Step 1 Deferral Procedures

Students may only sit for USMLE Step 1 once they have successfully completed all of the requirements of the phase 1 curriculum through Block 8 part 1. Students are expected to sit for the USMLE Step 1 exam by March 23, 2024, prior to returning for part 2 of Block 8(Synthesis) and Block 9 (Transition to Clerkships). Students who sit for the exam after March 23, 2024 will be considered to have deferred Step 1.

Due to the constraints of Phase 2 clerkship scheduling, if a student does not sit by March 23, 2024 they may not be registered for or begin core clerkships or Phase 2/3 electives on April 22, 2024. Students may not sit for the USMLE Step 1 exam during Block 8 part 2 or Block 9 if it requires them to miss scheduled class time. Please refer to procedure number two below for more information.

Students who have deferred the USMLE Step 1 exam may register for up to six weeks of non- clinical electives during a single term. They may not register for additional non-clinical or clinical courses until they have taken the USMLE step 1 exam. If the student is currently registered and attending a course when they receive their failing USMLE Step 1 score, they may complete that course before stepping out of the curriculum. They may not register for additional clinical courses until they have taken the USMLE step 1 exam.

Deferring the USMLE Step 1 exam, and thereby deferring the start of Phase 2, should only be considered under certain circumstances. Deferring the Step 1 exam requires the approval of the appropriate campus Dean of Student Affairs or the appropriate campus Dean of Curriculum.

Deferrals should be considered for: a) low likelihood of passing the exam at the time of the planned Step 1 date, based on data including, the Comprehensive Basic Science Self- Assessment (CBSSA) and NBME examinations given during Block 8 or during the dedicated study period, or b) extenuating personal circumstances.

Notes: a.) Students in the Medical Scientist Training Program (MSTP) and other joint degree programs (MPH, MBA, MS) are expected to take the USMLE Step 1 exam by March 23, 2024 and then must complete Block 8 (Synthesis) part 2 prior to “stepping out” of the MD curriculum to pursue the other degree. The same is true for students taking a leave of absence for any reason immediately following Phase 1. The student will be required to take Block 9 (Transition to Clerkships) upon return to the curriculum. If the student is planning to return to the curriculum before Block 9 is offered again, it is recommended that they take Block 9 before stepping out.

Students applying for ADA accommodations with the National Board of Medical Examiners (NBME) for taking the USMLE Step 1 exam are advised to begin the accommodations application process several months in advance because the application review process is very lengthy. Pending ADA accommodations decisions by the NBME do not entitle students to begin Phase 2 on schedule.

Further registration for additional terms/courses is determined by College Policy.

• APPS 2023-2024

1. Students who achieve less than 2 SD below the class mean for any NBME exam during the in-seat portion of Block 8 part 1 will be required to have a meeting with an advisor, learning specialist, or Dean within student affairs or curricular affairs to develop an adjusted and approved Step 1 study plan.
2. Students whose CBSSA examination scores or other self-assessments are of concern, based upon guidelines by the NBME and/or the Office of Student Affairs will be notified that they are required to:
   • Work with their advisor or learning specialist to determine the optimal date to sit for Step Students are advised to follow the “Key Elements of a Successful Study Plan” document, provided at the end of this document.
3. Prior to approving the study plan, the advisor or learning specialist will work with the student to assess whether the plan is being followed and Students should check with the advisor or learning specialist for advice on readiness.
4. Students who are concerned they are not making good progress toward sitting for USMLE Step 1 are encouraged to meet with a dean or student affairs/academic advisor to discuss all of the topics outlined in this document related to deferral of Step 1 and the effect of deferral on core clerkships and clinical electives. If after that meeting, the student still would like to defer, they must inform the appropriate campus deans. The request must fully outline the reason(s) the student is requesting the deferral.
5. Students who do not sit for Step 1 by March 23, 2024 must meet with the appropriate campus dean/academic advisor to discuss their academic progress toward sitting for the USMLE Step 1 exam and the likelihood that their promotion to Phase 2 will be
6. Core clerkship/clinical elective sites require that all additions or changes to students’ schedules be done at least four weeks prior to the start of the rotation due to the constraints of Phase 2 This four-week period is needed between sitting for USMLE Step 1 and starting core clerkships and/or the next clinical elective rotation. Students who are deferring will be scheduled into clerkships/electives based on availability; they are not guaranteed their originally planned rotation schedule.
7. Two-week availability: While four weeks is the standard time needed for courses to prepare for students, in rare instances a student might be allowed to register for a course within a shorter time frame, at the discretion of the campus and dependent on space available. Students must notify administration that they have sat and taken the Step 1 exam and are ready to be registered for core clerkships/clinical electives. Notification within this timeframe is not a guarantee of the ability of the program to place a student in a given core clerkship/elective.
8. Students approved to defer taking USMLE Step 1 are nonetheless required to participate in all of the Block 8 (Synthesis) part 2 and Block 9 (Transition to Clerkships) course activities. The content and skills in Block 8 part 2 and Block 9 are in the curriculum only once per year, so a student intending to begin Phase 2 at any time during the 2024- 2025 year must participate in all required dates. Block 8 part 2 and block 9 are time- intensive courses.
9. Any student who defers taking Step 1 is required to meet with their student affairs/academic advisor or learning specialist to design a study plan that must be approved by the designated student affairs staff/faculty/dean and must include the components of #2 A projected USMLE Step 1 exam date must be provided. Any changes to the student’s approved Step 1 exam date must be reported to the student’s academic advisor or learning specialist.
10. Failure to communicate promptly and reliably during the student’s designated study period and/or failure to follow guidance by student affairs staff (i.e., academic skills specialists, advisors, leads, etc.) may result in a professionalism form pursuant to the Student Academic Policies and Professional Standards (APPS). See the APPS for additional Please review the 2023-2024 College of Medicine’s policy on Sitting for Step 1 (Section IV.B.)
11. If a student does not register for any credit bearing course work during a single term, the deferral will constitute a Leave of Absence. For more information on Leaves of Absence, go here, see Section VIII of the APPS: APPS 2023-24
    • Such students will be required to make an official request for a Leave of Absence to the Office of Student Affairs for approval through the College Committee on Student Promotions.
    • If a student requires a leave of absence for the summer term of 2024, the LOA start date will be April 22, 2024.
    • Students will meet with their campus advising team to review the paperwork, financial aid, course registration and healthcare implications of a leave of absence.

Core clerkship/clinical elective grades must be received by mid-September of Phase 3 in order to be included in the Medical Student Performance Evaluation (MSPE) and/or the College of Medicine transcript sent to the AAMC Electronic Residency Application Service (ERAS). Any delay taking core clerkships may affect a student’s MSPE quartile, eligibility for AOA, and graduating with honors.

In some cases, it will be necessary for students who do not begin a core clerkship during the summer session to have their projected graduation date changed to August or December of 2026. Such a change will defer participation in the residency match programs to the subsequent year.

Deferring the Step 1 exam may affect scheduling of the Step 2CK licensure exam. The ERAS application is available for download to programs on the last Wednesday in September. Students should be aware of this date in order to sit for Step 2 CK in time for a score to be returned and available in the ERAS application on that day.

The following are topics related to the deferred student’s registration in the College of Medicine:

• Students are responsible to ensure that their registration is accurate and that it reflects all schedule changes that occur due to their Step 1 exam Any discrepancies must be reported by the student to the campus or college registrar.
• Any core clerkship or elective with a start date between April 22 and August 2, 2024 is considered a summer course.
• All students must be registered for a minimum of six credits in a term to be eligible to receive federal financial Thus, if a deferred student’s semester registration consists of less than six credits, the student is not eligible for financial aid, yet they are responsible for the tuition and fees for any hours for which they are registered, and may be required to pay back any dispersed monies. A leave of absence may also increase student loan debt.
• International students have different registration requirements that can impact their visa status and should consult with The Office of International Services (OIS).
• Any students who defer taking the Step 1 exam are strongly advised to meet with the College of Medicine Office of the Registrar and the College of Medicine Office of Financial Aid to discuss the implications of the deferral on their registration and eligibility for student financial aid.

Students should not contact individual sites or coordinators to ask for a site assignment. They should work with the Office of Student Affairs and their academic advisors/learning specialists. Contacting core clerkship sites or coordinators in this context is considered unprofessional behavior and can result in a professionalism form pursuant to the professionalism policy. Students who defer Step 1 must still complete the requirements of the Phase 2 Clinical Connections and Competencies course and will need to complete all unfinished course requirements during their fourth year.

In most cases, students are not eligible to do “away” rotations at another medical school until all Phase 2 core clerkships have been taken and passed. Having Phase 3 status is the usual requirement for being a visiting student at another medical school.

Students are not eligible to start their required Sub-Internship or the Transition to Residency course until all Phase 2 core clerkships have been completed with a passing grade

Approved by the Offices of Curricular and Student Affairs 8/22/2023

Students may only sit for USMLE Step 1 once they have successfully completed all the requirements of the phase 1 curriculum through Block 8 part 1. Students are expected to sit for the USMLE Step 1 exam by March 29, 2025, prior to returning for part 2 of Block 8(Synthesis) and Block 9 (Transition to Clerkships). Students who sit for the exam after March 29, 2025 will be considered to have deferred Step 1.

Due to the constraints of Phase 2 clerkship scheduling, if a student does not sit by March 29, 2025 they will not be registered for or begin core clerkships or Phase 2/3 clinical electives on April 28, 2025. Any absences related to sitting or studying for USMLE Step 1 during Phase 1 curriculum will be considered unexcused.

Students will take the Comprehensive Basic Science Self-Assessment (CBSSA) in advance of the CBSE during Block 8 part 1. The CBSSA will help inform students on how to prepare effectively for the CBSE. Results of the Comprehensive Basic Science Examination (CBSE) during Block 8 part 1 will determine if a student will be required to delay the first clerkship.

Our expectation is that all students will study for the comprehensive basic science exam (CBSE) given in block 8 part 1 and earn a score >50. Any student with a score on the CBSE less than 50 is at significant risk of delaying and/or failing their first attempt at Step 1.

Students with a score <40 on the CBSE in block 8 part 1 will be removed from their first clerkship/elective prior to the dedicated Step 1 study period which begins 2/3/2025. If a student with a CBSE score <40 were to sit by 3/29/25, the student may be able to add back clinical course work contingent on space. Students who sit before 3/29/25 will be able to add back credit bearing work.

Students who have deferred the USMLE Step 1 exam may register for up to six weeks of non- clinical electives during a single term. They may not register for additional non-clinical or clinical courses until they have taken the USMLE step 1 exam. If a student is currently registered and attending a course when they receive notice of failing USMLE Step 1, the student may complete that course before stepping out of the curriculum. They may not register for additional clinical courses until they have retaken the USMLE step 1 exam after a first failed attempt.

Deferring the USMLE Step 1 exam, and thereby deferring the start of Phase 2, should only be considered under certain circumstances. Deferring the Step 1 exam requires the approval of the appropriate campus Dean of Student Affairs or the appropriate campus Dean of Curriculum.

Deferrals should be considered for: a) low likelihood of passing the exam at the time of the planned Step 1 date, based on data including, CBSSA, CBSE, and NBME examinations given during Block 8 or during the dedicated study period, or b) extenuating personal circumstances.

Notes: a.) Students in the Medical Scientist Training Program (MSTP) and other joint degree programs (MPH, MBA, MS) are expected to take the USMLE Step 1 exam by March 29, 2025 and then must complete Block 8 (Synthesis) part 2 prior to taking a leave of absence from the MD curriculum to pursue the other degree. The same is true for students taking a leave of absence for any reason immediately following Phase 1. The student will be required to take Block 9 (Transition to Clerkships) upon return to the curriculum. If the student is planning to return to the curriculum before Block 9 is offered again, it is recommended that they take Block 9 before stepping out.

Students applying for ADA accommodations with the National Board of Medical Examiners (NBME) for taking the USMLE Step 1 exam are advised to begin the accommodations application process several months in advance because the application review process is very lengthy. Pending ADA accommodations decisions by the NBME do not entitle students to begin Phase 2 on schedule before taking the Step 1 exam.

Further registration for additional terms/courses is determined by College Policy.

1. Students who achieve less than 40 on either the CBSE or CBSSA during the in-seat portion of Block 8 part 1 will be required to have a meeting with an advisor, learning specialist, or Dean within student affairs or curricular affairs to develop an adjusted Step 1 study plan.
2. Students whose CBSSA or CBSE examination scores or other self-assessments are of concern, based upon guidelines by the NBME and/or the Office of Student Affairs will be notified that they are required to:
   • Work with their advisor or learning specialist and draft a study plan to address knowledge gaps throughout the rest of dedicated.
3. Students are expected to work with a learning specialist or advisor on a consistent basis to assess if their study plan is being followed, is effective, and readiness to sit for Step 1.
4. Students who are concerned they are not making good progress toward sitting for USMLE Step 1 are encouraged to meet with a dean or a student affairs/academic advisor to discuss all the topics outlined in this document related to deferral of Step 1 and the effect of deferral on core clerkships and clinical electives. If after that meeting, the student still would like to defer, they must inform the appropriate campus deans.
5. Students who do not sit for Step 1 by March 29, 2025 must meet with the appropriate campus dean/academic advisor to discuss their academic progress toward sitting for the USMLE Step 1 exam and the likelihood that their promotion to Phase 2 will be
6. Core clerkship/clinical elective sites require that all additions or changes to students’ schedules be done at least four weeks prior to the start of the rotation due to the constraints of Phase 2 This four-week period is needed between sitting for USMLE Step 1 and starting core clerkships and/or the next clinical elective rotation. Students who are deferring will be scheduled into clerkships/electives based on availability; they are not guaranteed their originally planned rotation schedule.
7. Two-week availability: While four weeks is the standard time needed for courses to prepare for students, in rare instances a student might be allowed to register for a course within a shorter time frame, at the discretion of the campus and dependent on space available. Students must notify administration that they have sat and taken the Step 1 exam and are ready to be registered for core clerkships/clinical electives. Notification within this timeframe is not a guarantee of the ability of the program to place a student in each core clerkship/elective.
8. Students approved to defer taking USMLE Step 1 are nonetheless required to participate in all the Block 8 (Synthesis) part 2 and Block 9 (Transition to Clerkships) course activities. The content and skills in Block 8 part 2 and Block 9 are in the curriculum only once per year, so a student intending to begin Phase 2 at any time during the 2025 – 2026 year must participate in all required dates. Block 8 part 2 and block 9 are time-intensive
9. Any student who defers taking Step 1 is required to meet with their student affairs/academic advisor or learning specialist to design a study plan that must include the components of two and three above.
10. Failure to communicate promptly and reliably during the student’s designated study period and/or failure to follow guidance by student affairs staff may result in a professionalism form pursuant to the Student Academic Policies and Professional Standards(APPS) Please review the 2024-2025 College of Medicine’s policy on Sitting for Step 1 (Section IV.B.)
11. If a student does not register for any credit bearing course work during a single term, the deferral will constitute a Leave of For more information on Leaves of Absence, go here, see Section VII of the APPS: Student Academic Policies and Professional Standards
    • Such students will be required to make an official request for a Leave of Absence to the Office of Student Affairs for approval through the College Committee on Student Promotions.
    • If a student requires a leave of absence for the summer term of 2025, the LOA start date will be April 28, 2025.
    • Students will meet with their student affairs team to review the paperwork, financial aid, course registration and healthcare coverage implications of a leave of absence.

Core clerkship/clinical elective grades must be received by mid-September of Phase 3 to be included in the Medical Student Performance Evaluation (MSPE) and/or the College of Medicine transcript sent to the AAMC Electronic Residency Application Service (ERAS). Any delay taking core clerkships may affect a student’s MSPE quartile, eligibility for AOA, and graduating with honors.

In some cases, it will be necessary for students who do not begin a core clerkship during the summer session to have their projected graduation date changed. Such a change will defer participation in the residency match programs to the subsequent year.

Deferring the Step 1 exam may affect scheduling of the Step 2CK licensure exam. The ERAS application is available for download to programs on the last Wednesday in September. Students should be aware of this date to sit for Step 2 CK in time for a score to be returned and available in the ERAS application.

The following are topics related to the deferred student’s registration in the College of Medicine:

• Students are responsible to ensure that their registration is accurate and that it reflects all schedule changes that occur due to their Step 1 exam Any discrepancies must be reported by the student to the campus or college registrar.
• Any core clerkship or elective with a start date between April 28 and August 8, 2025 is considered a summer course.
• Per the Department of Education policies, students must be registered for a minimum of six credits in a term to be eligible to receive federal financial aid. Thus, if a deferred student’s semester registration consists of less than six credits, the student is not eligible for financial aid; however, they remain responsible for the tuition and fees for any hours for which they are registered, and may be required to pay back any dispersed monies. A leave of absence may also increase student loan debt due to accruing interest charges.
• International students have different registration requirements that can impact their visa status and should consult with The Office of International Services (OIS).
• Any students who defer taking the Step 1 exam are strongly advised to meet with the College of Medicine Office of the Registrar and the College of Medicine Office of Financial Aid to discuss the implications of the deferral on their registration and eligibility for student financial aid.

Students should not contact individual sites or coordinators to ask for a site assignment. They should work with the Office of Student Affairs and their academic advisors/learning specialists. Contacting core clerkship sites or coordinators in this context is considered unprofessional behavior and can result in a professionalism form pursuant to the professionalism policy. Students who defer Step 1 must still complete the requirements of the Phase 2 Clinical Connections and Competencies course once they are enrolled in clinical clerkships and elective and will need to complete all unfinished course requirements during their fourth year.

In most cases, students are not eligible to participate in visiting student (away) rotations at another medical school until all Phase 2 core clerkships have been completed. Having Phase 3 status is the usual requirement for being a visiting student at another medical school.

Students are not eligible to start their required Sub-Internship or the Transition to Residency course until all Phase 2 core clerkships have been completed with a passing grade.

Approved by the Offices of Curricular and Student Affairs 8/23/2024