The Step 1 exam contains 350 questions and spans 8 hours of testing (including an hour of break time). It is administered as 7 one-hour "blocks" of 50 questions each. You will be able to skip back and forth among test questions, but only within a particular block. Once you leave a block (or time expires for that block), you will not be able to return to the questions of that block.
Step 1 questions are NOT grouped by subject within a block. For example, you won't find a section devoted to biochemistry. This random ordering of items presents you with a unique challenge. You must switch from thinking about one subject, such as pathology, to another, such as behavioral science, without skipping a beat.
In total, you will have 45-60 minutes of break time depending on whether you choose to complete the 15 minute tutorial at the start. You can "add" to your break time by finishing a block early. Please note, however, that finishing blocks early does not add to your total "test time" which remains constant at 7 hours. That means that you can't add time to one block by finishing another block ahead of time. You should only take breaks BETWEEN blocks; leaving the testing area DURING a block will be noted as a testing irregularity.
The only question format currently on the USMLE Step 1 is one best answer (matching questions as well as negatively phrased questions were eliminated a few years ago). Some of the Step 1 items test your fund of knowledge directly; however, the majority require application of basic science principles to clinically-relevant situations. You will also be asked to identify microscopic and gross specimens, interpret graphic or tabular information, and solve simple clinical problems.
In an effort to make the Step 1 exam more medically relevant, the USMLE items often assess basic medical science concepts in a clinical context. While some points are asked in a fairly traditional, straightforward manner, you will also be presented with many clinical vignettes. This style typically involves fairly long lead-in scenarios followed by relatively brief response options.
With the new computer exam, you should receive your score back within 3 weeks of your test date. The USMLE Step 1 is scored and reported on two-digit and three-digit scales. Your score report will also include a pass/fail designation as well as a graphic depiction of your performance by discipline and organ system. The defined scale is based on the performance of a criterion group. This group represents a previous group of second year US med students who took the exam for the first time at the end of their second year of medical school.
To achieve a passing score, you typically need to answer between 55-65% correct (it can vary based on the calculated difficulty of the exam you took as each candidate takes a different version of the exam).
Registration and Scheduling
Registering to take the Step 1 and scheduling your exam date is a multistep process:
1. Secure the application materials.
US medical students can get the registration materials from their medical schools or from the National Board of Medical Examiners. International medical graduates must apply through the ECFMG. Note: neither of these organizations currently register the students over the web; you'll need to fill out the paper application and send it in by mail.
2. Complete the application and submit with your application fee and a recent photo.
As part of the application process you will be asked to choose a three month "eligibility period" during which you want to take the exam. Once your eligibility period has been assigned, you will need to take your exam during that period of time or you will lose your application fee (hundreds of dollars). Once you submit your application, it will take 4-6 weeks for processing. Note: If the processing of your application is not completed before the START of the eligibility period you selected, you will not be assigned that 3-month period.
3. Receive your Scheduling Permit.
Once your application is processed, you will receive a Scheduling Permit in the mail. This permit will tell you the start and end dates of your three- Month eligibility period, instructions on scheduling your exam, as well as your Scheduling Number and your Candidate Identification Number.
4. Schedule your test date directly with Sylvan Prometric.
Your Scheduling Permit will have instructions on contacting Sylvan to select your test date (must be within eligibility period). Before making the call, you should decide on several dates and your preferred location.
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USMLE is a joint program of The Federation of State Medical Boards of the United States, Inc. and the National Board of American Medical Examiners.