What percent of people fail Step 1?

Around 10-20% of medical students fail USMLE Step 1, with rates varying by year and degree type, showing an overall decline since the exam switched to pass/fail scoring in 2022, with about 10-18% failing in 2023-2024 for US MD/DO students, and higher rates for International Medical Graduates (IMGs). In 2023, roughly 11,500 total failures occurred, with first-time MD/DO takers seeing around 90-92% pass rates, indicating a 8-10% failure rate for them, while IMGs had lower pass rates (around 72%).

What are the chances of failing Step 1?

In 2021—the year prior to Step 1's moving to pass-fail scoring—95% of first-time test takers from MD-granting medical schools and 94% from DO-granting schools passed Step 1. In the years since, that number has ranged from 91–93% for MD students and 86–89% for DO students.

What percent of Step 1 is passing?

However, examinees typically must answer approximately 60% of questions correctly to achieve a passing score.

How many people pass Step 1 every year?

Step 1 Passing Rates Are Down

About 95% of US/Canada test-takers passed the United States Medical Licensing Examination (USMLE) Step 1 until the scoring system changed to Pass/Fail in 2022. Since then, pass rates have dropped across the board, a phenomenon that has come to be known as “the Pass/Fail effect”.

Is Step 1 the hardest exam ever?

While USMLE Step 1 is notoriously difficult, often considered the hardest among medical licensing exams due to its vast knowledge base and high stakes, calling it the absolute "hardest in the world" is subjective; exams like China's Gaokao are also cited for extreme pressure, but Step 1's challenge lies in consolidating foundational medical science before clinical focus in later steps. Many students find it uniquely stressful as a major hurdle in becoming a doctor, testing broad concepts and clinical reasoning.
 

USMLE Step 1 is PASS/FAIL! What No One Else is Saying 🤫

Is 60% enough to pass Step 1?

Yes, around 60% correct is generally considered the approximate pass mark for USMLE Step 1, though the exact percentage varies with each exam form, and the score is reported as Pass/Fail, not a number, so consistently scoring higher (like 65-70%) on practice exams (NBMEs) is recommended for a comfortable pass. The official passing score (around 196 before 2022, now just "Pass") isn't a fixed number of questions, as some are experimental, but aiming for about 60% on practice tests is a good benchmark, with 70%+ being a safer target for a strong pass. 

Which is the 3 toughest exam in the world?

The three toughest exams globally often cited for their extreme difficulty, low pass rates, and high stakes are China's Gaokao (National College Entrance Exam) for its sheer scale and competitiveness, India's UPSC Civil Services Exam for its life-altering potential and minuscule selection, and India's IIT-JEE Advanced (Joint Entrance Exam) for its rigorous engineering entrance criteria, alongside prestigious UK fellowships like the All Souls Prize Exam, with difficulty varying by individual and goals. 

Is failing USMLE Step 1 bad?

If you fail the USMLE Step 1 exam once, your chances at a career as a physician remain high.

What is a 90% chance of passing Step 1?

A 90% chance of passing USMLE Step 1, often from an NBME practice test, means that for every 100 people with that score, 90 pass, but 10 still fail, so it's a strong indicator but not a guarantee, highlighting the need to focus on weak areas identified in the report, especially for Step 1's new pass/fail format where recent pass rates hover around 90-92%.
 

What is the 7 year rule for USMLE?

The USMLE 7-year rule, primarily for International Medical Graduates (IMGs) seeking ECFMG Certification, mandates completing all required USMLE Steps (1, 2 CK/CS, and eventually 3) within seven years of passing the first exam; failure to do so invalidates earlier scores, requiring retakes, though waivers or extensions may be granted for documented issues like PhD programs, severe illness, or certain military service. Most U.S. medical licensing boards also enforce this timeframe for state licensure, starting from the first successful Step pass. 

What is a 75% on Step 1?

A 75% on USMLE Step 1 usually refers to a high performance level, often meaning you scored better than 75% of other test-takers (75th percentile) or got around 75% of questions correct on practice exams, indicating a very high chance of passing, as a ~65% correct on NBMEs often predicts passing. While Step 1 is now pass/fail, historically, a score in the 75th percentile (around 240-250+ on the old scale) was considered strong for residency applications, and 70-75% on practice NBMEs suggests near-certain success on the actual exam.
 

How long should I study for Step 1?

Study timelines vary, but most students dedicate 6 to 12 weeks of focused preparation time for Step 1. The length depends on prior knowledge, study habits, and available time during dedicated study periods.

Is the USMLE pass failing now?

On January 26, 2022, the United States Medical Licensing Examination (USMLE) Step 1 exam transitioned to a pass-fail grading system instead of the conventional three-digit score.

Can you still be a doctor if you fail Step 1?

Step 1 is now pass/fail, so there is no reason to retake it for a higher score. However, your performance still matters for residency applications. A strong grasp of foundational sciences is crucial for your entire medical education journey, which includes Step 2 CK.

Do schools see if you failed Step 1?

Residencies have full access to how many times you've taken your Step exams, and admissions committees consider failing Step 1 to be a major red flag. Residency programs want to see if you can put your nose to the grindstone for an allotted amount of time to get a specific outcome.

Is failing Step 1 the end of the world?

Facing A Step 1 Failure: While challenging, failing Step 1 is not the end of your medical journey; it can be an opportunity for growth, helping you better prepare for future success. Turning Setbacks Into Growth: Analyzing what went wrong and creating a strategic study plan can transform obstacles into opportunities.

Is USMLE Step 1 the hardest exam?

Yes, USMLE Step 1 is widely considered the hardest USMLE exam due to its sheer volume of foundational science knowledge, extensive content, and high-stakes nature (historically), testing everything from first two years of med school, though its difficulty is subjective and Step 2/3 also present unique challenges, but Step 1's breadth makes it a significant hurdle.
 

Is Step 1 only pass fail?

As of January 2022, the USMLE Step 1 Exam shifted from being scored to a simple pass/fail grading structure.

What is a low pass on Step 1?

The Step 1 low-pass range represents performance that is above but near the passing standard. In other words, performance that is sufficient to pass Step 1, but only by a small margin. Any overlap between your likely score range and the Step 1 low-pass range should warrant extra caution.

Do residencies see if you fail Step 1?

Passing is paramount

While a Step 1 numerical score will not be a differentiator for physician residency applicants, a failed Step 1 or Step 2—still scored numerically—attempt can be, for the wrong reasons.

Can I pass Step 1 with only UWorld?

Is UWorld Enough to Pass Step 1? UWorld alone is not enough. You should use UWorld along with these tips to effectively prepare for Step 1: Combine UWorld with other resources, such as First Aid and NBME self-assessments.

Can you match into surgery after failing Step 1?

When general surgery residency program directors. Only 1% of programs often consider applicants who have failed. As you can see, the road to match success is difficult for those who have failed the Step 1 exam.

What is the hardest exam in Asia?

Asia is home to some of the hardest exams, including China's Gaokao and India's JEE and UPSC. In 2025, nearly 15 million candidates across these two nations alone sat for these high-stakes tests.

What is the passing grade for Step 1?

According to the USMLE, “On the three-digit score scale, the Step 1 passing score is 196.” Granted, this may be difficult to interpret—when completing Qbank blocks or an NBME/CBSE mock exam, you'll likely receive a number equal to the percentage of questions you answered correctly.

Are "tough" exams truly valuable?

Tough exams serve as critical gateways to prestigious universities and professional opportunities.