USMLE Step 1 Readiness Policy

PURPOSE
To support students in their USMLE Step 1 preparation and exam scheduling by outlining the readiness process, movement into the clerkship phase curriculum, and the process for remediating a USMLE Step 1 failure.

SETTING/AUDIENCE
All medical students who complete the per-clerkship phase in AY25-26 or after

LCME STANDARD
8.4 Evaluation of Educational Program Outcomes

POLICY

Definitions

  • CIS: refers to the 7-week longitudinal Clerkship Intersession course that takes place between each clerkship rotation. CIS 1 takes place between clerkship rotation 1 and 2; CIS 2 takes place between rotation 2 and 3; the annual academic calendar lists these dates. CIS 1 and CIS 2 are used in the USMLE Step 1 Pathway images. 
  • Comprehensive Basic Science Exam (CBSE): a general, integrated achievement test covering material learned during the pre-clerkship phase. The exam reflects content coverage on USMLE Step 1 and uses the same item formats.
  • LIC: is the Accelerated Competency-based Education in Primary Care (ACE-PC) Longitudinal Integrated Clerkship (LIC) year. This is used in the USMLE Step 1 Pathway ACE image.
  • Readiness Checkpoint: an assessment that determines a student’s readiness to attempt USMLE Step 1 by a given deadline and move into the clerkship phase curriculum.
  • Rotation: a 6-week period that encompasses a singular clerkship/selective(s) experience. These total blocks of time are referred to as rotation 1 (R1), rotation 2 (R2), rotation 3 (R3), and rotation 4 (R4). The abbreviations are used in the USMLE Step 1 Pathway images.
  • T2C: is an abbreviation for Transition to Clerkship, which is also known as clerkship orientation. T2C is used in the USMLE Step 1 Pathway images. 
  1. All students must pass the pre-clerkship phase curriculum of the School of Medicine (ie., the School) before attempting the USMLE Step 1 exam. 
  2. Passing the USMLE Step 1 exam is a graduation requirement of the School (Bylaws and Regulation - Regulation 60, A.2.). 
  3. Students are allowed 4 attempts at the USMLE Step 1 (Bylaws and Regulations - Regulation 80, D.1.a.iv.). 
    1. Students must successfully complete the USMLE Step 1 exam within 2 years of the completion of the pre-clerkship phase (Bylaws and Regulations - Regulation 80, D.1.a.v.). 
    2. Students must complete their first attempt by September 30 of the year they completed the pre-clerkship phase, regardless of enrollment or leave status. (See the Extending the M.D. Program for Non-Required Academic Enrichment Policy, the Satisfactory Academic Progress Policy, and the Student Leave Policy, located in the the References, for additional information on enrollment and leave.)
    3. Students must adhere to USMLE requirements related to exam timing and number of reattempts:
      1. Students may not attempt the USMLE Step 1 exam more than 3 times in a 12-month period (USMLE website).
      2. A fourth attempt of USMLE Step 1 must be at least 12 months after the first attempt and at least six months after the most recent attempt (USMLE website).

PROCEDURE

  1. Readiness to attempt the USMLE Step 1 exam and enter the clerkship phase is determined by performance on the CBSE which are administered by the School at regular intervals in the second year of the pre-clerkship phase.
    1. Full details on CBSE performance standards are found within these images. Those in the ACE-PC program, click this USMLE Step 1 Pathway ACE image, all others, click this USMLE Step 1 Pathway Traditional image.
    2. The dates of CBSE are published annually in the academic calendar. 
  2. Only scores from CBSE administered by the School will be accepted as demonstration of USMLE Step 1 readiness.
    • Scores on other practice assessments, including Comprehensive Basic Science Self-Assessments and UWorld Self-Assessments, cannot be used in place of a CBSE score.
  3. All students, including those deferring the start of the clerkship phase, will complete T2C.
  4. Participation in clerkship intersession weeks is based on when a student passes the USMLE Step 1 readiness checkpoint. (See the appropriate USMLE Step 1 Pathway image.)
  5. The timing of second and subsequent attempts and re-entry into the clerkship curriculum is outlined in the USMLE Step 1 Pathway images. 
  6. Students who reach the CBSE threshold but do not attempt USMLE Step 1 by the deadline specified in the images will enter clerkship as planned.
    1. The subsequent clerkship schedule will be retracted.
    2. Upon completion of R1 the student will step out of the clerkship phase until they have posted a passing USMLE Step 1 score. 
    3. A new clerkship schedule will be developed once a passing score has posted.
      • Re-entry to the clerkship phase is determined by site availability; graduation may be delayed.
  7. Students who attempt USMLE Step 1 without having reached the necessary CBSE threshold will not be allowed to enter the clerkship phase until a passing USMLE Step 1 score has posted.
    • Entry into the clerkship phase will be determined by site availability; graduation may be delayed.

RESPONSIBILITY
Associate Dean for Students
Committee on Student Promotions
Curriculum Managers
Office of Student Learning and Educational Resources

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
May 2025, annual review cycle

* indicates the Policy Owner