USMLE Step 1 is the first exam in the sequence. It is reported pass/fail, delivered in fourteen 30-minute blocks, and focused on applying foundational science to clinical problems. This guide covers who can take it, how to apply, how the exam is built, what it tests, how it is scored, and how to prepare. Facts come from usmle.org, read on October 31, 2026.
Step 1 at a glance
| Element | Exams on or after May 14, 2026 | Before May 14, 2026 |
|---|---|---|
| Blocks | Fourteen 30-minute blocks | Seven 60-minute blocks |
| Questions per block | No more than 20 | No more than 40 |
| Testing session | One 8-hour session | One 8-hour session |
| Minimum break | 55 minutes | 45 minutes |
| Optional tutorial | 5 minutes | 15 minutes |
| Result | Pass/fail (since January 26, 2022) | |
Break time can grow: USMLE says it may be increased by finishing a block or the optional tutorial before time expires.
Who can take Step 1
- You must be enrolled in, or a graduate of, an LCME-accredited MD program, a COCA-accredited DO program, or an eligible school outside the U.S. that is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements.
- You must meet this at the time you apply and again on exam day.
How to apply
- U.S. MD and DO students and graduates apply through NBME on the MyUSMLE portal.
- Students and graduates of schools outside the U.S. apply through FSMB.
- The listed application fee for 2026 and 2027 is $695. Exams taken outside the U.S. and Canada add a regional fee ($210 as listed). Fees can change.
- Once registered, USMLE provides the interactive testing experience, with tips for navigating the interface and sample questions. Use the version that matches your exam date.
What Step 1 tests
The Step 1 content outline says each test question is classified in one of 18 major areas and assesses one competency. Percentages are subject to change at any time.
| Competency | Share |
|---|---|
| Medical knowledge: applying foundational science concepts | 60-70% |
| Patient care: diagnosis | 20-25% |
| Communication and interpersonal skills | 6-9% |
| Practice-based learning and improvement | 4-6% |
| Discipline | Share |
|---|---|
| Pathology | 45-55% |
| Physiology | 30-40% |
| Nutrition | 15-20% |
| Gross anatomy and embryology; microbiology; pharmacology | 10-20% each |
| Behavioral sciences | 10-15% |
| Biochemistry; histology and cell biology; immunology | 5-15% each |
| Genetics | 5-10% |
| Area | Share |
|---|---|
| Reproductive and endocrine | 12-16% |
| Respiratory and renal/urinary | 11-15% |
| Behavioral health and nervous system/special senses | 10-14% |
| Blood and lymphoreticular/immune | 9-13% |
| Musculoskeletal, skin and subcutaneous | 8-12% |
| Multisystem processes and disorders | 8-12% |
| Cardiovascular | 7-11% |
| Gastrointestinal | 6-10% |
| Social sciences: communication and interpersonal skills | 6-9% |
| Biostatistics and epidemiology/population health | 4-6% |
| Human development | 1-3% |
Read high-yield topics from the outline and biostatistics for the USMLE.
Scoring and what a pass means
Step 1 results are pass or fail only. USMLE lists 196 as the passing standard on the three-digit scale that is no longer reported. A pass confirms the science foundation that later training builds on. See USMLE passing scores.
If you do not pass
You may not take Step 1 more than three times in 12 months, and four attempts, including incomplete ones, without a pass makes you ineligible for any Step. A fourth attempt must come at least 12 months after your first and six months after your latest. Details are in attempt limits and retakes.
Preparation roadmap
This is a study suggestion, not official guidance.
- Weeks 1-2: baseline. Read the content outline and take a diagnostic, such as an NBME self-assessment.
- Learning phase. Work through the systems with one main learning source. Compare options in study resources compared, including First Aid, Pathoma, Boards and Beyond and Sketchy.
- Practice phase. Move to mixed question blocks with a QBank such as UWorld or AMBOSS, and keep flashcards in Anki current.
- Final weeks. Do full-length timed practice in 30-minute blocks of 20 questions, and review weak areas. See pacing for 30-minute blocks.
Test day and after
- Plan your breaks and timeline, and review check-in and security rules.
- Results arrive after the exam; see results, rechecks and transcripts.
- Next is Step 2 CK: the complete Step 2 CK guide.
For the whole picture, read the complete USMLE guide and the Step 1 exam page.