Who can sit Step 1
Eligibility depends on your medical school and where you are in your degree. Here is the official picture, in plain English.
The two routes
Currently enrolled
- Officially enrolled at a school listed in the World Directory with an ECFMG eligibility note
- Enrolled both when you apply and on test day, and your graduation year is marked current
- Basic medical science completed, which typically means at least two years of medical school
Already graduated
- Graduated from a listed school, in a graduation year covered by its ECFMG note
- At least four credit years of medical education credited by a listed school
- Your Application for ECFMG Certification accepted before you apply for the exam
Source: ECFMG: eligibility for examination and the ECFMG 2026 Information Booklet, checked October 2026.
Before you register
- Check your schoolFind it in the World Directory of Medical Schools and read its ECFMG note.
- Open your accountsECFMG handles certification. FSMB handles USMLE registration for IMGs.
- Register for Step 1Choose a three-month eligibility period that fits your study plan.
- Book your centreOnce registered, schedule a Prometric test centre in your region.
See every testing region in the international medical graduate guide.
Attempts and limits
Four attempts
You can attempt each Step up to four times.
Three in 12 months
You cannot take the same Step more than three times in 12 months.
Seven years
For ECFMG certification, the required Steps must be passed within seven years of the first one you pass.
Rules can change. Always confirm in the USMLE Bulletin of Information.
Past papers and syllabus
Whatever your route, the exam tests the same official content outline, and USMLE does not release past papers. Start from the outline, then practise with original questions.
Step 1 eligibility questions
Can I take Step 1 before I graduate?
Does my nationality matter?
What if my school is not listed?
Ready to practise?
Tell us your plan on WhatsApp. We confirm your access and send your code.