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USMLE Step 1

USMLE Step 1 is the first examination in the United States Medical Licensing Examination sequence, assessing whether an examinee understands and can apply important concepts of the sciences basic to the practice of medicine. The USMLE program is co-sponsored by NBME and the Federation of State Medical Boards (FSMB); Step 1 is a one-day, approximately 8-hour computer-based exam of approximately 280 multiple-choice questions in fourteen 30-minute blocks (format effective May 14, 2026), delivered at Prometric test centers and reported pass/fail only.

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QuestionsApproximately 280 multiple-choice questions (MCQs), divided into fourteen 30-minute blocks; no more than 20 questions per block
Testing timeOne-day exam, approximately 8 hours (fourteen 30-minute blocks; includes a minimum allotment of 55 minutes of break time and a 5-minute optional tutorial)
ScoringPass/fail only — all Step 1 exam score outcomes are reported as pass/fail (for exams administered on or after January 26, 2022); no numeric score is reported to examinees and no numeric passing score is published
Exam feeUSD 695 for the Step 1 exam (NBME fee schedule for three-month eligibility periods from November 2025 through December 2027, applying to students and graduates of U.S. medical schools accredited by the LCME; payable to NBME via the MyUSMLE portal); regional surcharges apply at international test centers; eligibility period extension USD 70

Prep options

Study resources for Step 1

Independent prep

Courses and study resources

Exam overview

What to know before choosing your prep

Who runs it
NBME
Category
Physician Licensure
Current version
USMLE Step 1, current format effective May 14, 2026 (fourteen 30-minute blocks); specification published in the 2027 USMLE Bulletin of Information
Where it applies
United States — national
Exam languages
English
Testing provider
Prometric
Format
Computer-based multiple-choice exam at Prometric test centers
Availability
Year-round by appointment at Prometric test centers within a chosen three-month eligibility period; the eligibility period can be extended once for a fee
Results
Results are typically available within four weeks of the test date (allow at least eight weeks during peak periods); score reports remain available online roughly 365 days after notification, and scores are never given by phone, email, or fax
Remote testing
Not available

Exam structure

Single-day computer-based exam of approximately 280 multiple-choice items divided into fourteen 30-minute blocks, constructed according to an integrated content outline that organizes basic science material along two dimensions: system and process

Where rules vary

U.S. medical licensure examination: the USMLE is a single uniform national sequence, and passing all three Steps makes a physician eligible to apply for an unrestricted medical license in the United States; it is delivered at Prometric test centers including international sites (with regional surcharges) for international medical students/graduates seeking U.S. licensure

Eligibility

At the time of application AND on exam day: officially enrolled in or a graduate of an LCME-accredited U.S. MD program, OR a COCA-accredited U.S. DO program, OR an international medical school listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements (and meeting other ECFMG criteria)

Retake policy

A Step may be attempted at most four times (including incomplete attempts): after a fourth failed attempt the examinee is ineligible to apply for any Step in the USMLE sequence; many U.S. state medical boards also require all Steps to be completed within a certain time frame

Comparing options?

MCCQE All Physician Licensure exams