USMLE Overview

The United States Medical Licensing Examination (USMLE) Step 1 is a one-day computer exam you’ll most likely take after your second year of medical school. It assesses your understanding of, and ability to apply, important concepts of the sciences that are basic to practicing medicine.

Like many med students, you may see the Boards’ Step 1 as the single most important exam of your school career. After all, it’s one of the key ways you’ll demonstrate the kind of doctor you’ll be. USMLE - Format

Exam Format

Below is the format of the United States Medical Licensing Examination(USMLE) examination.

Step 1

  • 322 multiple-choice test items
  • Divided into seven 60-minute blocks
  • Administered in one eight-hour testing session

Step 2 CK

  • 346 multiple-choice test items
  • Divided into eight 60-minute blocks
  • Administered in one nine-hour testing session

Step 2 CS

  • You will be given 12 patient cases, for which you will have 15 minutes for each patient and 10 minutes to record each patient note. If you finish the case before 15 minutes alloted for the patient encounter, the remaining time will be added to the your time to record the patient note.
  • The testing session is approximately eight hours.

Step 3

  • 480 multiple-choice test items
  • Divided into blocks of 35 to 50 items. You will have 45 to 60 minutes to complete each of these blocks.
  • The number of computer-based case simulations may vary, but will generally be in the range of 9 to 12 cases.
  • There may be one or two cases in each block and the maximum time allowed per block will be in the range of 22 to 25 minutes.

For Step 1, Step 2 CK, and Step 3

For the Multiple-choice sections in each of the above steps, the questions are to be answered during the allotted time to complete the test. You can answer the questions in any order except for the questions mentioned for sequential answering. You can review your responses and change answers. Once you exit the block, or the time expires, you can no longer make changes or answer the questions.

Step 2 CS cases and Step 3

All the case simulations must be answered in the order as given. Once you exit the case or the time expires, you can no longer review test items or cases and change answers.


Frequently asked questions

Below are answers to some of the most common questions about Step 1.

The Step 1 exam is a computer-based test taken in a single day over an eight hour period. It’s a multiple choice question test that includes seven sections of up to 40 questions each for a total of up to 280 questions. One hour is allotted for each of the seven sections. That’s an average of one minute and 30 seconds per question.

Test takers are allowed 45 total minutes during the test for personal breaks. If you finish any section before the allotted hour is up, you can add that time to your personal break total. Six breaks total are allowed. There is an optional 15 minute tutorial period at the beginning of the exam. If you choose to skip the tutorial you can add the 15 minutes to your total break time.

Student or graduates of a medical school in the United States and Canada must  apply for the USMLE Step 1 exam with the NBME. Students or graduates of medical schools outside of the U.S. or Canada  register with the Educational Commission for Foreign Medical Graduates (ECFMG). Tests are administered by appointment year round.

As of 2017, Step 1 costs $605.

Most people take the test between their second and third years in medical school, after finishing basic science courses and before a clinical clerkship. Many have success taking it within two months of finishing basic courses because material is still fresh in their minds, combined with an extra month or two of studying.

A score of 192 is needed to pass the Step 1 exam. The average score in 2016 was 225 with a standard deviation of 20.

Scores for Step 1 are released each Wednesday. It usually takes three to four weeks for scores to be released. You will receive an email from the entity you registered with (NBME or ECFMG) when your score is available. It will also be posted to that entity’s website. If you don’t receive an email within two months, it’s recommended that you contact the registration entity directly.

Yes. You can retake the USMLE Step 1 exam up to 6 times. You can only take the exam a maximum of three times within a 12-month period. Your fourth and subsequent attempts must be at least 12 months after your first attempt, and at least six months after your most recent attempt.