Every USMLE score is used by licensing boards and residency programs to make decisions about patient safety. That only works if every examinee sits the same kind of exam, under the same rules, and every result can be trusted. This guide explains what to expect on test day, how USMLE keeps the exam fair, and how to request test accommodations.
Before test day
- Scheduling permit: bring a paper or electronic copy of your scheduling permit.
- Identification: bring a valid, unexpired, government-issued photo ID such as a passport, driver's license, or national identity card. The name must match your permit exactly; only minor differences such as capitalization, a middle name or initial, or a suffix are allowed. Fix name mismatches with your registering organization before test day.
- Arrive early: plan to arrive at least 30 minutes before your appointment. Late arrivals can be refused entry and the attempt may be forfeited.
Check-in and test center security
- Security screening with a handheld wand or walk-through detector. You will be asked to empty your pockets and remove eyeglasses for inspection.
- Your photo and fingerprints may be captured electronically, and you sign the test center log when you arrive and leave.
- Mobile phones, watches, fitness trackers, tablets, jewelry (other than wedding or engagement rings), notes, and study materials must be stored in a small locker. Religious headwear is inspected visually and may be worn.
- The session is monitored in person and through audio and video recording.
Breaks during the exam
Break time is shared across the day and every exit and return is recorded. You must show your ID each time you re-enter. If you leave during a block without authorization, the block clock keeps running. Plan your break budget before test day using the tutorial for your exam version.
Confidentiality and irregular behavior
Before you start, you agree to keep exam content confidential. You may not memorise, record, share, or post questions, and you may not seek out "recalls" of live items. USMLE treats these as irregular behavior, along with impersonation, bringing prohibited items, and communicating with others during the exam.
Consequences can include cancellation of scores, a bar from future testing, a permanent annotation on your USMLE transcript, and a report to the FSMB Physician Data Center, which licensing boards consult. If you see something concerning, you can report it anonymously through the STOPit app listed on the USMLE website.
How USMLE keeps the exam fair
- Expert-written questions: items are written and reviewed by committees of physicians and educators and screened for accuracy and bias before use.
- Unscored pretest questions: new items are tried out without counting toward anyone's score until their quality is confirmed.
- Equated scores: different exam forms can vary slightly in difficulty. Scoring adjusts for this, so your result does not depend on which form you received.
- No quota: there is no set percentage of examinees who must fail. Passing depends on meeting the standard. Typically that means answering roughly 60 percent of items correctly.
- Reviewed standards: the USMLE Management Committee reviews passing standards about every four years and announces changes in advance.
If something goes wrong on test day
If you have a significant technical problem, noise or other disruption, or a sudden illness, tell test center staff immediately so it is documented. Then email testadmin@nbme.org within 10 calendar days of your exam. Your score may be held while USMLE reviews a reported irregularity.
Test accommodations
If you have a disability covered by the Americans with Disabilities Act (ADA), you can request test accommodations for any Step exam. Since June 2026, all examinees, including international medical graduates who register through FSMB, submit requests online through NBME's MyUSMLE portal. NBME Disability Services reviews the requests.
Common types of accommodation
- Additional testing time, for example time-and-a-half or double time
- Additional break time, with standard testing time
- A separate or reduced-distraction testing room
- Assistive technology or alternative formats, where appropriate
Some accommodations change the structure of test day. For example, additional break time can make Step 2 CK a two-day exam and Step 3 a three-day exam, which requires an accommodated scheduling permit.
Documentation and timing
- Describe how your condition limits you in the testing setting. Include recent documentation from qualified professionals and any history of accommodations, such as prior testing or school accommodations.
- Request early. USMLE says to allow approximately 60 business days for a decision once your exam application and accommodation file are complete. You may be asked for more information, so build this into your eligibility period and study plan.
- Questions go to NBME Disability Services at disabilityservices@nbme.org.
Personal item exceptions (PIEs)
Some medical items are pre-approved and may be brought into the testing room after inspection, with no request needed. Check the current list on the USMLE website. Other items need a personal item exception request, usually with supporting documentation from a treating provider. Breast pumps and diabetic supplies have reduced documentation requirements.
Breastfeeding and lactation
Nursing examinees can choose between two options:
- Test under standard conditions and use a breast pump during authorized breaks. A request is still needed so Prometric can arrange a suitable space.
- Request additional break time for expressing milk. This extends the exam over more days and requires an accommodated permit.
Submit either request through the MyUSMLE portal well before your preferred test date.