Recommended Preparation Time: 4 - 6 months
Subjects tested: Anatomy, Physiology, Pathology, Pharmacology, Biostatistics, Epidemiology, Behavioral Sciences, Microbiology, Genetics
Questions: About 280 questions (7x 35-40 question sections)
Cost for US/CA-based students via NBME: $645
Cost for international students via ECFMG: $985 + $180 International Test Delivery surcharge + $160 ECFMG registration fee
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), and then Step 2 is taken in MS4 or before graduation. International students typically test all steps after graduation or post graduation - passing the USMLE Step 1, Step 2, and Step 2 CS 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
- Step 2 CS: 1 month
- ERAs: 1 month
In terms of importance, the USMLE Step 1 is the most looked at score. According to NRMP MATCH 2018 program director survey, 94% of program directors state USMLE Step 1 score as the most important factor they consider for selecting applicants to interview.
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.