All About the USMLE® Step 1 Exam

Everything you need to know to be ready for test day

USMLE Step 1 at a glance

The USMLE Step 1 is the first in a series of standardized exams required for earning medical licensure in the United States. Step 1 assesses your understanding of the important concepts of basic medical sciences. This computer-based test focuses on the principles and mechanisms of health, disease, and modes of therapy.

Who can take the USMLE Step 1?

To be eligible to take USMLE Step 1, you must be: 

  • a current MD student or graduate of a LCME-accredited medical school in the US or Canada, OR
  • a current DO student or graduate of an AOA-accredited medical school in the US, OR
  • a medical student or graduate of a medical school outside the US listed in the World Directory of Medical Schools who meets the ECFMG’s eligibility criteria.

When and where can I take the USMLE Step 1? 

Step 1 is administered year-round, but you must register in advance. Many students take Step 1 at the end of their second year of medical school (around April), however being prepared for the exam is more important than the precise timing of the exam, as you cannot retake it to improve a low passing score and any failing attempts will remain on your record. Your Step 1 score will likely play a significant role in the selection process for residency programs, so you want to take the exam when you are confident that you will be able to score well. Step 1 is administered at Prometric testing centers around the world. For international medical graduates, you can choose to do the USMLE Step 1 whenever you want, but we recommend doing the test at the end of your pre-clinical education. You must remember that once you start taking the USMLE steps, you need to finish steps 1, 2 and 3 within a seven-year period.

What is the format of USMLE Step 1?

Step 1 is a computer-based multiple choice exam with up to 280 questions total. This exam is administered in seven 60-minute testing blocks with a maximum of 40 questions per block, with a total of 45 minutes of break time (reserved for authorized breaks and computer transitions between blocks). Questions are posed in multiple choice format, based on patient-centered vignettes, with a single best answer. Multiple answer options may be partially correct, but there is only one best answer. If you are unsure about an answer, it is better to make an educated guess as unanswered questions are automatically counted as incorrect answers. 

If you complete a block early, the remaining time will be added to your total break time. Breaks can only be taken between blocks, and you can only take a maximum of six breaks that add up to 45 minutes. The entire testing experience takes about 8 hours. At the beginning of the exam, there is a 15-minute tutorial, which you can skip if you have completed it online prior to your testing day. Do, however, make sure to test your headphones on test day!

What topics are on the USMLE Step 1? 

Step 1 is designed to measure your knowledge of basic science. The exam is also organized by physician task and competency, such as medical knowledge, patient care (diagnosis), patient care (management), communication/professionalism, and practice-based learning and improvement. The content of the USMLE Step 1 exam can be divided into systems- or processes-based. 

Step 1 Test Specifications*

System Before
May 4, 2020
Range, %
On or after
May 4, 2020
Range, %
General Principles** 13-17 12-16
Blood & Lymphoreticular/Immune Systems 7-11 7-11
Behavioral Health & Nervous Systems/Special Senses 9-13 9-13
Musculoskeletal, Skin & Subcutaneous Tissue 6-10 6-10
Cardiovascular System 6-10 5-9
Respiratory & Renal/Urinary Systems 9-13 9-13
Gastrointestinal System 5-9 5-9
Reproductive & Endocrine Systems 9-13 9-13
Multisystem Processes & Disorders 7-11 6-10
Biostatistics & Epidemiology/Population Health 5-7 4-6
Social Sciences: Communication and Interpersonal Skills 3-5 6-9

Step 1 Discipline Specifications*

System Before
May 4, 2020
Range, %
On or after
May 4, 2020
Range, %
Pathology 45-52 44-52
Physiology 26-34 25-35
Pharmacology 16-23 15-22
Biochemistry & Nutrition 14-24 14-24
Microbiology 11-15 10-15
Immunology 7-11 6-11
Gross Anatomy & Embryology11-15 11-15
Histology & Cell Biology 9-13 8-13
Behavioral Sciences 8-12 10-15
Genetics 5-9 5-9

To learn more about the specific disciplines tested on each USMLE exam, visit the USMLE’s content outline page or view their detailed Content Outline PDF.

Taking the USMLE Step 1 exam

To apply to take the USMLE Step 1 exam, you will need to submit an application through the proper registration entity and pay the associated fees.

US Medical Students* International
Medical Graduates (IMGs)**
Registering for Step 1 apply through NBME on the NBME Licensing Examination Services page apply through ECFMG on Interactive Web Applications (IWA)
Step 1 Application Fee US $645 US $965
ECFMG Certification N/A US $145

Additional costs, such as transportation to the exam center, visa fees, etc. will vary based on your personal circumstances.

What is the minimum passing score for USMLE Step 1?

The current minimum passing score for USMLE Step 1 is 194. (Last updated January 2020)

How to study for the USMLE Step 1 

Every student can get an excellent score on the USMLE Step 1 exam. With the right practice materials and study strategies, you can too! 

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USMLE™ is a joint program of the Federation of State Medical Boards (FSMB®) and National Board of Medical Examiners (NBME®). MCAT is a registered trademark of the Association of American Medical Colleges (AAMC). NCLEX®, NCLEX-RN®, and NCLEX-PN® are registered trademarks of the National Council of State Boards of Nursing, Inc (NCSBN®). None of the trademark holders are endorsed by nor affiliated with Lecturio.

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