What Is the USMLE® Step 1?

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  • Written By: M. Walker
  • Edited By: Allegra J. Lingo
  • Last Modified Date: 28 February 2020
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The United States Medical Licensing Examination (USMLE®) is a professional exam that US medical doctors must pass in order to practice medicine, and the USMLE® Step 1 is the first part of the exam. It is in a multiple-choice, computer-based format and contains 322 questions spaced out over seven main sections, each of which lasts one hour. US medical students will generally take the USMLE® Step 1 after their first two years of medical school. International students must also take the exam if they wish to practice medicine in the US following schooling.

Specific topics covered by the USMLE® Step 1 are placed categorized as general principles or individual organ systems. Within the individual organ systems category there are four main concepts that are tested, including normal processes, abnormal processes, therapeutic principles, and other considerations relating to culture, the environment, and psychosocial factors. Each topic is tested with these ideas in mind, although the topics themselves have a wide range that corresponds to the traditional curriculum taught during the first two years of US medical school. Anatomy and physiology, pharmacology, pathology, biochemistry and molecular biology, and the behavioral sciences are generally the main topics tested. Additional topics include empathy and ethics in medicine.


The USMLE® Step 1 is about eight hours long and it consists of seven one-hour sections, each of which contains 46 questions. Throughout the test, there are several opportunities for breaks, which total to about 45 minutes for the duration of the exam, excluding the optional 15-minute tutorial that can be skipped. Additional break time can occur if a student finishes any given section early. Since the exam is computer-based, it is generally taken at a professional testing center where the time is carefully monitored.

Scoring for the USMLE® Step 1 occurs in both a two-digit format and a three-digit format, each of which can be calculated separate from the other. The three-digit score is based on a maximum of 300 points, but this score has not been seen before by various medical licensing boards. Average three-digit scores on Step 1 generally hover around 221 with a standard deviation of 24 points. The score needed to pass the exam is 188 on the three-digit scale and 75 on the two-digit scale. Contrary to some common assumptions, the two-digit score does not represent a test taker’s percentile status, as percentile scoring has not been used since 1999.


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