USMLE Step 1 Basics: Format & Content Breakdown

USMLE Step 1 Basics

The USMLE Step 1 is taken at the end of the second year of medical school. It is used to assess your understanding and ability to apply the important core concepts of the sciences learned in medical school years 1 and 2.

Your ability to pass Step 1 ensures the foundation has been laid for your safe and competent practice of medicine both now and in the future.

The USMLE Step 1 is among the most important tests you will ever take as a doctor-in-training.Click To Tweet

Content Covered on the USMLE Step 1

USMLE Step 1 is a multiple-choice test covering the following subjects:

  • Anatomy
  • Physiology
  • Biochemistry
  • Pharmacology
  • Pathology
  • Microbiology
  • Behavioral sciences
  • Interdisciplinary topics: nutrition, genetics, aging, ethics, and others

The Format of Questions on Step 1

USMLE Step 1 is a test that typically requires multiple steps of reasoning/knowledge in each question. The test questions will often 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 Breakdown: Content Covered


    • 25-35% General Principles
    • 65-75% Individual Organ Systems
      • hematopoietic/lymphoreticularUSMLE Step 1 Basics: Format & Content Breakdown
      • nervous/special senses
      • skin/connective tissue
      • musculoskeletal
      • respiratory
      • cardiovascular
      • gastrointestinal
      • renal/urinary
      • reproductive
      • endocrine
      • immune


    • 20-30% Normal Structure and function
    • 40-50% Abnormal processes
    • 15-25% Principles of therapeutics
    • 10-20% Psychosocial, cultural, occupational, and environmental considerations

More on USMLE Step 1 Question Formats

USMLE Step 1 utilizes several different test question formats. These include:

  • Single One Best Answer
    • This test question format is the traditional format used in all tests. There is a question and only one correct answer to choose.
  • Sequential Item Sets
    • Patient vignettes are the go-to test question format for most of your tests here on out. The vignette will give you the story of a patient, followed by one or several questions. Sequential Item Sets are multiple questions following a vignette.

TIP: When reading through the question, try to formulate an answer in your head prior to reading the available answers. The selection of available answers may play tricks on you and point you in the wrong direction.

How Long is the USMLE Step 1?

The USMLE Step 1 consists of up to 280 multiple-choice test questions. These questions are divided into seven 60-minute blocks over an 8 hour day. That means, to complete all the answers, you can spend between one and two minutes per question.

You can spend between one and two minutes per question on the Step 1 exam.Click To Tweet

Step 1 Testing Locations

The USMLE Step 1 is a computer-based test that is administered by Prometric Services.

Applying to Take Step 1

There are two pathways to apply for the USMLE Step 1 exam, depending on if you are a U.S. or Canadian student or not. Check out the USMLE Application Page to get started.

How Long Does It Take to Get Your Step 1 Score Back?

The typical score reporting time for the USMLE Step 1 exam is 4 weeks.

It takes about 4 weeks to get your Step 1 score back.Click To Tweet

Step 1 Test Prep: It’s All About the QBanks

Now we get to the good stuff! Ask 100 medical students how they studied for Step 1, and you’ll get one answer (bet you weren’t expecting that).

Ask 100 medical students how they study for Step 1, and you’ll get one answer: Qbanks.Click To Tweet

Beyond the obvious expert knowledge that you will have from the first two years of medical school, question banks (Qbanks) are the key to rocking Step 1. The majority of medical students use some sort of Qbank for their Step 1 test preparation.

Which one? That all depends! Each Qbank has pros and cons. Here is a short list of a few test prep companies:

  • USMLEWorld
  • Kaplan
  • Falcon

A Podcast to Help You Prepare for Your Boards

Check out the Board Rounds podcast for helpful information and practice as you’re working toward your Step 1 exam date!

The Mindset You Need for Step 1 Preparation

The preparation for the USMLE Step 1 begins the first day you step foot on your medical school campus. That doesn’t mean you begin studying for it on day one. But it’s an always-present motivation driving you in the first two years of medical school.

Preparation for Step 1 begins the first day you step foot on your medical school campus. Click To Tweet

What I’m talking about is a mindset. Understand that Step 1 is one of the biggest factors in your residency application. A solid foundation of core science knowledge will allow you to get the most out of your Qbank studying at the end of your second year.

So build good study habits from day one. Don’t get too far behind. Don’t cram! If you cram, the information won’t stick long-term. Then you’ll have to re-learn more during your dedicated Step-1 studying period. Build a solid foundation with your classes. There is a reason The Tortoise and the Hare is an everlasting fable in our society.

Up-to-date Information on Step 1

The information presented on this page is taken from the official USMLE website. Please visit for updated information.

Links and Other Resources