In January 2026 the USMLE consolidated exam services under its two co-sponsors. The change was administrative rather than academic, and it is the sort of thing that only becomes visible when you need support and contact the wrong organisation.
What happened, in two phases
On 12 January 2026, the Step exam services that ECFMG had provided to international medical graduates moved to FSMB. From that date, all three Step exams for international graduates are managed by FSMB.
On 26 January 2026, the Step 3 services that FSMB had provided to students and graduates of US medical schools moved to NBME.
The rule that results
It is simpler than the transition sounds.
If you attend or graduated from a US medical school, you register for all three Step exams through NBME.
If you attend or graduated from a medical school outside the United States, you register for all three through FSMB.
Previously the split ran by exam rather than by school, which meant most people dealt with two organisations across the sequence. Now it runs by where you trained, and you deal with one.
Transcripts
Separately, from June 2026 FSMB began processing USMLE transcript requests for the ERAS service. That centralises all USMLE transcript requests with FSMB, which already handled the others.
For applicants this is a single change of address rather than a change of process, but it is worth knowing which organisation to chase if a transcript does not arrive when expected.
Why it matters in practice
Mostly for support and for deadlines. When something goes wrong with a registration, an eligibility period or a score report, knowing which organisation owns the problem is the difference between a quick resolution and a week of being redirected.
It also matters for anything you read. Guidance written before 2026 will describe the previous arrangement, and registration instructions in older preparation material are now partly wrong. That includes a lot of otherwise good advice, which does not announce that its logistics section has expired.
What has not changed
The exams. Content, scoring, eligibility rules and the structure of the sequence are unaffected by who administers the registration. This was a consolidation of services rather than a change to the assessment.
The general lesson
Exam logistics decay faster than exam content. For registration, scheduling, transcripts and deadlines, go to the programme’s own current pages rather than a secondhand summary, however well written. For studying, older material is usually still fine.
Frequently asked questions
Do I need to do anything if I registered before the change?
Existing registrations were carried across in the transition. The practical difference is which organisation you contact for support and where you go for future registrations.
Did ECFMG stop being involved?
ECFMG's role in Step exam services for international graduates moved to FSMB in January 2026. ECFMG certification itself is a separate process.