IMPORTANT
You must become familiar with the information referenced in this Bulletin if you are an applicant with an eligibility
period in 2018. If your eligibility period extends into 2019 and you test in 2019, you must become familiar with and
will be subject to the policies and procedures detailed in the 2019 Bulletin of Information (BOI). If changes in the
USMLE program occur after the release of this BOI, they will be effective when posted on the
USMLE website
. You
are responsible for checking the
USMLE website
for updates and changes to the USMLE policies and procedures.
IMPORTANT
If you are a student or graduate of a medical school outside the US or Canada with an eligibility period in 2018, in
addition to becoming familiar with this BOI, you must also be familiar with the contents of the 2018 Information
Booklet published by the ECFMG. If your eligibility period extends into 2019 and you test in 2019, you must become
familiar with and will be subject to the policies and procedures detailed in the ECFMG 2019 Information Booklet. The
ECFMG Information Booklet is available on the
ECFMG website
. Students and graduates of medical schools outside
the US and Canada are responsible for monitoring the
ECFMG website
to ensure they understand current ECFMG
policies and procedures, including any changes.
Copyright © 2017 by the Federation of State Medical Boards of the United States, Inc. (FSMB) and the National
Board of Medical Examiners® (NBME®). All rights reserved.
The United States Medical Licensing Examination® (USMLE®) is a joint program of the FSMB and the NBME.
www.usmle.org
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2018 Bulletin of Information
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2018 Bulletin of Information
ELIGIBILITY FOR THE USMLE
CHANGE IN ELIGIBILITY STATUS
If your eligibility for a Step or Step Component changes after you submit your application but before your
scheduled test date(s), you must notify your registration entity promptly. Failure to notify your registration
entity that you may no longer be eligible to take the examination may result in a finding of irregular behavior. If
you take a Step or Step Component for which you are not eligible, results for that examination may not be
reported or, if previously reported, may be canceled.
GRADUATES FROM UNACCREDITED MEDICAL SCHOOLS IN THE US OR CANADA
If you graduated from an unaccredited medical school in the US or Canada and are eligible for initial licensure by a
US medical licensing authority, you may take the USMLE only upon specific request by that medical licensing
authority. The medical licensing authority should submit the request to sponsor you to the
USMLE Secretariat
in
advance of your application for each Step.
SEQUENCE OF STEPS
If you meet the eligibility requirements, you may take Step 1, Step 2 CK, and Step 2 CS in any sequence. You may
take Step 3 only after passing Step 1, Step 2 CK, and Step 2 CS.
NUMBER OF ATTEMPTS AND TIME LIMITS
The USMLE program limits to six the total number of times an examinee can take the same Step or Step
Component. An examinee is ineligible to take a Step or Step Component after six or more prior attempts to pass
that Step or Step Component, including incomplete attempts. All attempts at a Step or Step Component are
counted toward the limit, regardless of when the examinations were taken.
Information regarding state-specific requirements for licensure can be obtained on the
FSMB website
. Note:
MD/PhD students should reference the
USMLE website
for more specific information regarding exceptions to time
limits.
RETAKING FAILED EXAMINATIONS
You may not take the same Step or Step Component 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 examination and at least
six months after your most recent attempt at that examination.
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2018 Bulletin of Information
ELIGIBILITY FOR THE USMLE
RETAKING PREVIOUSLY PASSED STEPS
If you pass a Step or Step Component, you are not allowed to retake it, except to comply with the time limit of a
medical licensing authority or another authority recognized by the USMLE program. Visit the
USMLE website
for
more information. If you have not yet passed Step 3 and need to retake a previously passed Step 1 or Step 2
examination in order to meet a time limit imposed by a US medical licensing authority or another authority
recognized by the USMLE program, you should understand that if you fail a retake, you will no longer be eligible to
take Step 3. In order to meet the examination requirements for Step 3 eligibility, you must have achieved a
passing performance on the most recent administration of the examinations intended to meet those
requirements.
PREVIOUSLY LICENSED PHYSICIANS
If you have already been granted a license by a US medical licensing authority based on previous licensure
examinations, such as the Federation Licensing Examination (FLEX) or the NBME certifying examinations, you
are not eligible to take the USMLE.
▫ Passport
▫ Driver’s license with photograph
▫ National Identity Card
▫ Other form of dated, unexpired, government-issued identification
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2018 Bulletin of Information
EXAMINATION DAY AND TESTING
PERSONAL BELONGINGS – WHAT YOU CAN BRING INTO THE TESTING ROOM
Personal items are prohibited in the secure areas of the testing center. For computer-based examinations (Step 1,
Step 2 CK, and Step 3), the only items you are allowed to bring into the testing room are soft-foam earplugs
without strings. Earplugs must be removed from the packaging and be ready for inspection by test center staff
during check-in and must also remain at your workstation during all breaks. Visit the
USMLE website
for more
information.
For Step 2 CS, the entire test center, including the orientation room and the restrooms, is considered a
secure testing area. The only items you are allowed to bring into the secure testing area are your white
lab coat (pockets must be empty) and your personal stethoscope (there is a limited supply at the test
center). All other equipment, including pens, gloves, writing paper, and other medical equipment, is
provided by the test center. Visit the
USMLE website
for more information regarding the Step 2
CS examination experience and test center regulations.
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 or in the designated storage area for Step 2 CS; electronic devices must be
turned off. All personal items are subject to inspection.
ADMISSION TO THE TEST
Check-in Procedures
Step 1, Step 2 CK, Step 3
You should arrive at the test center approximately 30 minutes prior to your scheduled testing appointment. If
you arrive after your appointment time, you may not be admitted. If you arrive more than 30 minutes after
your scheduled testing appointment, you will not be admitted and must pay a
fee
to reschedule your
test. Your rescheduled test date(s) must fall within your eligibility period.
Step 2 CS
You should arrive at the test center at the time listed on the confirmation notice you will have printed
after scheduling your appointment. There will be an onsite orientation to demonstrate the equipment available
for you to use in the examination rooms and to review examination rules and procedures. If you arrive during
the onsite orientation, you may be allowed to test after signing a Late Admission Form. If you arrive after
the onsite orientation, you will not be allowed to test and must pay a
fee
to reschedule your test.
All Steps
When you arrive at the test center, you must present a paper or electronic copy of your scheduling permit and
the required identification as described on your scheduling permit. Acceptable forms of unexpired
identification include:
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2018 Bulletin of Information
EXAMINATION DAY AND TESTING
Your name, as it appears on your scheduling permit, must exactly match the name on your form(s) of
identification. Your identification must contain both your signature and a recent photograph. Please review your
scheduling permit for details and limited exceptions. If the name listed on your scheduling permit is not correct,
contact your registration entity immediately.
If you do not bring your scheduling permit on paper or electronically (e.g., via smartphone) and acceptable
identification on each day of your exam, you will not be admitted to the test and will be required to pay a
fee
to
reschedule your test. Your rescheduled test date(s) must fall within your eligibility period.
Security Procedures
For Step 1, Step 2 CK, and Step 3 ONLY
During check-in, test center staff will scan you with a metal detector (handheld or walk-through) and ask you to
empty and turn your pockets inside out before entering the testing room to confirm that you have no prohibited
items. You will be asked to repeat this process each time you return to the testing room after a break. Additionally,
your photo ID and fingerprint may be scanned electronically and you must sign the test center log each time you
enter or exit the test room.
Before you enter the test room, test center staff will give you laminated writing surfaces and markers to use for
making notes and/or calculations during the testing session. You will be instructed to write your name and CIN, as
shown on your scheduling permit, on one of the laminated writing surfaces provided. 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. If you have filled the laminated writing surfaces and need additional space for
making notes, raise your hand to ask test center staff for a replacement. You must return laminated writing
surfaces to test center staff at the end of the testing session. Do NOT write on anything other than the laminated
writing surface (e.g., your hand, other body part, tissue, etc.). Failure to comply may result in a finding of
irregular behavior.
Test center staff will escort you to your assigned testing station and provide brief instructions on use of the
computer equipment. You must enter your CIN to start the examination. A brief tutorial is available before each
examination. It is important that you run the sound check for the audio headphones either before the
examination begins or during the tutorial, so that problems can be resolved before you start the examination.
For Step 2 CS ONLY
During check-in, in addition to having your photo ID scanned electronically, you will be asked to place your
personal belongings (e.g., pens, study materials, cell phones, etc.) in small bins, which are inaccessible for the
duration of the examination day. Any personal belongings that you may need during breaks or during the
examination, including your lab coat and stethoscope, can be placed at your seat in the orientation room.
Please note that every area of the testing center is under video surveillance at all times; examinees are escorted by
proctors at all times, with the exception of restroom breaks.
All Steps
There are no facilities available for family and friends to wait at the center while you test; plan to meet them
elsewhere after the examination ends. All examinees will be required to remove eyeglasses for close visual
inspection by the test center administrator. These inspections will take a few seconds and will be done at check-
in and upon return from breaks. Jewelry, except for wedding and engagement rings, is prohibited. Hair
accessories are subject to inspection. You should not wear ornate clips, combs, barrettes, headbands, or other
hair accessories.
BREAK TIME
Step 1, Step 2 CK, and Step 3
Your test session is scheduled for a fixed amount of time and the computer keeps track of the time allocated
for each block and for breaks. At the start of the testing session, you have a total of 45 minutes of break time
for authorized breaks and for computer transitions between blocks. Authorized breaks include any time you
spend between test blocks, whether you remain at your seat or leave the testing room. If you complete the
tutorial or other testing blocks early, the remaining time will be added to your total break time.
Once you begin a testing block, you may not leave the room (except in the event of an emergency). If you leave
the room for a personal emergency and you are not on an authorized break, the block and daytime clocks
will continue to run and the test center will report the incident to the USMLE program. Additionally, the
unauthorized break screen, described in the examination tutorial, will appear on the monitor after a
defined period of inactivity. After the unauthorized break screen appears, you will need to enter your CIN
to continue with the examination. Each time you leave the testing room, you are required to sign out and sign
in when you return. You must present your identification each time you sign in.
If you exceed your allocated or accumulated break time, the excess will be deducted from your total testing time.
Use the time summary feature (explained in the tutorial on test day) to keep track of your time.
Step 2 CS
Your Step 2 CS administration will include 12 patient encounters. The examination session lasts approximately
eight hours. Examinees get a minimum of 45 minutes of break time, which includes a 30-minute lunch
period. During lunch, a light meal will be served. The test center is unable to accommodate special meal
requests. However, you may bring your own food, provided that no refrigeration is required. The frequency
and length of breaks, other than the lunch break, will vary slightly by testing center. Smoking is prohibited
throughout the centers.
STARTING AND COMPLETING THE TEST
Step 1, Step 2 CK, and Step 3
After you start taking an examination, you cannot cancel or reschedule that examination. 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, without loss of time.
The test session ends when you have started and exited all blocks or the total test time expires. You will receive a
notice during checkout that you have appeared for the test. If your test is scheduled for multiple days, be sure to
bring a copy of your permit with you each day or you may not be permitted to test.
In the rare event that a technical problem occurs that does not permit you to complete your examination, please
send a written description of the incident to Test Administration Services at the NBME.
Test Administration
Services
must receive your notice within 10 days of your testing date or it may not be possible to fully investigate
your concerns. Your correspondence should include your name, your USMLE ID number, the examination name
(Step 1, 2 CK, 2 CS, or 3), date of administration, and a message with a detailed description of the difficulty
experienced. Please allow at least 15 business days for your report to be investigated and evaluated. You will
receive written notification of the investigation results.
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2018 Bulletin of Information
EXAMINATION DAY AND TESTING
EXAMINATION DAY AND TESTING
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2018 Bulletin of Information
EXAMINATION DAY AND TESTING
If you start the examination but do not complete it for reasons other than a technical problem or expiration of
time, you should promptly write to
Test Administration Services
explaining, in detail, the reasons you decided not
to finish the examination. The attempt may appear as an “incomplete” on your USMLE transcript.
For more information on how to report a test administration problem, visit the
USMLE website
.
Step 2 CS
Once you enter the secure area of the test center, which includes the orientation area, you may not leave the area
until the examination has been completed. All examinees taking the Step 2 CS examination are required to type
the patient note portion of the exam. You are only permitted to handwrite your patient note if you were
approved to receive an accommodation for a disability, or if technical difficulties occur that make the patient
note-typing program unavailable.
You may not discuss the cases with anyone, including other examinees, at any time (before, during, or after
your examination). All conversation at the testing center among examinees must be in English.
IMPORTANT
The USMLE program may prohibit an examinee from completing the exam and/or may impose conditions on
retesting if the examinee appears to represent a health or safety risk to the standardized patients or test center
staff. Such circumstances include, but are not limited to, an examinee performing careless or hazardous acts
during the physical examination, exhibiting signs of illness (e.g., persistent coughing or sneezing) during the
examination, or showing visibly open skin lesions or active bleeding.
If you do not feel well on the day of your test, we strongly encourage you to consider rescheduling
your examination. If you become ill during your exam, inform a proctor promptly
.
IMPORTANT
The USMLE makes every effort to ensure that your registration information is properly processed and that the
Step examinations are properly prepared, administered, and scored. In the unlikely event that an error occurs in
the preparation, processing, administration, or scoring of your USMLE examination or in the reporting of your
USMLE scores, the USMLE will make reasonable efforts to correct the error, if possible, or permit you either to
retest at no additional fee or to receive a refund of the examination fee. These are the exclusive remedies
available to examinees for errors in the registration process; in preparing, processing, or administering exams; or
in determining or reporting scores.
REGISTRATION
ENTITY
TO REQUEST A SCORE RECHECK, VISIT:
NBME
http://examinee.nbme.org/interactive
ECFMG
http://www.ecfmg.org/forms/steprchk.pdf
FSMB
http://www.fsmb.org/licensure/usmle-step-3/cost-and-fees
For Step 1, Step 2 CK, and Step 3, when a request for a score recheck is received, the original response record is
retrieved and rescored using a system that is outside of the normal processing routine. The rechecked score is
then compared with the original score.
For Step 2 CS, the ratings received from the standardized patients and from the Physician Note raters are
retrieved, resummed, and reconverted into final scores to verify the accuracy of the original outcome. Encounters
and patient notes are not re-rated and videos are not rereviewed during the recheck.
SCORE VALIDITY
The performance of examinees is monitored and may be analyzed to detect aberrancies that raise questions about
the validity of scores. The USMLE program reserves the right to cancel scores that are at or above the passing level
if the USMLE program has a good faith basis for questioning whether they represent a valid measure of knowledge
or competence as sampled by the examination. Questions about score validity may result from irregular behavior
(please refer to the Irregular Behavior section of this BOI on pages 24-25) or other factors. If there are questions
related to the validity of your score, your score report may be delayed, or any further reporting or verification of
such scores may be withheld, pending completion of further review and/or investigation. You will have an
opportunity to provide information that you consider relevant.
After review and analysis of all available information, scores will either be classified as valid and will be reported,
or scores will be canceled and will not appear on your record. If scores are canceled, you will be advised of the
options for retaking the examination. Anyone who has received a report of scores that are later canceled will be
notified.
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2018 Bulletin of Information
SCORING AND SCORE REPORTING
For Step 2 CS, if you leave the test early or otherwise fail to carry out one or more of the cases, your performance
may be assessed on those cases you completed. If, based on the performance of the completed cases, a pass/fail
determination cannot be made, the attempt may be recorded as an incomplete on your USMLE transcript.
To avoid misinterpretation and to protect your privacy, the USMLE program does not provide scores or outcomes by
telephone, e-mail, or fax to anyone. Additionally, the scoring process is not expedited or accelerated for any
individual or group.
SCORE RECHECKS
For all Steps and Step Components, a change in your score or in your pass/fail outcome based on a recheck is an
extremely remote possibility. A rigorous process is used, including a double scoring method involving independent
scoring systems, to ensure accurate results; to date, the score recheck process has not resulted in a score change.
However, a recheck will be performed if you submit a written request and service fee to your registration entity.
Your registration entity must receive the request no later than 90 days after your result was released to you.
ANOMALOUS PERFORMANCE
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. Do not
test if you are not able or not ready on your scheduled test date.
IMPORTANT
You must pass all three subcomponents of Step 2 CS (ICE, CIS, SEP) in a single administration to obtain the
overall designation of passing on Step 2 CS.
IMPORTANT
Taking a Step examination to familiarize yourself with the examination format, or for any reason other than to
pass, is prohibited and may limit your future access to the USMLE.
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2018 Bulletin of Information
SCORING AND SCORE REPORTING
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2018 Bulletin of Information
IRREGULAR BEHAVIOR
IRREGULAR BEHAVIOR – INVESTIGATION PROCESS
If the USMLE program receives information suggesting that an individual has engaged in irregular behavior
the USMLE program will conduct an investigation. During this time, anyone alleged to have engaged in such
activity will be prohibited from registering for additional exams; previously unreleased scores, if any, may be
withheld; and pending examination appointments will be canceled. If the evidence suggests that the alleged
irregular behavior affects score validity, the score will also be reviewed as described in the Scoring and Score
Reporting section of this BOI (pages 21-23).
If you are the subject of a USMLE investigation, you will be advised of the matter and will have an opportunity
to provide information that you consider relevant. Individuals who are the subject of an investigation
must cooperate fully with the investigation, including providing all requested documentation and answering
truthfully all questions posed during investigative interviews conducted on behalf of the USMLE program. If
requested, individuals who are the subject of our investigation shall provide a signed release authorizing the
USMLE program to obtain information and records from educational institutions and other third parties. Failing
to cooperate with an investigation or providing misleading or untruthful information in the course of an
investigation will constitute irregular behavior that may be the basis of separate proceedings or other actions
by the USMLE program.
If it is determined that you engaged in irregular behavior, information regarding this determination will become
part of your permanent USMLE history. Your score report (if applicable) and USMLE transcript will contain a
notation of the finding of irregular behavior. The USMLE program will provide information about
the irregular behavior to third parties that receive or have received your USMLE transcript and may also
report to other legitimately interested entities, as determined by the USMLE program. You may be barred
from taking future examinations and/or special administrative procedures or conditions may be
implemented for your future examinations. The USMLE program also reserves the right to take such
action when information regarding irregular behavior on predecessor examinations suggests that
such actions may be appropriate to ensure the security of the USMLE.
COMMUNICATING WITH THE USMLE PROGRAM
APPLICATION AND REGISTRATION INQUIRIES
Contact the appropriate registration entity (see below) for information on how to apply for the USMLE, obtain
application materials, and receive information on the status of your application and scheduling permit.
EXAMINATION
TYPE OF APPLICANT
REGISTRATION ENTITY AND
CONTACT
STEPS 1, 2 CK, AND 2 CS
Students and graduates of medical
school programs in the US or Canada
accredited by the LCME or students
and graduates of medical schools in
the US accredited by the AOA
NBME
3750 Market Street
Philadelphia, PA 19104-3102
Website:
http://www.nbme.org
Telephone: (215) 590-9700
Fax: (215) 590-9460
E-mail:
webmail@nbme.org
STEPS 1, 2 CK, AND 2 CS
Students and graduates of medical
schools outside the US and Canada
ECFMG
3624 Market Street
Philadelphia, PA 19104-2685
Website:
http://www.ecfmg.org
Telephone: (215) 386-5900
Fax: (215) 386-9196
E-mail:
info@ecfmg.org
STEP 3
All medical school graduates who
have passed Step 1 and Step 2 (CK
and CS)
FSMB
Assessment Services
400 Fuller Wiser Road
Euless, TX 76039-3856
Website:
http://www.fsmb.org
Telephone: (817) 868-4041
Fax: (817) 868-4098
E-mail:
usmle@fsmb.org
SCHEDULING AND TEST CENTER INQUIRIES
For Steps 1, 2 CK, and 3, your scheduling permit includes instructions on how to contact
Prometric
to schedule
your appointment to test. Inquiries about your appointment, such as a request to reschedule an appointment
within your eligibility period, must be directed to Prometric. Visit the
Prometric website
for information on test
center locations.
To schedule an appointment for Step 2 CS, follow the instructions provided on your scheduling permit. To check
test center availability and to schedule or reschedule an appointment, visit the
USMLE website
.
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2018 Bulletin of Information
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2018 Bulletin of Information
COMMUNICATING WITH THE USMLE PROGRAM
If you receive a scheduling permit but experience a problem scheduling your appointment that
Prometric
or
CSEC scheduling staff are unable to resolve, you may contact your registration entity.
TEST ADMINISTRATION INQUIRIES
For questions and concerns about your administration, contact the NBME Test Administration office.
Attention: Test Administration
National Board of Medical Examiners
3750 Market Street
Philadelphia, PA 19104-3102
Telephone: (215) 590-9700
Fax: (215) 590-9457
E-mail:
testadmin@nbme.org
SECURITY CONCERNS
USMLE encourages you to provide information about cheating and other activities of which you are aware that
may compromise the security and integrity of the USMLE. Please visit the
USMLE website
to report such
information.
GENERAL INQUIRIES
Complete information about the USMLE is available on the USMLE website. General inquiries regarding the
USMLE or inquiries for the USMLE Secretariat may be directed to:
Attention: USMLE Secretariat
3750 Market Street
Philadelphia, PA 19104-3102
Telephone: (215) 590-9700
E-mail:
webmail@nbme.org
LIST OF ABBREVIATIONS
ACM
Advanced Clinical Medicine
ADA
Americans with Disabilities Act
AOA
American Osteopathic Association
CCS
Computer-based Case Simulations
CIN
Candidate Identification Number
CK
Clinical Knowledge
CS
Clinical Skills
CSEC
Clinical Skills Evaluation Collaboration
ECFMG
Educational Commission for Foreign Medical Graduates
FLEX
Federation Licensing Examination
FSMB
Federation of State Medical Boards
FIP
Foundations of Independent Practice
LCME
Liaison Committee on Medical Education
NBME
National Board of Medical Examiners
PIE
Personal Item Exception
USMLE
United States Medical Licensing Examination
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2018 Bulletin of Information
Document Outline - OVERVIEW
- ELIGIBILITY FOR THE USMLE
- APPLYING FOR THE TEST AND SCHEDULING YOUR TEST DATE
- EXAMINATION DAY AND TESTING
- SCORING AND SCORE REPORTING
- IRREGULAR BEHAVIOR
- COMMUNICATING WITH THE USMLE PROGRAM
- Blank Page
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