Exam Information

Format and length

One test day of roughly 8 hours, divided into 7 blocks of up to 40 multiple-choice questions each. No block exceeds 60 minutes and the total number of items does not exceed 280.

Break time

A minimum of 45 minutes of break time plus an optional tutorial. Skipping the tutorial adds its 15 minutes to your break pool. Break time is self-scheduled between blocks.

Pass/fail scoring

Step 1 is reported as pass/fail only — no three-digit score. The passing standard corresponds to the previously reported 196 equivalent and is reviewed periodically by the USMLE program.

Attempt limits

You may take Step 1 no more than four times in total, including incomplete attempts. Six attempts across all Steps is the lifetime limit, and a Step passed cannot be retaken.

Eligibility period

You are assigned a three-month eligibility period and must test within it. Extensions and rescheduling are handled through your registration entity and may carry fees.

Test-day identification

Bring your unexpired, government-issued photo ID whose name exactly matches your scheduling permit. A mismatch means you will not be admitted and the attempt is forfeited.

Score reporting

Results are typically available within three to four weeks of testing, though delays occur around content changes and holiday periods. Results are delivered by your registration entity.

Irregular behaviour

Anything from unauthorised materials to reconstructing exam content is treated as irregular behaviour. Findings are annotated on transcripts permanently and can bar you from future attempts.

New test delivery software

Test-centre delivery software is updated for May 2026. The item navigation, highlighting, strikethrough and lab-value panel look different — run the official practice software before test day so nothing is unfamiliar.

Refreshed content outline

The content outline continues to weight systems-based practice and communication competencies. Physician tasks such as diagnosis and management remain the largest share of items.

Pass/fail is stable

There is no return to numeric scoring. Programs increasingly weigh Step 2 CK, so a comfortable Step 1 pass plus early Step 2 preparation is the strategic play.

Biostatistics and ethics emphasis

Communication, ethics, patient safety and quality improvement items appear across every system. These are learnable points and should not be deferred to the final week.

Questions over reading

Retrieval practice beats rereading. From week two onward, questions should occupy more of your day than passive review, and every incorrect answer should generate a flashcard.

The 10-2 rule

Work in 10-minute committed starts followed by decision points, and never let a stalled block run past 2 minutes of unproductive staring. It converts avoidance into momentum.

Spaced repetition, daily

Cards scheduled by an SM-2 style algorithm must be cleared every day. A skipped day compounds — two skipped days doubles tomorrow's queue and breaks the schedule.

Explain out loud

One oral explanation per day of the hardest concept you touched. If you cannot say it cleanly in 90 seconds, you have recognition, not recall.