What Is the USMLE Step 1 Exam?

USMLE Step 1 is a standardized exam that tests your understanding of the basic medical sciences, including:

• Anatomy

• Physiology

• Biochemistry

• Microbiology

• Pathology

• Pharmacology

• Behavioral sciences

• Genetics & Immunology

• General principles of clinical diagnosis

The goal of Step 1 is to ensure that you can apply foundational concepts that are essential for safe and effective medical practice.

---

Exam Format

• Duration: 8 hours

• Sections: 7 blocks

• Questions: Approximately 40 questions per block (about 280 total)

• Type: Multiple-choice questions (single best answer)

Since 2022, Step 1 has shifted to Pass/Fail, but the importance of a strong performance remains high.

---

Why Step 1 Still Matters (Even After Pass/Fail)

Even though Step 1 no longer gives a numeric score, it still plays a major role in:

✔ Residency Applications

Program directors expect a solid foundation in basic sciences. A “Pass” on the first attempt helps you stand out.

✔ Preparing for Step 2 CK

Step 1 knowledge directly impacts your performance on Step 2 Clinical Knowledge, which does give a numeric score.

✔ Clinical Rotations

A strong understanding of pathology and physiology helps you excel in core clinical clerkships.

---

Who Can Take the Step 1 Exam?

You are eligible to take USMLE Step 1 if you are:

• A U.S. medical student enrolled in an LCME- or COCA-accredited school

• An international medical student/graduate from a school listed in WDOMS (World Directory of Medical Schools)

• Approved through ECFMG for exam eligibility

---

How to Prepare for USMLE Step 1

Here’s a proven preparation framework used by high-scoring students worldwide:

---

1. Start with the Best Resources

Use high-yield, trusted study materials:

• First Aid for the USMLE Step 1 – Your primary study book

• UWorld Question Bank – The most effective tool for practice

• Pathoma – Gold standard for pathology

• Boards & Beyond – Great for conceptual foundation

• Sketchy – Ideal for microbiology and pharmacology visuals

---

2. Create a Study Schedule That Works

A perfect Step 1 timeline usually includes:

• 3–6 months dedicated preparation

• Daily QBank practice

• Weekly self-assessments

• Spaced repetition using Anki decks (e.g., Brosencephalon, AnKing)

---

3. Focus on Understanding, Not Memorizing

Step 1 questions test your ability to apply concepts, not just recall facts.

Study smart by:

• Connecting pathology with physiology

• Understanding mechanisms instead of memorizing pathways

• Studying clinically relevant problem-solving questions

---

4. Practice With NBME Assessments

NBME self-assessments help you:

• Check exam readiness

• Identify weak topics

• Predict your performance

Even though Step 1 is pass/fail, these assessments are valuable for building confidence.

---

5. Review Mistakes Thoroughly

Every incorrect answer is a learning opportunity.
Maintain a “mistake notebook” to track:

• Weak subjects

• Question patterns

• Key takeaways

---

Day of the Exam: What to Expect

On the day of your exam:

• Arrive early at the Prometric center

• Bring valid ID and confirmation details

• Use your break time wisely

• Stay hydrated and energized

Remember Step 1 is a long exam. Mental endurance is key.

---

Tips From High Scorers

✔ Solve at least 2,000–3,000 UWorld questions
✔ Don’t skip physiology and pharmacology they make up big portions
✔ Keep revising your weak areas until exam day
✔ Avoid resource overload stick to the essentials

---

Final Thoughts

USMLE Step 1 is challenging, but with the right strategy and discipline, you can absolutely succeed.
Focus on understanding concepts, practice daily, and trust the process. Whether your goal is internal medicine, surgery, pediatrics, or a competitive subspecialty, a solid Step 1 foundation will support your journey throughout your medical career.