United States Medical Licensing Examination - Step 1

Step 1

USMLE Step 1 assesses whether medical school students or graduates understand and can apply important concepts of the basic sciences to the practice of medicine. As of 2007, it covers the following subjects, in both systemic (general and individual anatomical characteristics) and procedural (functional, therapeutic, environmental, and abnormality) themes:

• Anatomy,
• Physiology,
• Biochemistry,
• Pharmacology,
• Pathology,
• Microbiology,
• Behavioral sciences,

• Interdisciplinary topics, such as nutrition, genetics, and aging.

US medical students take Step 1 at the end of the Basic Sciences portion of the curriculum, usually after the second year of medical school. It is an eight-hour computer-based exam consisting of 322 multiple-choice questions (MCQs) divided into seven blocks each consisting of 46 questions. As of summer 2008, some questions include audio and video. Each block must be finished within an hour. The remaining hour is break time. An optional tutorial about how to use the computer program of the exam is offered at the beginning of the exam and takes 15 minutes. This time is deducted from the hour of allotted break time. A quality assurance survey is presented at the end, provided some of the original eight hours is left over.

Scores are reported as a three digit score and a two digit score, however as of July 1, 2011 only the 3-digit score is reported on USMLE transcripts. On January 1, 2010, the passing score was raised from 185 to 188. The average score in 2011 was 225 with a standard deviation of 22. If the student passes the exam, he or she may not repeat the exam to achieve a higher score.

The Step 1 score is frequently used in medical residency applications as a measure of a candidate's likelihood to succeed in that particular residency (and on that specialty's board exams). Step 1 score has been cited as the most important criteria by residency program directors when selecting graduating medical students for their residency program. Average USMLE Step 1 scores for various residencies are available in "Charting Outcomes in the Match" at http://www.nrmp.org/data/chartingoutcomes2011.pdf. Averages for graduates of U.S. medical schools who matched into residency range from 213 for a Family Medicine to 249 for Plastic Surgery.

The Step 1 exam is widely viewed as the hardest and most important examination a medical student will take during his/her career.