USMLE Step 1

The beginning

Step one of the USMLE is usually taken by students in year two of medical school. It covers a wide range of topics including (but not limited to) physiology, anatomy, biochemistry, microbiology, pharmacology and anatomy. You must be prepared to answer questions on any of these.

This first test contains 350 questions spread over eight hours of testing. Each section of 50 questions is administered by computer in a one hour block. Each block is completed as a whole, which means you can skip back and forth among questions within each block, but not among blocks. Each of the subject blocks is a set of random questions from different subject areas. The test is formatted in this way to determine your ability to quickly switch back and forth between different domains of knowledge.

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Step one gives you a total of 60 minutes break time, and there's an optional 15 minute tutorial at the beginning. Of course, you can add to your break time during the day if you're able to complete blocks early, however you won't be able to leave the testing area at these times..

Question Formats

Step one of the USMLE follows a 'one best answer' format. These questions test your knowledge and your ability to apply it to clinical situations. Some of these will be presented in a somewhat lengthy case scenario format.


The scoring for the USMLE is presented in a graphed form that displays results by knowledge area and organ system. With the computer-based USMLE, you'll receive your results within four weeks. A passing score for the USMLE Step One is between 55 and 65 percent.

Registering for the USMLE Step One

You can receive application materials from your medical school or from the National Board of Medical Examiners. International applicants must apply through the Educational Commission for Foreign Medical Graduates (EDFMG). Eligibility is contingent on standards in your home country. You'll need to complete this application process via standard mail, as it's not available online.

When you apply, you'll be asked to choose an eligibility period during which you want to take the exam. This is a three month period, as determined by the board, and if you don't take the exam during this period, you'll forfeit your application fee.

The dates will be printed on the scheduling permit that will be sent to you as part of your registration package. It's vital that you're fully prepared to write the test before you apply. Some other important notes include:

  • You'll be required to submit a photo with your application
  • There is a four to six week application processing period
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