USMLE Step 1: What’s on It?

Prepping for your USMLE Step 2 exam? Try 200 free USMLE Step 2 CK practice questions from The Pass Machine to help get your USMLE prep on track.

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Taking Step 1 of the United States Medical Licensing Examination

Any medical student hoping to become a doctor in the United States must take the United States Medical Licensing Examination (USMLE) as part of their medical education requirements, starting with USMLE Step 1. This rigorous exam consists of three “steps” designed to test a student’s knowledge and determine if they are ready to become a physician in the United States. This licensing exam is also required for physicians who are medical school graduates and medical students/graduates from outside US and Canada.

Before computerized exams, the adage that described the three USMLE steps was “Two months, two weeks, and two number two pencils.” This meant that USMLE Step 1 was the hardest of the three steps and required the most time, or at least two months, to study adequately. While all three steps of the USMLE (Step 1, Step 2 CK, and Step 3) have all moved to a computer-based test, the amount of time required to study for Step 1 still applies.

What Year of Medical School Do Students Take USMLE Step 1?

Most students from the United States and Canada take Step 1 between their second and third years of medical school when their knowledge of basic science content is fresh, while foreign medical students usually take it later. While the questions are derived from clinical scenarios in many cases, the questions are also designed to assess science knowledge, whether the student can correctly interpret clinical graphic and tabular material and scientific data, and identify normal and pathological features of gross and microscopic specimens. With that being said, up to 40% of Step 1 may include questions designed to assess diagnosis and physical examination skills, communication and interpersonal skills, and practice-based learning.

Step 1 Exam Duration and Structure

Step 1 of the USMLE is now Pass/Fail instead of a numerical score; however, the subject areas it covers can be used to help the candidate identify strengths and weaknesses and prepare for Step 2.

Step 1 of the USMLE is a one-day exam devoted to testing students’ understanding of basic medical sciences. The exam is eight hours long and is divided into seven 60-minute sessions. Students are presented with 40 questions in each 60-minute block, totaling 280 questions for the entire examination. If a block is completed in less than 60 minutes, the test-taker may rest until the next block starts. Test-takers may also take restroom breaks and a lunch break during the day.

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USMLE Step 1 Exam Preparation for Medical Students

To prepare for Step 1 of the USMLE, it is helpful for students to fully understand what is covered on the test so they can target their areas of study accordingly.

USMLE Step 1 Content Areas and Medical Knowledge

According to the National Board of Medical Examiners (NBME), Step 1 is divided into the following clinical medicine subject areas:

• General Principles
• Blood & Lymphoreticular/Immune Systems
• Behavioral Health & Nervous Systems/Special Senses
• Musculoskeletal, Skin & Subcutaneous Tissue
• Cardiovascular System
• Respiratory & Renal/Urinary Systems
• Gastrointestinal System
• Reproductive & Endocrine Systems
• Multisystem Processes & Disorders
• Biostatistics & Epidemiology/Population Health
• Social Sciences: Communication and Interpersonal Skills

Step 1 also covers basic science knowledge covered in the medical school curriculum, including:

• Anatomy
• Behavioral sciences
• Biochemistry
• Biostatistics
• Epidemiology
• Pathology
• Pharmacology
• Physiology
• Microbiology

Question Format

Every question on the USMLE Step 1 is a multiple-choice question. The test taker is presented with a brief clinical vignette and asked to provide the one best answer.

Tips for Answering USMLE Step 1 Questions

• Some answers may be partially correct but not completely correct. Do not select these! The correct answer will be the completely correct one and the best of the options provided.
• A good habit to develop as you use USMLE QBanks and practice exams is to generate an answer in your mind before reading the choices. It helps you avoid the confusion that can be caused by reading some of the craftier wrong answers.
• Answer every question! You have a zero percent chance of getting credit for a question you leave blank but a non-zero chance of guessing correctly.
• If you feel you must guess, your chances of guessing correctly increase substantially with every answer choice you can clearly eliminate. Many questions have at least one option that is rather obviously incorrect.

Next Steps to Medical Licensure

After USMLE step 1, the next step in the students medical education will be to get a passing score on USMLE step 2 before applying to residency programs. To help prepare for that exam, students can access the USMLE Step 2 QBank on our site.