ECFMG 2021 Information Booklet

The United States Medical Licensing Examination (USMLE)

Applying for Examination

Before applying to ECFMG for examination:

  • International medical students/graduates must complete an Application for ECFMG Certification, including the notarized Certification of Identification Form (Form 186). See Application for ECFMG Certification.
  • ECFMG must accept the Application for ECFMG Certification, including the notarized Form 186.
  • International medical students/graduates must read the applicable editions of the ECFMG Information Booklet and the USMLE Bulletin of Information.

To apply for USMLE Step 1 and/or Step 2 CK, use ECFMG's Interactive Web Applications (IWA). A complete application consists of the on-line part, which you complete using IWA; verification of your student or graduate status by your medical school; and any other required documents. You should read the detailed overview and instructions that accompany the application for examination in IWA before you begin working on the application; these resources will help you plan the timing of your application and outline any necessary items (such as official signatures) that require advance planning.

Important Note: You should also consider deadlines imposed by the National Resident Matching Program (NRMP) and graduate medical education (GME) programs. 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. See Examination Results for information on scoring turnaround times.

Exam Fees

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. You must pay all applicable fees at the time you apply for examination. For the current exam fees and international test delivery surcharges, see the Fees page on the ECFMG website.

Eligibility Periods

When you apply for Step 1 or Step 2 CK, you must select an eligibility period during which you would prefer to take the exam. The eligibility period you are assigned will be listed on your scheduling permit. You must take the exam during the eligibility period assigned to you.

If you are unable to take Step 1/Step 2 CK during the eligibility period assigned to you, you may request a one-time, contiguous eligibility period extension (EPEx) using ECFMG’s IWA. Refer to the EPEx Overview in IWA for more information and instructions.

If you do not take Step 1/Step 2 CK during your original or extended eligibility period or if you are unable to extend your eligibility period, you must reapply by submitting a new application and fee(s), if you wish to take the exam.

Testing Locations

Step 1 and Step 2 CK are delivered at Prometric test centers worldwide. Prometric's test centers are grouped into defined testing regions. When you apply for Step 1 or Step 2 CK, you must choose the testing region where you want to take the exam. A list of Prometric testing regions is available on the ECFMG website.

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. The test centers available for USMLE Step 1 and Step 2 CK are subject to change. To obtain current information on specific test centers, visit the Prometric website or follow instructions on the scheduling permit for contacting Prometric.

If you are unable to keep your Step 1 or Step 2 CK 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 reschedule more than 30 calendar days before your scheduled testing appointment. Refer to your scheduling permit for details.

If you are unable to take Step 1 or Step 2 CK in the testing region you selected, you may request a change to your testing region. For more information, see the Request to Change USMLE® Step 1/Step 2 CK Testing Region (Form 312), available in the Resources section of the ECFMG website and from ECFMG, upon request.

Examinees with Disabilities Requesting Test Accommodations

The USMLE program provides reasonable accommodations for examinees with disabilities under the Americans with Disabilities Act (ADA). If you are an individual with such a disability and require test accommodations, visit the USMLE website before you apply for each Step or Step Component for information regarding test accommodations, including procedures and documentation requirements.

Examinees Who Require Additional Break Time

Examinees with physical or health conditions, such as lactation (to express breast milk) and diabetes (to monitor/treat blood glucose), may apply for additional break time. See the USMLE Bulletin of Information for more information.

Personal Item Exceptions (PIE)

Unauthorized possession of personal items while you are in the secure areas of the test center is prohibited. Exceptions to this policy may be made in certain limited circumstances. See the USMLE Bulletin of Information for more information.

Important Note: Please note that ECFMG will not provide services of any kind if doing so would be considered violative of any applicable international, federal, state, or local laws or regulations. Additionally, ECFMG may delay or suspend provision of services while investigating whether the services or surrounding circumstances violate such laws, regulations, or ECFMG's policies and procedures.