USMLE Step Examination Procedures and Guidelines

• Any outstanding targeted skills development or remediation will be required prior to sitting for Step before the LIC.
• You will be required to communicate with your campus if you are entering the LIC in order to complete onboarding paperwork in a timely manner. Some clinical sites require onboarding to be completed up to 90 days prior to your clinical placement.
• If entering the LIC, you will be required to move (if necessary), have completed your onboarding paperwork, and be prepared at the time of LIC orientation for in person engagement, regardless of Step preparedness.
• You will be required to submit your minimum score threshold and attest you have completed all pre-clerkship requirements prior to taking Step 1 (details below). We highly encourage you to submit all CBSSA scores to better inform the program’s risk-based models and future interpretation of student progression through dedicated. All scores can be submitted on the USMLE Step 1 Eligibility Verification form and will be available to the Office of Educational Affairs (OEA) as well as your Step coach (if desired).

• Students must successfully pass all requirements of the pre-clerkship curriculum.
• The minimum threshold for meeting the requirement to test is a score of 65 on a NBME Exam (CBSSA or CBSE). This places you in the low-pass range for the NBME (PDF) and does not necessarily mean you are ready to test (see below).
• This minimum exam score and passing all requirements of the pre-clerkship is required by the COM at least 1 week prior to the scheduled testing date and must be submitted on the USMLE Step 1 Eligibility Verification form. Taking the exam without meeting these requirements will result in an incident card and may be reviewed by the Student Evaluation, Promotions, and Awards Committee (SEPAC) for consideration of disciplinary action.

• Showing evidence of meeting the minimum testing threshold is necessary to meet College of Medicine policy requirements. A score of 65 places you in the low-pass range for the NBME (PDF) and does not necessarily mean you are ready to take Step 1.
• Student specific readiness is complex and individualized, and the SLC and your Step Coach are available to individualize these discussions. The NBME insights dashboard also contains individualized passing estimates based on your prior NBME examination data (CBSE, CBSSA).

• Students with a CBSE in 512 < 40 will be required to meet with the Assistant Dean of Student Learning and Associate Dean of Assessment during 513 to discuss scheduling and exam preparation options. A meeting is strongly recommended for students with a 512 CBSE of 40-44. This meeting can also be requested by any student regardless of CBSE score.
• Some students with academic delays may wish to delay their LIC until the following academic year to prioritize Step 1 testing.
  • Testing on voluntary LOA will ONLY be allowed between Year 2 and Year 3 if you identify this need by April 30th in Year 2 (within the dedicated period).
• Students who progress past April 30th and are not ready to test for Step 1 prior to the LIC may still request a voluntary leave of absence but are not guaranteed approval to take Step 1 while on leave.

• The College does not manage or control scheduling in the Prometric centers. We have advocated heavily around challenges in the Spokane region. If you are unable to schedule your test on your preferred testing date, you may need to travel to another Prometric testing site.
• Exceptions to the dedicated period related to Prometric barriers will be supported if there is documentation that your testing date is cancelled by the testing center and cannot be rescheduled within the dedicated window. This will allow a rescheduled testing date but not an extended dedicated period.

• A testing reschedule will be allowed for a student who is ready to take the exam at the end of dedicated but encounters an acute illness, personal/family emergency, or prometric cancellation. You may be asked for proof of eligibility to take the exam (meeting minimum threshold) or documentation of scheduled test that had to be cancelled, as examples.
  • These short-term extensions do not support ongoing or lost preparation time. They can be requested to reschedule a testing date, typically within the next week, pending Prometric availability.
    • To request a short-term extension, please submit your request in writing via email to medicine.educationalaffairs@wsu.edu.
• The Step Policy Appeals Committee is made up of the Vice Dean of Admissions, Student Affairs, and Alumni Engagement, the Vice Dean of Educational and Faculty Affairs, the Associate Dean of Assessment, and student’s Regional Dean. The committee will review all requests and follow up directly with students.
• Students who are not ready to take the exam at the end of their testing window will enter the LIC and cannot take Step 1 during the LIC. The post-LIC testing options are detailed below.

• Timing to take the exam after dedicated is more limited due to the requirement to focus on clinical work during the clinical curriculum.
• Students cannot take the exam during the LIC.
• Students can take the exam during their Year 4 discretionary time or virtual courses but cannot take the exam during required or clinical Year 4 courses.
• Students can choose to continue into Year 4 or take a voluntary leave of absence after the LIC to further prepare and test. Students can take Step 1 on any voluntary leave of absence occurring after the LIC.
• Students should also refer to Eligibility Requirements to Apply to Residency Programs established jointly by the Offices of Educational Affairs and Student Experience to consider whether they are able to take and pass Step 1 and Step 2 in addition to completing Year 4 requirements within Year 4 or would benefit from a voluntary LOA.

• Step 1 testing on a voluntary LOA between Year 2 and 3 is restricted to specific circumstances. A student that has not attempted Step 1 and decides after April 30th to take a voluntary LOA before the LIC may not be able to test for Step 1 while on LOA (see Medical Student Leave, Withdrawal, and Readmission policy).
  • The Step Policy Appeals Committee will review requests to take Step 1 during a voluntary LOA on a case-by-case basis but, given the implications for cancelling clinical schedules, the committee will generally not approve testing unless the leave request is needed independent of the desire to test for Step 1.
  • Students planning a voluntary LOA between Years 2 and 3 may not be informed of a Step Policy Appeals Committee decision until after the leave is processed and should not take a leave of absence with the anticipation of being able to test for Step 1.
• Step 1 testing on voluntary LOA after the LIC is allowed.
• Students who have previously attempted Step 1 but failed can take Step 1 on any voluntary LOA regardless of timing.
• For more information about LOAs, please see this Student Handbook Leave of Absence page.

• For Step 1 testing, only students who do not test by the end of Year 4 and do not wish to extend Year 4 will be considered by the SEPAC for a required administrative LOA. This change is effective for students beginning the LIC in Academic Year 2025–2026.
• Non-step related administrative leaves may still be required for students based on decisions by SEPAC. Please see the Medical Student Leave, Withdrawal, and Readmission Policy for more details.

• By the beginning of the academic year in which the student is taking the exam, the Student Learning Center will assign a Step Coach. The Step Coach will partner with the student in the development, planning and monitoring of their study schedule and with assessing test readiness. Step coaching is not required but heavily encouraged; late utilization of this resource decreases its effectiveness.
• Additional resources available in the Student Learning Center include UWorld, practice exam vouchers, peer tutoring, limited faculty tutoring, learning specialist resources and support, and content available on the Student Learning Center.

• 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 2 testing on voluntary LOA after the LIC is allowed.
• Students should be mindful of required away rotations by specialties which are often completed prior to ERAS application release in September of Year 4.
• Students should review the guidance from the Career Advising Program about Step 2 Timing Based on Specialty (PDF) if planning on applying to residency.
• Students are encouraged to meet with the Student Learning Center to review study strategies and identify an appropriate testing date.

• Students must attempt Step 2 by November 1^st to graduate in December. Students must attempt Step 2 by April 1^st to graduate in May.
• Students must have a passing score on Step 2 by January 31^st to be verified in the Match in that year. See Eligibility Requirements to Apply to Residency Programs for more information.

• The NBME determines whether testing accommodations for USMLE Step exams are fully or partially granted or denied.
• Support for applying for NBME accommodations is provided through the Disability Resource Professional. Additional resources are available:
  • Guide to Requesting Accommodations on the USMLE Step Exams
  • USLME Test Accommodations
• The Disability Resource Professional can also support you in considering whether internal accommodations of relevant policies or procedures are appropriate for disability-related barriers.

Students should review the Eligibility Requirements to Apply to Residency Programs information about passing deadlines in order to apply for residency and participate in the NRMP Match and/or ERAS SOAP.