2.06 Licensure: USMLE (United States Medical Licensing Examination)
The National Board of Medical Examiners has established a single, three-step examination for medical licensure in the United States. The United States Medical Licensing Examination (USMLE) provides a common evaluation system for applicants for medical licensure. Harvard medical students are required to obtain passing scores on USMLE Step 1 and Step 2 CK (Clinical Knowledge) to be eligible for graduation. Step 3 is taken after the MD degree is earned. For additional information, please refer to the USMLE Bulletin of Information http://www.usmle.org/.
USMLE Step 1
Pathways students entering 2022 or earlier and HST entering 2023 or earlier
Students in Pathways (who entered in 2022 or earlier) and HST students who entered in 2023 or earlier take USMLE Step 1 following completion of the PCE – no later than December 31 of Year III for Pathways students and no later than April 30 of Year III for HST students. Pathways students must have individual meetings with their Society advisor to discuss the advantages and disadvantages of various scheduling options and are strongly encouraged to schedule one credit-bearing month during the three-month post-PCE period (i.e., a clinical elective, a core subinternship, Essentials II, research for the scholarly project requirement, or a non-clinical elective) during the quarter following the PCE. Students entering a PhD program after nine months of the PCE (Pathways) or after 3 months of the PCE (HST) are required to take Step 1 prior to beginning the PhD.
Students in the HST curriculum track who entered in 2023 or earlier will continue to take Step 1 during the three 1-month PCE blocks or upon completion of the PCE and no later than April 30 of Year III.
USMLE Step 1 – Beginning with the Pathways class entering in August 2023 and the HST class entering in August 2024
Preamble
Passing USMLE Step 1 is an HMS graduation requirement and a prerequisite for medical licensure. Preparing for Step 1 allows students to consolidate their preclerkship knowledge and improve their readiness for the core clerkships.
Beginning with the class entering in 2023, all HMS MD students in the Pathways curricular track are required to take USMLE Step 1 before progressing to the PCE phase of the curriculum. Pathways MD students have a designated USMLE Step 1 study period and are required to take the exam by a date specified by the Registrar’s Office each year. Pathways MD-PhD students must take Step 1 before beginning their PhD, either before the start of the PCE or in the summer after a portion of the PCE has been completed.
Beginning with the class entering in 2024, all HMS MD students in the HST curricular track are required to take USMLE Step 1 before starting the Introduction to Clinical Medicine (ICM) course. HST MD-PhD students must take Step 1 before beginning their PhD, either before the start of ICM or in the summer after a portion of the PCE has been completed.
Exceptions for Extraordinary Circumstances
Students may be unable to sit for Step 1 by the necessary deadline because of extraordinary circumstances outside of their control, including:
- Illness or accident
- Death in the immediate family
- Conflicts with religious obligations
- Cancellation of availability by the testing provider
We expect students to report these circumstances promptly and honestly. In these listed situations only, and assuming the student is otherwise academically ready to take and pass the exam, every effort will be made to allow the student to begin the PCE on the originally expected start date. At the MGH, BWH, and BIDMC PCE sites, students may be assigned to the four-week clerkships first, with one such clerkship deferred at the discretion of the Registrar, so that Step 1 can be taken within the first four weeks of the PCE. At the CHA PCE site, students may have their immersion weeks adjusted so that Step 1 can be taken within the first four weeks of the PCE. If Step 1 is not successfully taken and passed within the first four weeks, the student may be required to step out of the PCE until the exam is taken and passed; return to the PCE would typically occur at the beginning of the next quarter, at the earliest.
Academic Unpreparedness
On rare occasions, students may not be prepared enough to take Step 1 by the necessary deadline. In these cases, the students are expected to have been working closely with their Society advisor and staff from the Office of Learning Resources and Support. These individuals should guide them regarding their Step 1 preparedness, including by reviewing results of official Step 1 practice exams, which provide estimated probabilities of passing.
In these situations, students will not be permitted to begin the PCE within the first 12 weeks of the originally expected start date. Instead, they will begin the PCE at the beginning of the next quarter, assuming that Step 1 has been taken by then. The PROGRESS team will review students to ensure that maximal support is available to help with Step 1 preparation. The Promotion and Review Board (PRB) will be informed of the delay in PCE start, but a full review of the student’s case would not generally be required.
All Other Situations
Any other situation (other than extraordinary circumstances or academic unpreparedness as noted above) in which a student does not take Step 1 by the deadline will result in a full review by the Promotion and Review Board at its next regularly scheduled meeting. Students will not be permitted to begin the PCE until they take the exam; at the earliest this would generally occur at the beginning of the next quarter. In some situations, the student may need to be placed on Leave of Absence from the school, depending on the nature and duration of the delay from the originally expected PCE start date.
USMLE Step 2 – Clinical Knowledge (CK)
Students are required to pass Step 2 CK as a requirement for graduation. Because of limitations in the availability of test slots and the extended reporting timeline for Step 2 CK test results, students are required to complete Step 2 CK by December 31 of their final year. Test scores must be reported to the HMS Registrar in order to receive the MD degree. If a student’s passing scores are not reported to the HMS Registrar before the last date of attendance in the graduating year as published on the academic calendar, that student will not receive the MD degree at graduation. Because failure to receive an MD degree will have an impact on a student’s ability to start postgraduate training, the Academic Societies require students to confirm their test schedules as they prepare the MSPE (Medical Student Performance Evaluation, or Dean’s Letter). More information about resources available to help with study strategies, exam taking, etc., can be found on the Office of Learning Resources and Support.
Students should be aware that some residency programs may require that students have passing scores available for all parts of USMLE by the rank order deadline for the residency match (late February) in order to be considered for ranking by the program. Students should check directly with the residency programs for specific requirements.
For more information about Assessment and Evaluation requirements, please refer to Sections 1.04 and 2.03.
Students are permitted three attempts to pass each required licensing exam (Step 1 and Step 2 CK). Students who fail to pass either of these exams after three attempts are referred to the HMS Promotion and Review Board (PRB) and are ordinarily required to withdraw from Harvard Medical School.
During the late spring or summer of the 4th or final year of the MD program, each student will have an interview in preparation of the MSPE (Medical Student Performance Evaluation, or Dean’s Letter). At that meeting, each student must present proof that they have taken, or are scheduled to take, Steps 1 and 2 CK of the USMLE prior to December 31st of that year. If a student has not taken or scheduled one or both of the USMLE step exams at the time of preparation of the MSPE, HMS may include a sentence in the MSPE regarding the status of USMLE scheduling.
Updated 8/8/2025