The USMLE® Step 1 is the first part of the United States Medical Licensing Examination (USMLE®), which is a professional exam that US medical doctors must pass in order to practice medicine in the United States. It is a computer-based multiple-choice exam with 322 questions spread out over seven main sections, each lasting one hour. After their first two years of medical school, most US medical students will take the USMLE® Step 1 exam. If international students want to practice medicine in the United States after graduation, they must take the exam.
The USMLE® Step 1 topics are divided into two categories: general principles and individual organ systems. There are four main concepts tested within the individual organ systems category, including normal processes, abnormal processes, therapeutic principles, and other cultural, environmental, and psychosocial factors. Although the topics themselves cover a wide range that corresponds to the traditional curriculum taught during the first two years of medical school in the United States, each is tested with these ideas in mind. The main topics tested are anatomy and physiology, pharmacology, pathology, biochemistry and molecular biology, and behavioral sciences. Empathy and medical ethics are two other topics covered.
The USMLE® Step 1 exam lasts about eight hours and is divided into seven one-hour sections, each with 46 questions. Several breaks are available throughout the exam, totaling about 45 minutes for the duration of the exam, excluding the optional 15-minute tutorial that can be skipped. If a student completes a section early, he or she may be given additional break time. Because the exam is computer-based, it is usually taken in a professional testing center with strict time limits.
The USMLE® Step 1 has two scoring formats: two-digit and three-digit, each of which can be calculated independently of the other. The three-digit score has a maximum of 300 points, but it is the first time it has been seen by medical licensing boards. On Step 1, the average three-digit score is around 221 with a standard deviation of 24 points. The exam requires a score of 188 on a three-digit scale and 75 on a two-digit scale to pass. The two-digit score does not represent a test taker’s percentile status, contrary to popular belief, because percentile scoring has not been used since 1999.