What is the USMLE Step 1 Exam?

The USMLE Step 1 Examination is the national medical licensing exam to become a certified physician in the United States of America. It must be passed by all MD/DO candidates. It is the first of three medical licensing exams required in the United States to become a practicing physician.

Content on the Step 1?

The Step 1 exam focuses on the scientific foundations of medicine. It consists of multiple disciplines including microbiology, pharmacology, physiology, pathology, embryology, anatomy, biochemistry, histology, behavioral sciences, genetics, and more. These disciplines are subdivided into their relevant systems such as cardiology, hematology, endocrinology, gastrointestinal, MSK, neurology, psychiatry, reproductive, renal, respiratory, and more.

For a full outline on the Step 1 exam, visit the USMLE official outline.

Length of the Step 1?

The USMLE Step 1 exam is an 8-hour exam. The exam allocates 7 hours for questions and 1 hour for break time that can be used between question blocks.

Length of the Step 1 Exam

Question Time

The exam consists of 280 questions divided into seven blocks. Each block is allocated 60 minutes to complete. Once the 60 minutes finish, the block is automatically submitted and the student can no longer return to that block of questions. However, if the block is submitted early, any remaining time will be added to your break time.

Break Time

The 60 minutes of break can be divided in any way between the question blocks. It is completely up to the test-taker to decide how to divide up their break time. However, an important note is that breaks can only be taken between blocks; breaks cannot be taken during a block.

Tutorial Time

The exam begins with an optional 15-minute tutorial that is deducted from your break time. If you have done the tutorial before, you can skip it to save some break time. It is recommended to try the tutorial prior to your actual exam.


Every student develops their own pace for this exam. Most students have never taken an 8-hour exam, so it takes a lot of practice to develop endurance for this exam. Before the exam, it is recommended that students complete multiple full-length practice tests in order to develop a proper pace.

Strategies for Using Time Wisely

  1. Be familiar with the test interface before the actual exam. The tutorial can be accessed from the NBME website.
  2. Time your breaks during practice exams.
  3. Some students enjoy taking 10-minute breaks between each block. Other students prefer saving up break time for a larger lunch break after their 4th block.
  4. Sometimes it is helpful to glance at the multiple choices before reading the full question. This can prevent rereading long questions.


The exam contains 280 multiple choice questions in a clinical vignette format. A clinical vignette is a long patient description with associated labs that is followed by a question regarding the case. Each question will have at least five multiple choice options to pick from. In addition, some questions will have two parts.

Sample Clinical Vignette Question

A 22-year-old college student that is confused and lethargic is brought to the emergency room. His roommates say he was complaining of a severe headache and neck stiffness last night. Vital signs are remarkable for a temperature of 104.3F, blood pressure of 80/60 and heart rate of 120. Physical exam reveals a purpuric rash on the patient’s chest. Lumbar puncture reveals a high neutrophil count. What treatment should be given to his roommates as prophylaxis?

  • A. Acyclovir
  • B. Ceftriaxone
  • C. Doxycycline
  • D. Rifampin
  • E. Vancomycin

Correct answer: D


The difficulty of each question can vary. The questions can be first, second, or third order. These three orders describe the difficulty of the question and how many mental steps it takes to find the answer. Most questions are second or third order in difficulty.


Step 1 Exam is no longer scored. It is now a pass or fail exam.

Release dates

Step 1 scores are released about 3-4 weeks after the exam. Students receive an email once their results are posted.


The registration process for the USMLE Step 1 exam can take up to a month and should be started early if possible.

First, students are expected to register for an account through NBME. After registering, students will receive a USMLE ID within a day by email.

Second, students will login and apply for the Step 1 exam which will require a $645 fee.

Third, NBME will need to verify that you are currently enrolled in medical school. In order to verify, they will give you an authorization form that you can print, fill out, and attach your photo to.

Fourth, you will take this form to your medical school’s office where they will verify your identity as a student. Once you are verified as a student, the school will mail the verified authorization form to the NBME.

Lastly, once the NBME receives your authorization form, they will grant you a scheduling permit which you will receive by email. The scheduling permit will allow you to schedule your exam through Prometric’s website.


All scheduling of the exam is done through the Prometric website. Dates are only available up to 6 months in advance.


Step 1 exam fees vary depending on region. The following fees are based on US and Canada testing centers.


Registration fee for the Step 1 exam is currently $645.


Rescheduling fee for the Step 1 exam depends on when the student reschedules.

  • If 31 days or more from the exam day: $0
  • If less than 31 days: $50
  • If less than 5 days: $121

Last updated: June 24, 2022