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USMLE Step 1

The USMLE Step 1 (more commonly just Step 1 or colloquially, The Boards) is the first part of the United States Medical Licensing Examination. It assesses whether medical school students or graduates can apply important concepts of the sciences fundamental to the practice of medicine. US medical students typically take Step 1 at the end of the second year of medical school. Graduates of international medical schools must also take Step 1 if they want to practice in the US. Graduates from international medical schools must apply through ECFMG, and the registration fee is $850.[1] For 2015, the NBME registration fee for the test is $590, with additional charges for applicants who choose a testing region outside the United States or Canada.[2]


The exam is an eight-hour computer-based test taken in a single-day, composed of seven 44-question sections with a total of 308 multiple-choice questions.[3] One hour is provided for each section, allotting an average of a minute and eighteen seconds to answer each question.[4] Between test sections, the test taker is allotted a cumulative 45 minutes (during the test day) for personal breaks. (There is a 15-minute tutorial at the beginning of the exam, which the test-taker can choose to skip and have that time added to break time.) If the taker finishes any section before the allotted one hour time limit, the unused time is added to the break time total.[5] The test is administered at any of several Prometric computer testing sites.


Step 1 is designed to test the knowledge learned during the basic science years of medical school. This includes anatomy, behavioral sciences, biochemistry, microbiology, pathology, pharmacology, and physiology, as well as to interdisciplinary areas including genetics, aging, immunology, nutrition, and molecular and cell biology.[6] Epidemiology, medical ethics and questions on empathy are also emphasized. Each exam is dynamically generated for each test taker; while the general proportion of questions derived from a particular subject is the same, some test takers report that certain subjects are either emphasized or deemphasized.


The USMLE phased out the use of a percentile based system in 1999. Examinees receive a three-digit score and a two-digit score; the latter of which is not a percentile. The three-digit score is a scaled score with a mean that fluctuates test year to test year, and a standard deviation of approximately 21.[7] The three-digit score is calculated using a statistical percentile that ensures that scores from different years are read on a common scale, since the exam is known to get progressively more difficult as the years go on. However, the NBME does not disclose how this three-digit score is calculated. The two digit score is a scaled score that defines 75 as the minimum passing score, which is equivalent to a 192 on the three-digit scale.[8] The three-digit score is more commonly used. As of October 3, 2011, USMLE began the process of eliminating the reporting of results on the two-digit score scale to any parties, including residency programs, other than the examinee and any state licensing authority to which the examinee sends results.

In 2014, the national mean score was 230 with a standard deviation of 20;[9] the minimum passing score was 192.[10] This mean score represents an increase from the previous five years, as seen in the table below.[11] Many top residency programs use a "cutoff" score for Step 1, below which applicants are unlikely to be considered. Most other residency programs follow a similar "cutoff," but will allow consideration of applicants with significantly higher Step 2 scores.

National Step 1 means among US and Canadian first time test-takers by year
Year Mean Score Standard Deviation
2014 230 20
2013 227 21
2012 227 22
2011 224 22
2010 222 24
2009 221 24
2008 221 23

Effect on residency matching

The USMLE score is one of many factors considered by residency programs in selecting applicants. However, at present, this test is the only standardized measure of all applicants. The median USMLE Step 1 scores for graduates of U.S. Medical Schools for various residencies are charted in Chart 6 on page 9 of "Charting Outcomes in the Match" available through NRMP Website

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