PassProfessor’s USMLE Step 1 practice program — 2,000 original five-option questions built on the content specifications USMLE publishes for Step 1. Step 2 CK and Step 3 are separate programs in the PassProfessor catalog — enrollment for each opens as the catalog expands. Use this guide to plan your path through the Steps.
Step 1 practice is open now: see the USMLE Step 1 program for the bank, the drills, and full-length timed practice exams.
The USMLE, in one paragraph
The United States Medical Licensing Examination (USMLE) is a three-Step examination for medical licensure in the United States, sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). Step 1 is a one-day, multiple-choice examination of the sciences basic to medicine — up to 280 items in fourteen 30-minute blocks in an 8-hour session (current format, for exams taken on or after May 14, 2026) — reported as pass/fail. Step 2 CK is a one-day, multiple-choice examination of clinical knowledge — up to 318 items in sixteen 30-minute blocks in a 9-hour session (current format, for exams taken on or after May 7, 2026) — reported as a three-digit score, with a current minimum passing score of 218. Step 3 is a two-day examination of readiness for unsupervised practice — multiple-choice items on both days plus 13 to 14 computer-based case simulations on Day 2 — also reported as a three-digit score, with a current minimum passing score of 200. Which Steps you may take, and when, depends on where you went to medical school, and for international medical graduates the ECFMG Certification pathway runs alongside the Steps themselves.
Who can take the USMLE Steps?
Eligibility is set by the USMLE Bulletin of Information, and it differs by Step and by where your medical school is. The categories below are USMLE’s own, from its Bulletin eligibility page.
Step 1 and Step 2 CK
To be eligible, you must be in one of the following categories both at the time you apply and on the day of your examination:
- A medical student officially enrolled in, or a graduate of, a U.S. medical school program leading to the MD degree that is accredited by the LCME (Liaison Committee on Medical Education), or
- A medical student officially enrolled in, or a graduate of, a U.S. medical school leading to the DO degree that is accredited by the Commission on Osteopathic College Accreditation (COCA), or
- A medical student officially enrolled in, or a graduate of, a medical school outside the U.S. that is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements, and that meets ECFMG’s other eligibility criteria.
Two eligibility warnings from the Bulletin deserve emphasis. If your eligibility changes after you apply but before your test date, you must promptly inform the organization that registered you. And if you are dismissed or withdraw from medical school, you are not eligible for the USMLE — even if you are appealing the decision. Candidates on a leave of absence should check with their registration organization before applying or testing.
Step 3
Step 3 eligibility requires all of the following:
- Passing scores on Step 1 and Step 2 CK, and
- An MD or DO degree from an LCME- or COCA-accredited U.S. medical school, or the equivalent of the MD degree from a medical school outside the U.S. that is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements, together with ECFMG Certification and a valid, unexpired ECFMG Certificate, and
- All other eligibility criteria in the USMLE Bulletin of Information.
USMLE also recommends — as a recommendation, not a stated eligibility gate — that Step 3 applicants have completed, or be near completion of, at least one postgraduate training year in an accredited U.S. graduate medical education program that meets state board licensing requirements. Note what this means in practice: unlike Steps 1 and 2 CK, Step 3 is not open to enrolled students. You need the degree, the two prior passes, and — if you trained outside the U.S. — the ECFMG Certificate in hand.
The ECFMG pathway for international medical graduates
If your medical school is outside the U.S., ECFMG (the Educational Commission for Foreign Medical Graduates) sits at the center of your pathway, in two distinct roles that are easy to confuse:
- ECFMG Certification eligibility gates your Step registration. Per USMLE’s Service Transition FAQs, ECFMG continues to determine whether international medical graduates (IMGs) are eligible for ECFMG Certification, and that eligibility remains a core requirement for IMGs to take the USMLE. Your Application for ECFMG Certification must be accepted before you can apply for your first Step exam. Since January 2026, however, the Step exam services themselves — registration, score delivery, eligibility extensions — are provided to IMGs by FSMB, a USMLE co-sponsor, through FSMB’s USMLE portal; ECFMG’s own certification work continues through its MyIntealth portal.
- ECFMG Certification itself requires the Steps — plus more. Per ECFMG, the medical science examination requirement for ECFMG Certification is met by passing Step 1 and Step 2 CK. The clinical skills and communication skills requirements are met by completing an ECFMG Pathway, which includes attaining a satisfactory score on the Occupational English Test (OET) Medicine — or by a passing performance on the former USMLE Step 2 Clinical Skills (CS) component that remains valid for ECFMG Certification. ECFMG’s 2027 Pathways guidance also notes that, to participate in the National Resident Matching Program (NRMP) Main Residency Match, IMGs must have satisfied all examination requirements for ECFMG Certification by the NRMP Rank Order List Certification deadline.
One further routing note from USMLE’s transition guidance: individuals who graduate from Canadian medical schools on or after July 1, 2025 are considered IMGs for these purposes. Canadian graduates from before that date follow the Bulletin’s guidance for their cohort — if that is you, read the current Bulletin of Information rather than relying on any summary, including this one.
Finally: passing the Steps is the examination requirement for licensure, not the license itself. State medical boards grant licenses, and many boards require that all Steps be completed within a certain time frame. USMLE directs candidates to the FSMB website for state-specific licensure requirements.
The exams, piece by piece
All three Steps changed or settled into their current forms recently — Step 1 scoring in 2022, and the block structures of all three Steps by 2026. The single most common factual error in USMLE guides today is printing a retired format as the current one. Each Step below is given in its current form, with the retired form named only so you can recognize outdated advice.
Step 1 — the sciences basic to medicine
Step 1 assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. USMLE constructs it on an integrated content outline that organizes basic science material along two dimensions: system and process.
Current format (exams taken on or after May 14, 2026), per USMLE:
- One-day examination in one 8-hour testing session
- Fourteen 30-minute blocks; the number of questions per block may vary but does not exceed 20
- Total items do not exceed 280
- A minimum allotment of 55 minutes of break time and a 5-minute optional tutorial; finishing a block or the tutorial early adds to your break time
For exams taken before May 14, 2026, Step 1 used seven 60-minute blocks of up to 40 questions, with 45 minutes of break time and a 15-minute tutorial. If your preparation materials are built around 40-question, hour-long blocks, they are built for a retired format.
What Step 1 covers. USMLE’s published Step 1 content specifications give ranges by system, by competency, and by discipline (USMLE notes that its percentages are subject to change at any time):
| Step 1 system | Published range |
|---|---|
| Reproductive & Endocrine Systems | 12–16% |
| Respiratory & Renal/Urinary Systems | 11–15% |
| Behavioral Health & Nervous Systems/Special Senses | 10–14% |
| Blood & Lymphoreticular/Immune Systems | 9–13% |
| Musculoskeletal, Skin & Subcutaneous Tissue | 8–12% |
| Multisystem Processes & Disorders | 8–12% |
| Cardiovascular System | 7–11% |
| Gastrointestinal System | 6–10% |
| Social Sciences: Communication and Interpersonal Skills | 6–9% |
| Biostatistics & Epidemiology/Population Health | 4–6% |
| Human Development | 1–3% |
By competency, Medical Knowledge: Applying Foundational Science Concepts carries 60–70% and Patient Care: Diagnosis 20–25%, with Communication and Interpersonal Skills at 6–9% and Practice-based Learning & Improvement at 4–6%. By discipline, Pathology (45–55%) and Physiology (30–40%) lead; Nutrition, Gross Anatomy & Embryology, Microbiology, and Pharmacology each run 10–20%; Behavioral Sciences 10–15%; Biochemistry, Histology & Cell Biology, and Immunology 5–15% each; Genetics 5–10%. Discipline ranges overlap — one item can assess several disciplines — so treat them as emphasis, not partitions. USMLE also notes that foundational-science content is distributed throughout the organ systems based on disease process and diagnosis: there is no separate “basic science section” to cram in isolation.
Step 2 CK — clinical knowledge for supervised care
Step 2 Clinical Knowledge (CK) assesses your ability to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision, and includes emphasis on health promotion and disease prevention. It ensures due attention to clinical-science principles and basic patient-centered skills that form the foundation for safe, competent practice under supervision.
Current format (exams taken on or after May 7, 2026), per USMLE:
- One-day examination in one 9-hour testing session
- Sixteen 30-minute blocks; the number of questions per block may vary but does not exceed 20
- Total items do not exceed 318
- A minimum allotment of 55 minutes of break time and a 5-minute optional tutorial, with early finishes adding to break time
For exams taken before May 7, 2026, Step 2 CK used eight 60-minute blocks of up to 40 questions, with 45 minutes of break time and a 15-minute tutorial — likewise retired for current test-takers.
What Step 2 CK covers. USMLE publishes Step 2 CK specifications by system/discipline, by competency, and by clinical science:
| Step 2 CK system/discipline | Published range |
|---|---|
| Nutrition | 15–20% |
| Social Sciences: Legal/Ethical Issues & Professionalism/Systems-based Practice & Patient Safety | 10–15% |
| Renal & Urinary System & Reproductive Systems | 7–13% |
| Cardiovascular System | 6–12% |
| Musculoskeletal System/Skin & Subcutaneous Tissue | 6–12% |
| Behavioral Health | 5–10% |
| Blood & Lymphoreticular/Immune Systems | 5–10% |
| Gastrointestinal System | 5–10% |
| Nervous System & Special Senses | 5–10% |
| Respiratory System | 5–10% |
| Multisystem Processes & Disorders | 4–8% |
| Endocrine System | 3–7% |
| Pregnancy, Childbirth & the Puerperium | 3–7% |
| Biostatistics & Epidemiology/Population Health/Interpretation of Medical Literature | 3–5% |
| Human Development | 2–4% |
By competency, the weight sits in patient care: Diagnosis 16–20%, Laboratory/Diagnostic Studies 13–17%, Mixed Management 12–16%, Pharmacotherapy 8–12%, Clinical Interventions 6–10%, Health Maintenance/Disease Prevention 5–10%, and Prognosis/Outcome 5–9%, with Systems-based Practice & Patient Safety and Professionalism at 5–7% each and Practice-based Learning & Improvement at 3–5%. By clinical science, Medicine carries 55–65%, Pediatrics 17–27%, Obstetrics & Gynecology 10–20%, Psychiatry 10–15%, and Surgery 5–15%. The study implication is direct: Step 2 CK is primarily a Medicine exam about deciding what is wrong and what to do next, not a survey course in five equal subjects.
Step 3 — readiness for unsupervised practice
Step 3 is the final examination in the USMLE sequence leading to a license to practice medicine without supervision. It assesses the knowledge and skills of physicians assuming independent responsibility for providing general medical care, with emphasis on patient management in ambulatory settings. Its items and cases reflect the clinical situations a general, as-yet undifferentiated physician might encounter — you are examined as a generalist, whatever specialty training you may have begun.
Format, per USMLE — a two-day examination:
| Day 1 — Foundations of Independent Practice (FIP) | Day 2 — Advanced Clinical Medicine (ACM) | |
|---|---|---|
| Focus | Basic medical and scientific principles essential for effective health care | Applying comprehensive knowledge of health and disease to patient management and the evolving manifestation of disease over time |
| Multiple-choice items | 232 items in 12 blocks of 18–20 items; 30 minutes per block | 180 items in 9 blocks of 20 items; 30 minutes per block |
| Case simulations | None | 13 to 14 computer-based case simulations (CCS), each allotted a maximum of 10 or 20 minutes of real time, after a 6-minute CCS tutorial |
| Session length | Approximately 7 hours, including 55 minutes of break time and a 5-minute optional tutorial | Approximately 9 hours, including a minimum of 45 minutes of break time and a 5-minute optional tutorial; an optional survey at the end if time allows |
Day 1 (FIP) covers application of foundational sciences; biostatistics and epidemiology/population health, and interpretation of the medical literature; and the social sciences, including communication and interpersonal skills, medical ethics, systems-based practice, and patient safety. It also assesses diagnosis and management, particularly history and physical examination, diagnosis, and use of diagnostic studies. The day is multiple-choice only and includes newer item formats such as those based on scientific abstracts and pharmaceutical advertisements.
Day 2 (ACM) covers diagnosis and management with particular focus on prognosis and outcome, health maintenance and screening, therapeutics, and medical decision making, alongside history and physical examination, diagnosis, and diagnostic studies. The CCS cases are the structural difference: in a case simulation, you manage the patient yourself as the case unfolds over simulated time — ordering, deciding, and following up — rather than choosing among printed options about someone else’s management. Across the two days, Step 3 totals 412 multiple-choice items plus the Day 2 case simulations.
Older guides describe Step 3 days built from six longer blocks. The block counts and 30-minute block lengths above are what USMLE’s Step 3 Exam Content page currently publishes — verify them there before your exam, because this Step’s published format is the one most often misquoted.
The passing standards, explained
Each Step has its own passing standard, set by the USMLE Management Committee, which reviews data for each component of the sequence approximately once every four years and decides whether to change the recommended minimum passing score. Current standards, per USMLE’s Examination Results and Scoring page:
| Exam | Score reporting | Minimum passing standard | Applies to exams administered on or after |
|---|---|---|---|
| Step 1 | Pass/fail only | Reported as pass/fail | January 26, 2022 |
| Step 2 CK | Three-digit score | 218 | July 1, 2025 |
| Step 3 | Three-digit score | 200 | January 1, 2024 |
Three things candidates routinely get wrong about these numbers:
- Step 1 has no reported number. For exams taken on or after January 26, 2022, Step 1 outcomes are reported as pass or fail only. Anything that tells you your “Step 1 score” under the current system is describing the pre-2022 system.
- 218 and 200 are scale scores, not percentages. USMLE reports results on a three-digit scale. A minimum of 218 does not mean 218 out of some total, and it does not convert into a fixed percentage of questions you may miss — USMLE does not publish a percentage-correct threshold. The standard that applies to you is the one in force for your test date: Step 2 CK’s standard rose from 214 to 218 for exams on or after July 1, 2025, and Step 3’s rose from 198 to 200 for exams on or after January 1, 2024, which is why older guides quoting 214 or 198 are out of date, not wrong about their own era.
- A passed Step generally stays passed. Under the Bulletin’s rules, if you pass a Step you are not allowed to retake it, except to comply with a time limit imposed by a U.S. medical licensing authority (or another authority the USMLE program recognizes) for completing all Steps. If you retake a passed Step 1 or Step 2 CK for that reason and fail the retake, you are no longer eligible for Step 3 — and Step 3 eligibility requires a passing performance on the most recent administration of the exams used to meet its requirements. Treat a passed Step as an asset to protect, not a score to improve.
Score availability. Per USMLE, results for the computer-based Steps are typically available within four weeks of your test date, but a number of factors can delay reporting — USMLE advises allowing at least eight weeks when selecting a test date and inquiring about results. You are notified by email from the organization that registered you, and your score report remains available on that organization’s website for approximately 365 days from the notification; after that, scores are provided only as an official transcript, for a fee, through your registration organization. If you do not open every block of a Step, the examination may not be scored and the attempt may be reported as an incomplete on your USMLE transcript.
Fees and registration, step by step
What the real exams cost. USMLE’s Apply for Exams page lists the application fees for the 2026 and 2027 cycles, current as of October 2026:
| Payment | Amount | Notes |
|---|---|---|
| Step 1 application fee | $695 | Same fee listed for U.S. (LCME/COCA) and outside-U.S. schools |
| Step 2 CK application fee | $695 | Same fee listed for U.S. (LCME/COCA) and outside-U.S. schools |
| Step 3 application fee | $955 | USMLE marks this fee with its region-fee footnote for outside-U.S. applicants; see the Apply page for the current footnote text |
| Region fee — Step 1 taken outside the U.S. and Canada | $210 | USMLE states this is not a USMLE fee |
| Region fee — Step 2 CK taken outside the U.S. and Canada | $235 | USMLE states this is not a USMLE fee |
Separate from these: applicants who select the India testing region for Step 1 or Step 2 CK are subject to an 18% goods and services tax on OIDAR services that USMLE is required to collect and remit to India (in effect since December 4, 2024, per the Apply page). ECFMG Certification carries its own fees through Intealth/ECFMG, which are separate from the Step application fees above and are not stated in this guide. USMLE also operates a Fee Assistance Program, supported by co-sponsor NBME, to help medical students and residents with demonstrated financial need cover Step exam fees — the Apply for Exams page is the starting point.
Who you register with — this changed in January 2026. Under the USMLE Service Transition, consolidated in January 2026:
- Students and graduates of LCME- or COCA-accredited medical programs in the U.S. register through NBME (the MyUSMLE Portal) for Step exam services.
- Students and graduates of medical schools located outside the U.S. register through FSMB (FSMB’s USMLE Portal). For IMGs, the Application for ECFMG Certification — submitted through ECFMG’s MyIntealth portal — must be accepted before you can apply for your first Step exam, and FSMB confirms ECFMG Certification eligibility with ECFMG as part of registration.
The sequence, in order:
- *Read the current USMLE Bulletin of Information.* It is the governing document for eligibility, application, scheduling, and testing rules — this guide summarizes it, it does not replace it.
- Establish your registration route. U.S. LCME/COCA students and graduates: NBME/MyUSMLE. Outside-U.S. students and graduates: first MyIntealth and the Application for ECFMG Certification, then FSMB’s USMLE portal.
- Apply and pay the application fee for your Step through your registration entity, and receive your scheduling permit, which shows your chosen eligibility period. USMLE’s transition guidance advises allowing at least two weeks for IMG exam registration to be approved and the permit issued.
- Schedule with Prometric. All Steps are taken at authorized Prometric test centers. Step 1 and Step 2 CK are administered at available test centers worldwide; Step 3 is administered only in the U.S. and its territories. Steps are not offered on major local holidays, and available dates appear in the scheduling system.
- Mind the change rules. Rescheduling, canceling, or changing test-center location within 45 days of a scheduled exam date carries a fee; changes can be made up to the day before the exam, not on the exam date. A name change must be received and processed no later than seven business days before your appointment, and you must bring the revised scheduling permit — without it, you will not be permitted to test.
Retakes and attempt limits
USMLE’s Bulletin eligibility page states the attempt rules plainly, and they are stricter than many candidates assume:
- Four-attempt ceiling. If you have attempted a Step four or more times, including incomplete attempts, and have not passed, you are ineligible to apply for any Step in the USMLE sequence. Attempts at the formerly administered Step 2 Clinical Skills (CS) count toward the limit.
- Pacing rule. You may not take the same Step more than three times within a 12-month period. A fourth attempt must be at least 12 months after your first attempt at that examination and at least six months after your most recent attempt. Incomplete attempts count.
- Passed Steps. A passed Step cannot be retaken except under the licensing-authority time-limit exception described in the passing-standards section above — with the Step 3 eligibility consequence if such a retake is failed.
- Sequence time limits. Many U.S. state medical boards require all Steps to be completed within a certain time frame. Those limits are the boards’, not USMLE’s; USMLE directs candidates to the FSMB website for state-specific requirements.
The practical reading: attempts are a finite, program-wide resource, and an unprepared attempt spends one. The score report from a failed attempt is your retake plan — rebuild around what it shows rather than repeating the same preparation on a shorter clock.
Test day
- All Steps are taken at Prometric test centers — Step 1 and Step 2 CK worldwide, Step 3 only in the U.S. and its territories. USMLE publishes information about the Biometric Enabled Check-in System used at Prometric centers on its Apply page; expect identity verification at check-in, and bring the scheduling permit and identification your registration requires, with names matching exactly.
- Breaks are taken between blocks, never inside one. On Steps 1 and 2 CK you have a minimum of 55 minutes of break time, and finishing a block or the optional tutorial early adds to it. On Step 3 Day 1 the minimum break allotment is 55 minutes; on Day 2 it is a minimum of 45 minutes. With fourteen, sixteen, or twelve-plus-nine blocks, current-format exams offer more, shorter decision points about when to break — plan a break rhythm rather than improvising one.
- The tutorial is shorter than it used to be. Current Step 1 and Step 2 CK sessions include a 5-minute optional tutorial (down from 15 minutes in the retired formats), and Step 3 includes a 5-minute optional tutorial each day plus a 6-minute CCS tutorial on Day 2. USMLE expects you to have run its interactive testing experience for your Step before test day — the on-the-day tutorial has fewer screens than the practice experience. For Step 3, practice the CCS software in advance for the same reason.
- Open every block. If you do not open every block of a Step, the examination may not be scored and the attempt may be reported as an incomplete on your transcript — and incomplete attempts count toward the attempt limits above.
- Accommodations take time. USMLE’s guidance is to submit accommodation requests as early as possible and to allow at least 60 business days for a decision.
How to study for these exams
Each Step rewards a different kind of preparation, but the method is the same: the official specifications are the syllabus, and timed practice in the current format is non-negotiable.
- Build your plan from USMLE’s specifications, not a resource’s table of contents. USMLE publishes exactly what each Step covers, with ranges. If a topic is outside the specifications, it is not on your exam; if it is inside them, it is fair game whether or not a course emphasized it.
- Step 1: think in systems, study the disciplines inside them. Foundational-science application is 60–70% of the competency weight, and pathology and physiology dominate the discipline ranges. Learn mechanisms — why a lesion, a drug, or a defect produces the findings in the vignette — because the majority of items require applying principles and interpreting graphic and tabular material, not recalling isolated facts.
- Step 2 CK: train diagnosis and next steps under supervision. Diagnosis, laboratory/diagnostic studies, and mixed management together carry roughly 41–53% of the competency weight, and Medicine carries 55–65% of the clinical science. For each presentation, practice the sequence a supervising physician would expect: most likely diagnosis, best next test, best next management step — and the health-maintenance and prevention items the exam deliberately includes.
- Step 3: split your preparation by day. Day 1 rewards the foundational and evidence-based material — biostatistics, epidemiology, literature interpretation, ethics, and patient safety make up a defined share that pure clinical drilling misses. Day 2 rewards management over time, and the CCS cases reward a separate, practiced workflow: stabilize, order deliberately, advance the case, and close the loop. Give case simulations their own sessions with USMLE’s own CCS practice software first.
- Practice in the current block geometry. Thirty-minute blocks of up to 20 questions (12 blocks of 18–20 on Step 3 Day 1) reset the clock far more often than the retired hour-long blocks. That changes pacing, flagging discipline, and break strategy. Timed practice in any other geometry trains habits you will have to unlearn.
- Respect the attempt limits in your scheduling decision. With a four-attempt ceiling per Step and pacing rules on retakes, the cheapest attempt is a prepared one. Schedule when full-length timed practice in the current format sits comfortably above your Step’s standard — pass/fail margin for Step 1, score margin for Steps 2 CK and 3.
- For IMGs: run the certification clock alongside the study clock. ECFMG Certification requires Steps 1 and 2 CK and a Pathway with OET Medicine, and Match participation requires all examination requirements satisfied by the NRMP Rank Order List Certification deadline. Sequence the Pathway and credential verification early enough that paperwork, not knowledge, never becomes your bottleneck.
PassProfessor’s USMLE Step 1 program is built on these same published specifications. The USMLE Step 1 program page shows the Step 1 bank, the system drills, and full-length timed practice exams.
Frequently asked questions
How many Steps are there in the USMLE? Three: Step 1, Step 2 CK (Clinical Knowledge), and Step 3. Per the USMLE program, the sequence is sponsored by FSMB and NBME, and Step 3 is the final examination in the sequence leading to a license to practice medicine without supervision. The former Step 2 Clinical Skills (CS) component no longer exists as a Step exam; its attempts still count toward USMLE’s attempt limits, and ECFMG now addresses clinical and communication skills for IMGs through its Pathways.
Is Step 1 really pass/fail now? Yes. Per USMLE’s Examination Results and Scoring page, Step 1 is reported as pass/fail only for exams taken on or after January 26, 2022. Step 2 CK and Step 3 continue to be reported as three-digit scores.
What are the current passing scores for Step 2 CK and Step 3? Step 2 CK’s minimum passing score is 218, for exams administered on or after July 1, 2025. Step 3’s minimum passing score is 200, for exams administered on or after January 1, 2024. Both are as published by USMLE on its Examination Results and Scoring page, current as of October 2026. Guides quoting 214 for Step 2 CK or 198 for Step 3 are quoting the prior standards.
How long is each USMLE Step? Per USMLE: Step 1 is one 8-hour testing session; Step 2 CK is one 9-hour testing session; Step 3 runs approximately 7 hours on Day 1 and approximately 9 hours on Day 2. Session lengths include tutorials and break allotments as described in the format tables above.
Can I take Step 3 outside the United States? No. Per USMLE’s Service Transition FAQs, Step 3 continues to be administered only in the U.S. and its territories, at authorized Prometric test centers. Step 1 and Step 2 CK continue to be administered at available Prometric test centers worldwide.
Who registers me for the exams — NBME, FSMB, or ECFMG? Since the January 2026 USMLE Service Transition, students and graduates of LCME- or COCA-accredited U.S. medical programs register through NBME, and students and graduates of medical schools outside the U.S. register through FSMB, per USMLE’s Service Transition FAQs. ECFMG no longer registers IMGs for Step exams; ECFMG continues to run ECFMG Certification through MyIntealth, and an IMG’s Application for ECFMG Certification must be accepted before the first Step application.
What is ECFMG Certification, and do I need it? ECFMG Certification is ECFMG’s credential for international medical graduates entering U.S. graduate medical education. Per ECFMG, it requires passing USMLE Step 1 and Step 2 CK (the medical science examination requirement) and meeting the clinical and communication skills requirements through an ECFMG Pathway, which includes a satisfactory score on OET Medicine, or a valid passing performance on the former Step 2 CS. An IMG also needs ECFMG Certification — with a valid, unexpired Certificate — to be eligible for Step 3.
How many times can I attempt a Step? Per the USMLE Bulletin of Information eligibility page: if you have attempted a Step four or more times, including incomplete attempts, and have not passed, you are ineligible to apply for any Step. You also may not take the same Step more than three times within a 12-month period; a fourth attempt must be at least 12 months after your first attempt and at least six months after your most recent attempt.
How much do the USMLE exams cost in 2026? USMLE’s Apply for Exams page lists 2026 and 2027 application fees of $695 for Step 1, $695 for Step 2 CK, and $955 for Step 3, current as of October 2026. Step 1 and Step 2 CK taken outside the U.S. and Canada add a region fee of $210 and $235 respectively, which USMLE states is not a USMLE fee. ECFMG Certification fees are separate.
When will I get my score? Per USMLE, results for the computer-based Steps are typically available within four weeks of your test date, and you should allow at least eight weeks to receive notification that your score report is available. Notification comes by email from the organization that registered you, and the report stays available on that organization’s website for approximately 365 days.
Do I have to take the Steps in order? Step 3 cannot come first: its eligibility requires passing scores on Step 1 and Step 2 CK plus the degree (and, for IMGs, ECFMG Certification). Steps 1 and 2 CK share the same eligibility categories in the Bulletin, and ECFMG Certification requires passing both. Beyond those stated requirements, this guide does not impose an order USMLE does not state — check the current Bulletin of Information for your situation.
Does passing the USMLE give me a medical license? No. The USMLE is the examination sequence for licensure; licenses are granted by individual U.S. state medical boards, which impose their own additional requirements, including — for many boards — a time frame within which all Steps must be completed. USMLE directs candidates to the FSMB website for state-specific requirements.
Disclaimer
PassProfessor is an independent exam-preparation provider and is not affiliated with, sponsored by, or endorsed by the Federation of State Medical Boards (FSMB), the National Board of Medical Examiners (NBME), or the Educational Commission for Foreign Medical Graduates (ECFMG). USMLE® is a joint program of the FSMB and NBME. This guide is general information about the USMLE Steps, current as of October 2026; the USMLE program’s and ECFMG’s official publications govern if anything here differs from them.