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All about USMLE Step 1

  • USMLE Step 1 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.
  • USMLE Step 1 ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning. Step 1 is constructed according to an integrated content outline that organizes basic science material along two dimensions: system and process.
  • USMLE Step 1 is a one-day examination. It is divided into seven 60-minute blocks and administered in one 8-hour testing session. The number of questions per block on a given examination form may vary, but will not exceed 40. The total number of items on the overall examination form will not exceed 280.
  • USMLE Step 1 examinations will include an increased number of questions that assess communications skills (since October 2020).
  • The tables below provide information on the content weighting for Step 1 examinations administered before and after October 2020.
  • All USMLE examinations are constructed from an integrated content outline, which organizes content according to general principles and individual organ systems. Test questions are classified in one of 18 major areas, depending on whether they focus on concepts and principles that are important across organ systems or within individual organ systems.

USMLE Step 1 Question Distribution

  • Sections focusing on individual organ systems are subdivided according to normal and abnormal processes, including mechanisms of pharmacotherapy principles of therapy.
  • In most instances, knowledge of normal processes is evaluated in the context of a disease process or specific pathology.
  • While not all topics listed in the content outline are included in every USMLE examination, overall content coverage is comparable among the various examination forms that will be taken by different examinees for each Step.

System Specifications

Before October 20, 2020 On or After October 20, 2020
System Range, % Range, %
General Principles 13-17 12–16
Blood & Lymphoreticular/Immune Systems 7-11 7-11
Behavioural Health & Nervous Systems/Special Senses 9-13 9–13
Musculoskeletal, Skin & Subcutaneous Tissue 6-10 6-10
Cardiovascular System 6-10 5-9
Respiratory & Renal/Urinary Systems 9-13 9-13
Gastrointestinal System 5-9 5-9
Reproductive & Endocrine Systems 9-13 9-13
Multisystem Processes & Disorders 7-11 6-10
Biostatistics & Epidemiology/Population Health 5-7 4-6
Social Sciences: Communication and Interpersonal Skills 3-5 6-9
  • NB:
    • Percentages are subject to change at any time.
    • The General Principles category for the Step 1 examination includes test items concerning those normal and abnormal processes that are not limited to specific organ systems.
    • Categories for individual organ systems include test items concerning those normal and abnormal processes that are system-specific.

Physician Tasks/Competencies

Before October 20, 2020 On or After October 20, 2020
Competency Range, % Range, %
Medical Knowledge: Applying Foundational Science Concepts 52–62 60–70
Patient Care: Diagnosis 20–30 20–25
Patient Care: Management 7–12 0**
Communication and Interpersonal Skills 2–5 6–9
Practice–based Learning & Improvement 5–7 4–6
  • NB:
    • Percentages are subject to change at any time.
    • Test items related to management will be covered in Step 2 CK and Step 3 examinations.

Discipline Specifications

October 20, 2020
On or After
October 20, 2020
System Range, % Range, %
Pathology 45–52 44–52
Physiology 26–34 25–35
Pharmacology 16–23 15–22
Biochemistry & Nutrition 14–24 14–24
Microbiology 11–15 10–15
Immunology 7–11 6–11
Gross Anatomy & Embryology 11–15 11–15
Histology & Cell Biology 9–13 8–13
Behavioral Sciences 8–12 8–15
Genetics 5–9 5–9
  • NB: Percentages are subject to change at any time.
  • USMLE Step 1 consists of multiple-choice questions prepared by examination committees composed of faculty members, teachers, investigators, and clinicians with recognized prominence in their respective fields.
    • Committee members are selected to provide broad representation from the academic, practice, and licensing communities across the United States and Canada.

Design of USMLE step 1

  • Examination committees, composed of several hundred volunteer medical educators and clinicians, create,
    review, and update the examination materials each year. Committee members broadly represent the
    teaching, practice, and licensing communities across the United States. At least two committees of experts
    critically appraise each test question or case and revise or discard any materials that are outdated or
    inconsistent with current medical practice. These volunteers are also involved in its design, development,
    and continuous improvement.
  • Committee members are selected to provide broad representation from the academic, practice, and licensing communities across the United States and Canada.
  • The test is designed to measure basic science knowledge. Some questions test the examinee’s fund of information per se, but the majority of questions require the examinee to interpret graphic and tabular material, to identify gross and microscopic pathologic and normal specimens, and to solve problems through the application of basic science principles.
  • The content description is not intended as curriculum development or study guide. It provides a flexible structure for test construction that can readily accommodate new topics, emerging content domains, and shifts in emphasis.
    • Categorizations and content coverage are subject to change.
  • Broad-based learning that establishes a strong general understanding of concepts and principles in the basic sciences is the best preparation for the examination.
  • Download Outlines of step 1 syllabus


  • Read each question carefully.
    • It is important to understand what is being asked.
  • Try to generate an answer and then look for it in the option list.
    • Alternatively, read each option carefully, eliminating those that are clearly incorrect.
    • Of the remaining options, select the one that is most correct.
    • If unsure about an answer, it is better to guess since unanswered questions are automatically counted as wrong answers.
    • Single-Item Questions
  • A single patient-centered vignette is associated with one question followed by four or more response options.
    • The response options are lettered (ie, A, B, C, D, E).
    • A portion of the questions involves the interpretation of graphic or pictorial materials.
    • are required to select the best answer to the question.
    • Other options may be partially correct, but there is only ONE BEST answer.
    • This is the traditional, most frequently used multiple-choice question format on the examination.

Sample USMLE Step 1 Questions

1. A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure over the past 2 years. She has not yet started dialysis. Examination shows no abnormalities. Her hemoglobin concentration is 9 g/dL, haematocrit is 28%, and mean corpuscular volume is 94 m3. A blood smear shows normochromic, normocytic cells. Which of the following is the most likely cause?

    1. Acute blood loss
    2. Chronic lymphocytic leukemia
    3. Erythrocyte enzyme deficiency
    4. Erythropoietin deficiency (Answer: D)
    5. Immunohemolysis
    6. Microangiopathic haemolysis
    7. Polycythaemia Vera
    8. Sickle cell disease
    9. Sideroblastic anaemia
    10. β-Thalassemia trait

USMLE Step 1 Practice Materials

USMLE Computer-based Testing (CBT) Practice Session

  • Practice Sessions are available, for a fee, for registered examinees who want the opportunity to become familiar with the Prometric test center environment.
  • Register for a CBT Practice Session.

Also read:

  1. Eligibility for USMLE
  2. USMLE Application
  3. USMLE Test Day
  4. USMLE Results and Score
  5. All about USMLE Step 2 CK
  6. All about USMLE Step 2 CS
  7. All about USMLE Step 3
  8. Visit the official USMLE page

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