In response to concerns about the role of USMLE Step 1 scores in residency selection and the negative impact on medical student mental health, the United States Medical Licensing Examination (USMLE) announced significant changes to the exam in 2020. One of the major changes was the transition to a pass/fail scoring system from the previous three-digit score reporting system. The change was made to encourage a shift in focus from "high-stakes testing" to "learning and individual improvement," as well as to alleviate some of the stress associated with the exam.[3][4] These changes were implemented starting in January 2022, with the first USMLE Step 1 scores reported in the pass/fail format in February 2022.

The changes to the USMLE Step 1 exam have elicited mixed reactions from the medical education community. While some see the shift to pass/fail and the shorter exam format as positive steps toward reducing the pressure on medical students and promoting a more holistic approach to residency selection, others are concerned.[4]


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Since 2001, there has been a strong plea to remove the Step 1 score barrier that disproportionately affects select racial and ethnic groups. "Using Step 1 scores to screen residency applications puts students who are underrepresented in medicine at a disadvantage."[22] Black and Latino students receive markedly lower scores on Step 1 than white students.[16] The mean USMLE step 1 score was significantly greater among white applicants (223) as compared to black and Hispanic applicants (216).[23] Depending on the threshold score, an African American was 3-6x less likely to be offered an interview.[24]

The Step 3 examination devotes attention to the importance of assessing the knowledge and skills of physicians who are assuming independent responsibility for providing general medical care to patients. The first day of the Step 3 examination is referred to as Foundations of Independent Practice (FIP), and the second day is referred to as Advanced Clinical Medicine (ACM).

Step 3 is a two-day examination. The first day of testing includes 232 multiple-choice items divided into 6 blocks of 38-39 items; 60 minutes are allotted for completion of each block of test items. There are approximately 7 hours in the test session on the first day, including 45 minutes of break time and a 5-minute optional tutorial. Note that the amount of time available for breaks may be increased by finishing a block of test items or the optional tutorial before the allotted time expires.

The table below displays statistics on USMLE Step 1 and Step 2 Content Knowledge (CK) scores for first-year residents in 2020-21. For example, while 10.9% of first-year Anesthesiology residents had Step 2 CK scores above 259, only 1.8% had both Step 1 and Step 2 CK scores above 259. Tables are available for ACGME-accredited pipeline specialties (i.e., specialties that lead to initial board certification). Data are for graduates of MD-granting and DO-granting U.S. and Canadian schools and of international medical schools. International medical school graduates include both U.S. citizens and non-U.S. citizens who graduated from any medical school outside the United States and Canada. For individuals who took the USMLE Step 1 or USMLE Step 2 CK more than once, the most recent score was used in the analysis. Please contact residentreport@aamc.org with any comments or questions.

The Rx Bricks Podcast is a podcast for medical students preparing for the USMLE step 1 and step 2, designed to assist students on their journey through medical school. Every week, we air a new episode based on an important basic science topic or clinical concept. Each episode is an audio version of one of our Rx Bricks, which is based on our USMLE high-yield topics and interactive learning module.

Test dates are provided on a first-come, first-served basis. The USMLE program cannot guarantee the availability of test centers. Therefore, you should contact Prometric to schedule as soon as possible after receiving your scheduling permit.

Your rescheduled test date(s) must fall within your chosen eligibility period. Please note that you can schedule and take your two testing days on consecutive or non-consecutive days. However, Step 3 Day 1 must be taken first, followed by Step 3 Day 2. Your exam days may be no more than 14 calendar days apart, and you must schedule both test dates with Prometric at the same time and at the same center. 

You can take the exam at any Prometric test center in the United States or its territories. You can schedule and take your two testing days on consecutive or non-consecutive days. However, Step 3 Day 1 must be taken first, followed by Step 3 Day 2. Your exam days may be no more than 14 calendar days apart, and you must schedule both test dates with Prometric at the same time and at the same center. 

On your test days, you can present your scheduling permit either on paper (a printed copy) or electronically (e.g., via your smartphone). It is recommended that you print your permit before your first testing day and bring that copy with you, in case you are unable to access your email or the Step 3 site on your testing days and/or have technical problems accessing or printing the permit the day of.

If you do not receive an email regarding your score report within 8 weeks of your last test day, you should check the Step 3 site or contact the FSMB at (817) 868-4041 or usmle@fsmb.org to determine the status of your score report.

Once logged in you will be able to view, download, and print your score report. If you do not receive an email regarding your score report within 8 weeks of your last test day, you should check the Step 3 site or contact us at (817) 868-4041 or usmle@fsmb.org to determine the status of your score report.

Please make sure that you allow emails from usmle@fsmb.org to be received by your email address. Examinees that provide email addresses ending in an .edu and some free accounts will either reject the email notifications all together or will send the email to your spam or junk email folders.

One last thought: is there such a thing as taking an NBME too early? Of course. Your first NBME should occupy the exact moment when your coursework ends and your dedicated Step 1 studying begins. Deciding when to take your second NBME can be a little trickier. The easiest thing to do is to pepper your study schedule with NBME exams at regular intervals, making sure to leave a mind-clearing gap of about 10 days in between your final NBME and test day. Decide how many of the exams you need to take (most students need 3-4 for optimum performance, but everyone is different), and put them at even intervals in between your first NBME and the big test.

One of the best ways to score high on the Step 1 exam is to understand how the questions are made.The first thing to know is that the NBME exams, the body that writes them, emphasize understanding and application of knowledge. Using fact recall alone is not sufficient. You must have a good understanding of what it is you are studying.

The bad news first: there are no tricks. To score well in your Step 1 exam you have to practice, practice, practice. With that said, there are some guiding strategies that can help. For example, there are no negative points for answering a question wrong, so never leave a question blank. And remember, the NBME is not trying to trick you. Questions can be answered with medical knowledge and reasoning skills alone.

The SEPC will require any student repeating the first or second curricular year to retake all courses in which the student received a Fail grade. To be eligible for promotion, a student must earn a grade of Pass in each repeated course after remediation. Students shall not be permitted to take a remediation examination for repeated courses unless specifically allowed by the SEPC. A student may not repeat the first or second curricular year more than once. A student must pass all components of a full curricular year within two academic years. A student who is required to repeat a year is not allowed to repeat any subsequent year. A student may petition the SEPC to enter a modified or decelerated curriculum in the third or fourth year.

*First-time pass rate is the number of students passing the USMLE Step 1 exam on the first attempt divided by the number of students whose first attempt was 2017-2021. In order to sit for the USMLE Step 1 exam students must successfully complete the Medical Sciences curriculum and earn a satisfactory score on the NBME CBSE exam as listed in the student handbook.

Most US medical students take the USMLE Step 1 in their second or third year of medical school (MS2 or MS3) after completing preclerkship curriculum. The USMLE Step 2 CK is taken in MS4, before graduation, or after completing clinical rotations. International students typically test all steps after graduation or post graduation - passing the USMLE Step 1 and Step 2 is required to be eligible for ECFMG (Educational Commission for Foreign Medical Graduates) certification.

The following is a rough breakdown of how long to expect each step to take, assuming you pass each exam on the first try and are doing the entire USMLE in one go. At a minimum, you should expect it to take at least one year to complete:

As I understand it, Pharmacology is a huge part of step 1, and while first aid contains a lot of pharm, it is a good idea to get another source. The consensus is Lange Pharmacology Flash Cards, due to their straightforward simplicity. The front of the card has a short clinical vignette, and the back contains similar drugs, mechanism of action, clinical uses, and other information. They cost around $30 and can be found on amazon for about $30.

The McGraw-Hill USMLE First Aid Collection includes the full-text of books to help prepare you for all steps of the USMLE exams. They include clinical images, high-yield facts, mnemonics, concise summaries, and test-taking strategies. ff782bc1db

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