When should you take USMLE Step 1?

Most U.S. medical students take the USMLE Step 1 exam at the end of their second year (M2), after completing their pre-clinical basic science coursework and before starting clinical rotations in the third year, often during a dedicated summer study period. While this timing is standard, some students take it earlier or later, depending on their school's requirements, curriculum, and personal readiness, and it's also possible to take Step 2 CK before Step 1, though less common.

When to take USMLE Step 1?

You're ready to schedule USMLE Step 1 when:

1. Your NBME practice exams consistently score in the passing range.
2. You've completed your dedicated study period (typically 6 - 8 weeks)
3. You can integrate concepts instead of just memorizing them.

How early should I get to Step 1?

Arriving early is crucial. Aim to be at your testing center at least 30 minutes before your scheduled time.

What month do most people take Step 1?

Most medical students take Step 1 at the end of their second year, typically between February and April. The more prepared you are through spaced repetition early, the earlier you may be able to take the exam and then enjoy a well-deserved break before moving into third year clerkships!

When should I take my first Step 1 practice exam?

It may be a better use of your time over winter break to study the First Aid/Pathoma sections that cover topics that you learned as an MS1. This will make it even easier to review those topics during your dedicated study period later in the year. Then aim to take your first practice test ~10-12 weeks before your exam.

The Ultimate Guide to Crush USMLE Step 1 with First Aid (2025)

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. 

Is 60% enough to pass Step 1?

Yes, approximately 60% correct is generally considered the threshold to pass USMLE Step 1, as the USMLE program states examinees typically need to answer around 60% of questions correctly for a pass/fail result, though the exact percentage varies slightly by exam form. However, many experts recommend aiming for higher scores (like 70% or more) on practice exams (NBMEs) for a safer margin, as 60% can be cutting it close due to test-day factors, and lower scores can still pass, while some with higher scores might not. 

Is Step 1 harder than the mcat?

Most students find the MCAT harder than USMLE Step 1, primarily because the MCAT tests foundational science and critical reasoning for entry into medical school with a high-stakes score, while Step 1, now pass/fail, tests deep medical school knowledge and is more about integrated pathophysiology and clinical correlation, but less about raw score pressure. The MCAT is often described as a challenging critical thinking/reading test, whereas Step 1, though extensive (8+ hours), is a knowledge-based exam covering pre-clinical subjects, making it feel different, but generally less daunting than the MCAT by many. 

How long should I study for Step 1?

While the ideal study duration varies based on individual learning styles and knowledge levels, most students benefit from a dedicated 7 to 10-week study period to review core concepts, reinforce weak areas, and build test-taking stamina.

Do they give you headphones for Step 1?

They will give you headphones if you want them: Yes, Prometric provides headphones for test takers. The headphones are noise-canceling and cover your entire ear. They are provided to block out external noise and distractions.

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.
 

Do you take USMLE before or after residency?

Medical graduates typically sit for the USMLE Step 3 during postgraduate residency training. Many take the exam during their intern year of residency, although your timing may differ based on the duration and type of residency program you're completing.

How much does Step 1 cost?

What is the total cost of Step 1? The total cost of taking USMLE Step 1 ranges from $695–$3,507 for U.S. students and $1,760–$4,577 for IMGs, including Step 1 registration fees, ECFMG certification cost for IMGs, Step 1 question banks and common study resources.

Do all med students take Step 1?

(1a) All DGSOM students must successfully pass the USMLE Step 1 and Step 2 exams in order to graduate and receive their diploma. (1b) All students must take the USMLE Step 1 exam prior to being able to start MS4 electives / Phase 3 advanced electives.

What is a good USMLE score?

If you want to match to your first-choice program, you should aim for a score at or above 260. The highest possible score for the USMLE Step 2 CK is 300, but no one has ever achieved a “perfect” score. A score around 280 would be considered a top Step 2 CK score.

What is a 75% on Step 1?

A 75% on a USMLE Step 1 practice exam (like an NBME) generally indicates a very strong chance of passing the actual exam, often correlating to a high percentile (around the 70th-90th percentile range) on the actual score report, while a 75 on the old two-digit Step 1 score meant passing, but now Step 1 is pass/fail, so this percentage refers to your performance relative to peers on practice tests, suggesting excellent preparedness for the pass/fail outcome.
 

What is the top 3 toughest exam in the world?

The top 3 toughest exams globally consistently include China's Gaokao (college entrance), India's IIT-JEE Advanced (engineering), and India's UPSC Civil Services Exam (government jobs), due to their extreme competition, vast syllabi, and life-altering consequences, though other candidates like the All Souls Prize or Master Sommelier Diploma are also noted for extreme difficulty. These exams demand immense knowledge, analytical skills, and endurance, with failure often meaning significant setbacks, making them notoriously difficult.
 

Is a 3.7 GPA too low for med school?

No, a 3.7 GPA is not bad for medical school; it's generally considered competitive, often around the average or slightly below for highly selective MD programs, but strong enough for many schools, especially with an upward trend and a good MCAT score. A 3.7 combined with a strong BCPM (Science) GPA (Biology, Chemistry, Physics, Math) and compelling extracurriculars makes you a viable applicant, though lower GPAs might need more exceptional scores or experiences to compensate. 

How common is failing Step 1?

While most people pass USMLE Step 1, failure rates have increased, especially since the scoring change to pass/fail in 2022, with overall pass rates for first-time test-takers dropping, and international medical graduates (IMGs) and repeat test-takers facing significantly lower odds, though the exact number varies yearly, with thousands failing in recent years (e.g., over 11,000 in 2023). For MD students, first-time pass rates were around 90-93% in 2022-2023, compared to 82-83% for DO students and ~72% for IMGs in 2023, with repeaters seeing even lower success.
 

How important is Step 1 for residency?

In the 2021 National Residency Matching Program (NRMP) survey of residency program directors, 86.2% of program directors listed the USMLE Step 1 score as an important factor in deciding which applicants to interview.

How many times can you take Step 1?

Previous Attempt Limitations. According to USMLE policies, candidates are allowed a maximum of four attempts to pass Step 1 — including the initial attempt and any retakes. As of July 1, 2021, students who have attempted Step 1 four times or more are no longer eligible to retake the exam.

What is the shortest residency to become a doctor?

The shortest MD residencies are typically 3 years and include primary care fields like Family Medicine, Internal Medicine, Pediatrics, Emergency Medicine (sometimes 3-4 yrs), and Preventive Medicine, allowing doctors to start practicing sooner, with some specialties like Genetics & Genomics also listed at 3 years. 

What happens if you fail USMLE step 1-4 times?

If you have attempted a Step four or more times, including incomplete attempts, and have not passed, you are ineligible to apply for any Step in the USMLE sequence.

Is residency harder than med school?

Yes, residency is generally considered harder than medical school, but in a different way; medical school is academically intense with exams, while residency trades academic pressure for real-world responsibility, longer hours, physical exhaustion, critical patient-care decisions, and emotional stress, though it's where you truly become a doctor. Residency shifts focus from book learning to hands-on, high-stakes clinical practice, often involving 80+ hour weeks, overnight calls, and constant responsibility for patients' lives, making it more draining on stamina and time.