As an aspiring medical professional, you’ve likely heard of the United States Medical Licensing Examination (USMLE), a three-step examination process for medical licensure in the U.S. Among these, Step 1 is a critical assessment of your grasp of basic science concepts and your ability to apply this knowledge. Understanding this examination’s format, length, and content is paramount. In this comprehensive guide, we explore “how long is USMLE Step 1,” along with other vital aspects of this exam.


USMLE Step 1 is an 8-hour long examination consisting of 280 questions, with a 60-minute break time allowance.

The test comprises seven blocks, each lasting an hour and containing 40 questions. The average time per question is 90 seconds.

Mastery of content and careful reading are essential for time management during the test. The USMLE Step 1 differs significantly from the MCAT and the COMLEX Level 1 in terms of objectives, even though these are also crucial examinations for medical professionals.

The Importance of Step 1 for Residency in the Pass/Fail Era

Despite the transition to a pass/fail scoring system, the USMLE Step 1 remains a significant hurdle for medical students seeking to match into their desired specialty.

In addition, passing Step 1 is crucial to avoid automatic rejections from residency programs, many dismissing any applicant with a USMLE fail. Doing well on Step 1 is vital for making a positive impression with your application.

Moreover, a solid performance on Step 1 underpins success in clerkships, shelf exams, and the USMLE Step 2 CK. With Step 1 now being pass/fail, these other elements of your medical education and performance gain greater significance in residency selection.

How Long is Step 1?

The USMLE Step 1 is an 8-hour examination featuring 280 multiple-choice questions.

These questions are split into seven blocks, each lasting an hour and containing 40 questions.

The test allows for 60 minutes of break time, 45 minutes of which can be used between question blocks. An additional 15 minutes is available if you skip the orientation at the start of the exam.

Step 1 is an 8-hour examination, including 60 minutes of break time.

Number of Questions and their Coverage

USMLE Step 1 features 280 multiple-choice questions divided into seven blocks of 40 questions each. These questions assess your medical knowledge of basic science and clinical topics, covering core concepts and principles from anatomy, physiology, biochemistry, pharmacology, pathology, microbiology, and more.

Time Allotment per Step 1 Question

Time management is crucial when preparing for the USMLE Step 1. You have roughly 90 seconds to answer each question. As such, it’s critical to read each question carefully and efficiently. Striking a balance between speed and accuracy is key to successful time management on this examination.

Step 1 vs. MCAT: A Comparison of Length and Content

Two significant exams in a budding medical professional’s journey are the USMLE Step 1 and the Medical College Admission Test (MCAT). While both are important, they differ significantly in content and structure.

The MCAT, a 7.5-hour exam, serves as a critical benchmark for pre-medical students and comprises 230 questions. It covers fundamental scientific knowledge in physics, chemistry, biology, psychology, sociology, and critical analysis and reasoning skills. The MCAT aims to assess a student’s understanding of basic scientific principles and their potential to succeed in medical school.

On the other hand, the USMLE Step 1 is an 8-hour exam with 280 questions. Unlike the MCAT, the USMLE Step 1 delves deeper into medical topics. It evaluates a student’s ability to apply scientific concepts and principles related to medicine and focuses heavily on disease diagnosis and the fundamental principles of medicine. This test goes beyond the foundational sciences tested on the MCAT to include topics such as anatomy, physiology, biochemistry, pharmacology, pathology, and microbiology.

Both exams require extensive preparation and a thorough understanding of the material. However, they differ in their objectives: while the MCAT aims to determine if a student is ready for medical school, the USMLE Step 1 focuses on whether a student possesses the knowledge and skills necessary to practice medicine effectively.

Step 1 vs. COMLEX Level 1: Length and Content

The USMLE Step 1 and the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1 are two separate examinations that medical students may encounter. While they share similarities in length, their content and focus differ significantly.

The USMLE Step 1, as we’ve discussed, is an 8-hour exam with 280 questions divided into seven blocks of 40 questions each. In contrast, COMLEX Level 1 is also an 8-hour exam but includes a staggering 352 questions split between two 4-hour sessions. As a result, students have approximately 90 seconds per question for the USMLE Step 1 and a slightly shorter 82 seconds per question for the COMLEX Level 1.

While both exams assess a student’s understanding of medical science and its clinical applications, COMLEX Level 1 also integrates principles of osteopathic medicine. Topics unique to this exam include osteopathic manipulative medicine, neuromusculoskeletal medicine, and osteopathic principles. Additionally, COMLEX Level 1 emphasizes rote memorization more than USMLE Step 1, which prioritizes the mastery and application of medical concepts.

Study Strategies for the USMLE Step 1

Effective study strategies and resources can be crucial given the USMLE Step 1 in a medical student’s career. Here are some strategies and resources that have proven successful for many students:

  1. Start Early and Create a Study Plan: The sheer volume of information covered by the USMLE Step 1 requires that students start studying months in advance. A well-structured study plan will help manage the vast amount of material that needs to be mastered. Your plan should include which topics you will study and when and how much time you will spend reviewing previous material.
  2. Use High-Yield Resources: Utilize resources designed specifically for USMLE Step 1 preparation.
  3. Active Learning: Actively engage with the material as much as possible. This could include drawing out processes, teaching the material to someone else, or using flashcards to test your recall. One popular flashcard platform used by medical students is Anki.
  4. Practice Questions: Doing practice questions is one of the most effective ways to prepare for the USMLE Step 1. Not only do they help you apply what you’ve learned, but they also familiarize you with the exam format.
  5. Review Regularly: Regular review is key to ensuring that the information stays fresh in your memory. This could be through flashcards, quick reviews of your notes, or simply discussing topics with peers.
  6. Take Care of Your Health: Regular exercise, a balanced diet, and adequate sleep can significantly impact your study effectiveness and exam performance. Therefore, it’s essential to maintain a healthy lifestyle throughout your study period.
  7. Practice Exams: Full-length practice exams can help you gauge your readiness for the real test and identify areas of weakness. The NBME (National Board of Medical Examiners) provides practice exams that closely mimic the actual USMLE Step 1 in content and format.

Remember that everyone has different learning styles, so what works best for one person might not work best for another. Understanding your learning style and tailoring your study strategies is important. Stay focused, stay positive, and remember that every step you take brings you closer to your goal of becoming a physician.

Concluding Thoughts

Navigating the path to a medical career is no easy feat, and understanding the USMLE Step 1 exam’s length, structure, and content is a crucial part of that journey. This 8-hour exam, comprised of 280 multiple-choice questions divided into seven blocks, tests a range of medical knowledge. With an average of 1.5 minutes per question, medical students must balance speed and accuracy effectively.

Despite the recent change to a pass-fail grading system, the USMLE Step 1 remains a vital exam for students aiming to secure residency positions. In addition, the strategies, knowledge, and skills students develop during their Step 1 preparation often serve as the foundation for future exams and their overall medical career.

It’s essential to remember that while the USMLE Step 1 is a significant milestone, it’s just one step on the journey to becoming a proficient and compassionate medical professional. Diligent preparation, effective time management, and a deep understanding of the subject matter will serve you well, not just in passing this exam but in your future medical career.

Frequently Asked Questions (FAQs)

How long is the USMLE Step 1 exam?

The USMLE Step 1 is a one-day examination. The exam is about 7 hours long, divided into seven 60-minute blocks. Each block contains up to 40 questions, making a total of up to 280 questions.

Do I have to answer all questions in one block before moving to the next?

Yes, once a block of questions is opened, all questions must be answered before you can proceed to the next block. You cannot return to a block once it has been completed and exited.

Is there a break time during the USMLE Step 1 exam?

Yes, there is a 45-minute break time that you can divide and use between blocks as you prefer. There’s also a 15-minute tutorial at the start of the exam; if you skip it, this time is added to your break time, making a total of 60 minutes.

How long should I study for the USMLE Step 1?

The amount of study time varies between individuals. Generally, students spend between 6 to 12 months preparing for the USMLE Step 1, with more intense study in the last 1-3 months.

How long does it take to get my USMLE Step 1 results?

It typically takes about 3-4 weeks for the USMLE Step 1 results to be reported. However, this timeframe may vary, and you should check the USMLE official website for the most current information.

How long is my USMLE Step 1 score valid?

Once you pass the USMLE Step 1, the score is valid indefinitely. However, some residency programs prefer applicants who have passed the USMLE Step 1 within a certain number of years, often within the last 5-7 years.

How long do I wait to retake the USMLE Step 1 if I fail?

If you fail the USMLE Step 1, you can apply to retake the exam. As of my last update, the USMLE program allows a maximum of FOUR (4) attempts to pass each Step or Step Component. Therefore, it’s essential to check the USMLE official website for the most current information. The total number of attempts allowed per Step is four (4). 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 exam sequence.

How many questions are on the USMLE Step 1?

The USMLE Step 1 exam consists of up to 280 questions. These questions are divided into seven 60-minute blocks, each containing up to 40 questions. The total number of questions may vary slightly from test to test, but it will be close to 280.

Remember, the USMLE exam is a significant and challenging part of your medical education. Therefore, preparing thoroughly and taking care of your mental and physical health throughout the process is essential.