Intealth ECFMG

Educational Commission for Foreign Medical Graduates

ECFMG 2023 Information Booklet

The United States Medical Licensing Examination (USMLE)


Reexamination and Reapplication

USMLE policy generally does not allow applicants to retake a Step if they have already passed that Step. However, there are exceptions for the purpose of complying with a time limit imposed by a U.S. physician licensing authority or another authority recognized by the USMLE program. See Time Limit for Completing Examination Requirements below.

If you fail a Step, you must reapply, including payment of the appropriate fee(s), to retake 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, you may reapply at any time, however, ECFMG cannot begin to process a subsequent application for this exam until at least four weeks after the end of the eligibility period for the exam you did not take.

Number of Attempts Allowed

The USMLE program limits to four the total number of times an examinee can take the same Step. Examinees who have attempted a Step four or more times, including incomplete attempts, and have not passed are ineligible to apply for any Step in the USMLE exam sequence. Attempts at the formerly administered Step 2 CS count toward the limit. All attempts at a Step are counted toward the limit, regardless of when the exams were taken.

For the purpose of U.S. medical licensure, state medical licensing authorities may limit the number of attempts allowed to pass each Step. Information regarding specific state requirements can be obtained on the Federation of State Medical Boards (FSMB) website .

Time Between Examination Attempts

The USMLE program has established rules on how quickly you can retake the same Step. You may not take the same examination more than three times within a 12-month period. Your fourth attempt must be at least 12 months after your first attempt at that exam and at least six months after your most recent attempt at that exam. This includes incomplete attempts.

Example: An examinee took and failed her first attempt at Step 1 on January 15, 2021, her second attempt at Step 1 on April 15, 2021, and her third attempt at Step 1 on September 15, 2021. In January 2022, the examinee applied for a fourth attempt at Step 1 and wanted the March-April-May eligibility period. The earliest date that was both 12 months after her first attempt on January 15, 2021 and six months after her most recent attempt on September 15, 2021 was March 15, 2022. Since the March- April-May eligibility period began before this date, the earliest eligibility period that the applicant could request was April-May-June.

When you reapply, your eligibility period will be adjusted, if necessary, to comply with these rules. 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.

Time Limit for Completing Examination Requirements

For the purpose of ECFMG Certification, you must satisfy the examination requirements for ECFMG Certification within a seven-year period. If you do not satisfy the examination requirements for ECFMG Certification within a maximum of seven years, your earliest USMLE passing performance will no longer be valid for ECFMG Certification. See Time Limit for Completing Examination Requirements in Examinations for ECFMG Certification.

If you have passed a Step but this 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. The USMLE program’s policy on attempt limits may impact an applicant’s ability to retake the examination that is no longer valid.

For the purpose of U.S. medical licensure, time limits to complete the USMLE are established by state medical licensing authorities and may require completion of all Steps (including Step 3, which is not required for ECFMG Certification) within a certain number of years from the date the first Step is passed. Information regarding specific state requirements can be obtained on the FSMB website . You may request an exception to retake a previously passed exam to comply with the time limit of a U.S. physician licensing authority. Visit the USMLE website for more information.

Important Notes: You may only request an exception at the time that you apply for the previously passed exam. Complete requirements and instructions will be provided at the time of exam application. Exceptions to the reexamination requirements are not approved prior to your submitting the exam application.
Applicants who retake a previously passed Step to comply with a time limit should understand the implications of a failing retake performance on their Step 3 eligibility. See Retaking Previously Passed Steps in the USMLE Bulletin of Information.

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[Last update: September 14, 2022]

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