Who is Eligible for USMLE Step 1? The 2026 Eligibility Breakdown

You’ve spent the last two years learning more about the human body than you ever thought possible. You’ve mastered the Krebs cycle (mostly), you can identify a granuloma on a slide, and you’ve finally decided it’s time to face the "Beast." But before you can pick a test date, you have to answer the most important administrative question: Are you actually eligible?

The rules for USMLE Step 1 eligibility aren't just a "check the box" formality. With recent changes to international accreditation and the specific requirements for MD vs. DO students, it’s easy to get lost in the fine print.

Whether you’re a domestic student or an International Medical Graduate (IMG), here is exactly what you need to know to ensure your application gets approved.

The Three Main Pillars of Eligibility

To be eligible for Step 1, you must be in one of the following categories at the time you apply and on the day you test:

1. US and Canadian MD Students

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

2. US DO Students

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

3. International Medical Students (IMGs)

You must be a student or graduate of a medical school located outside the US and Canada. However, not just any school will do. Your school must meet the ECFMG (Educational Commission for Foreign Medical Graduates) eligibility requirements.

The ECFMG Accreditation Rule (The 2024/2026 Milestone)

If you are an international student, listen up. As of 2024, the ECFMG implemented a new "Accreditation Strategy." For you to be eligible for USMLE Step 1, your medical school must be accredited by an agency recognized by the World Federation for Medical Education (WFME).

Strategic Note: Don't assume your school is on the list just because it's in the World Directory of Medical Schools. Check the directory specifically for the "ECFMG Note" to confirm they are currently meeting the 2026 eligibility standards.

Requirements Beyond Your Enrollment Status

Being at the right school is only the first half of the battle. You must also meet these three criteria:

• Good Standing: You must be in "good standing" at your medical school. If you are on academic probation, a forced leave of absence, or have been dismissed, your school's registrar will not certify your status, and your application will be denied.
• Completion of Basic Sciences: While the NBME doesn't strictly mandate which month you take the test, most schools will not certify your eligibility until you have successfully completed the "Basic Science" portion of your curriculum (usually the end of year two).
• A Valid Testing Permit: You cannot simply walk into a Prometric center. You must apply through the NBME (for US/Canadian students) or ECFMG (for IMGs) to receive an official Scheduling Permit.

Real Talk: The Administrative Lead Time

One of the biggest mistakes students make is waiting until the start of their "Dedicated Study" period to check their eligibility.

The registration process can take anywhere from 3 to 6 weeks. For international students, the process involves identity verification via NotaryCam and multiple rounds of document certification. If you wait too long, you might find that all the "good" dates at your local Prometric center are gone, or worse—you might not get your permit in time to test before your clinical rotations start.

Secure Your Eligibility, Then Secure Your Pass

Once the paperwork is filed and your eligibility is confirmed, the clock starts ticking. Now that Step 1 is Pass/Fail, you don't need to memorize every footnote in a 2,000-page textbook. You need to focus on the high-yield concepts that actually appear on the exam.

Our Complete USMLE Step 1 Bundle is designed for students who are ready to stop stressing about the "what-ifs" and start focusing on the "must-knows." We’ve distilled the entire Step 1 syllabus into scannable, high-yield notes that help you build a passing foundation in half the time.

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