When Do You Take USMLE Step 1? 2026 Exam Dates & Costs

This blog was updated in October 2026 by Rebecca Lapides.

The USMLE Step 1 exam is an important early step in the career of any aspiring US-licensed doctor. In this blog post we will review some frequently asked questions about the exam. This includes USMLE Step 1 2026 exam dates and costs, the scope and length of the exam and more!

What is the USMLE Step 1 Exam?

The USMLE Step 1 exam is a standardized examination administered by the National Board of Medical Examiners (NBME). It assesses the medical knowledge, concepts, and principles of students who are in the process of completing their medical education and preparing to enter clinical practice.

The USMLE Step 1 is the first in a series of three exams that are required for medical licensure in the United States. It covers a broad range of topics, including anatomy, physiology, biochemistry , pharmacology, microbiology, pathology, and behavioral sciences.

The NBME website provides comprehensive content outlines for the exam. This provides more information on what could be on the test. There you can see the proportional representation of topics on the exam by systems, disciplines, and testable physician competencies. The USMLE Step 1 exam is designed to evaluate the student’s ability to apply scientific principles to the practice of medicine. It also tests their knowledge of the diagnosis and management of common medical conditions.

Medical students typically take the Step 1 exam at the end of their second year of medical school. Passing the exam is an important factor in successfully progressing through medical school and the residency matching process. 

For more information on the effects that the pass/fail system is having on medical students, see what the experts are saying.

When Do Students Take Step 1?

Usually, students take Step 1 in between their second and third years of medical school because there is often built-in study time, known as the dedicated study period, that schools allow for prior to the start of clerkship rotations. However, unless schools have their own rules/expectations for when students have Step 1 done, there is no requirement to take Step 1 at this time and there is even no requirement to take the USMLE Step 1 before Step 2. However, for students still in medical school, we recommend taking the USMLE Step 1 first. 

Step 1 does not have fixed test dates. You register for the exam through the NBME website, procure a registration permit to select a 3-month eligibility window, and then book your exam appointment at a Prometric test center. You may schedule your Step 1 exam anytime within your assigned eligibility window. Available exam dates for USMLE Step 1 depend on each testing center’s availability. 

When Should You Schedule Your Step 1 Eligibility Window?

The USMLE Step 1 eligibility window is one of the first logistical steps medical students encounter in the Step 1 preparation process. This three-month block determines when you are permitted to sit for the exam at a Prometric location. Once you complete registration and receive your scheduling permit, you gain access to Prometric’s system, where you can select a specific date and time that works within your chosen eligibility period. Understanding how this window works – and planning around it – is critical for a successful experience.

For many students, the question of when to take Step 1 is not just about the logistics of scheduling but also about the logic of predicting your readiness.  The answer depends heavily on your academic progress and personal readiness. Most students target the end of the second year of medical school, once their core pre-clinical curriculum is complete. At this point, the foundational sciences are still fresh, and students often have a built-in study block to prepare exclusively for the exam. My recommendation is that you think about these factors, select an exam date and secure it, and then focus on creating a study schedule around this date to have you prepared in time. 

Strategically choosing your window requires looking beyond academics alone. School calendars, family obligations, and even health should factor into your decision. It’s wise to allow room for unexpected challenges such as illness, burnout, or administrative delays in receiving your permit. Building flexibility into your plan makes a difference, particularly since some Prometric sites fill up fast. Limited availability at certain locations means last-minute scheduling can leave you stuck with inconvenient dates or long travel requirements. Plan ahead and consider that those hoping to test early may face higher competition for spring and summer dates, while later testers must balance preparation with the transition into clinical rotations. Adjusting your approach to match your academic goals is key.

Step 1 Rescheduling & Cancellation Fees Explained

Once you’ve secured a date, life events may still require changes. Prometric applies a tiered structure for rescheduling and cancellations:

• No fee if changed more than 30+ days before your appointment.
• A moderate fee if changed 5–29 days in advance.
• The highest fee if changed 4 days or fewer before your exam.

Students may reschedule within the same eligibility period but cannot move an appointment outside of that block unless they request an extension through NBME. Extensions usually involve additional charges and paperwork.

In emergency situations – such as sudden illness or a family issue – students can submit documentation for review. Missing your exam entirely risks being marked as a “no-show,” which could forfeit fees under the test cancellation policy.

What to wear for the USMLE?

We recommend you dress comfortably. You should wear comfortable clothes that are appropriate for a prolonged period of testing. Note that each testing center may have specific recommendations on attire. Call the testing center in advance and request answers to your questions around clothing. Note that wearing some clothing like hoodies might increase the time needed to enter and exit the testing room so plan accordingly.

It is important to avoid wearing anything that may cause discomfort or distraction during the exam. You should also consider the weather and dress accordingly. For example, you may want to dress in layers in case the temperature of the exam room fluctuates. 

What to Bring (and Not Bring) to Your Step 1 Exam

Preparing for Step 1 doesn’t end with studying – it also involves knowing what you can and cannot bring to the exam. The rules are strict, and failing to follow them could jeopardize your ability to sit for the test.

On test day, two items are absolutely mandatory: a valid government-issued photo ID that exactly matches the name on your registration, and your scheduling permit. These documents are checked carefully at the Prometric check-in desk. If the name on your ID doesn’t match the one used during USMLE Step 1 registration, you may be denied entry and forced to reschedule.

Once checked in, all personal belongings must be stored in lockers provided at the test center. This includes phones, wallets, outerwear, snacks, and water bottles. During scheduled breaks, you may return to your locker to eat, drink, or take medications.

Strict bans apply to prohibited items. Notes, books, calculators, electronic devices, and even accessories like smartwatches are not allowed inside the testing room. These restrictions exist to maintain the integrity of the exam and prevent distractions for both you and other students.

To feel confident, review Prometric’s online tutorial and rules in advance so you know exactly what to bring to Prometric center locations.

More USMLE Step 1 Help

If you’re navigating the challenges of the USMLE Step 1 exam, you’re not alone. Our subreddit, r/ask_a_usmle_tutor, is a community of experienced MD tutors and aspiring doctors discussing everything related to the USMLE. Whether you have questions about USMLE exam dates, study tips, a USMLE Step 1 cost breakdown to budget effectively, or need personalized advice, this is the place to be.

Join us now at r/ask_a_usmle_tutor and connect with peers and experts who can help you on your journey towards USMLE success.

For more resources, check out our 10-week or 6-week Step 1 study schedule , our blog post on the best predictor for passing Step 1 , and more Step 1 content.

If you are looking for more customized USMLE Step 1 help, consider enlisting the help of a 1-on-1 Step 1 tutor. Schedule a complimentary consultation today to hear more about what we can do to help you succeed!

The post When Do You Take USMLE Step 1? 2026 Exam Dates & Costs appeared first on Elite Medical Prep.