USMLE Step 1: format, content outline and fees

Step 1 tests whether you can apply the basic sciences to the practice of medicine. It is a one-day computer exam, scored pass/fail, and it is the first Step most international medical graduates take.

Checked against the official sources below on 21 October 2026.

At a glance

Format	Fourteen 30-minute blocks in one 8-hour day (for tests on or after 14 May 2026)^[1]
Questions	About 280 multiple-choice questions, no more than 20 in a block^[1][2]
Breaks	At least 55 minutes of break time, plus an optional 5-minute tutorial; finishing a block early adds to your break^[1]
Scoring	Pass/fail only, for exams taken on or after 26 January 2022^[3]
Passing standard	196 on the three-digit scale (only pass or fail is reported)^[3]
Results	Usually within four weeks of your test date^[3]
Attempts	Four per Step, incomplete attempts included; no more than three tries at the same Step in 12 months^[4]
Who can sit it as an IMG	Students and graduates of a medical school outside the US that the World Directory of Medical Schools lists as meeting ECFMG's requirements^[4]
Where IMGs apply	Through FSMB (since 12 January 2026), no longer through ECFMG^[5][6]
Fee for IMGs	US$695, plus a US$210 region fee to test outside the US and Canada^[5]
Test centres	Prometric test centres; you choose one on the Prometric website when you schedule^[7]

Syllabus

USMLE publishes how much of the exam each area makes up. A question can count towards more than one discipline, so the discipline ranges add up to more than 100%.

By system (% of the exam)^[8]

Human development 1-3%
Blood and lymphoreticular/immune systems 9-13%
Behavioral health and nervous systems/special senses 10-14%
Musculoskeletal, skin and subcutaneous tissue 8-12%
Cardiovascular system 7-11%
Respiratory and renal/urinary systems 11-15%
Gastrointestinal system 6-10%
Reproductive and endocrine systems 12-16%
Multisystem processes and disorders 8-12%
Biostatistics and epidemiology/population health 4-6%
Social sciences: communication and interpersonal skills 6-9%

By discipline (% of the exam)^[8]

Pathology 45-55%
Physiology 30-40%
Nutrition 15-20%
Gross anatomy and embryology 10-20%
Microbiology 10-20%
Pharmacology 10-20%
Behavioral sciences 10-15%
Biochemistry 5-15%
Histology and cell biology 5-15%
Immunology 5-15%
Genetics 5-10%

By physician task (% of the exam)^[8]

Medical knowledge: applying foundational science concepts 60-70%
Patient care: diagnosis 20-25%
Communication and interpersonal skills 6-9%
Practice-based learning and improvement 4-6%

Good to know

Step 1 and Step 2 CK can be taken in either order; Step 3 comes only after passing both.^[2]
Once you pass a Step you cannot retake it, except to meet a licensing authority's time limit.^[2]
A fourth attempt at the same Step must be at least 12 months after your first and at least 6 months after your most recent.^[4]
International graduates need ECFMG Certification before they can sit Step 3.^[5]

Build your basic sciences

Chapter-wise MCQs from medical textbooks, marked instantly with an explanation.

Practise MBBS questions

Sources

Waraq is an independent study platform, not affiliated with the USMLE program, NBME or FSMB. Exam rules change from year to year: always confirm with the official source before you register or apply.