What Is the USMLE Step 1?

Dr. Amin ali
Oct 10, 2024
4 min read

Updated: Jan 6

The USMLE Step 1 is the first major exam in the United States Medical Licensing Examination pathway. It’s a one‑day, computer‑based test designed to assess whether you understand and can apply key basic science concepts essential for practicing medicine safely and effectively.

In this blog, we will explore the basics of Step 1, eligibility and requirements, logistics and scheduling, the content you must study, high‑yield topics, proven study strategies, resources, and test‑day guidance to help you succeed.

What is the Usmle Step 1?

The USMLE Step 1 is a one‑day, computer‑based exam that assesses whether you understand and can apply basic science concepts essential for safe medical practice. It tests your mastery of foundational disciplines such as pathology, physiology, pharmacology, microbiology, anatomy, and biochemistry — but in clinical contexts.

Step 1 is a pivotal milestone in the medical licensing pathway, especially for residency applications and building a strong foundation for clinical practice and later Steps.

Eligibility & Requirements

Who Can Take Step 1?

A student or graduate of a medical school accredited by LCME (U.S./Canada) or COCA (osteopathic),
Or a graduate of a medical school listed in the World Directory and eligible for ECFMG certification (for IMGs).

Registration Portals

U.S./Canadian students: register through the NBME portal.
International Medical Graduates (IMGs): register via ECFMG’s MyIntealth portal --> is shifting to FSMB portal.

2026 Application Fees for Step 1

Step 1 standard fee (U.S./Canada): ~$695
International surcharge: additional fee if you choose a test center outside the U.S./Canada.

Note: Fees may change over time, so always check the official USMLE fee schedule.

Logistics & Scheduling

Eligibility Period

When you register, you select a three‑month window (e.g., May–July 2026) during which you must take the USMLE Step 1.

Scheduling Permit

Once your application is processed, you receive a Scheduling Permit via email. You need this permit to book your exam at a Prometric test center.

Prometric Testing Centers

Step 1 is administered at official Prometric centers worldwide — these are the only locations where you can take the exam.

Schedule your test date early! seats fill up fast, especially in summer months or major cities.

Step 1 Exam Structure & Format

Component	Details
Total Duration	~8 hours
Blocks	7 blocks
Questions per Block	Up to 40
Total Questions	Up to 280 MCQs
Break Time	45–60 minutes (total)
Question Type	Single‑best answer vignettes (may include images, audio)

Step 1 questions are mainly clinically oriented vignettes that require integration of basic sciences with clinical scenarios.

USMLE Step 1 Content Outline — What to Study

Step 1 content is organized by disciplines and organ systems, all designed to test your understanding of disease mechanisms, normal function, and clinical application.

Discipline Breakdown (Approximate Weighting)

Discipline	Range (%)
Pathology	45–55
Physiology	30–40
Pharmacology	10–20
Biochemistry & Nutrition	5–15
Microbiology	10–20
Immunology	5–15
Gross Anatomy & Embryology	10–20
Histology & Cell Biology	5–15
Behavioral Sciences	10–15
Genetics	5–10

These percentages show you how heavily each subject influences the exam. Prioritize pathology and physiology, which form the backbone of Step 1.

Organ System Distribution

Step 1 also assesses knowledge across systems:

System	Range (%)
Blood & Immune Systems	9–13
Behavioral Health & Nervous Systems	10–14
Musculoskeletal/Skin	8–12
Cardiovascular	7–11
Respiratory & Renal	11–15
Gastrointestinal	6–10
Reproductive & Endocrine	12–16
Multisystem Disorders	8–12
Biostatistics & Epidemiology	4–6

This integrated outline provides a roadmap for study planning. USMLE

High‑Yield Topics You Must Master

The most tested concepts often appear across disciplines and systems. Focus on these high‑yield areas:

Foundational Sciences

Physiology & Mechanisms of Disease
Pathology of Major Systems
Pharmacodynamics & Pharmacokinetics
Microbial virulence and immune response
Biochemistry pathways and genetic inheritance
Behavioral sciences and biostatistics

Organ Systems Core Concepts

Cardiovascular physiology and pathology
Renal acid‑base regulation and electrolyte disorders
Respiratory gas exchange and ventilation mechanics
Endocrine feedback loops and endocrine pathologies
GI absorption and hepatic functions
Neuroanatomy and nervous system disorders

Watch Dr. Amin Explaining USMLE Step 1

To help you understand USMLE Step 1 in depth, Dr. Amin Ali, an experienced medical educator and the founder of Brocali, walks you through the exam structure, high-yield topics, study strategies, and tips for passing on your first attempt.

Key Takeaways: All About USMLE Step 1

Step 1 is a one-day, 8-hour exam assessing foundational medical sciences through clinical vignettes.
Eligibility: U.S./Canadian students register via NBME; IMGs use the ECFMG portal. Must be enrolled in or graduate of an accredited medical school.
Exam Structure – 7 blocks, ~280 questions, multiple-choice, single-best-answer format, with 45–60 minutes of breaks.
Prep Strategy – Four-phase approach: Foundational learning → QBank practice → Self-assessment & simulation → Final review.
Practice Exams – Brocali or NBME self-assessments and Official Free 120 questions help simulate test conditions and track readiness.

Frequently Asked Questions

What is USMLE Step 1?

Step 1 is a one-day, computer-based exam that tests foundational medical sciences in clinical contexts.

Who is eligible to take Step 1?

Students or graduates of accredited medical schools (LCME, COCA, or ECFMG-certified for IMGs) can take Step 1.

How do I register for Step 1?

U.S./Canadian students register through NBME/MyUSMLE. IMGs register through the ECFMG MyIntealth portal.

How many questions are on Step 1?

Approximately 280 multiple-choice questions, divided into 7 blocks of up to 40 questions each.

Is Step 1 scored or Pass/Fail?

Step 1 is now Pass/Fail, but passing demonstrates mastery of core concepts essential for clinical practice.

What are the high-yield subjects for Step 1?

Pathology, Physiology, Pharmacology, Microbiology/Immunology, Biochemistry/Genetics, Anatomy, Behavioral Sciences.

How long should I study for Step 1?

Typically 4–6 months of structured preparation, depending on your background and schedule.

Where can I take Step 1?

At official Prometric Testing Centers worldwide. A Scheduling Permit is required to enter the exam center.

When will I receive my results?

Results are usually available 2–4 weeks after the exam date.

Contact us

What Is the USMLE Step 1?

What is the Usmle Step 1?