All about USMLE

Step 1


The Step 1 examination is the first component of the USMLE and is taken by medical students and graduates seeking to practice medicine in the United States. The overall purpose of the Step 1 exam is to assess an individual’s basic science knowledge. The content that comprises this multiple choice exam is organized into general science principles and individual organ systems. While some of the exam questions may involve testing an examinee’s range of knowledge, most of the questions place a strong emphasis on the application of basic science principles in the practice of clinical medicine.

Examination Content

Step 1 includes test items in the following content areas:

  • Anatomy
  • Behavioral sciences
  • Biochemistry
  • Microbiology
  • Pathology
  • Pharmacology
  • Physiology
  • Interdisciplinary topics, such as nutrition, genetics, and aging

Step 1 is a broadly based, integrated examination. Test items commonly require you to perform one or more of the following tasks:

  • Interpret graphic and tabular material
  • Identify gross and microscopic pathologic and normal specimens
  • Apply basic science knowledge to clinical problems

Step 1 classifies test items along two dimensions, system and process, as shown below:


40%–50% General principles
50%–60% Individual organ systems

  • Hematopoietic/lymphoreticular
  • Nervous/special senses
  • Skin/connective tissue
  • Musculoskeletal
  • Respiratory
  • Cardiovascular
  • Gastrointestinal
  • Renal/urinary
  • Reproductive
  • Endocrine


30%–50% Normal structure and function
30%–50% Abnormal processes
15%–25% Principles of therapeutics
10%–20% Psychosocial, cultural, occupational, and environmental considerations

Test Length and Format

Step 1 has approximately 336 multiple-choice test items. This is divided into seven sixty minute blocks and administered in one eight hour testing session. For Step 1, during the defined time to complete the items in each block, you may answer the items in any order, review your responses, and change answers. After you exit the block, or when time expires, you can no longer review test items or change answers.

Eligibility Criteria

To be eligible to take the USMLE Step 1, you must be in one of the following categories at the time of application and on the test day:

  • a medical student officially enrolled in, or a graduate of, a US or Canadian medical school program leading to the MD degree that is accredited by the Liaison Committee on Medical Education (LCME),
  • a medical student officially enrolled in, or a graduate of, a US medical school leading to the DO degree that is accredited by the American Osteopathic Association (AOA), or
  • a medical student officially enrolled in, or a graduate of, a medical school outside the United States and Canada and eligible for examination by the ECFMG.




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