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
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
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.
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.
[^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.
Patient Care: Diagnosis
- History / Physical Examination
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.
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.
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.
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.
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.
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.
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.
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.
Review with examples to understand exam-oriented, simplified concepts on biostatistics, and epidemiology. Includes a section on ethics and doctor-patient relationships.
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.
A comprehensive review of various psychiatric, developmental, and substance use disorders. Pharmacotherapy of psychiatric disorders is discussed along with the respective conditions.