The USMLE Step 1 is a one-day computer-based test that assesses your ability to apply foundational science concepts to clinical practice. Since January 2022, the exam reports only a Pass/Fail outcome — no three-digit score. Here is exactly what the exam looks like.
Exam Structure Overview
Step 1 consists of 280 multiple-choice questions divided into seven 60-minute blocks. Each block contains up to 40 questions. You get one 45-minute break and additional 15 minutes of optional break time (total break time = 60 minutes).
- Total questions: 280
- Number of blocks: 7
- Time per block: 60 minutes
- Total testing time: 7 hours
- Break time: 60 minutes (including one 45-minute scheduled break)
- Exam day length: Approximately 8 hours (including tutorial and break)
Question Format
All questions are single-best-answer multiple choice. You may see:
- Clinical vignettes (most common)
- Laboratory data interpretation
- Pathology images (histology, microbiology, radiology)
- Graphs and tables
Each question has exactly one correct answer. There is no negative marking — you are scored only on correct responses.
Marking Scheme
Your raw score (number of correct answers) is converted into a pass/fail determination using a statistically equated cut-off. The exact cut-off is not published, but it is set by the NBME to maintain a consistent standard across test forms.
- No penalty for guessing — always answer every question.
- No partial credit — only the single best answer matters.
- Pass/fail threshold — historically around 60-65% correct, but this varies by form. Do not aim for a percentage; aim to perform above the equated minimum.
Take a free USMLE Step 1 demo mock to find out where you stand: Try the demo →
Pass Criteria
Since 2022, Step 1 reports only Pass or Fail. There is no numeric score. The pass rate for first-time test-takers from US/Canadian MD programs is typically above 90%, but for international medical graduates (IMGs), it is lower — around 70-80%. Passing is required to advance to Step 2 CK and to be eligible for residency matching.
- Pass: You meet the minimum competency standard.
- Fail: You do not meet the standard. You may retake the exam up to three times within a 12-month period (subject to USMLE policies).
Timing and Breaks
You can allocate your 60 minutes of break time flexibly. The system automatically starts a 45-minute break after the fourth block. You can also take short breaks between blocks — the clock keeps running. Use your break time wisely: eat, hydrate, stretch.
- Scheduled break: 45 minutes after block 4
- Unscheduled breaks: Any time between blocks (deducted from total break allowance)
- Tutorial: 15 minutes before the exam (optional, but recommended)
What is Tested?
Step 1 covers basic sciences as applied to medicine:
- Anatomy, physiology, biochemistry, pathology, pharmacology, microbiology, immunology
- Behavioral sciences (biostatistics, epidemiology, ethics)
- Genetics, cell biology, molecular biology
Questions are integrated across disciplines. You will not see separate sections for each subject — expect mixed blocks.
See USMLE Step 1 mock-test packs and pricing: View plans →
How to Prepare
- Study resources: First Aid, UWorld, Pathoma, Sketchy, NBME practice exams.
- Practice tests: Take at least 3-4 full-length NBME forms or UWorld self-assessments before test day.
- Time management: Practice completing 40 questions in 60 minutes. On test day, pace yourself — you have 90 seconds per question.
- Review mistakes: Identify weak areas early and focus your study.
Key Changes in Recent Years
- Pass/Fail only (since January 2022)
- No three-digit score on score reports
- No change in question format or content blueprint
- Fees — verify on the official USMLE portal; fees were last revised in early 2026
Where to next?
- Take a free USMLE Step 1 diagnostic test to see your baseline
- Browse USMLE Step 1 question banks and mock tests with performance analytics
- Read our USMLE Step 1 study guide for a 12-week schedule