• Mar 18, 2026
  • Jason D'costa

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What Is Changing and When

The USMLE is updating its test delivery software for Step 1 and Step 2 CK in May 2026. The content does not change. The way the exam is delivered does.

Exam Software Launch Date Old Blocks New Blocks Block Length
Step 2 CK May 7, 2026 8 × 40 Qs / 60 min 16 × 20 Qs / 30 min 30 minutes
Step 1 May 14, 2026 7 × 40 Qs / 60 min 14 × 20 Qs / 30 min 30 minutes
Step 3 Live since Mar 10, 2026 - - Already updated

Total questions, exam duration, scoring, and content - all unchanged.

What the New Interface Actually Offers

Students worry the new software will be confusing on exam day. It will not be - if you prepare for it using USMLE study resources. Here is what is new:

  • Updated visual design that matches NBME self-assessment software — the same platform you already use for NBMEs.
  • Improved keyboard navigation — you can move through questions without touching the mouse.
  • A new settings menu to adjust display preferences.
  • Per-image contrast adjustment — directly useful for radiology, dermatology, and pathology questions that look washed out under test center lighting.

Why This Hits Indian IMGs Harder Than US MD Students

Indian doctors often read that this change is "minor" and "nothing to worry about." That framing is written for US MD students. For Indian IMGs, the situation in 2026 is different.

Three things are changing at the same time:

  • New test delivery software (May 2026).
  • Step 2 CK passing score increase from 214 to 218 (already in effect since July 2025).
  • FSMB registration portal shift replacing ECFMG for Step exam registration (since January 2026).

On top of that, the numbers are harder for Indian doctors from the start:

  • US MD first-attempt pass rate for Step 2 CK: 98%
  • Indian IMG first-attempt pass rate: 89%
  • Average Step 2 CK score for non-US IMGs who matched in 2024: 245

Step 1 is now pass/fail. That means your Step 2 CK score is the only number a residency program sees from you. It carries everything.

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The Step 2 CK Passing Score Increase - What Indian Doctors Must Know

This change is already in effect. Most students preparing right now do not fully understand what it means for them.

  Before July 1, 2025 After July 1, 2025
Step 2 CK passing score 214 218
Target for Indian IMG match (competitive specialties) 240+ 245+

What this means in practice:

  • A score between 218 and 230 means you passed, but it does not guarantee a match.
  • Since Step 1 became pass/fail, program directors now focus more on Step 2 CK scores, especially for IMGs.
  • The more competitive the specialty, the more an extra 10-15 points above passing matters.
  • Step 2 CK preparation plays a crucial role in determining your future.

Do not aim to pass. Aim to score high enough to compete.

FSMB Registration Portal - The Change Indian Students Are Missing

This is the most overlooked update of 2026 for Indian USMLE applicants. Many students are still navigating the old ECFMG process out of habit.

Here is what changed:

  • Effective January 12, 2026, all Step exam registration for IMGs moved from ECFMG to FSMB.
  • ECFMG still handles certification eligibility and receives your scores — that part has not changed.
  • Registration, scheduling, and all administrative tasks now go through the FSMB USMLE portal.
  • Applications submitted but not processed before the transition must be resubmitted through FSMB.

Action item: If you have not logged into the FSMB portal yet, do that before anything else. Do not assume your old ECFMG account carries over.

USMLE Fees for Indian Candidates in 2026

USMLE exam fees in India are higher than what most students expect. Here is the full breakdown:

Exam Region Surcharge (India) 18% GST (India)
Step 1 +$210 Applied on total
Step 2 CK +$235 Applied on total

Two things to know:

  • 18% GST on USMLE examsin India became applicable from December 4, 2024 — this is added on top of the base fee and region surcharge.
  • Taking your exam outside India removes the GST component entirely, which may be cost-effective for some students.

Exactly What to Do Before Your Exam

If your exam is before May 7 (Step 2 CK) or May 14 (Step 1):

Nothing in your USMLE preparation changes. Use the current tutorials. Sit the exam as planned. Do not reschedule out of fear of the new software.

If your exam is on or after those dates:

  • Complete the new official USMLE tutorial for your exam at USMLE.org – this is not optional.
  • Switch your UWorld and Amboss sessions to 20-question, 30-minute timed blocks right now – not occasionally, but as your default setting every time.
  • Practice keyboard navigation in every mock session – under pressure, using the mouse slows you down.
  • Run the contrast tool during your tutorial so it feels automatic before exam day.
  • If you have a testing accommodation, watch your email – NBME is sending updated decision letters outlining your new exam breakdown.

Do not do this:

  • Do not reschedule your exam because of the software change alone.
  • Do not change your study resources or methods - First Aid, UWorld, Pathoma, Sketchy, and NBME self-assessments are still the right tools.

FAQs

No. Content, total questions, scoring, and exam day duration are all unchanged.

Step 2 CK: May 7, 2026. Step 1: May 14, 2026.

A small number of appointments may need to be moved. If yours is affected, USMLE will contact you directly. Do not reschedule on your own.

218, effective July 1, 2025. The previous passing score was 214.

Through the FSMB portal. ECFMG no longer handles Step exam registration as of January 12, 2026.

Typically two to four weeks after your test date. When planning around a score deadline, allow at least eight weeks to be safe.

Yes. The 18% GST on USMLE fees only applies to exams taken in India. Taking your exam in another country removes that cost entirely.