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USMLE Test Day: Testing Regulations and Rules of Conduct

  • Administration of the USMLE Steps are monitored by test center staff, in person and through audio and visual recording. Test center staff is required to report any violations of the USMLE or test center rules.
  • You must follow instructions from test center staff throughout the examinations; failure to do so may result in a finding that you have engaged in irregular behavior and a permanent annotation of your transcript.
  • Test center staff is not authorized to answer questions regarding registration, examination content or format, or testing software, scoring, or retesting.

Rules of Conduct

  • When you submit your application to take the USMLE, you agree to the following:
    1. You are the person named on the scheduling permit for the examination.
    2. You will not seek, provide, or obtain any form of unauthorized assistance at any time , including during the examination or during breaks.
    3. You will not have prohibited materials, including formulas, study materials, notes, papers, or electronic devices of any kind in your possession while you are in the secure areas of the center.
    4. You will place in a locker or cubicle all personal belongings, including cell phones, watches, pagers, tablet PCs, iPods/media players, fitness and tracking monitors, any device with transmitting or receiving capabilities (eg, Bluetooth), formulas, study materials, notes, papers, pens/pencils, and your purse and/or wallet, before you enter the testing room (or “orientation room” for Step 2 CS).
    5. During computer-based testing (Steps 1, 2 CK, and 3), you will leave your testing station for breaks only when the break screen is visible on your monitor. It is a violation of the Rules of Conduct if you indicate on the center log that your break screen is visible when it is not.
    6. During computer-based testing (Steps 1, 2 CK, and 3), you may use a telephone or other communication device only when outside the secure testing area and during an authorized break. During Step 2 CS, you will not use a personal telephone at any time while you are in the testing center.
    7. You will not remove examination content from the test center by any means.
    8. You will maintain the confidentiality of the materials, including but not limited to the multiple-choice items and the case content for Step 2 CS and Primum CCS. You will not reproduce or attempt to reproduce examination materials through recording, memorization, or by any other means. Also, you will not provide information relating to examination content to anyone, including those who may be taking or preparing others to take the examination. This includes postings regarding examination content and/or answers on the Internet.
    9. You will not write on anything other than the laminated note boards (computer-based examinations) or scrap paper (Step 2 CS) provided.

Personal Belongings – What You Can Bring Into The Testing Room

  • Personal items are prohibited in the secure areas of the testing center. For computer-based examinations (Step 1, Step 2 CK, and Step 3), the only items you are allowed to bring into the testing room are soft-foam earplugs without strings.
    • Earplugs must be removed from the packaging and be ready for inspection by test center staff during check-in and must remain at your workstation during all breaks. Earplugs are prohibited for Step 2 CS. Visit the USMLE website for more information.
  • For Step 2 CS, the entire test center, including the orientation room and the restrooms, is considered a secure testing area. The only items you are allowed to bring into the secure testing area are your white lab coat (pockets must be empty) and a standard stethoscope, without digital amplification, electronics, or any other enhancement. (Should you forget to bring one, there are a limited number of standard stethoscopes available at the test center).
    • If you require an amplified stethoscope and wish to bring one to the exam, you must request a personal item exception (PIE) by contacting disabilityservices@NBME.org or by calling 215-590-9700 for additional information on how to request a PIE.
    • All other equipment, including pens, gloves, writing paper, and other medical equipment is provided by the test center. Visit the USMLE website for more information regarding the Step 2 CS examination experience and test center regulations.
  • For all Steps, if you bring personal items to the test center, you must store them in a small designated locker outside the secure testing area or in the designated storage area for Step 2 CS; electronic devices must be turned off.
    • Turning down the volume is not sufficient.
    • All personal items are subject to inspection.

Admission to the Test

  • Check-In Procedures for USMLE Step 1,  USML Step 2 CK, & USMLE Step 3
    • You should arrive at the test center approximately 30 minutes prior to your scheduled testing appointment. If you arrive after your appointment time, you may not be admitted.
    • If you arrive more than 30 minutes after your scheduled testing appointment, you will not be admitted and must pay a fee to reschedule your test.
    • Your rescheduled test date(s) must fall within your eligibility period.
  • Check-In Procedures for USMLE Step 2 CS
    • You should arrive at the test center at the time listed on the confirmation notice you received.
    • There will be an on-site orientation to demonstrate the equipment available for you to use in the examination rooms and to review examination rules and procedures.
    • If you arrive during the on-site orientation, you may be allowed to test after signing a Late Admission Form.
    • If you arrive after the on-site orientation, you will not be allowed to test and must pay a fee to reschedule your test. Your rescheduled test date must fall within your eligibility period.
  • All USMLE Steps
    • When you arrive at the test center, you must present a paper or electronic copy of your scheduling permit and a valid, unexpired government-issued photo identification. Please review your scheduling permit for additional identification requirements. Acceptable forms of unexpired identification include:
      1. Passport
      2. Driver’s license with photograph
      3. National Identity Card
      4. Other forms of unexpired, government-issued identification
    • Your name, as it appears on your scheduling permit, must exactly match the name on your form(s) of identification. Your identification must contain both your signature and a recent photograph.
    • Please review your scheduling permit for details and limited exceptions. If the name listed on your scheduling permit is not correct, contact the organization that registered you for your examination immediately.
    • If you do not bring your scheduling permit on paper or electronically (eg, via smartphone) and acceptable identification on each day of your exam, you will not be admitted to the test and will be required to pay a fee to reschedule your test. Your rescheduled test date(s) must fall within your eligibility period.

Security Procedures

  • For USMLE Step 1, USMLE Step 2 CK, & USMLE Step 3 only
    • During check-in, test center staff will scan you with a handheld or walk-through device designed to detect prohibited items and ask you to empty your pockets and turn them inside out before entering the testing room to confirm that you have no prohibited items.
    • You will be asked to repeat this process each time you return to the testing room after a break. Additionally, your photo ID and fingerprint may be scanned electronically, and you must sign the test center log each time you enter or exit the test room.
    • Before you enter the test room, test center staff will give you laminated writing surfaces and markers to use for making notes and/or calculations during the testing session.
    • You will be instructed to write your name and CIN, as shown on your scheduling permit, on one of the laminated writing surfaces provided. Writing surfaces and markers should be used only at your assigned testing station and only after you have entered your CIN in the computer to start your test session.
    • If you have filled the laminated writing surfaces and need additional space for making notes, raise your hand to ask test center staff for a replacement. You must return laminated writing surfaces to test center staff at the end of the testing session.
      • Do NOT write on anything (eg, skin, clothing, tissue) other than the laminated writing surface. Failure to comply may result in a finding that you engaged in irregular behavior.
    • Test center staff will escort you to your assigned testing station and provide brief instructions on use of the computer equipment. You must enter your CIN to start the examination. A brief tutorial is available before each examination.
    • You must run the sound check for the audio headphones either before the examination begins or during the tutorial, so that problems can be resolved before you start the examination.
  • For USMLE Step 2 CS only
    • In addition to having your photo ID scanned electronically, you will be asked to place your personal belongings (eg, pens, study materials, cell phones) in small bins, which are inaccessible for the duration of the examination day. Any personal belongings that you may need during breaks or during the examination, including your lab coat and stethoscope, can be placed at your seat in the orientation room.
    • After the onsite orientation, test center staff will scan you with a handheld or walk-through device designed to detect prohibited items and ask you to empty your pockets and turn them inside out before entering the testing room to confirm that you have no prohibited items.
    • Please note that every area of the testing center is under video surveillance at all times; examinees are escorted by proctors at all times, with the exception of restroom breaks.
  • All USMLE Steps
    • There are no facilities available for family and friends to wait at the center while you test; plan to meet them elsewhere after the examination ends.
    • All examinees will be required to remove eyeglasses for close visual inspection by the test center administrator. These inspections will be done at check- in and upon your return from breaks.
    • Jewelry, except for wedding and engagement rings, is prohibited.
    • Hair accessories such as ornate clips, combs, barrettes, or headbands are subject to inspection.
    • We reserve the right to terminate your administration if you engage in any activity that may compromise the validity, integrity or security of the USMLE, including possessing or using prohibited items.

Break Time

  • USMLE Step 1,  USML Step 2 CK, & USMLE Step 3
    • Your test session is scheduled for a fixed amount of time, and the computer keeps track of the time allocated for each block and for breaks.
    • At the start of the testing session, you have a total of 45 minutes of break time for authorized breaks and for computer transitions between blocks.
    • Authorized breaks include any time you spend between test blocks, whether you remain at your seat or leave the testing room. If you complete the tutorial or other testing blocks early, the remaining time will be added to your total break time.
    • Once you begin a testing block, you may not leave the room (except in the event of an emergency).
    • If you leave the room for a personal emergency and you are not on an authorized break, the block and daytime clocks will continue to run, and the test center will report the incident to the USMLE program.
    • Additionally, the unauthorized break screen, described in the examination tutorial, will appear on the monitor after a defined period of inactivity. After the unauthorized break screen appears, you will need to enter your CIN to continue with the examination.
    • Each time you leave the testing room, you are required to sign out and sign in when you return. You must present your identification each time you sign in.
    • If you exceed your allocated or accumulated break time, the excess will be deducted from your total testing time. Use the time summary feature (explained in the tutorial on your test day) to keep track of your time.
  • USMLE Step 2 CS
    • Your Step 2 CS administration will include 12 patient encounters. The examination session lasts approximately eight hours.
    • You will have 50 minutes of break time: a 10-minute break after the third patient encounter; a 30-minute break (which includes a light lunch) after the sixth patient encounter; and a 10-minute break after the ninth patient encounter.
    • The test center is unable to accommodate special meal requests. However, you may bring your own food, provided that no refrigeration is required. No smoking or use of tobacco products, including vaping, is allowed in any CSEC center.

Starting and Completing the Test

  • USMLE Step 1, Step 2 CK, & USMLE Step 3
    • After you start taking an examination, you cannot cancel or reschedule that examination. If you experience a computer issue during the test, notify test center staff immediately. The testing software is designed to restart the test at the point that it was interrupted, without loss of time.
    • The test session ends when you have started and exited all blocks or the total test time expires. You will receive a notice during checkout that you have appeared for the test. If your test is scheduled for multiple days, be sure to bring a copy of your scheduling permit with you each day or you may not be permitted to test.
    • In the rare event that a technical problem occurs that does not permit you to complete your examination, please send a written description of the incident to Test Administration Services at the NBME. Test Administration Services must receive your notice within 10 days of your testing date or it may not be possible to fully investigate your concerns. Your correspondence should include your name, your USMLE ID number, the examination name (Step 1, 2 CK, 2 CS, or 3), the date of administration, and a message with a detailed description of the difficulty experienced. Please allow at least 15 business days for your report to be investigated and evaluated. You will receive written notification of the investigation results.
    • If you start the examination but do not complete it for reasons other than a technical problem or expiration of time, you should promptly write to Test Administration Services explaining, in detail, the reasons you did not finish the examination. The attempt may appear as incomplete on your USMLE transcript.
    • For more information on how to report a test administration problem, visit the website
  • USMLE Step 2 CS
    • Once you enter the secure areas of the test center, which includes the orientation area, you may not leave the area until the examination has been completed. All examinees taking the Step 2 CS examination are required to type the patient note portion of the exam.
    • You are permitted to handwrite your patient note only if you were approved to receive an accommodation for a disability or if technical difficulties occur that make the patient note-typing program unavailable.
    • You may not solicit information about cases or discuss the cases with anyone, including other examinees, at any time (before, during, or after your examination).
    • This includes any activity on the Internet, including on social media. All conversation at the testing center among examinees must be in English.

Why does USMLE Security matter?

  • Protects the health of the public by ensuring that doctors are competent to practice.
  • Helps to maintain a testing environment where no examinee has an unfair advantage.
  • Promotes equitable opportunities for training and career advancement.
  • Helps to control increases in exam fees by minimizing the number of items removed from USMLE due to exposure.

DO’s and DON’Ts on exam day

  • DO:
    • Familiarize yourself with the Rules of Conduct.
    • Take a break only when on an authorized break screen.
    • Place all personal belongings, including watches, electronic devices (cell phones, etc.), study materials, notes, and purses/wallets/bags in your locker or cubicle.
    • Maintain confidentiality of all USMLE content.
    • Share general exam day experiences, such as how to dress or where to stay.
  • DON’T:
    • Attempt to register for or take an exam unless you are eligible.
    • Bring study materials, notes, papers or electronic devices (cell phones, etc.) into secure areas of the test center.
    • Discuss your exam with others at the center or otherwise communicate about test items, cases, and/or answers.
    • Remove exam materials from the test center in any form (written, printed, recorded or in any other medium) or attempt to reproduce exam materials through memorization or any other means.

Examples of Security Violations

  • Specific examples of conduct that may be deemed a security violation include, but are not limited to, the following:
  • Before the examination
    • seeking, providing, and/or obtaining unauthorized access to examination materials
    • providing false information or making false statements on or in connection with application forms, scheduling permits, or other USMLE-related documents
    • applying for an examination for which you are not eligible
    • communicating or attempting to communicate about specific test items, cases, and/or answers with another examinee, potential examinee, or formal or informal test preparation group at any time before, during, or after an examination
  • During the examination
    • taking an examination for which you are not eligible
    • taking an examination for someone or engaging someone to take an examination for you
    • giving, receiving, or obtaining unauthorized assistance during the examination or attempting to do so
    • making notes of any kind while in the secure areas of the test center, except on the writing materials provided at the test center for this purpose
    • failing to adhere to any USMLE policy, procedure, or rule, including instructions of the test center staff
    • verbal or physical harassment of test center staff or other examination staff, or other disruptive or unprofessional behavior during the registration, scheduling, or examination process
    • possessing any unauthorized materials, including photographic equipment, communication or recording devices, fitness and tracking monitors, and cell phones, in the secure testing areas
    • communicating or attempting to communicate about specific test items, cases, and/or answers with another examinee, potential examinee, or formal or informal test preparation group at any time before, during, or after an examination
  • After the examination
    • altering or misrepresenting examination scores
    • any unauthorized reproduction by any means, including, but not limited to, reconstruction through memorization, and/or dissemination of copyrighted examination materials by any means, including the Internet
    • communicating or attempting to communicate about specific test items, cases, and/or answers with another examinee, potential examinee, or formal or informal test preparation group at any time before, during, or after an examination
    • failure to cooperate fully in any investigation of a violation of the USMLE rules

Sanctions Imposed for Security Violations

  • Security violations are investigated by USMLE staff and reviewed by the USMLE Committee for Individualized Review (CIR). If the committee makes a finding of Irregular Behavior, the penalties include one or more of the following:
    1. Cancellation of your exam scores
    2. Ban on future testing for periods ranging from 6 months – 3 years
    3. Permanent annotation of your USMLE transcript
    4. Report to the Federation of State Medical Boards’ disciplinary databank*
    5. Possible legal action

Also read:

  1. Eligibility for USMLE
  2. USMLE Application
  3. USMLE Results and Score
  4. All about USMLE Step 1
  5. All about USMLE Step 2 CK
  6. All about USMLE Step 2 CS
  7. All about USMLE Step 3
  8. Visit the official USMLE page

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