All About the USMLE Step 1

The United States Medical Licensing Examination (USMLE) Step 1 is a one-day computer exam you’ll most likely take after your second year of medical school. It assesses your understanding of, and ability to apply, important concepts of the sciences that are basic to practicing medicine. Questions about Step USMLE 1? We’ve got answers!

[ Read Next: USMLE Step 1 Transition to Pass/Fail ]

The Three USMLE Steps

  • Step 1 (multiple-choice exam)

    This exam is designed to test how well the examinee applies basic, integral science concepts to clinical scenarios.

  • Step 2 (multiple-choice exam)

    The Step 2 Clinical Knowledge (CK) is a multiple-choice exam designed to determine whether the examinee possesses the medical knowledge and understanding of clinical science considered essential for the provision of patient care under supervision.

  • Step 3 (multiple-choice exam)

    This exam assesses the examinee’s ability to apply medical knowledge and the understanding of the basic mechanisms of disease pathogenesis and treatment essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings.

What is USMLE Step 1?

The USMLE Step 1 is an eight-hour, computerized examination that assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes oftherapy. Step 1 ensures you know the science within clinical contexts to safely and competently practice medicine under supervision.

USMLE® Step 1 at a Glance

Test Type: Computer-based
Examination Length: Seven 60-minute “blocks” administered in one eight-hour testing session; computer tutorial: 15 minutes; breaks: 45 minutes, self-scheduled
Number of Questions: Approximately 280; maximum 40 questions per block
Question Type: Single best answer multiple-choice test items
Average Time per Question: Approximately 90 seconds

The USMLE Step 1 is different and, in many ways, broader, more difficult, and more comprehensive than any exam you have ever taken in medical school. As such, it requires a different type of preparation than most medical school exams.

More time, effort, and money go into the creation of the USMLE exams than any other exam you have taken. Items on the exam are not just questions to be answered, but problems to be solved. Good USMLE questions test the students’ capacity to think about important medical knowledge and apply it in specific presented situations. The USMLE doesn’t test mere recall of facts; it assesses students’ ability to use that knowledge in clinical situations. A good knowledge base is essential, but is not sufficient. Students must know how to use the information that they know.

Who takes the USMLE Step 1?

To be eligible to take the exam, you must be in one of these categories at the time you apply for Step 1 and on the day of testing:

  1. A medical student officially enrolled in, or a graduate of, a U.S. or Canadian medical school program leading to the MD degree that’s accredited by the Liaison Committee on Medical Education (LCME).
  2. A medical student officially enrolled in, or a graduate of, a U.S. medical school leading to the DO degree that’s accredited by the American Osteopathic Association (AOA).

Find out more about USMLE Step 1 prep options.

When should I take the USMLE Step 1?

Step 1 is administered by appointment on a year-round basis. While most students take Step 1 of the Boards at the end of their second year, consider not taking the exam until you’re very confident you’ll pass.  Ideally, take Step 1 by April.

Two unique features of Step 1 are:

  1. It thoroughly assesses how well you can apply your skills, values, and attitudes to real-life, patient-centered scenarios.
  2. It’s considered by many residency program directors as their most important criterion in selecting graduating medical students for their residency program.

Those are two big reasons to have a strong plan for USMLE prep.

Where will I take the Step 1 exam?

The USMLE Step 1 can be taken at Prometric® test centers worldwide. On test day, you’ll want to remember to bring your scheduling permit on paper or electronically along with required identification, because you won’t be allowed to test without them. Be sure to arrive 30 minutes before your testing appointment.

Step 1 exam sessions are monitored by test center staff in person and through audio and visual recording. They aren’t authorized to answer questions about registration, examination content or format, testing software, scoring, or retesting.

What’s on the USMLE Step 1?

This one-day examination takes eight hours to complete. It’s divided into seven 60-minute blocks. The number of questions per block on a given examination form will vary but won’t exceed 40. As of this post, the total number of items on the overall examination form is 280. However, the number of questions could change.

According to the USMLE, each Step 1 exam covers content related to the following traditionally-defined disciplines:

  • Anatomy
  • Behavioral sciences
  • Biochemistry
  • Biostatistics and epidemiology
  • Microbiology
  • Pathology
  • Pharmacology
  • Physiology

Other content that’s covered is related to the following disciplinary areas:

  • Aging
  • Genetics
  • Immunology
  • Molecular and cell biology
  • Nutrition

Step 1 is a broadly based, integrated examination. Test items commonly require you to perform one or more of the following tasks:

  • Interpret graphic and tabular material
  • Identify gross and microscopic pathologic and normal specimens
  • Apply basic science knowledge to clinical problems

USMLE Step 1 Classification

Step 1 classifies test items along two dimensions, system and process.

  • System
  • 15%–20% General principles
  • 60%–70% Individual organ systems (hematopoietic/lymphoreticular, nervous/special senses, skin/connective tissue, musculoskeletal, respiratory, cardiovascular, gastrointestinal, renal/urinary, reproductive, endocrine, immune)
  • Biostatistics, epidemiology, and population health
  • 10%–15% Psychosocial, cultural, occupational, and environmental consideration
  • Process
  • 10%–15% Normal structure and function
  • 55%–60% Abnormal processes
  • 15%–20% Principles of therapeutics
  • 10%–15% Psychosocial, cultural, occupational, and environmental consideration

How to Succeed on the USMLE

Step 1 test prep can take a number of forms, including reading review books, watching videos, using question banks, and doing review programs. As you begin your focused USMLE Step 1 studying, it’s good to keep in mind that you don’t have to know it all—this exam only tests the general principles of the basic medical sciences.

Although that doesn’t make the exam any less challenging, it should help give you some perspective: USMLE Step 1 can be conquered with the right attitude, strong discipline, and solid prep support. Doing your best requires forethought and preparation. This preparation must be on several levels.

  1. You must be familiar with the types of questions you will face, as well as the overall structure of the exam itself.
  2. You must organize your study time efficiently to get the most out of it.
  3. You must know how to use the content being tested, not just recognize it. You must be able to apply it in hypothetical situations.
  4. You must physically and mentally prepare yourself for the task at hand.

In short, you must know the exam, master the material tested, and be prepared to handle yourself during this stressful time. USMLE prep is where we come in. Take the first step towards your dream future by preparing for the USMLE Step 1 with Kaplan.