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USMLE Step 1: Format, Length, Eligibility, Subjects, and Scoring

In 2020, more than 1,00,000 students sat for the United States Medical Licensing Examination (USMLE) in their journey to become practicing physicians. If you want to become a practicing physician in the USA, you have to pass all three steps of the USMLE exam.

The performance you show in each of these steps will be of high value to you for being able to select your favorite specialty and residency programs. Therefore, before you even start preparing, you need to understand the exam. But let's focus on one step at a time. Here is all you need to know about the USMLE Step 1 Exam.

What is the USMLE Step 1 Exam?

As the name suggests, USMLE Step 1 is the first of the three exams you will have to pass to become a practicing physician in the USA. You will be taking it at the end of the second year of med school.

The USMLE exams provide development, delivery, and continual improvement of the high-quality assessment of the students preparing for medical practice. The USMLE Step 1 exam aims to assess your understanding and application of essential concepts of basic medical sciences. It mainly emphasizes principles and mechanisms underlying health, diseases, and modes of therapy.

It ensures that you have mastery of the foundational sciences for safe and competent medical practice and a lifelong learning competency.

Format and Length of USMLE Step 1 Exam

USMLE Step 1 exam is a multiple-choice questions exam administered at Prometric centers. (Prometric is a US bases testing company that hosts many tests in the USA across various fields of studies, including USMLE)

The exam will have 280 multiple choice questions, divided into seven 60 minutes blocks. The number of questions per block may differ, but it will not exceed 40. The total length of the exam, including breaks, is 8 hours which is administered in a single day.

If you suffer from a physical or health condition, you can apply for additional break time during the examination. You need to fill out the request form and submit it with a letter reporting the medical need from a qualified healthcare professional.

This request should be made before or during the registration for the examination. Examples of medical conditions are Lactation (expression of milk) and diabetes (monitoring and treating blood glucose.)

Eligibility For USMLE Step 1: 

To be eligible to appear for the USMLE Step 1, you should be in one of the following categories when you apply for and take the exam.

  • A medical student officially registered in, or a graduate of, a US or Canadian medical school for the MD degree recognized by the Liaison Committee on Medical Education (LCME), OR
  • A medical student officially registered in, or a graduate of, a US medical school leading to the DO degree that is recognized by the Commission on Osteopathic College Accreditation (COCA), OR
  • A medical student officially enrolled in, or a graduate of, a medical school outside the US and Canada. The medical school should be part of the World Directory of Medical Schools as meeting ECFMG eligibility requirements and other eligibility criteria of the ECFMG. 

Number of Attempts: 

If you have attempted the USMLE Step 1 four times, including incomplete attempts, and have not passed. You are not eligible to retake the exam.

You cannot take the exam more than 3 times in a year. The fourth attempt must be at least 1 year after your first attempt at the exam and not less than six months after your most recent try, including incomplete attempts. 

Subjects for USMLE Step 1: 

The USMLE exam covers various topics related to the basic medical sciences. The best way to prepare for the exam is to build a strong understanding of concepts and principles in these basic sciences. The list of topics in the USMLE exam can be categorized into 3 Specifications. -

Content Specifications General Principles → 12–16%

  • Blood & Lymphoreticular/Immune Systems→ 7–11%
  • Behavioural Health & Nervous Systems/Special Senses→ 9-13%
  • Musculoskeletal, Skin & Subcutaneous Tissue→ 6–10%
  • Cardiovascular System→5–9%
  • Respiratory & Renal/Urinary Systems→ 9–13%
  • Gastrointestinal System→ 5–9%
  • Reproductive & Endocrine Systems→ 9–13%
  • Multisystem Processes & Disorders→ 6–10%
  • Biostatistics & Epidemiology/Population Health→4 - 6%
  • Social Sciences: Communication and Interpersonal Skills→ 6–9%

Physician Tasks/Competencies Specifications: 

  • Medical Knowledge: Applying Foundational Science Concepts→ 60–70%
  • Patient Care: Diagnosis→20–25 %
    • History/Physical Examination
    • Diagnosis
  • Communication and Interpersonal Skills→ 6–9%
  • Practice-based Learning & Improvement→ 4–6%

Discipline Specifications:

  • Pathology→ 44–52%
  • Physiology→ 25–35%
  • Pharmacology→ 15–22%
  • Biochemistry & Nutrition→ 14–24%
  • Microbiology→ 10–15%
  • Immunology→ 6–11%
  • Gross Anatomy & Embryology→ 11–15%
  • Histology & Cell Biology→ 8–13%
  • Behavioural Sciences→ 8–13%
  • Genetics→ 5–9%

Scoring in USMLE Step 1 Examination:

USMLE Step1 exam has now turned into a pass/ fail exam. The recommended level of performance in USMLE is based on the specified level of mastery, so there is no pre-determined percentage of students that pass or fail the exam. You typically need to answer approximately 60% of the test questions correctly to achieve a passing score in the exam.

You will typically get your score within three to four weeks of appearing for the exam. Once your score is available, you will receive an email notification from the organization that you used you registered for the exam.

Sitting for the USMLE Step 1 is vital in your journey to becoming a practicing physician. You must be fully prepared when you decide to appear for the exam. Now that you know what to expect from the exam, you need to create a study plan that will guarantee you success. ArcherReview is here to support you at each step in achieving your medical goals. Our comprehensive question banks will help you get ready for any type of question Step 1 might throw at you.


  1. https://www.usmle.org/