Step 1 Deferral Procedures

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 28, 2026, prior to returning for part 2 of Block 8(Synthesis) and Block 9 (Transition to Clerkships). Students who sit for the exam after March 28, 2026, 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 28, 2026, they will not be registered for or begin core clerkships or Phase 2/3 clinical electives on April 27, 2026. Any absences related to sitting or studying for USMLE Step 1 during the 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 of less than 50 is at significant risk of delaying and/or failing their first attempt at Step 1.

Students with a score less or equal to 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 2/2/2026. If a student with a CBSE score less or equal to 40 were to sit by 3/28/26, the student may be able to add back clinical coursework contingent on space. Students who sit before 3/28/26 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 a passing score on 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 28, 2026, 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 or equal to 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 the dedicated time.
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 is ready 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 28, 2026, 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 delayed.
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 the 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 2026 – 2027 year must participate in all required dates. Block 8, part 2, and Block 9 are time-intensive coursework.
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 College of Medicine’s policy on Sitting for Step 1 (Section IV.B.)
11. If a student does not register for any credit-bearing coursework during a single term, the deferral will constitute a Leave of Absence. 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 2026, the LOA start date will be April 27, 2026.
    • 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 in 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 the 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 for ensuring 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 27 and August 7, 2026 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 electives, 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.

Approved by the Offices of Curricular and Student Affairs 5/7/2025

Students may only sit for USMLE Step 1 after successfully completing all requirements of the Phase 1 curriculum through Block 8, Part 1. Students are expected to sit for the USMLE Step 1 exam by March 27, 2027, before returning for Part 2 of Block 8(Synthesis) and Block 9 (Transition to Clerkships).

Students who have not sat for USMLE Step 1 by March 27, 2027, will be considered to have deferred Step 1 under this procedure.

Due to the constraints of Phase 2 clerkship scheduling, if a student does not sit by March 27, 2027, they will not be registered for or begin core clerkships or Phase 2/3 clinical electives on April 26, 2027. Any absences related to sitting or studying for USMLE Step 1 during the 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 students 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/elective.

We expect 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 CBSE score below 50 is at significant risk of delaying or failing their first attempt at Step 1.

Students with a score of 45 or lower on the CBSE in block 8 part 1 will be removed from their first clerkship/elective before the dedicated Step 1 study period, which begins 2/1/2027.  If a student with a CBSE score of 45 or lower were to sit by 3/27/27, the student may be able to add back clinical coursework contingent on availability. Students who sit before 3/27/27 will be able to add back credit-bearing coursework.

Students who defer 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.

Students who defer USMLE Step 1 for more than one term will not be eligible to register for clinical or non-clinical coursework until they receive a passing score on USMLE Step 1.

Students who defer the Step 1 exam for longer than one term will be reviewed at least once each term by their campus progress review subcommittee.

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 a passing score on 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 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 ( MBA, MS) are expected to take the USMLE Step 1 exam by March 27, 2027, and then must complete Block 8 (Synthesis) Part 2 before 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 prior to starting Block 9. 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. 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 2027 – 2028 year must participate in all required dates. Block 8, part 2, and Block 9 are time-intensive coursework.

Students applying for disability accommodations with the National Board of Medical Examiners (NBME) for the USMLE Step 1 exam are advised to begin the accommodations application process several months in advance, as the review process is lengthy. Students cannot begin Phase 2 before taking the Step 1 exam, regardless of disability accommodation application

College Policy determines further registration for additional terms/courses.

1. Students who achieve 45 or less on either the CBSE or CBSSA during the in-seat portion of Block 8, Part 1, will be required to meet 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 to draft a study plan to address knowledge gaps during the remaining dedicated time.
3. Students are expected to work with a learning specialist or advisor consistently to assess if their study plan is being followed, is effective, and is ready to sit for Step 1.
4. Students who are concerned that 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 topics outlined in this document related to deferral of Step 1 and its effects 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 27, 2027, 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 the start of their clinical clerkships will be delayed.
6. Core clerkship/clinical elective sites require that all additions or changes to students’ schedules be made at least 4 weeks before the start of the rotation due to Phase 2 scheduling constraints. 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 subject to space availability. Students must notify the administration that they have taken the Step 1 exam and are ready to be registered for core clerkships/clinical electives. Notification within this timeframe does not guarantee placement in a core clerkship or elective.
8. 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 College of Medicine’s policy on Sitting for Step 1 (Section IV.B.)
9. If a student does not register for any credit-bearing coursework during a single term, the deferral will constitute a Leave of Absence. 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.
• If a student requires a leave of absence for the summer term of 2027, the LOA start date will be April 26, 2027.
• 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.
• Students who defer the USMLE Step 1 exam for longer than one term or are on leave of absence due to deferral will be reviewed each term by their Campus Progress Review Subcommittee, as described in Section VIII of the Student Academic Policies and Professional Standards

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 in completing core clerkships may affect a student’s graduation timeline, MSPE quartile, eligibility for AOA, and the likelihood of graduating with honors.

In some cases, students who do not begin a core clerkship during the summer session will need 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 the 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 for ensuring their registration is accurate and reflects all schedule changes resulting from their Step 1 exam. The student must report any discrepancies to the campus or college registrar.
• Any core clerkship or elective with a start date between April 26 and August 6, 2027, is considered a summer course.
• Per the Department of Education policies, students must be registered for a minimum of five credits in a term to be eligible to receive federal financial aid. Thus, if a deferred student’s semester registration consists of less than five 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. Extension of a student’s medical education beyond 11 terms may make them ineligible for further federal 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 electives, and will need to complete all unfinished course requirements during their fourth year.

Phase 2 Core Clerkships must be completed prior to a student taking sub-internship, acute care, and Physician-Assessed-Patient-Facing selectives. Exceptions may only be considered for students who are required for career readiness in any year they participate in a match, with prior approval from the curricular dean or their designee. 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.