Career Planning Advice


The United States Medical 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 TCP, as you will not be given approval for the time off.



Reasons you might choose to write USMLE Step 1:

You are thinking of pursuing residency training in the US

For most US residency programs, particularly those that are highly competitive, USMLE Step 1 has historically been an extremely important part of the residency application process. With the transition in January 2022 to a Pass/Fail system for the USMLE Step 1, some programs may begin to rely more heavily on the USMLE Step 2 score instead.

Many programs even have “minimum scores” below which they will not even consider an applicant (see average USMLE scores of matched applicants to various disciplines: Charting Outcomes in the Match: International Medical Graduates).

You are thinking of pursuing fellowship training in the US

This is a bit trickier because not all fellowship training programs require USMLE, but if you want to “moonlight” (work) while doing your fellowship, you will need to be licensed in the state you are in, which may require completion of the USMLEs.

You will have to confirm specific exam requirements with your target fellowship programs. For this reason, many medical students choose to delay taking their USMLE exams until residency, when their fellowship plans are a bit clearer.

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 (CA, NY and VT are examples of states that will accept the Canadian licensing examinations). To find out, you need to look up the state medical board website, and basically click around on it until you find the deeply buried subpage or PDF which indicates which examinations that state will accept for licensure. If it's unclear, you'll need to contact that state board directly.

Reasons you might decide against writing USMLE Step 1:

You are fairly convinced that you only want to stay in 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's ok to decide against writing Step 1. There are many other things you can do with your time in Med2 and summer: extracurriculars that will be relevant to your CaRMS applications, rest, vacation, and visiting family.

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 may have to write Step 1 at that time. This is a great example of writing it "Just in Time" rather than "just in case."

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


How to Avoid USMLE Security Violations:

Examinees who behave in ways that compromise security standards could jeopardize their future medical careers. Consult the USMLE safety web page which presents examples of security violations and information about sanctions that may be imposed on examinees who commit security violations and a video that clearly explains what these breaches may consist of to safety.

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