About the USMLE® Step 1 Exam

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 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.

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.