ECFMG 2008 Information Booklet - Examination Requirements

Examination Requirements

The 2008 USMLE™ application materials are no longer current. If you wish to apply for examination, you must use the 2009 Information Booklet.

Applicants for ECFMG Certification must satisfy both the medical science examination and clinical skills requirements. To satisfy these requirements, applicants must pass Step 1 and Step 2 of the United States Medical Licensing Examination (USMLE). Step 2 of the USMLE has two separately administered components, the Clinical Knowledge (CK) component and the Clinical Skills (CS) component.

The United States Medical Licensing Examination (USMLE)

The USMLE is the three-step examination for medical licensure in the United States. The USMLE provides a common system to evaluate applicants for medical licensure. The USMLE is sponsored by the Federation of State Medical Boards of the United States, Inc. (FSMB) and the National Board of Medical Examiners (NBME). The USMLE is governed by a committee consisting of representatives of FSMB, NBME, ECFMG, and the American public. If you apply for examination, you are required to read the USMLE Bulletin of Information for complete information on the USMLE. The Bulletin of Information is available on the USMLE website.

Registration Entity and Test Delivery Entity

Step 1 and Step 2

ECFMG serves as the registration entity for international medical students/graduates taking Step 1 and Step 2 (CK and CS). This means that ECFMG processes your application and payment, determines your eligibility, and notifies you of the outcome of your application. The NBME serves as the registration entity for students/graduates of U.S. and Canadian medical school programs accredited by the Liaison Committee on Medical Education (LCME) and U.S. medical schools/programs accredited by the American Osteopathic Association (AOA).

For eligible Step 1/Step 2 CK applicants, ECFMG forwards registration information to NBME, and NBME issues the exam scheduling permits. Scheduling and test centers for USMLE Step 1 and Step 2 CK are provided by Thomson Prometric, a part of The Thomson Corporation. Prometric serves as the test delivery entity for all examinees taking Step 1/Step 2 CK. Step 1 and Step 2 CK are delivered at Prometric test centers worldwide. ECFMG is not responsible for errors or any associated computer problems that may occur in issuing Step 1/Step 2 CK scheduling permits or in delivering these exams. These functions are the responsibility of NBME and/or Prometric.

For eligible Step 2 CS applicants, ECFMG issues the exam scheduling permits. The Clinical Skills Evaluation Collaboration (CSEC), a collaboration of ECFMG and NBME, is responsible for delivery of the Step 2 CS exam. Step 2 CS is delivered to all examinees at regional CSEC Centers in the United States.

Step 3

The FSMB serves as the registration entity for all Step 3 applicants. To be eligible for Step 3, international medical graduates must have passed Step 1 and Step 2 and must be certified by ECFMG, among other requirements. See Eligibility in the USMLE Bulletin of Information. If you have not met all eligibility requirements, your application for Step 3 will not be accepted. For detailed information and application procedures for Step 3, contact the individual medical licensing authorities or the FSMB (see Communicating About USMLE in the USMLE Bulletin of Information). Scheduling and test centers for Step 3 are provided by Prometric, which serves as the test delivery entity for all Step 3 examinees. Step 3 is delivered at Prometric test centers in the United States.

Important Note: Step 2 CS has replaced the former ECFMG CSA. ECFMG-certified physicians, and physicians who have successfully completed Fifth Pathway programs, must have taken and passed either Step 2 CS or the CSA in order to register for Step 3. See Who Is Required to Take Step 2 CS? in the USMLE Bulletin of Information.

Medical Science Examination Requirement

Step 1 and Step 2 CK of the USMLE are the exams currently administered that satisfy this requirement. To meet the medical science examination requirement for ECFMG Certification, applicants must pass both Step 1 and Step 2 CK within a specified period of time. See Time Limit for Completing Examination Requirements.

ECFMG also accepts a passing performance on the following former examinations to satisfy the medical science examination requirement for ECFMG Certification: ECFMG Examination, Visa Qualifying Examination (VQE), Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS), and the Part I and Part II Examinations of the National Board of Medical Examiners (NBME).

Combinations of exams are also acceptable. Specifically, if you have passed only part of the former VQE, FMGEMS, or the NBME Part I or Part II, you may combine a passing performance on the basic medical science component of one of these exams or USMLE Step 1 with a passing performance on the clinical science component of one of the other exams or USMLE Step 2 CK, provided that the components are passed within the period specified for the exam program.

Additionally, ECFMG accepts a score of 75 or higher on each of the three days of a single administration of the former Federation Licensing Examination (FLEX), if taken prior to June 1985, to satisfy this requirement.

Important Note: Use of the former NBME Parts or FLEX Components to fulfill eligibility requirements for Step 3 is no longer accepted. See Formerly Administered Examinations in the USMLE Bulletin of Information. You should also contact the FSMB for general information and the medical licensing authority of the jurisdiction where you plan to apply for licensure for definitive information on licensure requirements.

Clinical Skills Requirement

Step 2 CS of the USMLE is the exam currently administered that satisfies this requirement. Specific time limits for passing Step 2 CS for ECFMG Certification may apply. See Time Limit for Completing Examination Requirements.

Applicants who have both passed the former ECFMG CSA and achieved a score acceptable to ECFMG on an English language proficiency test (such as the TOEFL exam or the former ECFMG English Test) can use these passing performances to satisfy the clinical skills requirement for ECFMG Certification.

Time Limit for Completing Examination Requirements

ECFMG policy requires that applicants pass those USMLE Steps or Step Components required for ECFMG Certification within a seven-year period. 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. 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 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 CK within a seven-year period for ECFMG Certification. For these applicants, the seven-year period begins on the date the first USMLE Step or Step Component is taken and passed, regardless of when the CSA was passed.

On June 14, 2004, USMLE Step 2 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.

Important Note: These policies apply only to ECFMG Certification. The USMLE program recommends to 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. The USMLE program also recommends to state medical licensing authorities a limit on the number of attempts allowed to pass each Step or Step Component. See Time Limit and Number of Attempts Allowed to Complete All Steps and Retakes in the USMLE Bulletin of Information. Some state medical licensing authorities accept the USMLE-recommended limits, but others do not. You should contact the 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.

Eligibility for Examination

The eligibility requirements for examination differ depending on whether you are a medical school student or a medical school graduate.

Important Notes:

If your eligibility for an exam changes after you apply but before you take the exam, you are required to inform ECFMG immediately of this change in your status.

Medical school students who transfer to another medical school after submitting an application for examination must inform ECFMG immediately of this transfer.

Medical School Students

To be eligible for Step 1, Step 2 CK, and Step 2 CS, you must be officially enrolled in a medical school located outside the United States and Canada that is listed in IMED both at the time that you apply and at the time you take the exam. In addition, the “Graduation Years” in IMED for your medical school must be listed as “Current” at the time you apply and at the time you take the exam. Your Medical School Dean, Vice Dean, or Registrar must certify your current enrollment status; instructions will be provided at the time of application. As soon as you graduate and receive your medical diploma, you must send two photocopies of your medical diploma and one full-face, passport-sized, color photograph to ECFMG (see Provision of Credentials and Translations). The photograph that you send must be current; it must have been taken within six months of the date that you send it. A photocopy of a photograph is not acceptable.

In addition to being currently enrolled as described above, to be eligible for Step 1, Step 2 CK, and Step 2 CS, you must have completed at least two years of medical school. This eligibility requirement means that you must have completed the basic medical science component of the medical school curriculum by the beginning of your eligibility period.

Although you may apply for and take the examinations after completing the basic medical science component of your medical school curriculum, you should consider the following recommendations before applying for Step 2 CK and Step 2 CS. Before taking Step 2 CK and Step 2 CS, it is recommended that you complete your core clinical clerkships, including actual patient contact. If English is not your first language, it is recommended that you take the Test of Spoken English™ (TSE®), offered by the Educational Testing Service® (ETS®), and achieve a score of at least 45 before taking Step 2 CS. For more information on the TSE exam or to obtain application materials, visit www.ets.org/tse or call ETS at (609) 921-9000. This recommendation is for self-assessment purposes only; if you take the TSE exam, do not send your TSE score to ECFMG.

If you have passed the former ECFMG CSA, you are not eligible to take Step 2 CS, except under certain, well-defined circumstances. Eligible circumstances include: taking Step 2 CS to permanently validate an expired CSA examination date (see Validity of Examinations for Entry into Graduate Medical Education), taking Step 2 CS because your most recent performance on a clinical skills exam (CSA or Step 2 CS) is a failing performance (see Official Performance of Record for Examinees Retaking a Previously Passed Step in the USMLE Bulletin of Information), and retaking Step 2 CS to meet a time limit (see Reexamination and Reapplication in this publication and Retakes in the USMLE Bulletin of Information).

ECFMG reserves the right to reverify with the medical school the eligibility of medical school students who are registered for an exam. If ECFMG requests reverification of your student status with your medical school, ECFMG will issue your score report only after reverification of your status has been received by ECFMG.

Medical School Graduates

To be eligible for Step 1, Step 2 CK, and Step 2 CS, you must be a graduate of a medical school located outside the United States and Canada that is listed in IMED. Your graduation year must be included in the medical school’s IMED listing. You must have had at least four credit years (academic years for which credit has been given toward completion of the medical curriculum) in attendance at a medical school that is listed in IMED.

You must also submit two photocopies of your medical diploma at the time of application if you have not sent the diploma to ECFMG previously. One full-face, passport-sized, color photograph must accompany the copies of your diploma. The photograph that you send must be current; it must have been taken within six months of the date that you send your application. A photocopy of a photograph is not acceptable. If you have graduated and met all requirements for your medical diploma but your medical diploma has not yet been issued, you must submit with the application a current, full-face, passport-sized, color photograph and a letter signed by your Medical School Dean, Vice Dean, or Registrar. The letter must include the following statement:

This is to confirm that [applicant name] has graduated and completed all requirements to receive the [degree title] degree from [medical school/university name]. The degree will be issued [month and year].

You must then send the photocopies of your medical diploma to ECFMG as soon as your diploma is issued. See Medical Education Credentials.

If English is not your first language, it is recommended that you take the Test of Spoken English (TSE), offered by the Educational Testing Service (ETS), and achieve a score of at least 45 before taking Step 2 CS. For more information on the TSE exam or to obtain application materials, visit www.ets.org/tse or call ETS at (609) 921-9000. This recommendation is for self-assessment purposes only; if you take the TSE exam, do not send your TSE score to ECFMG.

Applying for Examination

To apply, use ECFMG’s Interactive Web Application (IWA). A complete application consists of the on-line part, which you complete using IWA; the Certification Statement (Form 183) or Certification of Identification Form (Form 186), which you obtain through IWA; and any other required documents, as outlined in IWA and in this publication.

Detailed instructions accompany the application. Follow the instructions carefully and answer all questions completely. You should review the instructions before you begin working on the application. Some of the necessary items require advance planning. These items may include photographs, official signatures, and additional documentation, such as copies of your medical diploma if you are a medical school graduate. If your application is not complete, it will be rejected.

ECFMG will notify you by e-mail when your application is received. You can check the status of your exam application on-line using OASIS.

ECFMG will process your application and determine your eligibility to take the exam(s) you requested. ECFMG processes applications typically within three weeks of receipt of the complete application. Once your application has been processed, ECFMG will notify you of the outcome of your application. For eligible applicants, important information about scheduling and taking the exams will be issued.

Important Note: Application and other requests for services will not be processed if it is determined that doing so would be violative of any applicable federal laws or regulations.

Students
Medical school students must print a Certification Statement (Form 183) after completing the on-line part of the application and return the completed Form 183 to ECFMG. Students must complete and submit Form 183 for each on-line application.

Form 183 must be completed by the student and certified by an appropriate official of the student’s medical school. This certification must be current; the official must have signed the form within four months of its receipt by ECFMG.

Any additional documentation that is required at the time of application must be accompanied by a completed IWA Document Submission Form (Form 187). Form 187 facilitates more efficient processing of the application by ensuring that any additional documentation is matched with the on-line part of the application. Do not send Form 187 if you do not have any documents to submit to ECFMG. The only items that should not be submitted with Form 187 are requests and supporting documentation for test accommodations; follow the instructions in the Test Accommodations information on the USMLE website for submitting these items to ECFMG (see Examinees with Disabilities Requesting Test Accommodations in this publication, and Examinees with Disabilities Requesting Test Accommodations in the USMLE Bulletin of Information).

Applications from students are not considered complete until ECFMG receives the completed Form 183 accompanied by any other required documents. All required documents must be sent in one envelope, accompanied by Form 187.

You can print Form 183 from IWA after completing the on-line part of the application.

Graduates
Medical school graduates must print a Certification of Identification Form (Form 186) after completing the on-line part of the application and send the completed Form 186 to ECFMG. Once accepted by ECFMG, this form remains valid for on-line applications received during the following five-year period, and subsequent applications during this period can be completed entirely on-line.

Form 186 must be completed by the graduate and certified by an appropriate official. This certification must be current; the official must have signed the form within four months of its receipt by ECFMG.

Applications from graduates are not considered complete until the completed Form 186 (if the applicant does not have a valid Form 186 on file with ECFMG) and any other required documents are received at ECFMG. All required documents must be sent in one envelope, accompanied by Form 187.

You can print Form 186 from IWA after completing the on-line part of the application. Form 187 is available from IWA and the Publications page of this website.

When to Apply

Step 1, Step 2 CK, and Step 2 CS are offered regularly throughout the year; however there may be occasional, brief periods when all test centers are closed or the exam is not available. In planning the timing of your application, see Eligibility Periods for information on how eligibility periods are assigned. You should also consider deadlines imposed by the National Resident Matching Program (NRMP) and graduate medical education (GME) programs. (See Applying to Graduate Medical Education Programs.) Finally, you should be aware that demand for test dates/centers at certain times during the year may exceed the number of testing spaces available.

Important Note: It is solely the responsibility of the applicant to complete the required exams in time to meet deadlines imposed by the NRMP and/or GME programs. Since the number of applicants seeking to complete these exams may exceed the spaces available in time to meet those deadlines, there is no guarantee that sufficient spaces will be available for all applicants to meet deadlines imposed by the NRMP and/or GME programs. ECFMG assumes no liability of any kind if an applicant does not complete the exams in time to have results available to meet NRMP and/or GME program deadlines.

Fees

You must pay all applicable fees at the time of application. If you apply for more than one exam at the same time, you must pay applicable fees for all exams at the time of application. If you do not pay all fees, your application will be rejected. If your application is rejected, any payment received with that application will be credited to your ECFMG financial account. See Payment.

For all exams, there is an examination fee. For Step 1 or Step 2 CK, there is an additional international test delivery surcharge, if you choose a testing region other than the United States/Canada. These surcharges represent the additional cost of offering Step 1 and Step 2 CK by computer outside the United States and Canada. If you choose to take the exam in the United States or Canada, you do not need to pay a surcharge. For information on Step 1/Step 2 CK testing regions, see Testing Locations. For the current exam fees and international test delivery surcharges, refer to the ECFMG website or the USMLE application materials.

All fees are subject to change without notice.

Examinees Who Require Personal Items in the Testing Room

As explained in the USMLE Bulletin of Information, unauthorized possession of personal items in the secure areas of the testing centers is prohibited. However, in certain limited circumstances, exceptions to this policy may be made for medical reasons, provided that permission is granted in advance of test administration. Examples of items that require advance permission include medication, an external appliance, or electronic device; examples of appliances and devices to which this policy applies include insulin pumps, inhalers, medications, TENS units, breast pumps, hearing aids, electronic or digitally amplified or otherwise enhanced non-standard stethoscopes (for Step 2 CS), wheelchairs, canes, crutches, and casts. This list is not exhaustive. If you believe that you have a medical condition that requires you to use any of these items in the secure areas of the test center or if you are unsure whether you should request an exception, see Examinees Who Require Personal Items in the Testing Room in the USMLE Bulletin of Information for instructions.

Examinees with Disabilities Requesting Test Accommodations

The USMLE program provides reasonable accommodations for examinees with disabilities who are covered under the Americans with Disabilities Act (ADA). If you are a disabled individual covered under the ADA and require test accommodations, you must obtain information regarding procedures and documentation requirements before applying for each Step or Step Component.

Detailed information and the required forms are available on the USMLE website or from ECFMG, upon request. International medical students/graduates must submit official requests and documentation to ECFMG. ECFMG forwards these requests to NBME for processing. The NBME processes requests for test accommodations in accordance with USMLE policies and procedures and renders a decision. Once your request has been processed, NBME will inform you of the outcome of your request. If you take USMLE Steps or Step Components with test accommodations, your score reports and transcripts may indicate that such accommodations were provided. Score recipients who inquire about the annotation will be provided with information about the nature of the accommodation only.

All requests and accompanying documentation must be in English. If you request test accommodations, you must send your official request/documentation to the ECFMG Test Accommodations Coordinator at the address indicated in the Test Accommodations information on the USMLE website at the same time that you apply for the exam. To protect your privacy, do not send your request for test accommodations to the same address or in the same envelope with application materials.

For additional information, see Examinees with Disabilities Requesting Testing Accommodations in the USMLE Bulletin of Information.

Testing Locations

Step 1 and Step 2 CK

Step 1 and Step 2 CK are delivered at Prometric test centers worldwide. Prometric’s test centers are grouped into distinct testing regions. Within each region, Prometric has a central office known as the Regional Registration Center.

When you complete your application, you must choose the testing region where you want to take the exam. If you apply for both Step 1 and Step 2 CK at the same time, you can choose the same testing region for both Step 1 and Step 2 CK, or you can choose a different testing region for each exam. Although you will choose a testing region when you apply, you will not choose a particular test center within that region until you schedule your testing appointment. You can take the exam at any test center in your testing region that offers USMLE, provided there is space available on the date you choose. A list of Prometric testing regions is available on this website. The test centers available for USMLE are subject to change. To obtain current information on test centers in specific testing regions, visit the Prometric website or follow instructions on the scheduling permit for contacting Prometric.

If you are unable to keep your testing appointment at the test center you select, you can reschedule for a different test center within your testing region, subject to availability. To avoid a rescheduling fee, you must cancel or reschedule at least five business days before your scheduled testing appointment. See Rescheduling.

Step 2 CS

Step 2 CS is administered at regional test centers in Atlanta, Chicago, Houston, Los Angeles, and Philadelphia in the United States. You will not choose a test center when you complete the application. Once registered, you will select a test center, subject to availability, when you schedule your testing appointment. If you are unable to keep your testing appointment at the test center you select, you can reschedule for a different center, subject to availability. To avoid a rescheduling fee, you must cancel or reschedule more than 14 days before your scheduled testing appointment. See Rescheduling.

Travel information for each test center is available on the USMLE website.

Eligibility Periods

Step 1 and Step 2 CK

When you apply for Step 1 or Step 2 CK, you must select a three-month period, such as January-February-March, February-March-April, etc., during which you would like to take the exam. This three-month period is referred to as your eligibility period. If you apply for Step 1 and Step 2 CK at the same time, you can select the same eligibility period for both Step 1 and Step 2 CK, or you can select a different eligibility period for each exam. You must take the exam during the eligibility period assigned to you. You can take the exam on any day that it is offered during your assigned eligibility period, provided that there is space available at the test center that you choose.

When choosing your eligibility period, remember that: Prometric test centers are closed on major local holidays; Step 1 and Step 2 CK are not offered during the first two weeks in January; and the busiest testing times in the United States/Canada testing region are May through July and November through December. Your eligibility period will not be adjusted to compensate for dates when the exams are not available.

To obtain a specific eligibility period:

ECFMG must receive your complete application by the 24th day of that eligibility period, and
Your application must be processed by ECFMG by the 25th day of that eligibility period.

Example: On May 10, an applicant selects the May-June-July eligibility period for Step 1 and submits her application. The application is processed by ECFMG on May 23. The applicant is assigned the May-June-July eligibility period that she selected on her application.

Keep in mind that delays or interruptions in postal service may delay delivery to ECFMG of materials needed to complete your application. Although processing times vary, it typically takes three weeks from receipt of a complete application for ECFMG to process the application. This means that, although you can select an eligibility period as late as the 24th day of that eligibility period, there is no guarantee that you will be assigned that eligibility period, since your application may not be processed by the 25th day of the eligibility period. If your application is not processed in time to assign the eligibility period you select, you will be assigned to the next eligibility period. You must read the editions of the ECFMG Information Booklet and the USMLE Bulletin of Information that pertain to the eligibility period in which you take the exam. The eligibility period assigned to you will be listed on your scheduling permit.

Example: On July 23, an applicant selects the July-August-September eligibility period for Step 2 CK and submits his application. The application is processed by ECFMG on August 12. The applicant is assigned the next eligibility period, August-September-October.

As shown in both examples, you will be able to obtain an eligibility period that has already begun, or that will have begun by the time you are registered and your scheduling permit is issued. Your assigned eligibility period will not be adjusted to compensate for days that have already passed.

Eligibility Period Extension

If you are unable to take Step 1/Step 2 CK during the three-month eligibility period assigned to you, you may request a one-time extension. You may extend your eligibility period only through the next, contiguous eligibility period (the next eligibility period that does not overlap with your original eligibility period).

Example: An applicant’s original eligibility period is April-May-June 2008. The eligibility period may be extended only through July-August-September 2008.

You may request an extension on-line using IWA or by completing a Request to Extend a USMLE™ Step 1/Step 2 CK Eligibility Period (Form 176) and submitting it to ECFMG. Payment of the appropriate fee must be submitted with the request. You may request an extension of your eligibility period only once for each exam registration. You may request an extension of your eligibility period only after your eligibility period has begun. Requests received at ECFMG more than 25 days after the end of the original eligibility period will not be processed. For specific information on deadlines, refer to IWA or Form 176.

Additionally, you must continue to be eligible to take the exam during the extended eligibility period (you must still be officially enrolled in a medical school located outside the United States and Canada that is listed in the International Medical Education Directory [IMED] and the “Graduation Years” for your medical school must be listed as “Current,” or you must be a graduate of such a medical school and your graduation year must be included in the school’s IMED listing). See Eligibility for Examination.

If your eligibility period is extended, NBME will issue a new scheduling permit reflecting the extension. You can obtain the new scheduling permit by accessing IWA. You must bring the new scheduling permit to the test center on the date of your exam.

If you have a scheduled appointment during your original eligibility period and need to cancel and reschedule the appointment for your extended eligibility period, you must cancel or reschedule at least five business days before your scheduled appointment to avoid a rescheduling fee. Requesting an extension of your eligibility period does not cancel a scheduled appointment. See Rescheduling.

If you are unable to take the exam during your original or extended eligibility period or you are unable to extend your original eligibility period, you must reapply, including payment of the appropriate fee(s), to take the exam.

Step 2 CS

When you are registered for Step 2 CS, you are assigned a 12-month eligibility period that begins on the date that the processing of your application is completed.

Example: A complete Step 2 CS application is received at ECFMG on July 15, 2008, and processing of the application is completed on July 28, 2008. The applicant will be assigned an eligibility period of July 28, 2008 – July 27, 2009.

Your eligibility period will be listed on your Step 2 CS scheduling permit. You must take the exam during your eligibility period. You can schedule a testing appointment for any available date in your eligibility period. Once your eligibility period is assigned, it cannot be changed. Although you cannot change your assigned eligibility period, you can reschedule a testing appointment for a different date within your eligibility period, subject to availability. To avoid a rescheduling fee, you must cancel or reschedule more than 14 days before your scheduled testing appointment. See Rescheduling.

You may take Step 2 CS only once during each assigned eligibility period. If you take and fail the exam, you may retake it, but you must reapply, pay the examination fee, and obtain a new eligibility period. You may reapply as soon as your failing score report becomes available. You do not need to wait for the previously assigned eligibility period to end. If you do not take the exam within your eligibility period, you must reapply, including payment of the examination fee, to take the exam.

Your Scheduling Permit

When your registration is complete, you will be issued an exam scheduling permit. If you apply for more than one exam at the same time, you will be issued separate scheduling permits for each exam. The scheduling permit includes instructions for scheduling your testing appointment and a description of the form(s) of identification you must bring to the test center on your exam date (see Acceptable Identification).

The scheduling permit is a very important document, and you should be careful not to lose it. You must bring your scheduling permit to the test center on your exam date. If you do not bring your scheduling permit, you will not be allowed to take the exam.

Additionally, your name as it appears on your scheduling permit and your form(s) of identification must match exactly. If the names do not match, you will not be allowed to take the exam (see Acceptable Identification). If you are not allowed to take the exam, you will need to reschedule your testing appointment and pay a rescheduling fee. Your rescheduled testing appointment must fall within your assigned eligibility period.

You should verify that all information included in your scheduling permit is correct. The scheduling permit includes your name, the exam for which you registered, and the eligibility period during which you must take the exam. For Step 1 and Step 2 CK, it also includes your assigned testing region. If any of the information on the scheduling permit is incorrect or you have questions or concerns about this document, contact ECFMG by e-mail at permits@ecfmg.org or by telephone or fax (see General Inquiries).

Step 1 and Step 2 CK

If ECFMG determines that you are eligible, ECFMG will forward your registration information to NBME. The NBME will issue your scheduling permit within two weeks. Scheduling permits are issued in electronic format and can be accessed using ECFMG’s Interactive Web Application (IWA). Once your scheduling permit is available, ECFMG will send a notification to the e-mail address in your ECFMG record; this message will include instructions for accessing the electronic scheduling permit using IWA.

If the beginning of your assigned eligibility period is more than six months away, your scheduling permit will not be available and the notification e-mail will not be sent until approximately six months before the beginning of the assigned eligibility period.

Applicants must print a copy of the electronic scheduling permit and bring it to the test center on their exam date. The Step 1/Step 2 CK scheduling permit includes two important numbers:

Your Scheduling Number – you must provide this number when you schedule your testing appointment; and
Your Candidate Identification Number (CIN) – you must enter your CIN into the computer at the test center to start the exam and to initiate each block of the exam. You must keep this number confidential. For your own protection, do not share your CIN with anyone, except as directed by test center staff on your test day.

If the name in your ECFMG record is changed or your Step 1/Step 2 CK eligibility period is extended while you are registered, a new scheduling permit reflecting this change will be issued. You must access this new scheduling permit using IWA and bring it to the test center on your test date.

If you lose your scheduling permit, you can reprint it by accessing IWA.

Step 2 CS

Once you are registered, ECFMG will send your Step 2 CS scheduling permit to the e-mail address in your ECFMG record. If the name in your ECFMG record is changed while you are registered, a new scheduling permit reflecting this change will be issued. You must access this new scheduling permit using IWA and bring it to the test center on your test date.

If you lose or do not receive your scheduling permit, you can reprint it by accessing IWA.

Scheduling

You can schedule your testing appointment as soon as you receive your exam scheduling permit. Your scheduling permit provides instructions for reviewing available test dates and centers and scheduling a testing appointment.

To schedule a testing appointment, you must select a test date and center. The test date you select must fall within your assigned eligibility period. For Step 1/Step 2 CK, the test center you select must fall within your assigned testing region.

Testing appointments are available on a “first-come, first-served” basis. You should monitor the availability of test dates within your eligibility period. You should also review the important information in When to Apply. If you do not schedule and take the exam during your eligibility period, you will lose your payment for the exam and you will need to reapply, including payment of applicable fees, to take the exam in the future.

Step 1 and Step 2 CK

You can schedule your testing appointment with Prometric up to six months in advance of the beginning of your eligibility period. You must schedule before 12:00 noon (local time at the Regional Registration Center for your testing region) at least five business days prior to the exam date that you want.

When you schedule, you must provide the Scheduling Number listed on your scheduling permit. You will receive your Prometric Confirmation Number. Be sure to keep this number. If you need to reschedule your testing appointment, you will need your Prometric Confirmation Number.

Step 2 CS

A schedule for reporting Step 2 CS results is available on the ECFMG and USMLE websites. Please refer to this information before scheduling a testing appointment if you need your results by a specific deadline. You should also review the important information in How Step 2 CS Test Dates Become Available.

Step 2 CS is administered in both morning (AM) and afternoon (PM) sessions. Although you will select your test date and center, you will not be able to choose your test session. When you confirm a testing appointment, you will be assigned to either an AM or PM session. A PM session is assigned if, for that test date and center, AM sessions have been filled and PM sessions have been opened. When reviewing available test dates, you will be informed whether AM or PM sessions are currently being assigned for each date, and you can continue to check available dates for one offering your preferred session. Before you confirm a testing appointment, you will be informed once again whether an AM or PM session will be assigned.

After you confirm your testing appointment, you will be able to print a confirmation notice that includes your scheduled test date, arrival time, test center, and other important information. You should bring the confirmation notice to the test center on your test date. If you lose the confirmation notice, you can reprint it by accessing Step 2 CS Calendar and Scheduling.

How Step 2 CS Test Dates Become Available

Test dates are opened so that dates will be available throughout your 12-month eligibility period.
Additional test dates are opened, depending on demand. These dates are opened in ways that maximize operational efficiency at all centers and may not reflect applicant demand for particular test dates and/or test centers.
Testing appointments are available on a “first-come, first-served” basis (although scheduling restrictions may be imposed). It is possible that you will not be able to obtain a testing appointment for the time period and/or test center you prefer.
The availability of testing appointments will change frequently as a result of applicant scheduling, rescheduling, and the opening of additional test dates.
It is possible that testing appointments will become available for the time period and/or test center that you prefer after you have scheduled an appointment for a different time period and/or center. In this event, you can change your scheduled test date and/or center, subject to availability. A fee may be charged for this service (see Rescheduling).
Although you can monitor available test dates for the time period and test center that you prefer, availability is not guaranteed. You must take the exam during your assigned eligibility period. If you do not take the exam during your eligibility period, you must reapply, including payment of the exam fee, to take the exam.

Rescheduling

Step 1 and Step 2 CK

If you are unable to keep your testing appointment on the scheduled date or at the scheduled test center, you may change your date and/or center, subject to availability. You may cancel and reschedule at the same time, or you may cancel and then reschedule at a later date. Your new test date and center must fall within your assigned eligibility period and testing region, respectively. You will need to provide your Prometric Confirmation Number when you cancel or reschedule.

To reschedule your appointment, follow the instructions for contacting Prometric on your scheduling permit. To avoid a rescheduling fee, you must cancel or reschedule your appointment at least five business days before your appointment. If you are testing in the United States or Canada, you must cancel or reschedule by 12:00 noon, Eastern Time, at least five business days before your scheduled appointment. If you are testing outside the United States/Canada, you must cancel or reschedule by 12:00 noon, local time at the Regional Registration Center for your testing region, at least five business days before your scheduled appointment. If you give notice of less than five business days, you must pay Prometric a rescheduling fee when you arrange your new appointment. If you give notice of less than five business days, Prometric may require additional time to process your request.

If you cannot take the exam during your assigned eligibility period, you may request an extension. See Eligibility Period Extension for additional information. However, you must still cancel a scheduled testing appointment, as described above, if you cannot keep the appointment. Requesting an extension of your eligibility period does not cancel a scheduled testing appointment.

Step 2 CS

If you have a scheduled testing appointment and are unable to take the exam on your scheduled test date or at your scheduled test center, you can cancel your scheduled testing appointment and reschedule for a different date and/or center, subject to availability. A fee may be charged for this service depending on how much notice you provide when canceling your appointment, as described below. To cancel or reschedule, access Step 2 CS Calendar and Scheduling.

Before canceling and/or rescheduling a scheduled testing appointment, you will have the opportunity to review available test dates at all testing locations. Your rescheduled test date must fall within your assigned eligibility period. There is no limit on the number of times you can cancel and reschedule your testing appointment However, a rescheduling fee is charged for each rescheduled testing appointment that does not meet the notice requirements described below. Any change to a scheduled testing appointment constitutes rescheduling.

You can cancel and reschedule at the same time, or you can cancel and then reschedule later. You can cancel and/or reschedule at any time through the end of the day before your scheduled test date. However, no canceling or rescheduling is allowed beginning at 12:00 midnight, Eastern Time in the United States, on the scheduled test date until it is confirmed that you did not take the exam (typically one to two days). If you do not cancel and you miss your scheduled testing appointment, you can reschedule after this confirmation period.

Important Note: If you cancel without rescheduling or miss your scheduled testing appointment, there is no guarantee that testing appointments during your eligibility period will be available at a given test center, or at any test center, when you attempt to reschedule. If you do not reschedule within your eligibility period, you must reapply, including payment of the exam fee, to take the exam.

There is no fee to cancel a scheduled testing appointment; the fee, if applicable, is due at the time of rescheduling. However, the date that you cancel your appointment, using Eastern Time in the United States, will determine whether you pay a rescheduling fee and the amount of this fee.

If you cancel more than 14 calendar days before (but not including) your scheduled test date, there is no fee to reschedule.
If you cancel during the 14-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.

If you are unable to keep your scheduled testing appointment, you should cancel your appointment as soon as possible to avoid a rescheduling fee, regardless of whether you are ready to reschedule.

Preparation

Format of the Exams

Step 1 and Step 2 CK are each one-day, multiple-choice exams that are administered by computer. Each exam consists of multiple-choice questions divided into 60-minute blocks. The Step 1 testing session lasts approximately eight hours. The Step 2 CK testing session lasts approximately nine hours.

Step 2 CS is a one-day exam that consists of 12 simulated patient cases. The Step 2 CS testing session lasts approximately eight hours.

For detailed information on test lengths and formats, see Preparing for the Test in the USMLE Bulletin of Information. You should also review the USMLE sample test materials available for each exam.

Sample Test Materials

Sample test materials for all Steps and Step Components, as well as additional information on examination content and test formats for Step 1/Step 2 CK, are available on the USMLE website.

The sample Step 1/Step 2 CK test materials on the USMLE website will help you become familiar with the types of questions and exam software that you will encounter on the date of your exam. It is recommended that you practice with the exam software before taking the exam. If you do not have extensive experience with computers, you may be concerned about taking a computer-based exam. The NBME has conducted field trials to determine the effect of prior computer experience on examinee performance on computer-based exams. These field trials show that experience with computers generally does not affect how examinees score on computer-based, multiple-choice exams.

For Step 2 CS, the materials include the Step 2 Clinical Skills (CS) Content Description and General Information booklet, a practice patient note program that is similar to the one you will use if you choose to type your post-encounter patient notes, and samples of handwritten patient notes. Two orientation videos are also available.

If you are registered for an exam and cannot access the materials on the USMLE website, you may request a CD that contains most of the orientation materials available on the USMLE website. To request a CD, submit a completed Request for USMLE™ Orientation Materials CD (Form 108) to ECFMG.

NBME Self-Assessments

The NBME offers web-based self-assessments to help medical students and graduates evaluate their readiness for computer-based Steps and Step Components (Step 1, Step 2 CK, and Step 3).

The Comprehensive Basic Science Self-Assessment (CBSSA), which is built to the same content specifications as Step 1, covers material in basic science medical education courses. There are four unique CBSSA forms available, each featuring 200 multiple-choice questions divided into four sections.
The Comprehensive Clinical Science Self-Assessment (CCSSA), which is built to the same content specifications as Step 2 CK, covers material in core clinical clerkships. There are three unique CCSSA forms available, each featuring 184 multiple-choice questions divided into four sections.

A self-assessment built to the same content specifications as the multiple-choice component of Step 3 is also available.

NBME research demonstrates that under certain circumstances there is a moderate relationship between performance on the CBSSA and CCSSA and subsequent Step 1 or Step 2 CK exams. Medical students and graduates may find these self-assessments to be valuable tools as they prepare for USMLE Step 1 and Step 2 CK.

All questions have appeared previously in the USMLE, and no questions are duplicated across forms. Users can choose to take the self-assessments under two timing conditions: standard USMLE pacing or self-pacing. The self-assessments are available for $45.00 per form.

Users receive immediate performance feedback in the form of a diagnostic profile showing content areas of strength and weakness. For the CBSSA (Step 1) and CCSSA (Step 2 CK), feedback also includes a table that “translates” the self-assessment score to an approximate score on the USMLE scale.

For complete information, to view a sample assessment, or to purchase an assessment, access the NBME Self-Assessment Services Interactive website.

Step 1/Step 2 CK Practice Session at a Prometric Test Center

If you have received your scheduling permit for Step 1 or Step 2 CK, you can register to take a practice session for this exam at a Prometric test center. You must pay a fee to Prometric for this service. The materials used for the practice sessions at Prometric test centers are the same USMLE sample test materials that are available on the USMLE website. No new material will be presented during the Prometric practice sessions.

If you would like to take a practice session at a Prometric test center, you must register for the practice session and obtain a practice session scheduling permit. You can register for a practice session on the USMLE website. Information on the fee for the practice sessions is also available on this site.

When you register for a practice session, you will be asked for the Scheduling Number and Candidate Identification Number from your Step 1 or Step 2 CK scheduling permit. You should allow two weeks for issuance of your practice session scheduling permit. Once your scheduling permit is available, ECFMG will send a notification to the e-mail address in your ECFMG record; this message will include instructions for accessing the electronic practice session scheduling permit using IWA.

Taking the Exam

Step 1/Step 2 CK

You should arrive at the Prometric test center 30 minutes before your scheduled testing appointment. If you arrive after your appointment time, you may not be allowed to take the exam. If you arrive more than 30 minutes after your scheduled testing appointment or do not have both the scheduling permit and acceptable identification, you will not be allowed to take the exam. If you are not allowed to take the exam for these reasons, you will need to reschedule your testing appointment and pay Prometric a rescheduling fee. Your rescheduled testing appointment must fall within your assigned eligibility period.

You must bring both your scheduling permit and acceptable identification. If the name in your ECFMG record is changed or your eligibility period is extended while you are registered for Step 1/Step 2 CK, NBME will issue a new scheduling permit reflecting this change. You must access this new scheduling permit using IWA and bring it to the test center. Name changes must be received and processed by ECFMG no later than seven business days before your testing appointment, or you will not be able to test.

If you need directions to the test center, visit the Prometric website or contact Prometric in advance of your test date. If you are testing in the United States/Canada, call the test center using the telephone number provided when you scheduled your appointment. If you are testing outside the United States/Canada, contact the Regional Registration Center for your testing region using the contact information on your scheduling permit.

For detailed information on procedures upon arrival and throughout the testing day, see Testing in the USMLE Bulletin of Information.

Step 2 CS

The time you should arrive will be listed on the confirmation notice you will print after scheduling your testing appointment. If you arrive during the on-site orientation, you may be allowed to test; however, you will be required to sign a Late Admission Form. If you arrive after the on-site orientation, you will not be allowed to test. You will have to reschedule your testing appointment and pay the rescheduling fee. If you start to test and elect not to complete the examination, the attempt may appear as an "incomplete examination" on your USMLE transcript.

You must bring your scheduling permit and acceptable identification. If the name in your ECFMG record is changed while you are registered for Step 2 CS, a new scheduling permit reflecting this change will be issued. You must access this new scheduling permit using IWA and bring it to the test center. Name changes must be received and processed by ECFMG no later than seven business days before your testing appointment, or you will not be able to test.

You should also bring your confirmation notice to the test center. You can reprint your confirmation notice by accessing Step 2 CS Calendar and Scheduling.

Travel information for each test center is available on the USMLE website.

For detailed information on procedures upon arrival and throughout the testing day, see the USMLE Step 2 Clinical Skills (CS) Content Description and General Information booklet, available on the USMLE website, and Testing in the USMLE Bulletin of Information.

Travel Status

Applicants traveling to the United States to take an exam are responsible for making the necessary travel and accommodation arrangements. If you are neither a U.S. citizen nor U.S. lawful permanent resident, you are responsible for obtaining required travel documents. These documents may include a visa to enter the United States. The requirements of the U.S. Department of Homeland Security (DHS) and U.S. embassies and consulates regarding issuance of visas and travel to and from the United States are subject to change. You should review current requirements before applying for a visa. For additional information, visit the DHS website and the U.S. Department of State website.

Step 2 CS is administered only in the United States. Upon request, ECFMG provides Step 2 CS applicants with a letter that may assist during the process of applying for a visa. The letter indicates that the applicant is registered for Step 2 CS, one of the exams required for ECFMG Certification. The letter also indicates that the applicant is required to travel to the United States to take the exam and provides the date by which the applicant must complete the exam. You can request this letter when you apply for Step 2 CS. After completion of the registration process, ECFMG will issue the letter, and it will be available to you through IWA. If you are unable to obtain the appropriate visa to enter the United States to take Step 2 CS, you may request a full refund of the exam fee. See Refunds.

If you are traveling from a distant location, you should consider arriving a day or two before the examination in order to be rested.

Acceptable Identification

Your name as it appears on your scheduling permit and your form(s) of identification must match exactly. Since your name on the scheduling permit appears in the Latin alphabet (in “English language letters”), the name on your identification must also appear in the Latin alphabet. The spelling of the name on your scheduling permit must match exactly the spelling of the name on the form(s) of identification you present at the test center. If the names do not match as described above, you will not be allowed to take the exam. See Name of Applicant.

The form of identification you present must be one of the forms of unexpired, government-issued identification listed below that contains your name in the Latin alphabet, your signature, and your recent (no more than 10 years earlier) photograph. The following forms of identification are acceptable, only if they meet all of these requirements:

Passport;
Driver’s license;
National identity card; or
Other form of unexpired, government-issued identification that meets all of these requirements.

If your unexpired, government-issued form of identification contains your name in the Latin alphabet and your photograph but not your signature, you can use another form of unexpired identification that contains your signature, such as a student/employee identification card or a credit card, to supplement your photo-bearing, government-issued identification.

If you do not have acceptable identification, as described above, that contains your name in the Latin alphabet, you can apply for an ECFMG Identification Card (EIC). You may use a valid EIC in place of one of the forms of identification listed above to gain admittance to the test center on the date of your exam. To receive an EIC, you must complete an ECFMG Identification Card Request Form (Form 180) for each exam for which you are applying and submit Form 180 at the time of application. To submit Form 180 to ECFMG, follow the instructions for additional documentation in Applying for Examination. For complete information, see Form 180, available on the Publications page of this website or from ECFMG, upon request. Each EIC is valid for one testing appointment only and will be collected at the test center at the end of your testing appointment.

Important Note: The purpose of the EIC is to provide acceptable identification for examinees who do not have identification that contains their name in the Latin alphabet. Do not request an EIC if you already have identification that meets all of the requirements listed above. Requests for EICs are processed typically within two weeks of completion of registration.

Scoring and Score Reporting

Minimum Passing Scores

For ECFMG Certification, you must obtain at least the USMLE-recommended pass outcome for each required Step or Step Component. The USMLE-recommended minimum passing level is reviewed periodically and may be adjusted at any time. Notice of such review and any adjustments will be posted on the USMLE website. (See Minimum Passing Scores in the USMLE Bulletin of Information.)

Reporting of Scores

Once your result is available, ECFMG will issue your score report. Results for Step 1/Step 2 CK are typically available within three to four weeks after your test date. However, delays are possible for various reasons. In selecting your test date and inquiring about results, you should allow at least eight weeks after your test date for your score report to become available. Results for Step 2 CS are available according to the Step 2 CS Schedule for Reporting Results, available on the USMLE and ECFMG websites. To avoid misinterpretation and to protect the privacy of examinees, ECFMG will not provide scores or pass/fail outcomes by telephone, fax, or e-mail to anyone, including examinees.

Please note that the reporting of scores may be delayed if additional data and/or analyses are required to assure the validity of the test scores. Additionally, ECFMG reserves the right to reverify with the medical school the eligibility of medical school students who are registered for examination. If ECFMG requests reverification of your student status with your medical school, ECFMG will issue your score report only after reverification of your status has been received by ECFMG.

Score reports are issued in electronic format and can be accessed using ECFMG’s OASIS. Once your score report has been issued, ECFMG will send a notification to the e-mail address in your ECFMG record. Instructions on how to view, download, and print your examination results will be available in the e-mail notification and in OASIS.

Score reports are available in OASIS for approximately 120 days. Once the score report is removed from OASIS, your results will be provided to you only in the form of an official USMLE transcript.

Step 1/Step 2 CK

Score reports for Step 1 and Step 2 CK include a pass/fail designation, numerical scores, and graphical performance profiles, which summarize areas of strength and weakness to aid in self-assessment. These profiles are developed as assessment tools for the benefit of examinees only and are not reported or verified to third parties.

Except as otherwise specified below, to receive a score for Step 1/Step 2 CK, you must begin every block of the test. If you do not begin every block, no results are reported, and the “incomplete examination” attempt appears on your USMLE transcript.

If your examination is incomplete, you may request that a score be calculated and reported, with all missed test items scored as incorrect. This score is likely to be lower than the score you would have achieved had you completed all sections of the examination. If you decide to request calculation and reporting of your score, the score will appear on your USMLE transcript as though it were complete. It will remain the permanent score for the examination administration. If your exam is incomplete, you will be notified in writing by NBME. You will have 45 days from the date of this notification to request the exam to be scored as described above.

Step 2 CS

Performance on Step 2 CS is reported as pass or fail. Examinees who fail receive performance profiles, which reflect the relative strengths and weaknesses of the examinee’s performance across the subcomponents of Step 2 CS.

For Step 2 CS, if you do not begin every case, your performance may be assessed on those cases completed. If this assessment would result in a passing outcome no matter how poorly you may have performed on the missed case(s), then a “pass” will be reported. If this assessment would result in a failing outcome no matter how good your performance on the missed case(s), then a “fail” will be reported. Otherwise, the attempt may be recorded as an “incomplete examination.”

Additional information on scoring and score reporting for all Steps and Step Components is available in the USMLE Bulletin of Information.

Score Rechecks

For Step 1/Step 2 CK, standard quality assurance procedures ensure that the scores reported for you accurately reflect the responses recorded by the computer. When a request for score recheck is received, your 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 your original score.

For Step 2 CS, score rechecks first involve retrieval of the ratings you received from the standardized patients and from the physician note raters. These values are then resummed and reconverted into final scores in order to confirm that the reported pass/fail outcome was accurate. There is no rerating of your encounters or of your patient notes; videos of encounters are not reviewed. Videos are used for general quality control and for training purposes and are only retained for a limited period of time.

Patient notes are carefully reviewed, in some instances by multiple physicians, before scores are released. As part of the quality control procedures for initial scoring, examinees who fail Step 2 CS solely on the basis of the Integrated Clinical Encounter subcomponent and who are performing at a level that is near the minimum passing point, have their patient notes rated by multiple physician note raters. Therefore, patient notes are not reviewed again when a recheck is requested.

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. However, a request for a recheck will be honored if you submit a Request for Recheck of USMLE™ Step 1, Step 2 CK, or Step 2 CS Score (Form 265) and the fee for this service to ECFMG. Your request must be received at ECFMG no later than 90 days after your score report release date.

USMLE Transcripts

To request official copies of your USMLE scores, you must contact the appropriate registration entity. You must contact the Federation of State Medical Boards if you are registered for or have taken Step 3 and/or you want to send your transcript to a medical licensing authority. In all other cases, submit your transcript request to ECFMG by sending a completed Request for Official USMLE™ Transcript (Form 172) and the appropriate fee to ECFMG. Form 172 and additional information are available on this website and from ECFMG, upon request. You can check the status of your USMLE transcript request on-line using OASIS. For a description of the information provided in USMLE transcripts, see Official USMLE Transcripts and Providing Scores to Third Parties in the USMLE Bulletin of Information.

If you apply to residency programs through the Electronic Residency Application Service (ERAS), you may request electronic transmittal of your USMLE transcript to these programs. For additional information, refer to the ERAS applicant information available on this website. Information on the status of requests for electronic transmittal of USMLE transcripts via ERAS is not available through OASIS.

CSA Performance History

If you took the former ECFMG CSA, your USMLE transcript will indicate only that you have CSA examination history. It will not provide any additional information on your attempt(s) on the CSA. To request official copies of your CSA performance history, you must complete a Request for an Official ECFMG® CSA® History Chart (Form 297) and submit it to ECFMG with the appropriate fee. For each attempt on the ECFMG CSA, the Official ECFMG CSA History Chart includes the month and year of the administration and the result of your performance. For additional information, refer to the instructions that accompany Form 297.

Testing Conditions, Validity of Scores, and Irregular Behavior

Testing Conditions

Policies and procedures to govern the administration of the exams have been established to ensure that no examinee or group of examinees receives unfair advantage on the exam, inadvertently or otherwise. If the integrity of the examination process is jeopardized, the USMLE parent organizations reserve the right to invalidate all or any part of an exam. If information indicates that continued testing would jeopardize the security of the examination materials or the integrity of scores derived from the exam, the USMLE parent organizations reserve the right to suspend or cancel test administration. See Testing in the USMLE Bulletin of Information.

Validity of Scores

To ensure the integrity of the examination system, the validity of scores reported for USMLE Steps is assured by every means available to the USMLE program. The performance of all examinees is monitored and may be analyzed statistically to detect aberrancies that may result in a classification of scores as indeterminate. To designate a score as indeterminate means that the score achieved may not represent a valid measure of the examinee’s knowledge or competence as sampled by the exam, based upon statistical analyses or otherwise. To ensure the meaningfulness of ECFMG Certification, a score that has been classified as indeterminate will not be reported. See Validity of Scores in the USMLE Bulletin of Information.

Irregular Behavior

The USMLE program’s definition of irregular behavior includes, “any action by applicants, examinees, potential applicants, or others when solicited by an applicant and/or examinee that subverts or attempts to subvert the examination process.” All USMLE exams are monitored through use of audio and video monitors, recording equipment and by test center staff. Failure to adhere to the instructions of test center staff during the exam may result in a determination of irregular behavior and permanent annotation of your USMLE record and transcripts. If you are observed engaging in a possible violation of test administration rules or other forms of irregular behavior during an exam, you will not necessarily be told of the observation by a proctor at the time of the exam. See Irregular Behavior in the USMLE Bulletin of Information.

Important Note: Postings and discussion of examination content and/or answers on the Internet are violations of the USMLE Rules of Conduct. If there is evidence that you have violated this or any other test administration rule, actions may be taken under the USMLE policies and procedures on irregular behavior. If you are found to have engaged in irregular behavior, your score report and USMLE transcripts will include this finding, and you may also be barred from taking the USMLE in the future. See Testing Regulations and Rules of Conduct and Irregular Behavior in the USMLE Bulletin of Information.

Reexamination and Reapplication

For the purpose of ECFMG Certification, there is no limit on the number of times you can take a Step or Step Component you have not passed. If you pass a Step or Step Component, you may not retake it, and you will have seven years to pass the other Step(s) or Step Component(s) required for ECFMG Certification. This seven-year period begins on the exam date for the first Step or Step Component that you pass and ends exactly seven years from this exam date. If you do not pass all required USMLE Step(s) and Step Component(s) within a maximum of seven years, your earliest USMLE passing performance will no longer be valid for the purpose of ECFMG Certification. See Time Limit for Completing Examination Requirements.

If a USMLE passing performance is no longer valid for ECFMG Certification, you may request an exception to retake the previously passed exam that is no longer valid. See Retakes in the USMLE Bulletin of Information. You may only request the exception at the time that you apply for the previously passed exam. Exceptions to the reexamination policy are not approved prior to your submitting the exam application.

If you fail or do not complete a Step or Step Component, you may retake it, but you must reapply, including payment of the appropriate fee(s). The following restrictions apply:

You may take Step 1 no more than four times in any 12-month period.
You may take Step 2 CK no more than four times in any 12-month period.
You may take Step 2 CS no more than three times in any 12-month period.

When you reapply, your eligibility period will be adjusted, if necessary, to comply with these restrictions. You must read the editions of the ECFMG Information Booklet and the USMLE Bulletin of Information that pertain to the eligibility period in which you take the exam.

If you do not take an exam during your assigned eligibility period, you must reapply, including payment of the appropriate fee(s), if you wish to take the exam. In this event ECFMG cannot process a subsequent application for this exam until two weeks after the end of the eligibility period for the exam you did not take.

Important Note: These policies apply only to ECFMG Certification. The USMLE program recommends to 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. The USMLE program also recommends to state medical licensing authorities a limit on the number of attempts allowed to pass each Step or Step Component. See Time Limit and Number of Attempts Allowed to Complete All Steps and Retakes in the USMLE Bulletin of Information. Some state medical licensing authorities accept the USMLE-recommended limits, but others do not. You should contact the 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.

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