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 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.

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.

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)

Delay in USMLE Step 1 Score Reporting

Most score reporting of Step 1 results occurs within four weeks of testing. However, because of necessary modifications to the test item pool, there will be a delay in reporting for some examinees testing beginning in mid-May 2011. The target date for reporting Step 1 scores for most examinees testing from May 17 through late June will be Wednesday, July 13, 2011.

Examinees should monitor the USMLE website for the latest information.

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)