USMLE Step 1 Overview and Structure

The USMLE Step 1 exam tests how well students apply basic, integral science concepts to clinical scenarios.

Exam Overview

USMLE Step 1 is the first in a series of three USMLE exams are required in order to qualify for medical licensure in the United States. This one-day computer exam is usually taken by US medical students at the conclusion of their second year of medical school.

The computer based USMLE exam is administered by appointment on a year-round basis.

The Step 1 emphasizes basic science principles:

• Anatomy
• Behavioral science
• Biochemistry
• Microbiology
• Pathology
• Pharmacology
• Physiology

Interdisciplinary areas such as immunology, genetics, and nutrition are also tested.

The Step 1 exam spans 8 hours and contains 350 questions. There are 50 questions in 7 one-hour "blocks". Within a particular block you can skip back and forth among test questions. If your time in a block expires or you leave, you will not be able to return to the questions.

Questions within block are NOT grouped by subject and this random ordering of items presents students with a unique challenge. Students have to stop thinking about one subject and switch to another without skipping a beat.

In total, you will have 45-60 minutes "break" depending on whether you opt to complete the 15 minute tutorial at the start. Students can "add" to their break time by completing a block before the hour. Please note, that finishing blocks early does not add to your total "test time" which is constant at 7 hours. Therefore you can't add time to one block by finishing another block ahead of time.

Question Formats

The only question format currently on the USMLE Step 1 is best answer. Some of the Step 1 items test your knowledge directly; however, most require application of basic science principles to clinically-relevant situations.

To make the Step 1 exam medically relevant, the USMLE items often assess basic medical science concepts. While some points are asked in a fairly traditional, straightforward manner, you will also be presented with many clinical scenarios. This style typically involves fairly long lead-in situations followed by brief response options.

Scoring

To achieve a passing score, you typically need to answer between 55-65% correct.

• Two-digit and three-digit scales
• Pass/fail designation
• Graphic depiction of your performance by discipline and organ system.
• Defined scale based on the performance of a criterion group, representing a previous group of second year US med students who took the exam for the first time at the end of their second year of medical school.

The minimum passing score on the three-digit scale is 185, while the passing score on the two-digit scale remains 75 (75 does NOT mean 75%).