USMLE Step 1Format Subjects Scoring Residency Matching Uses of test

By Live Dr - Sun Nov 08, 1:59 pm

USMLE Step 1

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The USMLE Step 1 (more commonly just Step 1 or The Boards) is the first part of the United States Medical Licensure Examination. It assesses whether medical school students or graduates can apply important concepts of the sciences fundamental to the practice of medicine. US medical students typically take Step 1 at the end of the second year of medical school. Graduates of international medical schools must also take Step 1 if they want to practice in the US.


  • 1 Format
  • 2 Subjects
  • 3 Scoring
  • 4 Effect on Residency Matching
  • 5 Uses of test


Traditionally, the exam was an eight-hour single-day computer-based test composed of seven 50-question sets (350 multiple-choice questions in total). However, as of May 9, 2008 the number of questions has been reduced to 48 questions per set with a total of 336 questions for the day. The time provided for each section has not changed. Each section is one hour long, allotting a minute and fifteen seconds for each question. [1] The test taker is permitted 45 minutes in total for the whole day for the purpose of breaks that can only be taken between sections. There is a 15 minute tutorial at the beginning of the exam, which the test-taker can choose to skip, and have the time added to the break time. If the taker finishes any section before the alloted 1 hour time limit, the remainder of the time is added to break time. [2] The test is administered at Prometric testing sites around the world.

As of 2008, the USMLE has begun using a small number of audiovisual questions on Step 1. These questions generally have interactive animations and may have audio components, such as heart sounds, which must be evaluated by the test taker. These questions are currently considered experimental, and the USMLE is delaying score reporting during Summer 2008 to evaluate the results of the new questions.


Step 1 is designed to test the knowledge learned during the basic science years of medical school. This usually includes anatomy, biochemistry, histology, physiology, neuroscience, psychiatry, genetics, pathology, microbiology, pharmacology, molecular biology, immunology and statistics. Epidemiology, medical ethics and questions on empathy are also emphasized. The exams are dynamically generated for each individual test taker, so while the general proportion of questions from each subject is relatively the same for each person, some test takers report that certain subjects are either emphasized or deemphasized on their particular exam.


The USMLE phased out the use of a percentile based system in 1999. A score report is given as a three-digit and two-digit score. The 3-digit score is calculated using statistical procedures that ensure that scores from different years are on a common scale and have the same meaning. The 2-digit score is derived from the 3-digit score; it is not a percentile. It is used in score reporting to meet requirements of some medical licensing authorities that the passing score be reported as 75. Those who take the exam on or after January 1, 2007, will need a score of 185 to pass in the exam. Currently, the national mean score is 221, with a standard deviation of 21. This is an increase from the previous two means, which were 218 (standard deviation 23) and 215 (standard deviation 20). Many residency programs have cutoffs for Step 1 scores below which applicants are unlikely to be interviewed. 300 is the highest score possible; however, whether this score was ever achieved is unknown.

Effect on Residency Matching

The USMLE score is one of many factors considered by residency programs in selecting applicants. However it is notable in that it is the only standardized measure of all applicants. The median USMLE Step 1 scores for graduates of U.S. Medical Schools for various residencies are charted in Figure 4 on page 11 of “Charting Outcomes in the Match” available at http://www.nrmp.org/data/chartingoutcomes2007.pdf

Uses of test

Students in American medical schools take this test at the end of their second year of medical school and it is usually required for progression into the third year of medical school. The test is standardized and it allows medical students to be directly compared with each other on a national basis although the creators of the USMLE wish that scores not be used for this purpose. Performance on this test is one of the selection criteria used in the NRMP match program for residencies. A favorable score on this test indicates that the medical student has grasped the core scientific knowledge taught during the ‘basic sciences’ years.


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