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.

Step 2 Clinical Skills (CS) Test Center in Chicago Temporarily Closed

UPDATE: The Step 2 Clinical Skills (CS) test center in Chicago reopened for all scheduled Step 2 CS examinations on August 15.

The Clinical Skills Evaluation Collaboration (CSEC) test center in Chicago sustained significant damage during a recent rainstorm and is currently closed. All Step 2 CS examinations scheduled at the Chicago test center through August 12 have been cancelled. Examinees scheduled to take the Step 2 CS exam at the Chicago test center July 25 through August 12 are being contacted via email. Please also monitor the USMLE website for updated information about when the Chicago test center will be re-opened.

View full announcement on the USMLE website.

(posted July 28, 2011; updated July 28, 2011, August 16, 2011)

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.

Reminder: IMGs Participating in 2012 Match Should Apply for Step 2 CS Now

International medical students/graduates and graduates of Fifth Pathway programs who plan to participate in the 2012 Main Residency Match (in March 2012) are reminded that they must take Step 2 Clinical Skills (CS) by December 31, 2011. As published in the 2011 Schedule for Reporting Step 2 CS Results, if you do not take Step 2 CS by December 31, 2011, your result will not be available in time to participate in the 2012 Match.

IMPORTANT NOTE: This deadline applies only to participation in the 2012 Main Residency Match. For updated information on deadlines to participate in the Supplemental Offer and Acceptance Program (SOAP), which is expected to replace the post-Match Scramble in 2012, monitor the NRMP website and the ECFMG website.

If you need to pass Step 2 CS to participate in the 2012 Match, you are strongly encouraged to apply for Step 2 CS now. If you do not register early and schedule a test date as soon as possible, you may not be able to obtain a test date in 2011.

At the time of this writing, the earliest available test date at any test center is in November 2011. It is expected that demand for testing appointments through December will be high. Additionally, test sessions at all test centers may be subject to scheduling restrictions that may limit the number of test dates available to you.

To maximize your chances of obtaining a test date in 2011,

  • Apply for Step 2 CS now, provided you meet the eligibility requirements.
  • Once registered, schedule your testing appointment as soon as possible.

Early registration and scheduling may offer a number of benefits. If you plan to apply for Step 2 CS, you should consider the following:

  • All Step 2 CS sessions are opened 12 months in advance.
  • Applicants registered for Step 2 CS can schedule and take the exam during the 12-month eligibility period that follows their registration. By registering early, applicants increase the likelihood they will be able to obtain a testing appointment for a preferred date/test center.
  • Applicants who schedule a testing appointment can change the testing appointment without cost, provided they give more than 14 days’ notice. See Rescheduling in the ECFMG Information Booklet.

Updated information on Step 2 CS scheduling will be posted to the ECFMG website as it becomes available. Individuals planning to take Step 2 CS should monitor the ECFMG and USMLE websites for the latest information.

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)

IMGs Participating in 2012 Match Should Apply for Step 2 CS Now

International medical students/graduates and graduates of Fifth Pathway programs who plan to participate in the 2012 Main Residency Match (in March 2012) are reminded that they must take Step 2 Clinical Skills (CS) by December 31, 2011. As published in the 2011 Schedule for Reporting Step 2 CS Results, if you do not take Step 2 CS by December 31, 2011, your result will not be available in time to participate in the 2012 Match.

IMPORTANT NOTE: This deadline applies only to participation in the 2012 Main Residency Match. For updated information on deadlines to participate in the Supplemental Offer and Acceptance Program (SOAP), which is expected to replace the post-Match Scramble in 2012, monitor the NRMP website and the ECFMG website.

If you need to pass Step 2 CS to participate in the 2012 Match, you are strongly encouraged to apply for Step 2 CS now. If you do not register early and schedule a test date as soon as possible, you may not be able to obtain a test date in 2011.

At the time of this writing, the earliest available test date at any test center is in March 2011. It is expected that demand for testing appointments in the period from June through December will be high. Additionally, test sessions at all test centers may be subject to scheduling restrictions that may limit the number of test dates available to you.

To maximize your chances of obtaining a test date in 2011,

  • Apply for Step 2 CS now, provided you meet the eligibility requirements.
  • Once registered, schedule your testing appointment as soon as possible. Scheduling conditions are expected to be most favorable from March through June.

Early registration and scheduling may offer a number of benefits. If you plan to apply for Step 2 CS, you should consider the following:

  • All Step 2 CS sessions are opened 12 months in advance.
  • Applicants registered for Step 2 CS can schedule and take the exam during the 12-month eligibility period that follows their registration. By registering early, applicants increase the likelihood they will be able to obtain a testing appointment for a preferred date/test center.
  • Applicants who schedule a testing appointment can change the testing appointment without cost, provided they give more than 14 days’ notice. See Rescheduling in the ECFMG Information Booklet.
  • Applicants who take Step 2 CS earlier in the year and receive a failing result are more likely to have the opportunity to retake the exam in 2011 and receive their result in time to participate in the 2012 Match.

Updated information on Step 2 CS scheduling will be posted to the ECFMG website as it becomes available. Individuals planning to take Step 2 CS should monitor the ECFMG and USMLE websites for the latest information.

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.

Step 2 CS Scheduling Restrictions

Demand for the Step 2 CS examination is expected to be heavy at all clinical skills evaluation centers at certain times throughout the year. The CS scheduling system is designed to handle the expected high volume, while maximizing the likelihood that most examinees can meet requirements and deadlines. This system also provides a representative mix of examinees at most testing sessions, which is helpful in maintaining a high quality assessment system both within and across test centers.

Spaces within test sessions may be allocated based on a variety of factors, including time of year, location of the test center and whether the examinee’s institution of undergraduate medical education is located within the US or Canada, or is an international medical school. These controls on spaces for each test session will remain in place until 60 days before the test date, at which time all testing spaces that have not been filled will be available to all registered applicants on a first come, first served basis. Scheduling patterns and demand will be monitored, and allotment of spaces may be changed as needed.

Applicants rescheduling into newly-available testing spaces will not be charged a rescheduling fee, provided they cancel existing testing appointments with more than 14 days’ notice. However, applicants who cancel with notice of 14 or fewer days will be charged a rescheduling fee of $150.

Scheduling Guidelines for Applicants

If you plan to take Step 2 CS, you should consider the following:

  • Applicants for Step 2 CS are encouraged to register and schedule their testing appointments as soon as possible.
  • Registered applicants are encouraged to schedule a testing appointment, even if they are uncertain that they will be able keep the testing appointment. You will be able to cancel an existing appointment without incurring a rescheduling fee, provided that you give more than 14 days’ notice.
  • Registered applicants can check which test dates are available to them at any time by accessing Step 2 CS Calendar and Scheduling from the website of their registration entity.

(posted December 21, 2004, updated February 16, 2005, March 18, 2005, December 1, 2006, March 3, 2006, December 7, 2006)

Step 2 CS Rescheduling Policy Allows Early Scheduling, Flexibility in Changing Testing Appointments

There are no Step 2 CS rescheduling fees for applicants who cancel scheduled testing appointments more than 14 days before the scheduled test date. Rescheduling fees do apply to applicants who cancel within 14 days of their scheduled test date and those who miss their scheduled test date without canceling.

This policy allows applicants registered for Step 2 CS to schedule their testing appointments early, while retaining the flexibility to reschedule at no cost, with a minimal period of notice. Applicants are strongly encouraged to register early and schedule testing appointments for the earliest possible date. If you have registered or plan to register for Step 2 CS, you should be familiar with the requirements and fees associated with rescheduling a Step 2 CS testing appointment.

  • If you cancel more than fourteen calendar days before (but not including) your scheduled test date, there is no fee to reschedule.
  • If you cancel during the fourteen-day period before (but not including) your scheduled test date, your fee will be $150 when you reschedule.
  • If you miss your scheduled testing appointment without canceling, your fee will be $400 when you reschedule.

Registered applicants can check which test dates are available to them at any time by accessing Step 2 CS Calendar and Scheduling. For complete information on Step 2 CS rescheduling policies, refer to Rescheduling in the ECFMG Information Booklet.

(posted June 22, 2005, updated December 1, 2005, March 28, 2006, December 7, 2006)