New Attempt Limit for USMLE Examinations

The USMLE program is introducing a limit on the total number of times an examinee can take the same Step or Step Component. When this limit takes effect, an examinee will be ineligible to take a Step or Step Component if the examinee has made six or more prior attempts to pass that Step or Step Component, including incomplete attempts.

The effective date for the six-attempt limit depends upon whether an examinee has taken any Step or Step Component (including incomplete attempts) before January 1, 2012.

Examinees Who Have NOT Taken Any Step Or Step Component Before January 1, 2012
If you have not taken any Step or Step Component before January 1, 2012, the six-attempt limit will go into effect for all exam applications that you submit on or after January 1, 2012.

Example 1: On January 15, 2012, Examinee A submits his application for his first attempt at any Step or Step Component. The six-attempt limit will be effective at that time for all Steps and Step Components and Examinee A will be allowed to take each Step or Step Component no more than six times, including incomplete attempts.

Examinees Who Have Taken Any Step Or Step Component Before January 1, 2012
If you have taken any Step or Step Component (including incomplete attempts) before January 1, 2012, the six-attempt limit will go into effect for all exam applications that you submit on or after January 1, 2013.  Beginning on that date, all attempts at a Step or Step Component will be counted toward the limit, regardless of when the exams were taken.

Example 2: Examinee B’s application for a seventh attempt at a particular Step or Step Component is received on December 15, 2012. For this examinee, the six-attempt limit will not prevent the seventh attempt, since the application was submitted before January 1, 2013.  However, if Examinee B fails the exam, he will not be eligible to submit an application on or after January 1, 2013 to retake that Step or Step Component.

Example 3: Examinee C attempts to submit an application for a seventh attempt at a particular Step or Step Component on or after January 1, 2013. The application will not be processed, since all exam applications submitted on or after January 1, 2013 will be subject to the six-attempt limit.

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 www.nbme.org 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.

Change in Number of Items / Delay in Score Reporting for Step 2 CK

Starting on or around August 3, a transition period will begin in which the number of items in current forms of the Step 2 CK examination will change from 352 items to 346 items. Because of this change, as well as routine modifications to the test item pool, there will be a delay in score reporting for most Step 2 CK examinations administered from August 3 through mid-September.

View full announcement.

Changes to USMLE Procedures for Reporting Scores

Starting July 1, 2011, USMLE transcripts reported through the ERAS reporting system will no longer include score results on the two-digit score scale. USMLE results will continue to be reported on the three-digit scale. This affects the Step 1, 2 CK, and 3 examinations only; Step 2 CS will continue to be reported as pass or fail. These changes do not alter the score required to pass or the difficulty of any of the USMLE Step examinations.

Since its beginning in the 1990s, the USMLE program has reported two numeric scores for the Step 1, Step 2 CK, and Step 3 examinations, one on a three-digit scale and one on a two-digit scale. The three-digit score scale is considered the primary reporting scale; it is developed in a manner that allows reasonable comparisons across time. The two-digit scale is intended to meet statutory requirements of some state medical boards that rely on a score scale that has 75 as the minimum passing score. The process used to convert three-digit scores to two-digit scores is designed in such a way that the three-digit minimum passing score in effect when the examinee tests is associated with a two-digit score of 75.

The USMLE program requires its governing committees to reevaluate the minimum passing score every three to four years. This process has, at times, resulted in changes in the minimum passing score, expressed on the three-digit scale, and an accompanying change in the score conversion process, to ensure that a two-digit score of 75 is associated with the new minimum passing requirement. A by-product of the adjustment of the score conversion system over time has been a shift in the relationship between the two score scales. This shift has no impact for USMLE score users who use the three-digit scoring scale or for those using the two-digit scale with a primary interest in whether the examinee has a passing two-digit score of at least 75. However, it may create challenges in interpretation for score users who are focusing on two-digit scores, other than 75, and are doing so for purposes of comparing USMLE scores that span several years.

To simplify matters and make interpretation of USMLE information more convenient for score users, the USMLE Composite Committee has asked staff to report two-digit scores only to those score users for whom the scale is intended, i.e., the state medical boards. The Committee also asked that examinees continue to receive scores on both scales so that they are fully informed about the information that will be reported when they ask that results be sent to a state medical board. When examinees request that their results be sent to other score users, only the three-digit score will be reported. Current plans call for these changes to begin with the elimination of the two-digit score from USMLE transcripts reported through the ERAS reporting system starting July 1, 2011. Other systems and procedures for reporting results will be similarly modified as soon as possible after the July 1, 2011 date.

UPDATE: New Fees for Changing Appointments at Prometric Test Centers Effective January 1, 2011

Effective January 1, 2011, Prometric will charge a fee if USMLE examinees change testing appointments (e.g., reschedule, cancel, change test center location) at Prometric Test Centers thirty or fewer days before their scheduled test date. No fee is charged for changing testing appointments 31 or more days prior to the first day of the scheduled test.

The date that you change your appointment, using local time at the Regional Registration Center for the Prometric Testing Region, will determine whether you pay a fee and the amount of this fee:

  • If you change your appointment 31 or more days before (but not including) the first day of your scheduled test date, there is no fee.
  • If you change your appointment fewer than 31 days but more than 5 days before (but not including) the first day of your scheduled test date, there is a $50 fee.
  • If you change your appointment 5 or fewer days before (but not including) the first day of your scheduled test date, there is a higher fee. This fee varies by Prometric Testing Region and by exam.

For complete information and a schedule of fees, visit the USMLE website.

This policy applies only to appointments for USMLE Step 1, Step 2 Clinical Knowledge (CK), and Step 3. For information on the fees associated with changing testing appointments for Step 2 Clinical Skills (CS), refer to Rescheduling in the ECFMG Information Booklet.

(posted December 22, 2010; updated December 29, 2010)

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)

On-line Posting or Discussion of USMLE Content Constitutes Irregular Behavior

If you post or discuss United States Medical Licensing Examination (USMLE) examination content via the Internet, you will be in violation of the USMLE Rules of Conduct, as outlined in the USMLE Bulletin of Information. Examination content includes, but may not be limited to, questions, case content, and answers.

The Bulletin specifically advises that, “you will maintain the confidentiality of the materials, including the multiple-choice items, and the case content for Step 2 CS and Primum CCS. You will not reproduce or attempt to reproduce examination materials through memorization or any other means. Also, you will not provide information relating to examination content that may give or attempt to give unfair advantage to individuals who may be taking the examination. This includes postings regarding examination content and/or answers on the Internet.”

The USMLE program continuously monitors Internet forums and chat rooms. Examinees who post information about examination content are identified and referred to the USMLE Committee on Irregular Behavior. If the Committee finds that you posted examination content, your scores may be delayed and you may be subject to the following sanctions:

  • Permanent annotation of your USMLE transcript (such annotations will read “Irregular Behavior/Security Violation” and will be seen by any entity that receives your transcript, i.e., residency training programs, state licensing authorities, etc.);
  • A report to the Federation of State Medical Boards Board Action Databank (a central repository for formal actions taken against physicians and available to licensing and disciplinary boards, the military, governmental and private agencies, and organizations involved in the employment and/or credentialing of physicians);
  • A bar from taking future administrations of USMLE.

A determination of irregular behavior can put your medical career in jeopardy. Do not endanger your career: Do not post information from exams you have taken and do not solicit others to provide such information.

For more information, refer to Testing Regulations and Rules of Conduct and Irregular Behavior in the USMLE Bulletin of Information, available on the USMLE website.

Reminder: Time Limit for Completing Examination Requirements for ECFMG Certification

ECFMG would like to remind applicants that they are required to pass those United States Medical Licensing Examination (USMLE) Steps and Step Components required for ECFMG Certification within a seven-year period. This means that once an applicant passes a Step or Step Component, the applicant will have seven years to pass the other Step(s) or Step Component(s) required for ECFMG Certification. (For complete information on the examination requirements for ECFMG Certification, see Examination Requirements in the ECFMG Information Booklet.)

This seven-year period begins on the exam date for the first Step or Step Component passed and ends exactly seven years from this exam date. If an applicant does not pass all required Steps and Step Components within a maximum of seven years, the applicant’s earliest USMLE passing performance will no longer be valid for ECFMG Certification.

EXAMPLE: An applicant took his first Step or Step Component on October 1, 2006 and passed. The applicant has through October 1, 2013 to take and pass all other Step(s) and Step Component(s) required for ECFMG Certification. If he does not take and pass all other required Step(s) and Step Component(s) on or before October 1, 2013, his passing performance on the October 1, 2006 exam would no longer be valid for ECFMG Certification.

This seven-year limit does not apply to the former ECFMG Clinical Skills Assessment (CSA) because the CSA was not a USMLE Step or Step Component. Applicants who satisfied the clinical skills requirement for ECFMG Certification by passing the CSA are required to pass only Step 1 and Step 2 Clinical Knowledge (CK) within a seven-year period for ECFMG Certification. For these applicants, the seven-year period begins on the exam date for the first USMLE Step or Step Component passed, regardless of when the CSA was passed.

On June 14, 2004, USMLE Step 2 Clinical Skills (CS) became a requirement for ECFMG Certification, replacing the ECFMG CSA as the exam that satisfies the clinical skills requirement. As part of the USMLE, Step 2 CS may be subject to the seven-year time limit for ECFMG Certification as described below:

  • If an applicant’s earliest USMLE passing performance that is valid for ECFMG Certification took place on or after June 14, 2004, the applicant is required to pass Step 1, Step 2 CK, and, if required for ECFMG Certification, Step 2 CS within a seven-year period for ECFMG Certification.
  • If an applicant’s earliest USMLE passing performance that is valid for ECFMG Certification took place before June 14, 2004, the applicant is required to pass only Step 1 and Step 2 CK within a seven-year period for ECFMG Certification; if required for ECFMG Certification, Step 2 CS can be passed outside the seven-year period.

The policies outlined above apply only to ECFMG Certification. The USMLE program recommends to U.S. state medical licensing authorities that they require applicants to pass the full USMLE sequence (including Step 3, which is not required for ECFMG Certification) within a seven-year period. See Time Limit and Number of Attempts Allowed to Complete All Steps and Retakes in the USMLE Bulletin of Information.

Many state medical licensing authorities accept the USMLE recommendation, but some do not. You should contact the Federation of State Medical Boards of the United States, Inc., (FSMB) for general information and the medical licensing authority of the jurisdiction where you plan to apply for licensure for definitive information, since licensure requirements vary among jurisdictions.

Additionally, applicants who retake a previously passed Step or Step Component to comply with a time limit should understand the implications for Step 3 eligibility of a failing attempt on a retake. See Official Performance of Record for Examinees Retaking a Previously Passed Step in the USMLE Bulletin of Information.