USMLE Step 1 Readiness Policy

PURPOSE
To outline the process for assessing student readiness, scheduling and attempting USMLE Step 1, and transition to clinical education. The School of Medicine (i.e., the School) is committed to supporting every student in achieving readiness for USMLE Step 1 and a successful transition to the clerkship phase of the curriculum.

SETTING/AUDIENCE
All UC Davis medical students except those in the Accelerated Competency-based Education in Primary Care program (ACE-PC). This includes the students who were formerly held to the previous version of this policy, the previous USMLE Step 1 Policy, and the previous USMLE Step 1 Exam Deferral Policy.

LCME STANDARD
8.4 Evaluation of Educational Program Outcomes

POLICY

Definitions

  • Comprehensive Basic Science Exam (CBSE): is a nationally benchmarked assessment administered during the pre-clerkship phase. It evaluates foundational medical science knowledge and uses content and item formats aligned with those found on USMLE Step 1. CBSE performance provides one measure of readiness and helps students identify if they may benefit from additional preparation and support.
  • Core Clerkship: specific clinical courses which include Family Medicine (FAP 430), Internal Medicine (IMD 430), Obstetrics and Gynecology (OBG 430), Pediatrics (PED 430), Psychiatry (PSY 430), and Surgery (SUR 430).
  • Readiness Threshold: a benchmark used to identify when a student has demonstrated a level of preparation associated with likelihood of passing USMLE Step 1; it helps students and advisors identify the most appropriate timing for a USMLE Step 1 attempt.
  • Rotation: a six-week period consisting of a core clerkship or approved third-year elective; they are numbered sequentially during the clerkship phase, beginning with Rotation 1.
  • Transition to Clerkship (T2C): a required orientation experience that prepares students for entry into clinical learning environments through onboarding, compliance activities, and clinical readiness training.
  1. Students must successfully complete the pre-clerkship curriculum before attempting USMLE Step 1.
  2. A passing score on USMLE Step 1 is a graduation requirement of the School of Medicine (see References: Bylaws and Regulation, Regulation 60, A.2.).
  3. Students are required to successfully complete USMLE Step 1 within two years of completing the pre-clerkship phase (see References: Bylaws and Regulations, Regulation 80, D.1.a.v.).
  4. Students must comply with all USMLE policies regarding exam scheduling and allowable attempts (see References: USMLE official website)
    1. No more than three USMLE Step 1 attempts within a 12-month period.
    2. A fourth attempt must occur at least six months after the most recent attempt and at least 12 months after the first attempt.
    3. Students are permitted a maximum of four attempts at USMLE Step 1.

PROCEDURE

  1. Determination of Readiness and Entry into the Clerkship Phase
    1. The School administers five CBSE examinations at designated time points during the second year of the pre-clerkship phase. 
    2. Students who do not meet a readiness threshold may require additional preparation time and support before attempting USMLE Step 1. Not meeting a readiness threshold does not reflect a student's overall potential for success as a physician.
    3. Readiness thresholds are:
      1. CBSE #1: equal to or greater than 50%
      2. CBSE #2: equal to or greater than 55%
      3. CBSE #3, #4, and #5 : equal to or greater than 63%
    4. When a student meets a readiness threshold they will receive a core clerkship rotation schedule.
    5. The student will transition into the clerkship curriculum phase according to this timeline:
      1. Meeting the Readiness Threshold on CBSE 1, 2, or 3: attempt USMLE Step 1 before T2C and enter the clerkship phase in Rotation 1.
      2. Meeting the Readiness Threshold on CBSE 4: attempt USMLE Step 1 before the start of Rotation 2, and enter the clerkship phase in Rotation 2.
      3. Meeting Readiness Thresholds on CBSE 5: attempt USMLE Step 1 before the start of Rotation 3, and enter the clerkship phase in Rotation 3.
  2. Students Requiring Additional Preparation Time for the Clerkship Phase
    1. Students who have not met a readiness threshold as outlined in Procedure A may continue preparation and attempt USMLE Step 1 when they, in consultation with their academic support team, determine they are ready to do so.
    2. Students who require additional preparation time or who do not achieve a passing USMLE Step 1 score will be connected with academic advising, learning specialist services, wellness resources, and other supports designed to facilitate continued progress toward their educational goals. 
    3. Upon receipt of a passing USMLE Step 1 score, students may enter the clerkship phase according to scheduling availability and the following timelines:
      1. Core Clerkships: A passing USMLE Step 1 score must be posted at least six weeks before the published rotation start date.
      2. Third-Year Electives: A passing USMLE Step 1 score must be posted at least four weeks before the start of a clinical elective, or at least two weeks before the start of a didactic elective.
    4. The School will make every reasonable effort to identify available educational opportunities that support timely progression; core clerkship placement is dependent upon site capacity and scheduling availability.
  3. Students Who Meet a Readiness Threshold but Delay a USMLE Step 1 Attempt
    1. Students who meet a Readiness Threshold but do not attempt USMLE Step 1 by the designated deadline, see Procedure A, may initially transition into the clerkship phase as scheduled. 
    2. If the examination is not completed before the start of the rotation:
      1. The student's future clerkship rotation schedule will be revised.
      2. The student will step out of the core clerkship rotation while preparing for USMLE Step 1.
      3. Re-entry into the clerkship phase requires a posted passing USMLE Step 1 score and remains subject to the scheduling timelines outlined above. 
        • The School will work collaboratively with students to identify available pathways for re-entry; however, placement is dependent upon site availability.
  4. Transition to Clerkship (T2C) Requirement: All students, including those whose entry into clerkship is delayed, are required to complete T2C following the completion of the pre-clerkship curriculum phase.
  5. Clerkship Intersession Course Participation
    1. Students will begin participating in the Clerkship Intersession course following the completion of their first rotation/elective in the phase. 
    2. Students who have a delayed start to the phase, (e.g., do not begin the Clerkship Intersession course after Rotation 1), will be required to completed the missed course week(s) the following academic year.
  6. Students Who Do Not Achieve a Passing Score on USMLE Step 1
    1. Students who receive a non-passing score while enrolled in a clerkship rotation may complete the rotation before pausing participation in subsequent clerkship phase courses. 
    2. Students who do not pass USMLE Step 1 will receive individualized guidance and support designed to facilitate academic recovery and continued progress.
      1. During this period, students will work with academic advisors, learning specialists, and other appropriate support personnel to develop a personalized preparation plan for reattempting USMLE Step 1. 
      2. The School recognizes that not achieving a passing score on a first attempt does not define a student's future success in medicine. 
    3. Students must obtain a passing USMLE Step 1 score before returning to the phase.
      1. Return to Core Clerkships: A passing score must be posted at least six weeks before the published rotation start date.
      2. Return to Third-Year Electives: A passing score must be posted at least four weeks before the start of a clinical elective, or at least two weeks before the start of a didactic elective.
    4. The School will make every reasonable effort to facilitate re-entry into clinical training as soon as feasible.
      1. Placement remains dependent upon site availability and curricular requirements.
      2. Graduation timelines may be adjusted.

RESPONSIBILITY
Associate Dean for Students
Committee on Student Promotions
Curriculum Managers
Office of Academic Support and Individual Success (OASIS)

REFERENCES
UC Davis School of Medicine Bylaws and Regulations, Regulation 60 and 80
USMLE official website

RELATED POLICIES
Extending the MD Program for Non-Required Academic Enrichment Policy
Satisfactory Academic Progress Policy
Student Leave Policy

POLICY OWNER
Committee on Student Promotions

REVIEWED BY
Associate Dean for Students
Committee on Student Promotions*

REVIEWED DATE and REVIEW CYCLE
September 2026, annual review cycle

* indicates the Policy Owner