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The United States Medical Licensing (USMLE) Step 1 exam is the first medical licensing exam you need to pass to become a MD. Achievable is the only USMLE exam prep course that uses memory science technology to ensure you pass.
Achievable exam prep includes our complete online textbook and 1,500+ topic review questions.
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Achievable USMLE Step 1 exam prep uses adaptive learning techniques to create and update a personalized model of your memory, individually tracking your retention and mastery of each USMLE Step 1 exam learning objective. Our learning engine monitors your study progress and continually adjusts your quiz questions to ensure you're focusing on the topics that matter most for you, improving study effectiveness while reducing overall study time.
Review quizzes
Continually reviewing the material you've learned while studying is essential, but you need more than simple USMLE Step 1 flashcards. Our USMLE Step 1 exam study materials include a quiz bank of 1,400+ review questions so you can quickly drill the key facts for any particular chapter.
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Easy-to-read online textbook
You'll see within minutes why our concise online textbook is a cut above other USMLE Step 1 exam prep - it's easy to understand and written in plain English, filled with straightforward explanations cutting right to the chase. Achievable USMLE Step 1 study materials are easy to read, mobile friendly, and include detailed walkthroughs of sample questions. Each of the USMLE Step 1 sections are covered in detail in our USMLE Step 1 online course.
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Whether you're studying on the web or a smartphone, the Achievable USMLE Step 1 exam prep platform UX is clean and responsive. Progress charts highlight your journey through the USMLE Step 1 course content and your current strength in each section.
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Use our study planner tool to create a personalized day-by-day study plan and ensure you get through all your USMLE Step 1 content by exam day. All you need to do is focus on studying and our system will help you stay on track.
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USMLE Step 1 - Key Stats

Recommended Preparation Time: 4 - 6 months

Subjects tested: Anatomy, Physiology, Pathology, Pharmacology, Biostatistics, Epidemiology, Behavioral Sciences, Microbiology, Genetics

Questions: approx. 280 questions (7x 35-40 question sections)

Cost for US/CA-based students via NBME: $660

Cost for international students via ECFMG: $1000 + $195 International Test Delivery surcharge + $160 ECFMG registration fee

What is the process to fully pass the USMLE?

The USMLE is a difficult and rigorous process, even for top students, but you're not alone - approximately 40,000 US and international students take the USMLE Step 1 each year.

Most US medical students take the USMLE Step 1 in their second or third year of medical school (MS2 or MS3) after completing preclerkship curriculum. The USMLE Step 2 CK is taken in MS4, before graduation, or after completing clinical rotations. International students typically test all steps after graduation or post graduation - passing the USMLE Step 1 and Step 2 is required to be eligible for ECFMG (Educational Commission for Foreign Medical Graduates) certification.

The following is a rough breakdown of how long to expect each step to take, assuming you pass each exam on the first try and are doing the entire USMLE in one go. At a minimum, you should expect it to take at least one year to complete:

  • Step 1: 4 - 6 months
  • Step 2 CK: 4 months
  • ERAs: 1 month

What does the USMLE Step 1 score report tell you?

The USMLE Step 1 is now a pass fail exam. To pass the exam, typically 60-70% of the questions must be answered correctly. This varies by exam due to content weighting and scaled scoring.

In place of scored sections, the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners® (NBME®), which make the USMLE Step 1 exam, still wanted to give you feedback on your performance by topic. This is especially helpful for students that do not pass because it identifies which topics they are underperforming on.

If you Pass, your USMLE Step 1 score report will give you a breakdown of the content weighting of the exam by discipline and system.

If you Fail, your USMLE Step 1 score report will have three sections:

National performance distribution

This is your overall performance versus the national average. It includes your score, the national passing score, and a histogram chart of scores for the entire test taking audience.

Your relative strengths and weaknesses

This is the section that will help you most with your next attempt. It shows your score performance across three different breakdowns: Performance by Physician Task relative to a Low Pass, Performance by System relative to a Low Pass, and Performance by Discipline relative to a Low Pass.

It only shows whether you had a Higher, Same, or Lower score than the “Low Pass” national average for each category, but this is still helpful information to guide your studies. If you scored lower than a Low Pass on a topic, then you know that you need to work on that area. Similarly, scoring the same as a Low Pass on a topic means that you barely passed that section, and could improve.

Supplemental information: Understanding of content areas

This section of the score report will tell you the breakdown of different content on the USMLE Step 1 exam you took. This should guide your studies as well, as you should be focusing the most time on the content that is most frequently tested on the exam.

By combining what you've learned from the strengths and weaknesses and content areas sections, you can identify the largest opportunities to improve your score.

USMLE Step 1 exam details

The USMLE Step 1 is a comprehensive overview of the medical field, and is the first required exam for a National Board of Medical Examiners (NBME) license.

The USMLE Step 1 exam is hosted by USMLE and costs $660 to register. Participants have 8 hours (7x60min) to answer approx. 280 multiple-choice questions.

8 hours (7x60min)
approx. 280 questions
Exam fee
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NBME's USMLE Step 1 exam summary
Step 1 test content specifications
Range, %
General Principles [^1]
Blood & Lymphoreticular/Immune Systems
Behavioral Health & Nervous Systems/Special Senses
Musculoskeletal, Skin & Subcutaneous Tissue
Cardiovascular System
Respiratory & Renal/Urinary Systems
Gastrointestinal System
Reproductive & Endocrine Systems
Multisystem Processes & Disorders
Biostatistics & Epidemiology/Population Health
Social Sciences: Communication and Interpersonal Skills

[^1] The General Principles category for the Step 1 examination includes test items concerning those normal and abnormal processes that are not limited to specific organ systems. Categories for individual organ systems include test items concerning those normal and abnormal processes that are system-specific.

Step 1 physician tasks / competencies specifications
Range, %
Medical Knowledge: Applying Foundational Science Concepts

Patient Care: Diagnosis

  • History / Physical Examination
  • Diagnosis
Communication and Interpersonal Skills
Practice-based Learning & Improvement
Step 1 discipline specifications
Range, %
Biochemistry & Nutrition
Gross Anatomy & Embryology
Histology & Cell Biology
Behavioral Sciences
Achievable's content outline
1. Anatomy

An exam-focused, comprehensive review of anatomy organized according to organ systems. Includes essential topics derived from the USMLE content outline and helps you apply anatomy concepts to clinical scenarios like nerve injuries, localization of lesions, etc.

2. Microbiology

A review of general and systemic microbiology focused on laboratory diagnosis and clinical features of infectious diseases. Includes a detailed description of high yield topics like antimicrobial resistance, classification of viruses, and bacterial toxins.

3. Physiology

A detailed, organ system-wise review of physiology with exam-oriented descriptions of fundamental mechanisms and factors affecting the functions of the human body. Clarify concepts on one of the most heavily tested subject areas for USMLE step 1 system-wise, including the functioning of the special senses.

4. Pathology

A comprehensive review of pathology, the most highly tested subject for the USMLE Step 1. Includes general and systemic pathology, important biopsy, radiology, and laboratory findings. Clinical features are explained to help solve clinical vignettes.

5. Pharmacology

A high yield review of general and systemic pharmacology, including pharmacodynamics, pharmacokinetics, important drugs, and adverse effects. Detailed explanations with graphs, receptor interactions, and newer chemotherapeutic agents.

6. Immunology

Covers basic concepts and application of immunology, including the development of immune cells, the functioning of the immune system, and immunodeficiency disorders. Includes dedicated units to highly tested topics of transplant rejections and blood transfusion reactions.

7. Biochemistry

Learn the various biochemical and metabolic pathways and the disorders that result from congenital or acquired defects that affect these pathways. The comprehensive review includes clinical and diagnostic characteristics of metabolic disorders to score higher on your exam.

8. Cell and molecular biology

Covers fundamental concepts of cell biology such as nuclear structure and organization, transcription and translation, and cellular signaling pathways. It also includes high yield concepts on the cell biology of cancer.

9. Biostatistics and epidemiology

Review with examples to understand exam-oriented, simplified concepts on biostatistics, and epidemiology. Includes a section on ethics and doctor-patient relationships.

10. Genetics

Learn common terminologies, inheritance patterns, and important genetic disorders. Focuses on the heavily tested application of genetic principles to calculate the risk of inherited genetic disorders, Hardy Weinberg equation, and LOD score.

11. Behavioral science

A comprehensive review of various psychiatric, developmental, and substance use disorders. Pharmacotherapy of psychiatric disorders is discussed along with the respective conditions.

Learn from the best
Our content was written exclusively for Achievable by GraceUSMLE's founder Sujata Arecanteparamb, M.D. A 250+ USMLE scorer with more than 10 years experience as a clinician and medical tutor, Sujata has taught hundreds of students as a part of GraceUSMLE and has now expanded her program through Achievable.
Sujata Arecanteparamb - Achievable USMLE expert
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