USMLE Step 1
Offered by NBME / Federation of State Medical Boards (USMLE)
USMLE Step 1 is the first exam in the United States Medical Licensing Examination sequence. It assesses whether you can apply basic-science concepts...
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USMLE Step 1 exam at a glance
Format
Up to 280 single-best-answer multiple-choice questions in 14 blocks of up to 20 questions (30 minutes per block, from the 2026 software update)
Duration
One-day, 8-hour testing session (includes a 45-minute break allotment)
Delivery
Prometric test center
Passing score
Pass/fail (no three-digit score is reported)
Exam cost
$695 USD (2026–2027); additional regional surcharge if testing outside the U.S. and Canada
Validity
A passing Step 1 result remains valid for completing the USMLE sequence subject to USMLE attempt and time-limit rules; state boards set licensure recency rules.
Prerequisites
Enrollment in or graduation from a medical school listed in the World Directory of Medical Schools that meets USMLE eligibility; application via NBME (U.S./Canadian) or ECFMG (IMGs)
About the USMLE Step 1 certification
USMLE Step 1 is the first exam in the United States Medical Licensing Examination sequence. It assesses whether you can apply basic-science concepts (anatomy, biochemistry, microbiology, pathology, pharmacology, physiology, and related disciplines) to medicine.
Results for exams taken on or after January 26, 2022 are reported as pass/fail only. Updated test-delivery software with shorter 30-minute blocks rolled out for Step 1 on May 14, 2026; total questions and exam length did not change.
Who it’s for: Medical students (typically after pre-clerkship coursework) and graduates seeking U.S. medical licensure.
Official exam page· Details verified 2026-08
What the USMLE Step 1 exam covers
- Systems (cardiovascular, respiratory, renal, GI, neuro, musculoskeletal, etc.)
- Physician tasks (diagnosis, management, mechanisms)
- Disciplines (pathology, physiology, pharmacology, microbiology, biochemistry, anatomy, behavioral)
How to study for the USMLE Step 1
- 1Map your school's pre-clerkship curriculum to the official Step 1 content outline.
- 2Use a dedicated question bank and review every explanation, not just the letter answer.
- 3Build a systems-based review (cardio, renal, neuro) rather than isolated fact lists.
- 4Sit timed NBME self-assessments; Step 1 is pass/fail, but you still need a comfortable margin.
- 5Practice the 30-minute block pacing introduced with the 2026 software.
USMLE Step 1 — frequently asked questions
Is Step 1 still scored numerically?
No. Since January 26, 2022, Step 1 is pass/fail only. Step 2 CK is now the primary numerical USMLE score for residency applications.
Did the 2026 software change the content?
No. Block length became 30 minutes, but the 280-question cap, overall day length, and question format stayed the same.