USMLE Step 1 Guide 2026: Format, Scoring, and Exam Day
Everything you need to know about the 2026 USMLE Step 1 exam, from format and timing to scoring and results.
Updated May 4, 2026
USMLE Step 1 is the first exam in the United States Medical Licensing Examination sequence. It tests whether medical students understand and can apply basic science concepts important for medical practice, especially the mechanisms underlying health, disease, and therapy. Step 1 is reported as pass/fail for exams taken on or after January 26, 2022. This guide covers the official logistics: format, timing, passing, registration, test day, score release, official resources, and when to start preparing. It is not a substitute for the USMLE Bulletin of Information, which examinees are expected to review before registering.
2026 Step 1 update: new software and 30-minute blocks
The biggest 2026 change is the test-delivery software transition on May 14, 2026. Step 1 remains a one-day, 8-hour test with a maximum of 280 multiple-choice questions, but the block structure changes from seven 60-minute blocks to fourteen 30-minute blocks.
| 2026 update | What changed | What students should know |
|---|---|---|
| May 14, 2026 software transition | Step 1 moves to updated test-delivery software | Same 8-hour exam day and same max 280 questions |
| Block structure | 7 blocks becomes 14 blocks | New blocks are 30 minutes each, with up to 20 questions per block |
| Break/tutorial time | Break time increases; tutorial shortens | Minimum break time becomes 55 minutes; optional tutorial becomes 5 minutes |
| Scheduling pause | Scheduling/rescheduling paused during the transition | Step 1 scheduling/rescheduling is paused May 4-13, 2026; existing appointments during those dates can test as scheduled |
| Practice software | New interactive testing experience | Students testing on or after May 14 should use the new Step 1 interactive testing experience |
Step 1 quick facts
| Question | Answer |
|---|---|
| What is Step 1? | A basic science exam focused on applying concepts important to medical practice |
| Is Step 1 pass/fail? | Yes, for exams taken on or after January 26, 2022 |
| How long is Step 1? | One 8-hour testing session |
| How many questions are on Step 1? | Up to 280 multiple-choice questions |
| Format before May 14, 2026 | 7 blocks of 60 minutes; up to 40 questions per block |
| Format on or after May 14, 2026 | 14 blocks of 30 minutes; up to 20 questions per block |
| How many questions do you need to pass? | No fixed official raw number; USMLE says examinees typically need approximately 60% correct |
| When do results come out? | Typically 2-4 weeks after test day; allow at least 8 weeks |
| Where do students register? | US LCME/COCA students and graduates apply through NBME; students/graduates of medical schools outside the US apply through FSMB |
| 2026 Step 1 fee | $695 base; exams outside the US and Canada have a $210 region fee |
What is USMLE Step 1?
Step 1 assesses whether examinees understand and can apply basic science concepts important to medicine, with emphasis on principles and mechanisms underlying health, disease, and modes of therapy. The content is organized around an integrated outline that combines organ systems and scientific processes. The exam is designed to test whether a medical student can use foundational science to reason through clinical and biologic problems, not just recall isolated facts. USMLE states that broad-based learning in the basic sciences is the best preparation.
USMLE Step 1 format and timing
Step 1 is a one-day computer-based exam administered in a single 8-hour testing session. The format depends on whether your exam date is before or on/after May 14, 2026.
| Timing element | Before May 14, 2026 | On or after May 14, 2026 |
|---|---|---|
| Total exam-day length | 8 hours | 8 hours |
| Test blocks | 7 | 14 |
| Time per block | 60 minutes | 30 minutes |
| Max questions per block | 40 | 20 |
| Max total questions | 280 | 280 |
| Optional tutorial | 15 minutes | 5 minutes |
| Minimum break time | 45 minutes | 55 minutes |
| Can break time increase? | Yes, by finishing blocks or tutorial early | Yes, by finishing blocks or tutorial early |
Examinees can review questions only within the current block and cannot return to previous blocks once they are closed.
How many questions do you need to pass Step 1?
There is no fixed official number of questions you must answer correctly. USMLE says the percentage required varies by Step and by exam form, but examinees typically need approximately 60% correct to pass. Because Step 1 has a maximum of 280 questions, 60% is about 168 questions. That number is useful only as rough mental math; it is not an official cutoff.
Step 1 is not curved. USMLE states that no predetermined percentage of examinees will pass or fail; the passing standard is based on a specified level of proficiency.
If you are unsure about an answer, guess. Unanswered questions are automatically counted as wrong.
Is Step 1 pass/fail?
Yes. Step 1 exams taken on or after January 26, 2022 are reported as pass/fail only. On the legacy three-digit score scale, the passing standard is 196, but future Step 1 passing-standard reviews are not reported as a three-digit score. USMLE reviewed the standard in December 2024 and voted to maintain it.
What types of questions are on Step 1?
Step 1 uses single-best-answer multiple-choice questions. A typical question includes a patient-centered vignette followed by four or more answer choices. Other choices may be partially correct, but there is one best answer. Some questions require interpretation of images, graphics, tables, or other visual material.
What is tested on Step 1?
USMLE publishes official Step 1 content specifications by system, physician task/competency, and discipline. These ranges are test-construction specifications, not a complete study plan, and USMLE notes that percentages are subject to change.
Step 1 content by system
| System / content area | Official range |
|---|---|
| Human Development | 1-3% |
| Blood & Lymphoreticular / Immune Systems | 9-13% |
| Behavioral Health & Nervous Systems / Special Senses | 10-14% |
| Musculoskeletal, Skin & Subcutaneous Tissue | 8-12% |
| Cardiovascular System | 7-11% |
| Respiratory & Renal/Urinary Systems | 11-15% |
| Gastrointestinal System | 6-10% |
| Reproductive & Endocrine Systems | 12-16% |
| Multisystem Processes & Disorders | 8-12% |
| Biostatistics & Epidemiology / Population Health | 4-6% |
| Social Sciences: Communication and Interpersonal Skills | 6-9% |
Step 1 content by physician task / competency
| Competency | Official range |
|---|---|
| Medical Knowledge: Applying Foundational Science Concepts | 60-70% |
| Patient Care: Diagnosis | 20-25% |
| Communication and Interpersonal Skills | 6-9% |
| Practice-Based Learning & Improvement | 4-6% |
Step 1 content by discipline
| Discipline | Official 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% |
Step 1 eligibility, registration, and scheduling
To be eligible for Step 1, you must be eligible both when you apply and on the day of your exam. Eligible examinees include students or graduates of LCME-accredited US MD programs, COCA-accredited US DO programs, or medical schools outside the US that are listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements and meet other ECFMG criteria.
| Step | What to do |
|---|---|
| 1. Confirm eligibility | Make sure you are eligible when applying and on exam day |
| 2. Use the correct portal | US LCME/COCA students and graduates apply through NBME/MyUSMLE; students/graduates outside the US apply through FSMB after the January 2026 USMLE service transition |
| 3. Choose an eligibility period | Step exams are taken within an assigned eligibility period |
| 4. Wait for your scheduling permit | After your application is processed, you receive a scheduling permit by email |
| 5. Schedule at Prometric | Appointments are first-come, first-served; schedule soon after receiving your permit |
| 6. Confirm fees | 2026 Step 1 fee is $695; international region fees may apply |
| 7. Reschedule carefully | Rescheduling rules and fees depend on timing and eligibility period |
| 8. Know attempt limits | You may not take the same Step more than three times in a 12-month period; lifetime limit is four attempts |
| 9. Do not retake a passed Step 1 | A passed Step usually cannot be retaken, except in limited time-limit situations |
Step 1 is administered at Prometric test centers. USMLE recommends scheduling at your preferred center as soon as you receive your scheduling permit, because appointments can fill quickly.
What to bring and expect on exam day
| Exam-day item | Official guidance |
|---|---|
| Arrival | Report to the test center at least 30 minutes before your appointment |
| Scheduling permit | Bring a paper or electronic copy |
| ID | Bring acceptable, unexpired, government-issued photo identification |
| Rules of Conduct | Review them before arriving |
| Security | Comply with check-in and security procedures throughout the day |
| Personal items | Follow test-center rules about what can and cannot enter the testing room |
| If sick or unprepared | Consider rescheduling rather than testing when not ready |
| Problems on test day | Report issues or suspicious behavior |
USMLE exams are monitored by test-center staff, in person and through audio and visual recording. Rule violations can lead to irregular-behavior findings, transcript annotation, future testing restrictions, and score cancellation.
When do Step 1 results come out?
| Question | Answer |
|---|---|
| When are Step 1 results usually available? | Typically 2-4 weeks after test day |
| Should students allow extra time? | Yes, allow at least 8 weeks |
| How are students notified? | By email from the organization that registered them |
| Where is the score report posted? | On the secure website of the registration organization |
| How long is the score report available? | Approximately 365 days from the email notification |
| Can scoring be expedited? | No |
| Can results be provided by phone, email, or fax? | No |
| What happens after the report is removed? | Scores are available only through an official transcript, for a fee |
What happens if you fail Step 1?
A failing Step 1 score report includes performance feedback intended to guide further study, and the failed attempt remains part of your USMLE record. You must reapply and pay again before retesting.
Attempt limits matter. You may not take the same Step more than three times in any 12-month period, and the lifetime limit is four attempts (including incomplete attempts). After four unsuccessful attempts at any Step, you are ineligible to apply for any Step in the USMLE sequence.
Step 1 study resources
A complete Step 1 prep system covers five categories: a QBank, a flashcard system, videos, practice exams, and reference material. None of these are official USMLE requirements, but most students build their prep around some combination of them. The best stack is usually the smallest one that lets you consistently learn, practice, review, and benchmark.
| Tier | Resource type | Best options | When to use |
|---|---|---|---|
| Primary | QBank | UWorld, Ora | Daily; the center of your prep |
| Primary | Flashcards | Anki/AnKing, Ora | Daily review of misses and weak areas |
| Primary | Pathology video | Pathoma | During path blocks and Step 1 review; first 3 chapters are especially high-yield |
| Primary | Micro mnemonics | Sketchy Micro | Durable visual recall for microbiology |
| Primary | Practice exams | NBME self-assessments, Free 120 | Benchmark every few weeks and near exam time |
| Supplemental | Pharm and path mnemonics | Sketchy Pharm, Sketchy Path | When you need extra help with pharmacology or pathology recall |
| Supplemental | General video review | Boards and Beyond | Targeted review of weak topics if you have time during dedicated |
| Supplemental | Reference / lookup | AI tools (Ora Copilot, ChatGPT), medical library (Ora, AMBOSS), First Aid | Quick answers while studying; not for reading through |
For a deeper breakdown of how each resource compares and how to build a workflow around them, see our full guide to the best Step 1 resources.
Two free official practice tools are worth using alongside any stack: the Step 1 sample questions (100+ official items in PDF and as the interactive testing experience; use the new version for exams on or after May 14, 2026) and the NBME CBSSA for benchmarking readiness with an estimated probability of passing.
When should you start preparing for Step 1?
There is no single official study timeline that applies to every student. In LCME-accredited medical schools, USMLE notes that most students take Step 1 at the end of the second year, although Step 1 and Step 2 CK can be taken in either order before Step 3 eligibility.
| Timeline | Focus |
|---|---|
| During preclinical coursework | Build a strong foundation during organ-system blocks |
| 3-6 months before exam | Choose core resources, understand registration logistics, and begin structured review |
| Final 6-8 weeks | Use timed question blocks, review missed concepts, and take periodic self-assessments |
| Final 1-2 weeks | Complete official sample questions, use the correct interactive testing experience, and confirm exam-day logistics |
| After the exam | Expect results in 2-4 weeks, but allow up to 8 weeks |
For a detailed schedule, see our full Step 1 study plan.
FAQs
How long is Step 1 in 2026?
Step 1 is a one-day exam administered in one 8-hour testing session.
What changed for Step 1 on May 14, 2026?
Step 1 moves to updated test-delivery software. The exam remains 8 hours with up to 280 questions, but the structure changes to fourteen 30-minute blocks with up to 20 questions per block.
How many questions are on Step 1?
Step 1 has a maximum of 280 multiple-choice questions.
How many questions do I need to pass Step 1?
There is no fixed raw number. USMLE says the percentage required varies by Step and form, but examinees typically need approximately 60% correct.
Is Step 1 pass/fail?
Yes. Step 1 exams taken on or after January 26, 2022 are reported as pass/fail only.
When do Step 1 results come out?
Results are typically available two to four weeks after test day, but USMLE says to allow at least eight weeks.
Can I retake Step 1 if I passed?
Usually no. A passed Step generally cannot be retaken except in limited time-limit situations recognized by USMLE.
What should I bring on exam day?
Bring your scheduling permit and acceptable, unexpired, government-issued photo identification. USMLE also says to report at least 30 minutes before your appointment.
Which Step 1 resources are official?
Official resources include the USMLE Step 1 content outline, sample questions, interactive testing experience, Bulletin of Information, NBME self-assessments, and the Prometric practice session.
Official sources used
This guide is based primarily on official USMLE, NBME, and FSMB information, including:
- USMLE Step 1 exam content
- Step 1 content outline and specifications
- Test delivery software updates for Step 2 CK and Step 1 coming in May 2026
- USMLE Bulletin of Information
- Bulletin of Information: Eligibility
- Bulletin of Information: Scoring & Score Reporting
- Examination results and scoring
- Apply for exams
- Step 1 pass/fail score reporting implementation date
- Change to Step 1 passing standard begins January 26, 2022
- No change to minimum passing standard for Step 1
- USMLE Service Transition launching January 2026
- Common questions
- Performance data