USMLE Step 1: All You Need to Know

April 25, 2024


Reviewed by:

Akhil Katakam

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!

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USMLE Step 1 Format

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. 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.

USMLE Step 1 Question Formats

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 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.

What Is On The USMLE Step 1?

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:

  • Pathology
  • Physiology
  • Pharmacology
  • Biochemistry & Nutrition
  • Microbiology
  • Immunology
  • Gross Anatomy & Embryology
  • Histology & Cell Biology
  • Behavioral Sciences
  • Genetics

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

USMLE Step 1 Sample Question 

Here’s an example of the type of questions & format you can expect on the USMLE Step 1 exam. 


“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:

USMLE Step 1 sample question table

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.

USMLE Step 1 sample answer
Source: Step 1 interactive testing experience

Some other questions use visual elements, audio clips, or other tools as part of the prompt. To learn more about what types of questions you can expect on the USMLE Step 1 exam, review the Step 1 interactive testing experience.

How Long Is The USMLE Step 1?

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.

When Should I Take the USMLE Step 1?

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 post successful 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.

How To Prepare for the USMLE Step 1

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.

1. Start Studying Early

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. 

2. Familiarize Yourself With The Software

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.

3. Take The USMLE At The Right Time

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.

4. Create A Comprehensive Study Schedule

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.

FAQs: USMLE Step 1

Here are our answers to the most frequently asked questions about the USMLE Step 1 exam.

1. Is USMLE Step 1 Difficult?

The general consensus is that the USMLE Step 1 exam is the most challenging of all three Step exams. However, students have reported that with the right study material, it was not too difficult to pass. That said, if you do not pass, you can retake the exam up to six times.

If you're wondering where you stand in your preparation, take our USMLE Practice Questions Quiz with free sample questions and answers!

2. How Much Does USMLE Step 1 Cost?

As of 2023, the USMLE Step 1 exam costs $1000 to register. 

3. How Long Does It Take To Prepare For Step 1 USMLE?

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. 

4. Who Is Eligible For USMLE Step 1?

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).

5. Can I Retake The USMLE Step 1?

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.

Final Thoughts: USMLE Step 1

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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