Preliminary Preparation: USMLE Step 1


The United States Licensing Examination (USMLE) is a 3-step examination required for medical licensure in the US. 

All US medical students are required to write Step 1 at the end of their second year of medical school before moving into the clinical phase of their training. 

None of the USMLE steps are mandatory for medical student promotion at McGill or licensure in Canada.

If you decide to take Step 1, we suggest scheduling it for your time off between Med 2 and Med 3. We do not recommend that you plan to travel to write Step 1 during ICM, as you will not be given approval for the time off.

Reasons you might choose to write USMLE Step 1:

1. You are thinking of pursuing residency training in the US

  • For most residency programs, particularly those that are highly competitive, USMLE Step 1 scores are an extremely important part of the residency application process 

  • Many programs even have unpublished “minimum scores” below which they will not even consider an applicant (see average USMLE scores of matched applicants to various disciplines here)

2. You are thinking of pursuing fellowship training in the US

  • This is a bit trickier because not all fellowship training programs require USMLE scores, but if you want to “moonlight” (work) while doing your fellowship (and who can’t use some extra cash??), you will need to be licensed in the state you are in, which may require completion of the USMLEs

3. You are thinking of ultimately practicing in the US

  • Again, this can be tricky since medical licensure in the US is state-dependent, and not all states require USMLE scores

  • However, unless you are quite certain that the state in which you ultimately want to practice does not require (and will not require by the time you finish residency) the USMLE, you may want to strongly consider writing at least Step 1

Reasons you might decide against writing USMLE Step 1:

1. You are very convinced that you only want to stay within Canada

  • Since none of the USMLE steps are required for Canadian licensure, if you know that you most likely never want to pursue training or practice in the US, it is not unwise to decide against writing Step 1

  • Just be aware that if unforeseen circumstances intervene several years down the line and you find yourself unexpectedly on your way to the US, you will most likely have to write Step 1 at that time, which means reviewing material that you haven’t used in a long time

For more detailed information on the exam, study materials, and registration, see

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