The United States Medical Licensing Examination (USMLE) assesses medical knowledge foundational to clinical practice. In 2026, the registration process changed significantly as part of the USMLE Service Transition. All Step exam registration services are now unified under the exam co-sponsors: the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners, using updated portals.
The exam itself and its content remain unchanged; the administrative process and portals are what have changed.
Step 1 Registration for USMLE: Everything You Need to Know
Step 1: Verify Your Eligibility
Before the registration for USMLE Step 1, confirm you are eligible:
U.S. / Canadian Students
You must be officially enrolled in or a graduate of a medical school in the U.S. or Canada accredited by LCME (MD) or COCA (DO).
International Medical Students (IMGs)
You must be enrolled in or graduated from a medical school outside the U.S. and Canada that is listed in the World Directory of Medical Schools and meets ECFMG eligibility criteria.
International examinees still must complete ECFMG Certification eligibility before registering for the exam—this is a verification step separate from exam registration.
Step 2: Understand the 2026 Registration Pathways
Due to the 2026 service transition:
For U.S. / Canadian Students
- Register through the MyUSMLE℠ Portal managed by NBME.
- MyUSMLE replaces the prior NLES (NBME Licensing Exam Services).
For International Medical Students (IMGs)
- Register through the FSMB USMLE Portal.
- As of January 12, 2026, IMGs no longer use ECFMG’s MyIntealth portal for registration; it is now FSMB’s portal for all Step exam registration and scheduling.
Note: ECFMG continues to determine your eligibility for certification, which FSMB will check as part of your registration.
Step 3: Create Your Official Registration Account
U.S. / Canadian Candidates (MyUSMLE Portal)
- Visit the MyUSMLE℠ Portal.
- Create your account using accurate personal information.
- Receive your unique USMLE ID—you will use this for all USMLE steps and services.
IMGs (FSMB USMLE Portal)
- Visit the FSMB USMLE Portal.
- Create your FSMB account with the same name and date of birth used on your medical credentials.
- Link your record to your ECFMG eligibility (FSMB will verify eligibility via ECFMG).
- Receive your USMLE ID for all future Step exams.
Step 4: Complete the Online Application
Once your account is set up:
What You Will Submit
- Personal identity details
- Medical school information
- Graduation status
- Choice of eligibility period (three-month window)
Choose the Eligibility Period
You select a 3-month period (for example: June–August). You can schedule your exam anywhere within that window. Choose based on your preparation timeline.
Eligible periods that span into 2026 use the current 2026 fee structure.
Step 5: Pay the Examination Fee
The 2026 USMLE Step 1 exam fee is $695 USD (base) for all candidates—U.S./Canadian via MyUSMLE (NBME) or IMGs/international via FSMB portal. For testing outside the U.S./Canada (most IMGs), add a $205 region surcharge (not a USMLE fee, collected during registration/scheduling), totaling approx. $900 USD; slight variations may occur with local taxes (e.g., 18% GST in India at Prometric).
Fees are non-refundable/non-transferable, separate from ECFMG certification costs (handled first for IMGs via MyIntealth), and paid by credit card in your portal. Verify exact/current amounts on official sites: usmle.org/apply-exams or during FSMB registration (usmle.fsmb.org).
Step 6: Verification and Approval
U.S. Students
- Your school verifies your enrollment electronically.
IMGs
- FSMB will confirm with ECFMG that your certification eligibility is complete before approving your exam application.
Processing times can vary. Apply well before your desired test date.
Step 7: Receive Your Scheduling Permit
Once your application and verification are approved:
- You’ll receive an email notification.
- Log back into your portal (MyUSMLE or FSMB) to download your Scheduling Permit.
- This contains your eligibility period and scheduling number.
You must have this permit on exam day.
Step 8: Schedule Your Exam with Prometric
USMLE Step 1 is administered at Prometric test centers worldwide.
- Visit the Prometric scheduling site.
- Enter your scheduling number from your permit.
- Select your test center location and preferred date within your eligibility period.
- Confirm your appointment.
Seats are limited; scheduling early increases your chances of securing your desired date.
Step 9: Prepare Your ID for Exam Day
On the day of your exam, bring:
- A valid, unexpired government-issued photo ID
- The same name and date of birth as on your registration record
Any mismatch can result in denied entry.
Important Policies to Know
Eligibility Period Rules
- You must take the test within your selected three-month window.
- If your window expires without testing, you must apply again and pay fees again.
Rescheduling
- You can reschedule within your eligibility period.
- Fees may apply depending on how close you are to the exam date.
Credential Verification
IMGs must complete ECFMG eligibility verification before FSMB will approve registration.
Common Errors to Avoid
- Incorrect name or date of birth
- Applying too late to secure desired test dates
- Failing to complete eligibility verification first (especially for IMGs)
- Uploading inconsistent educational documentation
Final Timing Tips
Start the process 3–4 months before your planned test date.
Allow extra time if you are an IMG needing credential verification.
Download your permit as soon as it’s issued—especially around system outages or transition periods.
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Final Thoughts
The 2026 service transition simplified the USMLE Step registration architecture by separating:
- Eligibility verification and certification (ECFMG) for IMGs.
- Exam registration and scheduling (FSMB or MyUSMLE) based on your pathway.
The key to success is starting early, using the correct portal, verifying eligibility before payment, and scheduling your exam promptly after approval. With this structured approach, you’ll complete registration accurately and on time—allowing you to focus fully on preparation and performance.
