Reviewed by:
Third-Year Medical Student, Lewis Katz School of Medicine at Temple University
Reviewed: 4/25/24
Are you ready to take your USMLE Step 1 exam? Follow along for everything you need to know about preparing for Step 1 of the USMLE.
If you’re about to take the USMLE Step 1 exam, you may be wondering what it's all about. The USMLE (or United States Medical Licensing Examination) is the examination required for US medical licensure. It is divided into three Step exams. Step 1 of the USMLE is taken at the end of your second year of medical school.
Here we’ll talk about how to get prepared for the USMLE Step 1 exam, including material on the test, format, test length, study tips, and more. Keep reading to learn advice from our experts on how to ace your first Step exam.
Let’s get started!
Since this is your first Step exam, you need to pay extra close attention to the Step 1 interactive testing experience. This free online tool will show you how to navigate each item and function of the online test. Step 1 consists mainly of multiple-choice questions (MCQs), which are referred to as “items.”
Step 1 of the USMLE takes one day (eight hours) to complete and is divided into seven 60-minute blocks.
The multiple-choice questions on the USMLE Step 1 exam are designed to measure your basic science knowledge, and ask the testee to “interpret graphic and tabular material, to identify gross and microscopic pathologic and normal specimens, and to solve problems through the application of basic science principles.”
It should be noted that there is a tutorial at the beginning of the Step 1 exam, but it does not contain as much detailed information as the tutorial in the Step 1 interactive testing experience. You’ll also need to review the audio findings on the simulator to become familiar with how audio test items function before you take your test.
In the past, the Step 1 score range was 1 to 300. However, starting in 2022, the score was simply reported as a pass or fail to help students match with more residency programs.
According to the USMLE Content Outline, the MCQs on the USMLE are designed to test your basic science knowledge and comprehension skills. Here is a breakdown of the subjects on the Step 1 exam:
For more in-depth information on what you’ll need to know going into your USMLE Step 1 exam, visit the USMLE content outline page and click the follow-through links on each subject in tables 1, 2, and 3.
There are about 40 questions in each block, though there may be less as the exact number of questions on each block varies. The total number of questions (or “items”) on the exam form will be no greater than 280.
Here are some examples of the USMLE Step 1 questions and format you can expect to see.
“A previously healthy 34-year-old woman is brought to a physician due to fever and headache for 1 week. She has not been exposed to any disease. She takes no medications. Her temperature is 39.3℃ (102.8℉), pulse is 104/min, respirations are 24/min, and blood pressure is 135/88 mm Hg. She is confused and oriented only to person. Examination shows jaundice of the skin and conjunctivae. There are a few scattered petechiae over the trunk and back. There is no lymphadenopathy. Physical and neurologic examinations show no other abnormalities. Test of the stool for occult blood is positive. Laboratory studies show:
Blood and urine cultures are negative. A CT scan of the head shows no abnormalities. Which of the following is the most likely diagnosis?”
The answer in this example is highlighted in green; however, it will not be highlighted on your actual test.
“A 50-year-old man comes to the office because of a 2-month history of increasing daytime somnolence. He has obstructive sleep apnea for which he has only intermittently used a continuous positive airway pressure device. He is 170 cm (5 ft 7 in) tall and weighs 181 kg (400 lb); BMI is 63 kg/m². His temperature is 37°C (98.6°F), pulse is 100/min, respirations are 12/min, and blood pressure is 135/80 mm Hg. Physical examination shows a gray-blue tinge to the lips, earlobes, and nail beds. Cardiac examination shows no other abnormalities. Arterial blood gas analysis on room air shows a pH of 7.31, PCO₂ of 70 mm Hg, and PO₂ of 50 mm Hg. Which of the following additional findings would be most likely in this patient?”
Here’s the answer, highlighted in green:
“A 5-year-old girl is brought to the emergency department because of a 2-day history of fever, urinary urgency, and burning pain with urination. She has had four similar episodes during the past year. A diagnosis of urinary tract infection is made. Subsequent renal ultrasonography shows one large U-shaped kidney. Which of the following is the most likely embryologic origin of this patient's condition?”
The correct answer is:
“A 14-year-old girl is brought to the office by her mother because of a 3-month history of red bumps on her skin. The patient says the bumps are not itchy or painful but that she finds them embarrassing. She has no history of major medical illness and takes no medications. Her vital signs are within normal limits. Physical examination shows the findings in the photograph. Which of the following is the most likely diagnosis?”
You’ll see some questions with visual elements, audio clips, or other tools as part of the prompt. For this question with a visual element, the right answer is:
“A 65-year-old woman is brought to the emergency department because of a 10-minute history of chest tightness and severe pain of her left arm. Physical examination shows jugular venous distention. Crackles are heard over the lung fields. An ECG shows ST-segment elevation greater than 1 mm in leads V₄ through V₆ and new Q waves. Serum studies show an increased troponin I concentration. Which of the following labeled points in the graph best represents the changes in cardiac function that occurred during the first 10 seconds after the onset of pain in this patient?”
These types of answers are typically the trickiest! Here’s the correct answer:
“A 51-year-old man with a 10-year history of gastroesophageal reflux and suspected Barrett esophagus comes to the office because his omeprazole dose "doesn't work around the Christmas holidays." He states that he prides himself on having a large appetite and "holding his liquor" during the holidays. He currently takes the maximum dose of omeprazole. Which of the following is the most appropriate initial action by the physician?
The right response to this question is:
To learn more about what types of questions you can expect on the USMLE Step 1 exam, review the Step 1 interactive testing experience.
If you're wondering where you stand in your preparation or simply want more practice, take our USMLE Practice Questions Quiz with free sample questions and answers!
The USMLE takes one day to complete and is administered in one 8-hour testing session. Each of the seven sections in the exam takes one hour to complete. Examinees will be allowed one approved break time. If you require test accommodations, you may apply through the USMLE website.
The USMLE Step 1 is an extensive test, but most medical tests are! Here’s a quick comparison to some other tests you’ll encounter throughout your med journey:
As you’ll notice, most medical tests are quite lengthy! The Step 1 USMLE is actually the shortest of the USMLE exams!
Most students take the USMLE Step 1 exam at the end of their second year in medical school. This timeline is recommended to allow students enough time in school to learn the necessary material for the Step 1 exam. Technically, you can take the USMLE Step 1 exam anytime after the three-month period after registration.
In order to register, you must be a graduate or current student in an MD program. So, the earliest you can possibly take the USMLE Step 1 exam is after you have enrolled in medical school.
The USMLE Step 1 exam is known to be challenging, mainly because of its length, the comprehensive content it covers, the high standards test-takers have in mind when making it, and the added psychological fact that it is so high stakes!
Achieve your best score with the help of USMLE tutors. Meet your own tutor and take the next step toward USMLE success today!
However, students that study adequately should be able to pass on the first try! The 2023 USMLE Step 1 pass rates should offer some reassurance:
The USMLE Step 1 exam fee is quite high. It’ll cost $680 starting in 2025!
International students can expect to pay even more for their exam. If you’re testing outside of the US or Canada, it’ll cost $1000.
The dates that USMLE scores are released vary. While they are typically available two to four weeks after your exam, they can be delayed! Give your score up to eight weeks to show up on the website of the organization that registered you for your exam.
Here are some USMLE Step 1 study tips from our experts. If you’re studying for the USMLE and want a personalized study guide, consider setting up a consultation with one of our experts.
It is recommended to start studying six months or more before you intend to take the USMLE Step 1 exam. Some students even begin a year before the test. Starting early will ensure that you will have time to cover all of the material on the test.
Don’t forget about the USMLE as you’re navigating medical school! While you’re studying, you should be in the first or second year of your MD degree. Beginning the process of memorizing important information will help you stay sharp throughout the year and better retain information.
The USMLE stresses that you should take plenty of time to familiarize yourself with the software you’ll use on your test. By reviewing the Step 1 interactive testing experience early, you’ll have a better idea of what to study for and what to expect. Throughout your six months of study time, you should continuously refer to the online simulator.
Most students take the USMLE at the end of their second year; however, you have the option to take it at any point after enrolling in medical school. We strongly recommend waiting to take the exam until the end of your second, or even in third year, if you do not feel prepared.
You’ll learn the materials you’ll need to know for the Step 1 exam in medical school, so the more time you spend learning, the better. Additionally, waiting will give you enough time to start studying for the test several months before your scheduled exam.
Keep yourself on track and organized by creating a study schedule that encompasses your busy med student life. You can do this on your own or with the assistance of an experienced USMLE tutor. Keeping a schedule will also help to reduce stress throughout your first and second years of med school.
Here are our answers to the most frequently asked questions about the USMLE Step 1 exam.
Step 1 of the USMLE is considered the most challenging, so at least six months of preparation time is recommended. Most students choose to take the USMLE at the end of their second year in medical school, which allows the student plenty of time to absorb the necessary study material before taking the exam.
You should also allow yourself several weeks to familiarize yourself with the website and test format.
To be eligible for the USMLE Step 1 exam, you must be a current or graduate medical student (MD) of a US or Canadian medical school. The medical school you attend must be accredited by the Liaison Committee on Medical Education (LCME).
You can take any of the three USMLE Step exams up to 6 times in your lifetime. However, you can not attempt to retake the same Step exam or component more than three times within a 12-month window.
Step 1 of the USMLE is commonly considered the most challenging of the three USMLE Step exams. You’ll be using unfamiliar software, and you will have to make time to study throughout your first and second years of medical school.
To properly prepare yourself, you should thoroughly review the USMLE interactive testing experience multiple times. You should also build a rigorous study schedule and maintain it throughout the six to twelve months before your exam. Do everything you can to reduce stress and get familiar with the test format and the material.
Good luck!
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