content should be aware of the consequences, which include the possible cancellation of USMLE registration and/or testing, the withholding or cancellation of scores, and the imposition of additional sanctions.

Step 2 CS Examinees Will Be Required to Type Patient Notes on a Computer Beginning July 17, 2011

As of July 17, 2011, all examinees taking the Step 2 Clinical Skills (CS) examination will be required to type the patient note. Examinees will not be permitted to handwrite the note unless technical difficulties make the patient note typing program unavailable. A simulation of the computerized patient note program, which examinees may use to practice typing the patient note, is available on the USMLE website.

View full announcement.

(posted March 24, 2010; updated January 20, 2011, April 19, 2011)

Comprehensive Review of USMLE (CRU): March 2011 Update

Updated information on the Comprehensive Review of USMLE (CRU) is available. Access the March 2011 update on the USMLE website.

CRU was initiated in 2004. The goal of this review was to determine whether the mission and purpose of USMLE are effectively and efficiently supported by the current design, structure, and format of the USMLE. This review resulted in recommendations for changes. In 2009, the proposed changes were approved by the USMLE parent organizations, the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards of the United States, Inc. (FSMB). Research, planning, and implementation of the changes have begun.

Changes resulting from CRU are planned for all USMLE Steps and Step Components. These changes may affect both content and item formats. As changes are implemented, the orientation and practice materials available on the USMLE website at may be updated to reflect these changes.

If you plan to take USMLE examinations, you should monitor the USMLE and ECFMG websites for the latest information on changes related to CRU. Comprehensive information on CRU is available on the USMLE website at

(posted June 30, 2010; updated April 1, 2011, October 20, 2011)

NBME® Self-Assessments with Expanded Feedback

The National Board of Medical Examiners® (NBME) offers web-based self-assessments to help medical students and graduates evaluate their readiness for the computer-based components of the United States Medical Licensing Examination (USMLE). The content of the Comprehensive Basic Science Self-Assessment (CBSSA) resembles the content of USMLE Step 1, while the content of the Comprehensive Clinical Science Self-Assessment (CCSSA) resembles the content of USMLE Step 2 Clinical Knowledge (CK).

The NBME is pleased to announce that it now provides expanded feedback for four forms of the CBSSA and one form of the CCSSA. In addition to the performance profile and score interpretation guide available with all forms, the expanded feedback also shows the number of items answered incorrectly by content category, the average amount of time spent on each incorrect item, and the percentage of incorrect items marked during the assessment. The feedback also provides the capability to review the text of the incorrect items. The fee for expanded feedback forms is $60.00; the fee for standard forms is $50.00.

For complete information, to view a sample assessment, or to purchase an assessment, visit the NBME Self-Assessment Services website.

(posted October 20, 2009; updated September 15, 2011)