USMLE limits how many times you may attempt a Step and how soon you may retake it. These rules come from the USMLE Bulletin eligibility page, and they matter as soon as a result is a fail, a withdrawal or an incomplete attempt.
The rules, as USMLE states them
- Four attempts: "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 former Step 2 Clinical Skills count toward the limit.
- Three in 12 months: you may not take the same Step more than three times within a 12-month period.
- Waiting before a fourth attempt: it must be at least 12 months after your first attempt at that exam and at least six months after your most recent attempt. This includes incomplete attempts.
- Passed Steps: 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.
The Bulletin wording does not spell out whether the four attempts are counted per Step or across all Steps, so read the full page and ask your registering organization (NBME or ECFMG) if your situation is not clear.
Incomplete attempts count
An attempt that you start and do not finish still counts. Before you sit an exam, be sure you can complete it, and read the rules on test-day security and accommodations.
After a fail
- Read the content-area feedback in your score report.
- Check your attempt count and the waiting periods above before you schedule.
- Plan a different preparation approach, using timed practice in the 30-minute block format and an NBME self-assessment.