USMLE Step 1 Exam: 9 Things to Know Before Taking the Exam

The United States Medical Licensure Exam (USMLE) Step 1, commonly called “the Boards,” is a standardized test that assesses a medical student’s ability to apply basic science fundamentals to the practice of medicine. The entire exam has three steps, but this article applies only to Step 1. Students take Step 1 following their second year of medical school. The test is administered by the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB).

Do you have questions about Step 1? Below are answers to some of the most common questions.

1. What is the Step 1 exam format?

The Step 1 exam is a computer-based test taken in a single day over an eight hour period. It’s a multiple choice question test that includes seven sections of up to 40 questions each for a total of up to 280 questions. One hour is allotted for each section. That’s an average of one minute and 30 seconds per question.

Test takers are allowed 45 total minutes during the test for personal breaks. If you finish any section before the allotted hour is up, you can add that time to your personal break total. Six breaks total are allowed. There is an optional 15-minute tutorial period at the beginning of the exam. If you choose to skip the tutorial you can add the 15 minutes to your total break time.

Be Prepared: During the test, you are only allowed to bring soft foam earplugs into the examination room. Nothing else is allowed – no bags, electronics, phones, or even jackets are allowed. Be sure to check with the exam monitor prior to entering the test room for complete details.

2. How do I apply for Step 1?

Student or graduates of a medical school in the United States and Canada must apply for the USMLE Step 1 exam with the NBME. Students or graduates of medical schools outside of the US or Canada register with the Educational Commission for Foreign Medical Graduates (ECFMG). Tests are administered by appointment year round.

3. How much does the test cost?

As of 2020, the USMLE Step 1 exam costs $645.

4. What is covered on the exam?

According to the USMLE Step 1 Content Outline, Step 1 questions are classified in 1 of 18 major areas. Questions mainly covers basic scientific principles including anatomy, behavioral sciences, biochemistry, biostatistics & epidemiology, microbiology, pathology, pharmacology, and physiology. Interdisciplinary topics covered include genetics, aging, nutrition, immunology, molecular and cell biology, epidemiology, and medical ethics.

Some questions test your understanding of basic facts and definitions. But the majority deal with your ability to solve problems using basic scientific principles. For example, you’ll be asked to interpret graphs, identify gross and microscopic pathology and normal specimens, and apply concepts and principles relevant to individual organ systems.

5. When should I take the test?

Most people take the test between their second and third years in medical school, after finishing basic science courses and before a clinical clerkship. Many have success taking it within two months of finishing basic courses because the material is still fresh in their minds, combined with an extra month or two of studying.

6. What Score Do I  Need To Get To Pass?

The passing score for the USMLE Step 1 is 194. The average score in 2018 was 230 with a standard deviation of 19.

The Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners® (NBME®) have announced several upcoming policy changes to the USMLE® exams. We have created a guide to help you navigate these changes.

7. When do I get my USMLE test results?

Scores for Step 1 are released each Wednesday. It usually takes three to four weeks for scores to be released. You will receive an email from the entity you registered with (NBME or ECFMG) when your score is available. It will also be posted to that entity’s website. If you don’t receive an email within two months, it’s recommended that you contact the registration entity directly.

8. I passed Step 1 but am not thrilled with my score. Can I retake it to raise my score?

Unfortunately, the answer to this is no, you can’t retake the USMLE Step 1 Exam to raise your score if you pass. If you pass the Step 1 Exam, you may only retake it to comply with certain state board requirements.

9. I didn’t pass the first time. Can I retake the exam?

Yes. You can retake the USMLE Step 1 exam up to six times. You can only take the exam a maximum of three times within a 12-month period. Your fourth and subsequent attempts at the exam must be at least 12 months after your first attempt, and at least six months after your most recent attempt.