About the USMLE® Step 1 Exam

Discover key details about the USMLE® Step 1 exam, including content, exam format, and test-day procedures.
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Preparing for the USMLE Step 1 is a significant milestone in your medical education. Understanding the exam’s purpose, format, and content will help you succeed. This guide will provide you with the information you need to approach Step 1 strategically, understand what to expect on test day, and prepare effectively.

USMLE Step 1 Exam Overview

The United States Medical Licensing Examination (USMLE) Step 1 is a critical milestone in your medical education, designed to assess your ability to apply basic science concepts to medical practice. It is part of the 3-exam USMLE series, which is required for medical licensure in the United States.1

The exam content is developed by the National Board of Medical Examiners (NBME) and is regularly reviewed to ensure it reflects current medical knowledge and best practices. Step 1 plays a crucial role in verifying your readiness for clinical training and ensuring you have the foundational knowledge needed to begin rotations and practice medicine under supervision. As a nationally standardized exam, it provides a consistent measure of students' medical knowledge across different schools and educational programs.2

Exam Timeline: From Step 1 to Residency

While Step 1 is your first major licensing exam, it’s just 1 aspect of the process. The timeline below outlines when students typically take each USMLE exam, giving you a clear view of what’s ahead and how these milestones will shape your path to becoming a physician.

For most students, Step 1 is taken after the preclinical years, typically at the end of the second year of medical school, once core foundational coursework is complete. However, since Step 1 transitioned to pass/fail in January 2022, some students now opt to take it earlier in their second year, depending on their school’s curriculum and personal readiness. Your testing timeline is up to you and your individual needs.

Exam: Typical Timing: Timeline Notes:
USMLE Step 1 End of second year of medical school Taken after completing preclinical coursework; some students take it earlier in the second year due to pass/fail change (Jan 2022)
USMLE Step 2 CK Fourth year of medical school Taken after completing clinical rotations
USMLE Step 3 After first year of residency Assesses ability to practice medicine independently
Source3

Exam Content: Topics Tested on Step 1

The USMLE Step 1 covers the foundational medical sciences essential for clinical practice. According to the December 2024 review by the USMLE Management Committee, no major changes were made to the exam content itself, meaning the core topics remain consistent. The exam continues to assess your ability to integrate basic science concepts and apply them to clinical scenarios.1

Rather than testing subjects in isolation, Step 1 presents case-based questions requiring you to draw from multiple disciplines simultaneously. Mastering these topics will help you pass Step 1 and strengthen your critical thinking ability in clinical settings.3

Here’s a breakdown of the key subjects covered on Step 1:

Foundational Sciences:

  • Anatomy: Gross anatomy, histology, and neuroanatomy
  • Physiology: Organ systems, homeostasis, and regulatory mechanisms
  • Biochemistry: Metabolism, molecular biology, and genetics

Pathophysiology & Disease Mechanisms:

  • Pathology: Disease processes, inflammation, and neoplasia
  • Microbiology: Bacteria, viruses, fungi, and parasites
  • Immunology: Immune responses, hypersensitivity, and autoimmunity
  • Pharmacology: Drug mechanisms, side effects, and interactions

Interdisciplinary Concepts:

  • Behavioral Sciences: Patient communication, ethics, and psychology
  • Public Health Sciences: Epidemiology, biostatistics, and preventive medicine
  • Genetics, Aging, and Nutrition: Key concepts in disease prevention and management

Rather than simply memorizing facts, you’ll need to understand how these subjects relate to clinical decision-making. The best way to prepare is to practice case-based questions with a QBank that mirrors the complexity of the exam.

Exam Structure: Step 1 Exam Format

Step 1 follows a structured format to test your ability to apply foundational medical knowledge under timed conditions. Understanding the exam’s layout will help you develop an effective pacing strategy and avoid surprises on test day. The table below outlines the key components of the exam, including its duration, question format, and break allowances.

Total Duration: 8 hours
Number of Blocks: 7 blocks
Questions per Block: Up to 40 questions
Total Questions: No more than 280
Break Time: 45 minutes (can be extended to 60 minutes by skipping the tutorial)
Question Format: Single best answer (some may include images, histology slides, or audio clips)
Test Interface: Digital
Source4

USMLE Step 1 Testing Policies

Understanding the USMLE Step 1 testing policies is helpful for a smoother exam experience. From eligibility requirements to test-day procedures and retake policies, knowing what to expect can help you avoid delays and feel more prepared on exam day. By familiarizing yourself with these policies in advance, you can be ready to perform your best on exam day.

Eligibility Requirements

To take the USMLE Step 1, you must meet certain eligibility requirements based on your medical school enrollment and accreditation status. The specific requirements vary for U.S. medical students and international medical graduates (IMGs).

If you are a U.S. medical student, you must be officially enrolled in or have graduated from a medical school accredited by the Liaison Committee on Medical Education (LCME) or the Commission on Osteopathic College Accreditation (COCA).5

If you are an international medical graduate (IMG), your medical school must be listed in the World Directory of Medical Schools (WDOMS) and meet Educational Commission for Foreign Medical Graduates (ECFMG) certification requirements. Since eligibility policies may change, always check the official USMLE website for the latest updates before registering.6

Exam Day Preparation

Being fully prepared for the USMLE Step 1 test day means understanding what to bring, what to expect, and how to manage your time. Since the exam is administered at Prometric testing centers under strict security protocols, it's essential to be familiar with the process to ensure a smooth experience. With the right materials and a solid game plan, you can stay focused and at ease, knowing you're set up for success.

Step 1 Test Day Essentials:

  • Government-issued photo ID (that matches the name you registered with)
  • Snacks and water (must be kept in provided lockers)
  • Comfortable clothing (layering recommended for warmth)
  • Approved medical items (must be pre-approved by the facility)

Arriving prepared ensures you can focus without distractions. Plan to arrive at least 30 minutes early for check-in, and dress in layers for comfort. Use breaks wisely — hydrate, eat a snack, and reset your focus. With the right preparation, you’ll walk in ready to pass.7

Retake Policy

If you do not pass Step 1, you are allowed to retake the exam, but there are restrictions on the number of attempts and the timing between retakes. You may take Step 1 up to 4 times — 3 initial attempts plus 1 final attempt. You must wait at least 60 days before retaking the exam, and you cannot take Step 1 more than 3 times in a 12-month period.8

Failing Step 1 can feel discouraging, but it does not mean the end of your medical career by any means. Many students successfully pass on a second or third attempt by adjusting their study strategies and focusing on their weak areas.

The key to passing on your next attempt is identifying where you struggled the first time and refining your approach. Open your QBank and use the performance-tracking tools to pinpoint the topics that challenged you. Even if your subscription has ended, your progress is saved — so when you renew, your metrics will be there. Use those insights, along with what you learned from your first Step 1 attempt, to let the algorithm create a personalized study plan that guides you toward a passing score.

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Frequently Asked Questions (FAQs)

When preparing for the USMLE Step 1 exam, many students have common concerns about exam policies, scoring, eligibility, and logistics. Below, we’ve answered some of the most frequently asked questions to help you stay informed.8

Yes, the USMLE Step 1 exam transitioned to a pass/fail scoring system for all administrations on or after January 26, 2022. To pass, you must achieve a score of 196 or higher.

You can take Step 1 up to 4 times. There is a mandatory 60-day waiting period between attempts, and you may only take the exam 3 times within a 12-month period.

With the transition to pass/fail, Step 1 no longer directly impacts residency applications. However, passing is still essential, and programs now focus more on Step 2 CK scores, clinical evaluations, research experience, and personal statements.

IMGs can take Step 1 if they attended a medical school listed in the World Directory of Medical Schools and meet ECFMG certification requirements. Since Step 1 is now pass/fail, IMGs must strengthen other aspects of their application to remain competitive.

Yes, you can reschedule your exam, but fees and policies vary. It’s best to check with the USMLE program or Prometric testing center for the latest rescheduling procedures.

If you miss your Step 1 exam, you will need to reapply and pay the required fees to reschedule. A new application cannot be processed until at least 4 weeks after the end of your missed eligibility period.

Step 1 results are typically released within 3-4 weeks after your exam date. However, processing times may vary, so check the USMLE website for the most up-to-date information.

While most students take Step 1 during medical school (typically at the end of their second year), it is possible to take it after graduation. However, taking it during medical school is recommended to align with your curriculum and preparation.

References

  1. United States Medical Licensing Examination. (n.d.). Step 1. USMLE. https://www.usmle.org/step-exams/step-1
  2. National Board of Medical Examiners. (n.d.). Comprehensive Basic Science Self-Assessment (CBSSA). NBME. https://www.nbme.org/examinees/nbme-self-assessments/comprehensive-basic-science-self-assessment
  3. American Medical Association. (n.d.). What is the USMLE? AMA. https://www.ama-assn.org/medical-students/usmle-step-1-2/what-usmle
  4. United States Medical Licensing Examination. (n.d.). Step 1 exam content. https://www.usmle.org/step-exams/step-1/step-1-exam-content 
  5. Harvard Medical School. (n.d.). Licensure & USMLE: United States Medical Licensing Examination. Harvard Medical Student Handbook. https://medstudenthandbook.hms.harvard.edu/206-licensure-usmle-united-states-medical-licensing-examination
  6. United States Medical Licensing Examination. (n.d.). Eligibility. USMLE. https://www.usmle.org/bulletin-information/eligibility
  7. United States Medical Licensing Examination. (n.d.). Exam day information: Personal belongings. USMLE. https://www.usmle.org/what-to-know/exam-day-information/personal-belongings
  8. United States Medical Licensing Examination. (n.d.). Common questions. USMLE. https://www.usmle.org/common-questions
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