Who Can Take USMLE Step 1? A Guide to Eligibility and Requirements

So, you’ve reached the point in your journey where "The Boards" are no longer a distant myth but a looming reality. You’ve seen the memes, you’ve bought the highlighters, and you’re ready to start the grind. But before you can dive into the world of renal pathology and biochemical pathways, there’s a massive administrative hurdle to clear: Eligibility.

The question of "who can take USMLE Step 1" might seem straightforward, but between LCME accreditation, the ECFMG, and the recent changes to international student requirements, it can get complicated fast. Whether you are a US MD student, a DO student, or an International Medical Graduate (IMG), here is exactly what you need to know to get your permit.

The Three Official Categories of Eligibility

To be eligible to sit for Step 1, you must fall into one of the following three categories at the time you apply and on the day you take the exam:

1. US and Canadian MD Students

You must be a student officially enrolled in, or a graduate of, a US or Canadian medical school program that leads to the MD degree. Your school must be accredited by the Liaison Committee on Medical Education (LCME).

2. US DO Students (Osteopathic)

You must be a student officially enrolled in, or a graduate of, a US medical school leading to the DO degree. Your school must be accredited by the American Osteopathic Association (AOA) Commission on Osteopathic College Accreditation (COCA).

3. International Medical Students & Graduates (IMGs)

This is where the most questions arise. To be eligible as an IMG, you must be a student or graduate of a medical school outside the US and Canada that is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements.

The ECFMG 2024/2026 Milestone

For international students, there is a major rule change currently in effect. Your medical school must now be accredited by an agency recognized by the World Federation for Medical Education (WFME). If your school doesn't meet these specific accreditation standards, you may be barred from taking the USMLE or applying for ECFMG certification.

Real Talk: If you are an IMG, check your school's status on the World Directory of Medical Schools immediately. Don't spend months studying for an exam you aren't yet authorized to take.

When is the "Right" Time to Take It?

Being eligible to take the exam and being ready to take the exam are two very different things.

• For US Students: Most schools require you to finish your "pre-clinical" years (the first two years of med school) before you are eligible to sit for Step 1. You typically take it during a dedicated 6–8 week block before starting rotations.
• For IMGs: The timing is more flexible. Some take it after their basic science years, while others wait until they have completed their entire degree.

The "Good Standing" Requirement

Even if you are enrolled in an accredited school, you must be in "Good Standing." This means if you are on a leave of absence or have been dismissed, you cannot sit for the exam. Your school’s registrar must officially certify your status before the NBME or ECFMG will issue your testing permit.

Strategic Insight: Don't Rush the Registration

The registration process for Step 1 is notoriously slow. Between identity verification (NotaryCam for IMGs) and school certification, it can take 4 to 6 weeks just to get your "Scheduling Permit."

Do not wait until your dedicated study period to start this process. You don't want to be three weeks into a hardcore study schedule only to find out there is a delay with your paperwork, leaving you unable to book a seat at a Prometric center near you.

Prepare for the Pass

Once you’ve confirmed you are eligible and secured your testing window, the real work begins. Now that Step 1 is Pass/Fail, the strategy is no longer about "aiming for the moon"—it's about securing your foundation. You need to master the high-yield concepts that the NBME loves to test, without getting bogged down in the administrative fluff of your textbooks. Our Complete USMLE Step 1 Bundle is specifically designed to help students—whether in the US or abroad—distill the massive Step 1 syllabus into digestible, high-yield notes.

You handle the eligibility; we’ll handle the content. Let's get you that "Pass."