USMLE Step 1 exam: format, cost, eligibility and preparation

What is the USMLE exam?

The United States Medical Licensing Examination (USMLE) is the exam sequence used for medical licensure in the U.S. It has three Steps: Step 1, Step 2 CK and Step 3. If you are asking what is the USMLE exam for international graduates, the answer includes ECFMG Certification: Step 1 and Step 2 CK continue to be required by ECFMG.

Step 1 comes first for most students. USMLE says the USMLE Step 1 exam 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.

Source: USMLE — Step 1 Exam Content. Checked 18 October 2026.

USMLE Step 1 test format

The USMLE Step 1 test is a one-day exam. For exams on or after 14 May 2026 it is divided into fourteen 30-minute blocks in one 8-hour testing session. Each block has no more than 20 questions, and the whole exam has no more than 280. You get at least 55 minutes of break time and a 5-minute optional tutorial.

Before 14 May 2026, Step 1 used seven 60-minute blocks of up to 40 questions. USMLE states that the exam content, total number of items and overall exam day duration did not change with the new software, so older descriptions of the content still apply.

Source: USMLE — Step 1 Exam Content. Checked 18 October 2026.

What the USMLE Step 1 questions cover

USMLE builds Step 1 on an integrated content outline with two dimensions: organ system and process. Most USMLE Step 1 questions test whether you can apply foundational science: applying foundational science concepts makes up 60 to 70% of the exam, and diagnosis 20 to 25%.

Disciplines overlap, so their ranges add up to more than 100%. The largest are listed below, with the systems that carry the most weight.

• Pathology 45–55%, Physiology 30–40%
• Pharmacology, Microbiology, and Gross Anatomy & Embryology 10–20% each
• Reproductive & Endocrine Systems 12–16%
• Respiratory & Renal/Urinary Systems 11–15%
• Behavioral Health & Nervous Systems/Special Senses 10–14%
• Blood & Lymphoreticular/Immune Systems 9–13%; Cardiovascular System 7–11%

Source: USMLE — Step 1 Content Outline and Specifications. Checked 18 October 2026.

USMLE Step 1 cost

The USMLE Step 1 cost is a $695 application fee for 2026 and for 2027. The fee is the same whether you apply through NBME as a student or graduate of a U.S. LCME- or COCA-accredited program, or through FSMB as a student or graduate of a school outside the U.S.

If you test outside the U.S. and Canada, a $210 region fee applies; USMLE notes this is not a USMLE fee. NBME lists $70 for an eligibility period extension. So the cost of USMLE Step 1 is $695 in the U.S. and Canada, and $905 elsewhere before any extension or local tax.

Source: USMLE — Apply for Exams. Checked 18 October 2026.

Eligibility and how to register

You must be in an eligible category both when you apply and on the day of the exam: enrolled in or graduated from a U.S. MD program, a COCA-accredited U.S. DO program, or a school outside the U.S. listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements.

Students of U.S. schools apply through NBME. Students and graduates of schools outside the U.S. have applied through FSMB since 12 January 2026, when registration moved from ECFMG to FSMB. You choose an eligibility period (NBME uses three-month periods) and then receive a scheduling permit.

Source: USMLE — Bulletin of Information: Eligibility. Checked 18 October 2026.

Booking your USMLE Step 1 exam at Prometric

With your scheduling permit you book a date at a Prometric test center. Dates are first-come, first-served and may not be available more than six months ahead, so book early in your eligibility period. Details on dates, rescheduling and score release are on our USMLE Step 1 exam page.

Source: USMLE — Bulletin of Information: Applying and Scheduling. Checked 18 October 2026.

How to pass USMLE Step 1: scoring and pass rates

All Step 1 results since 26 January 2022 are reported as pass or fail. Behind that, the passing standard on the three-digit scale is 196, and USMLE says examinees typically must answer approximately 60 percent of items correctly to pass. To pass USMLE Step 1 you need to reach that standard; there is no fixed share of candidates who pass.

In 2025, 93% of first-takers from U.S. MD schools and 75% of first-takers from schools outside the U.S. passed. Results are typically available within four weeks of your test date.

Source: USMLE — Examination Results and Scoring. Checked 18 October 2026.

Retakes and attempt limits

You may not take the same Step more than three times in 12 months. A fourth attempt must be at least 12 months after your first and at least six months after your most recent attempt. If you have attempted a Step four or more times, incomplete attempts included, without passing, you are no longer eligible for any Step. Once you pass Step 1, you may not retake it except to meet a licensing authority’s time limit.

Source: USMLE — Bulletin of Information: Eligibility. Checked 18 October 2026.

Free USMLE Step 1 sample questions and the NBME practice test

USMLE publishes more than 100 free USMLE Step 1 sample questions as a PDF and as an interactive testing experience. These are the closest thing to official USMLE model questions: a sample of USMLE Step 1 questions written in the exam’s style, and the best USMLE example questions to see how items are built. If your exam is on or after 14 May 2026, use the new interactive version with 30-minute blocks.

There is no official USMLE Step 1 mock exam or timed USMLE Step 1 practice test from USMLE itself. The closest thing to a USMLE Step 1 NBME practice test is NBME’s Comprehensive Basic Science Self-Assessment (CBSSA): four sections of 50 questions, seven forms, from $62. Its report gives an estimated probability of passing Step 1, which NBME says is not a guarantee.

Source: USMLE — Step 1 Sample Test Questions. Checked 18 October 2026.

Is there a USMLE question of the day?

Not from USMLE or NBME: neither offers a USMLE Step 1 question of the day on the pages we checked. The official free USMLE practice materials are the sample questions, the content outline and the interactive tutorial. A daily question can be a useful habit, but count it as warm-up, not as a measure of readiness.

Source: USMLE — Step 1 Sample Test Questions. Checked 18 October 2026.

USMLE Step 1 exam preparation

Good USMLE Step 1 preparation starts with the content outline, because it tells you how the exam is weighted. Build your USMLE Step 1 study calendar around pathology and physiology, which together dominate the disciplines, and around the systems with the highest ranges. Our study guide covers study plans and resources in more detail.

Whether you call it USMLE Step One prep or USMLE prep for the boards, use practice questions to find gaps rather than only reread notes. USMLE warns that third-party materials and courses are not affiliated with or sanctioned by the USMLE program, and that using actual USMLE exam questions is unlawful. Avoid any source that claims to sell real USMLE test questions.

Step 1 vs the USMLE 2 exam: Step 2 CK follows Step 1 and moves from foundational science to clinical knowledge. Unlike Step 1, it is reported on a three-digit scale.

Source: USMLE — Use caution in selecting review courses. Checked 18 October 2026.

USMLE Step 1 practice questions

Certsqill’s USMLE Step 1 practice questions are expert-developed and mapped to the Step 1 content outline, from pathology and physiology to each organ system. Use them as a USMLE Step 1 question bank alongside the official samples and USMLE practice exams from NBME.

Every question comes with an explanation for each answer option, and your results build a readiness score per content area, so you see where you stand before test day. A 7-day money-back guarantee applies.

USMLE Step 1 questions people ask

What is USMLE exam Step 1 in short?

The first exam of the United States Medical Licensing Examination: a one-day, 8-hour test of the sciences basic to medicine, reported as pass or fail. Source: USMLE, checked 18 October 2026.

How many USMLE Step 1 exam questions are there?

No more than 280 multiple-choice questions, in fourteen 30-minute blocks of up to 20 questions each. Source: USMLE Step 1 Exam Content, checked 18 October 2026.

What is the USMLE Step 1 cost?

$695 for 2026 and 2027, plus a $210 region fee if you test outside the U.S. and Canada. Source: USMLE Apply for Exams, checked 18 October 2026.

Is USMLE Step 1 pass/fail?

Yes, for all exams since 26 January 2022. The passing standard is 196 on the three-digit scale. Source: USMLE Examination Results and Scoring, checked 18 October 2026.

Where can I find free USMLE sample questions?

On usmle.org: more than 100 free sample test questions for Step 1, as a PDF and as an interactive testing experience. Source: USMLE, checked 18 October 2026.

Is there an official USMLE 1 question of the day?

Not on the USMLE or NBME pages we checked on 18 October 2026. The official free practice items are the sample questions.

Which question bank for USMLE Step 1 is official?

USMLE does not sell one. NBME sells self-assessments (CBSSA) from $62, and USMLE publishes free samples. A USMLE 1 question bank from any other provider is not affiliated with USMLE. Source: NBME and USMLE, checked 18 October 2026.

How many times can I take USMLE Step 1?

Up to three times in 12 months. After four attempts without a pass, including incomplete attempts, you are ineligible for any Step. Source: USMLE Bulletin of Information, checked 18 October 2026.

How do I start prep for USMLE Step 1?

Begin your USMLE Step 1 prep with the content outline and the official sample questions, then use questions for USMLE Step 1 and a self-assessment to find weak areas. Plan your time around the most heavily weighted disciplines.

USMLE Step 1 in detail

• The USMLE Step 1 exam: questions, score, pass rate and test dates →
• USMLE Step 1 study guide: study plan, schedule and resources →
• USMLE Step 1 prep courses, review classes and programs →