Exceptions to USMLE® Reexamination Policy

USMLE policy on reexamination generally does not allow applicants to retake Step 2 CS if they have already passed this exam or the former ECFMG Clinical Skills Assessment (CSA®). There are, however, certain exceptions to this policy.

Exception #1

Applicants who have already passed Step 2 CS or the former ECFMG Clinical Skills Assessment (CSA®) may retake Step 2 CS to comply with the time limit of a medical licensing authority for the completion of all Steps. This exception applies only to applicants for medical licensure in a jurisdiction who have fulfilled all requirements for licensure in that jurisdiction; are eligible for licensure in that jurisdiction except for the out-of-date exam; and have completed the full USMLE sequence, including Step 3. If you are repeating a Step because of a time limit, you may apply to retake the Step only after the applicable time limit has expired.

If you wish to request exception from the USMLE policy on reexamination on this basis, you should send your written request to ECFMG marked to the attention of the Registrar. You may only request the exception at the time that you apply for the exam that was previously passed. Exceptions to the reexamination policy are not approved prior to your submitting the exam application. You must make a written request to ECFMG for each exam application you submit. Your request must be supported by the following:

  • The USMLE Retake Sponsorship Form. The USMLE Retake Sponsorship Form must be completed in its entirety by the medical licensing authority in which you are applying for licensure, including original signature and original seal, and sent by the medical licensing authority directly to ECFMG on your behalf. ECFMG must be able to determine that the USMLE Retake Sponsorship Form came directly from the medical licensing authority.

    The USMLE Retake Sponsorship Form confirms to ECFMG that you are an applicant for licensure in the medical licensing authority's jurisdiction; that you have completed the full USMLE sequence, including Step 3; that you are otherwise eligible for licensure in that jurisdiction except for the medical licensing authority's time limit for completion of all Steps; and that retaking the previously passed Step will not exceed the medical licensing authority's limit on the number of attempts to pass the Step.

    You do not need to provide the USMLE Retake Sponsorship Form to the medical licensing authority. The medical licensing authority has this form.

Exception #2

You may retake a passed Step or Step Component to comply with the time limit imposed by ECFMG for the completion of all Steps or Step Components required for ECFMG Certification. For the purpose of ECFMG Certification, ECFMG requires that applicants pass the USMLE Steps and Step Components required for ECFMG Certification within a seven-year period. Effective June 14, 2004, applicants must pass Step 1, Step 2 CK, and, if required for ECFMG Certification, Step 2 CS within a seven-year period for ECFMG Certification; this seven-year requirement applies to applicants whose earliest USMLE passing performance that is valid for ECFMG Certification took place on or after June 14, 2004. Prior to June 14, 2004, ECFMG required that applicants pass only Step 1 and Step 2 CK within seven years of each other for ECFMG Certification; this prior seven-year requirement continues to apply to applicants if their earliest USMLE passing performance that is valid for ECFMG Certification took place before June 14, 2004. For these applicants, Step 2 CS, if required for ECFMG Certification, can be passed outside of this seven-year period.


Exception #3

According to ECFMG policy, passing performance on administrations of the ECFMG CSA that took place before June 14, 2001 was valid for three years from the date passed for the purpose of entering U.S. programs of graduate medical education (GME). If an applicant's CSA pass date expired before entering a GME program, the applicant must revalidate this date by passing a subsequent exam, if he/she wishes to enter such a program. An applicant whose CSA pass date has expired and who plans to enter a GME program may take Step 2 CS for these revalidation purposes.

If you wish to request exception from the USMLE policy on reexamination on this basis, you should send your written request to ECFMG marked to the attention of the Registrar. You may only request the exception at the time that you apply for the previously passed exam. Exceptions to the reexamination policy are not approved prior to your submitting the exam application. You must make a written request to ECFMG for each exam application you submit. Your request must be supported by a written statement of intent from you that you are requesting the exception in order to revalidate your expired CSA pass date for the purposes of entering a GME program.


Instructions for submitting support documentation for the exceptions outlined above.

  • Make a written request to ECFMG marked to the attention of the Registrar at ECFMG, 3624 Market Street, Philadelphia, PA 19104-2685, USA.

  • You must make a written request to ECFMG for each exam application you submit.

  • For Exceptions #1 and #3, your written request must be supported by specific documentation as outlined under each exception described above.

  • Exceptions to the reexamination policy are not approved prior to your submitting the exam application.