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Ultimate Guide to the USMLE Step 1 Exam

Everything you need to know if you’re going to sit the USMLE Step 1 exam.

What is the USMLE Step 1 Exam?

USMLE stands for US Medical Licensing Examination. The USMLE Step 1 exam is the first of the United States Medical Licensing Exam stages (also known as ‘the boards’). Physicians with an MD degree are required to pass these exams in order to practice medicine in the United States. It consists of USMLE 3 Steps, USMLE Step 1, USMLE Step 2 CS, USMLE Step 2 CK and USMLE Step 3. The first two steps of the series are usually taken while a student is still in medical school, while the third step takes place after graduation.

It is a license examination for practice, residency, and fellowships in the USA. It’s not easy to be a doctor! There’s a lot of challenges and hurdles coming up if you’re looking to become a doctor. The biggest challenge is that the practicing doctors face on their educational path is- THEY MUST PASS THE USMLE.

USMLE Step 1 is a multiple-choice examination conducted by the FSMB (Federation of State Medical Boards) and NMBE (National Board of Medical Examiners). The main objective of this review is to test your basic medical knowledge and the application of basic ethical practice.

The Step 1 exam assesses your ability to provide safe and effective patient care. It covers most of the first and second years of the MBBS syllabus.It’s notoriously tricky and often affects your future options for residency. Many experts say there is no detail too small for Step 1. states that the Step 1 exam assesses “whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy”.

In order to pass, you’ll need to prove a foundational knowledge of the safe and ethical practice of medicine, as well as your ability to solve problems using basic scientific understanding. To dominate this exam, an in-depth understanding of the pathophysiology, epidemiology, semiology, and management of numerous disease entities is critical.

Importance of USMLE

The examinations are sponsored by two organizations: the Federation of State Medical Boards (FSMB) and the National Medical Examiners Board (NBME). The USMLE exams, especially Step 1, are often referred to colloquially as “The Boards.”

Most U.S. medical schools require students to graduate from USMLE Step 1 — and some also require students to pass USMLE Step 2 / Clinical Knowledge (CK) and Step 2 / Clinical Skills (CS) to graduate.

The scores from the first two steps (Step 1, Step 2 CK, and Step 2 CS) play an important role in the assessment of residency training positions for medical students in the US.

Passing the last step (Step 3) is necessary in order to be admitted to U.S. specialty boards, such as the American Board of Internal Medicine, but state medical boards are also required to allow physicians to practice in their specialty. (Boards are governing bodies at the state level which certify doctors as well as more than 150 specialties).

USMLE Step 1 Syllabus

Step 1 examination focuses on basic medical knowledge, including anatomy, biochemistry, microbiology, pathology, pharmacology, physiology, and also behavioral sciences, biostatistics, and epidemiology.

Initials 6 topics are covered in the first and second year of MBBS, while in the third year, you will be expected to read psychiatry and preventive and social medicine, which are MBBS topics for the third year.

What does High-Yield Mean?

You hear it all the time – “This is really high-yield information!”, but what does that really mean? Step 1 is an extremely detailed exam which dives into the minute details of clinically relevant topics.

There are inherently details within each topic which have historically been repeatedly tested. Individuals who have invested a significant amount time in reviewing practice tests, taking the steps, and reviewing most of the practice materials recognize this recurrent, “high-yield” information.

Test-review organizations (questions banks, review books) spend a tremendous amount of time and resources to generate content with the highest probability to be tested.

Focusing on this high-yield information will give you the biggest bang for your buck; however, I like to tell students that there is no detail too small for Step 1. This is why having a variety of high-yield resources is advantageous.

USMLE Step 1 Exam Pattern

The one-day USMLE Step-1 exam contains seven 60-minute blocks to be completed in one 8-hour testing session. The number of questions per block may vary but there will be no more than 40. The total number of questions in the exam won’t exceed 280.

The whole USMLE Step 1 exam takes about 8 hours, broken down as follows:

  • Tutorial: 15 minutes (optional—more on that later)
  • Breaks: 45 minutes
  • 7 Testing Blocks: 60 minutes per block (~1.5 minutes per question)

How Do You Register for the USMLE Step 1 Exam?

For US Students:

For students and graduates of LCME-or AOA-accredited medical programs in the US or Canada, you will need to obtain a USMLE identification number. Applications are made through the NBME (the National Board of Medical Examiners) on NLES (NBME Licensing Examination Services).

You will need your SSN and medical school information for the online application. After registration, you will receive your USMLE ID and password via email within one business day.

During the registration process, you will be asked to designate a three-month window, during which your registration permit will be valid. You must schedule your test date within this three-month period. Note that additional fees may apply if you need to extend this period, or change your test date.

The USMLE Step 1 exam is administered by a third-party company, Prometric. As Prometric administers many exams in addition to the USMLE, test dates and preferred locations fill up quickly, so ensure that you secure your test date well ahead of time.

When your registration has been processed, NBME will then e-mail you with your scheduling permit to confirm the three-month window in which you can schedule your exam date.

  • US. or Canadian allopathic medical school accredited by the Liaison Committee on Medical Education (LCME), leading to an M.D. degree.
  • US. or Canadian osteopathic medical school accredited by the American Osteopathic Association (AOA), leading to a D.O. degree.

For International Medical Graduates (IMGs):

If you are a student or graduate of a medical school outside the US or Canada, to take the USMLE Step 1, you will first need to apply for ECFMG Certification. To be eligible for ECFMG Certification, your medical school must be listed in the World Directory of Medical Schools.

You can apply online and the application costs $135. The process can take up to six weeks so it’s advisable to get it done well in advance of when you want to start studying for USMLE Step 1.

  • Medical schools outside the U.S. or Canada that are listed in the International Medical Education Directory (IMED) and that meet Educational Commission for Foreign Medical Graduates (ECFMG) criteria.

What is the Passing Score for USMLE Step 1?

Your USMLE Step 1 result is reported as a binary pass/fail, along with a 3-digit score ranging from 1 to 300. The passing score is 194, slightly up from 192 in 2017. Despite the reputation of the USMLE Step 1 as one of the most difficult exams in the world, the U.S. and Canadian candidates achieved a 94% pass rate in 2018.

Is the USMLE Step 1 Score Changing to a Pass/Fail Result?

On 12 February 2020, co-sponsors of the USMLE Program, the FSBM, and NBME announced a number of important policy changes regarding USMLE eligibility and score reporting.

The most notable of these changes is that the USMLE Step 1 exam will no longer be scored as a 3-digit numeric score. This change will be implemented by January 2022 at the latest.

What is a Good Step 1 Score?

In 2018, US & Canadian candidates achieved a mean score of 230, with a standard deviation of 19. That means that around two-thirds of these candidates scored between a 211, and a 249. You can read more about how scores are calculated in the Examination Score Interpretation Guidelines from the USMLE.

USMLE Step 1 scores can have a direct impact on your residency choices later on. Some residency programs can be very competitive, such as dermatology, plastic surgery, otolaryngology, orthopedic surgery and neurosurgery.

Fellowship programs are also inclined to use a resident’s Step 1 score as a primary indicator of past performance, especially more competitive fellowships such as gastroenterology, oncology, cardiology, and surgical fellowships. For example, according to the National Resident Matching Program, the mean score for candidates who matched in Orthopedic Surgery in 2018 was 248.

While you do need to ace the exam to secure a tough residency, do remember that your Step 1 score is one of many factors which will be considered when you apply. The fundamental knowledge obtained in this process will also set you up for success during the clinical years and Step 2.

When Should You Take USMLE Step 1?

Scores are assigned in the context of a cohort of test-taker scores; however, the USMLE also uses past cohorts as controls. This means that the idea of strategizing to take the exam during the time of year that is easiest to score best” is likely invalid.

You should not worry about this issue but rather focus on the optimal time based on your individual study plan (usually set by your institution’s schedule).

How Long Does it Take to Get Your Step 1 Score After the Exam?

Typically, results are available within three to four weeks of your test date. It’s not unheard, however, of missing test results by up to eight weeks. In most situations, if there is any national holiday in the US, expect a weekly break.

Once your score is available, you’ll be provided with email instructions to access your one-year USMLE score chart. You will only be able to access your scores through an official USMLE transcript after that year, which is available at a fee.

It is advisable to save a pdf version of this report as this will be required for residency applications (ERAS) in the future.

Subjects Covered in USMLE Step 1

  • Anatomy
  • Biochemistry
  • Behavioral Sciences
  • Biostatistics and Epidemiology
  • Pathology
  • Microbiology
  • Physiology
  • Nutrition
  • Pharmacology
  • Genetics
  • Aging
  • Molecular and Cell Biology
  • Immunology

How Much Does the USMLE Step 1 Cost?

There is a registration fee of $630 ($645 for 2020 registrations) for students and graduates of LCME- or AOA-accredited medical programs in the US or Canada. The Eligibility Period Extension fee is $70.

Prometric also charges a $50 fee for examinees to change their testing appointment-if you change your appointment five days or less before the test date, a higher fee will apply.

If you’re a Foreign Medical Graduate (IMG), taking the USMLE Phase 1 with a minimum of $160 surcharge would cost $940 if you’re taking the exam outside the USA.

Additional fees – some quite high – are also applicable for changing the date or location of your exam, as well as translation fees if translated

Check the latest fees from Here

USMLE Step 1 Preparation Tips

Find Your Starting Point 

Before calculating your study needs and setting a USMLE study schedule, you must know where you stand. Instead of relying on unstandardized grades from the medical school, sign up for NBME self-assessments or other tests to better understand your baseline score, strengths, and weak points.

Set a Goal

Define what you want to achieve when your USMLE preparation is finished. You ‘re aiming for a score above 240 for example, or just looking to pass the exam? Take career goals into account but be practical, as it will take more time or energy to leap from a baseline score of 140 to over 260 than to target for 200!

USMLE Step 1 Questions and Answers

We hope you’ve found this guide useful. Download Free USMLE Step 1 Q & A from Here

Where and When Can You Take the USMLE Step 1 Exam?

Most cities in the US will have at least one testing center for the USMLE Step 1 – New York, for example, has eight test centers. There are also test centers in major cities in countries around the world.

To find your nearest test center and schedule your examination, visit the Prometric website. It’s useful to note that the Step 1 exam is not offered during the first two weeks of January or on major local holidays.

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