Policy Number: AD 10.08.240604
Applies to: Washington State University’s Elson S. Floyd College of Medicine faculty, staff, administration, and students.
Date: 11/4/2025
1.0 Policy Statement
It is the WSU College of Medicine policy that individuals who receive the MD degree are prepared to successfully enter postgraduate training and be licensed to practice medicine. The United States Medical Licensing Examination (USMLE) Step Examination Policy delineates deadlines, procedures, and expectations for completing the USMLE Step 1 and Step 2 Clinical Knowledge (CK) examinations. As such, the college establishes as policy that:
- Students must pass Step 1 before applying to residency and Step 2CK before certification for the match.
- All required examinations must be attempted prior to completion of the MD program per Graduation Requirements. Failure to meet deadlines may result in an administrative leave of absence or delay of graduation.
- A dedicated period of time for studying and taking Step 1 is provided in Year 2.
- Eligibility to sit for Step 1 requires successful completion of the pre-clerkship curriculum and meeting an annually published minimum NBME practice exam score.
- Students who do not pass Step 1 by the end of the dedicated period cannot sit for the exam until after they have successfully completed all requirements of the Longitudinal Integrated Clerkship.
- Students cannot take Step 1 while on a Year 4 clinical rotation. Additional eligibility requirements for Y4 courses are detailed in the Clinical and Non-Clinical Rotations Policy.
- Students are not permitted to take the USMLE Step 2CK prior to the final assessment week of Year 3.
2.0 Definitions
Administrative Leave of Absence
A leave required by the College during which the student is not registered in coursework.
Dedicated Period
Protected time identified in the curriculum dedicated to preparation for USMLE Step exams.
NBME
National Board of Medical Examiners; the body that oversees the USMLE.
NRMP
National Residency Matching Program – the national program that matches the majority of specialties.
SEPAC
Student Evaluation, Promotion, and Awards Committee.
SLC
Student Learning Center.
SOAP
Supplemental Offer and Acceptance Program – a program via the NRMP that allows programs to make unfilled seats available for application to unmatched students for potential offers.
United States Medical Licensing Examination
The USMLE has three examinations, called “Steps” – which are taken at different points in an allopathic physician’s education and training. Examinees who pass each Step of the USMLE have demonstrated they understand and can apply medical knowledge, clinical concepts, and fundamental patient-centered skills to obtain a license to practice medicine in the United States.
USMLE Step 1
Step 1 is a computer-based test that assesses medical student knowledge of the foundational sciences fundamental to the practice of medicine.
USMLE Step 2 Clinical Knowledge
Step 2CK assesses medical students’ ability to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision and includes emphasis on health promotion and disease prevention.
Voluntary Leave of Absence
A leave of absence initiated voluntarily by the student and limited to the following: Academic, Financial, Medical, Military, Personal, Scholarly.
3.0 Responsibilities
Responsible Office: Office of Educational Affairs
Oversight Committee: Undergraduate Medical Education Committee
4.0 Procedures
4.1 USMLE STEP 1 (see the Student Handbook for detailed procedures)
Dedicated Testing Period
- Students will have a dedicated window in Spring Term of Year 2 to prepare for and take Step 1.
- Students cannot sit for the exam prior to the dedicated period or before completing all pre-clerkship requirements.
- Students who demonstrate a high likelihood of needing additional support beyond dedicated time may have additional requirements for participation in support services and schedule changes. The specific dates and any requirements will be published at the beginning of the academic year.
- Students who are ready to test but unable to finish the testing process due to extenuating circumstances at the end of dedicated will be able to apply for a limited extension to test with an additional one-week to sit for the exam (or next available testing date). The details of this process will be published at the beginning of the academic year. This extension is not to support ongoing preparation, but to schedule/reschedule a testing date.
Minimum Testing Threshold
- A minimum threshold on an NBME practice exam is required to test; this minimum threshold will be released at the beginning of the academic year. This threshold is different from the threshold used to determine exam readiness.
- Taking the exam without meeting this minimum threshold may result in disciplinary action.
LIC Progression, Delayed Testing, and Year 4
- Students unable to pass Step 1 by the time of their progression to the LIC are required to fully engage with the Year 3 curriculum and may not sit for the exam until they have completed all LIC course requirements.
- Immediately following completion of LIC requirements, any student who has not yet attempted or passed the Step 1 exam can choose (1) to take a voluntary leave of absence to prepare for Step 1 and/or (2) to continue in the Y4 curriculum.
- Students cannot take Step 1 during required or clinical Year 4 rotations and should consider financial aid implications of enrollment and credit status.
Step 1 Failure without a Desire to Enter Residency
- If a student does not wish to pursue residency and has made one attempt at the exam, they are required to meet with Student Affairs to discuss their career goals. They can choose to progress through the program towards graduation.
Step 1 testing while on Voluntary Leave of Absence
- Students planning to take voluntary leave of absence (LOA) between Year 2 and 3 are eligible to take Step 1 while on LOA if the LOA is requested by the Step 1 Voluntary LOA Deadline.
- A student who requests a personal LOA after this deadline is not guaranteed permission to take the Step 1 exam.
4.1 USMLE STEP 2CK (see the Student Handbook for detailed procedures)
USMLE STEP 2CK Attempt
- Students with a May graduation who have not yet attempted Step 2 CK have until April 1 to test; those with December graduation dates have until November 1 to test. If they have not attempted by the applicable date, they will be given the option of either an Administrative LOA or an extended Year 4 (and a delayed graduation to the following December or May) to complete this requirement (i.e., attempting the exam).
- There is no dedicated period for USMLE Step 2. When helping to develop the Year 4 schedule with their campus team, students can request discretionary time to prepare.
- Step 2CK testing on voluntary LOA after the LIC is allowed.
USMLE Step 2 Failure
- In the event of a Step 2 failure, students can choose to proceed with their graduation date (provided all requirements are met) or choose an extended Year 4 (and a delayed graduation to the following December or May).
5.0 Related Policies and Bylaws
- Medical Student Leave, Withdrawal, and Re-admission Policy
- Student Promotion, Dismissal, and Graduation Policy
- MD Program Graduation Requirements
6.0 Key Search Words
USMLE Step exams, leave of absence.
7.0 Revision History
Original Approval: 6/4/2024
Policy Number: AD 10.07.240206, AD 10.08.240604
Review/Revision: 11/4/2025