Surviving Step 1: Format, Scoring & Attempt Limits

By Walter Wiggins

The USMLE Step 1 is unlike any test you’ve taken before. Therefore, it’s important to know how it works before you walk in the door of the testing center on test day. In this post, I’ll go over the format of the test, how it is scored, and what the rules are on retaking the test.

Step 1 is administered via a computer-based testing (CBT) software package, FREDv2, in Prometric testing centers. Most online question banks (discussed in my most recent post) employ a software package that mimics FREDv2 in order to provide a more accurate testing experience. The USMLE also offers sample materials here. If you’re still uncomfortable with this style of CBT, you can schedule a practice exam at a Prometric testing center for a fee through the USMLE website. You will be able to select a Prometric testing center near you when you register for either the practice exam or the real deal (which you should do, if you haven’t already and are planning to take Step 1 this year).

The format for Step 1 is as follows:

– You may NOT bring ANYTHING with you into the test room except medically necessary items (they’re even difficult about this, so bring a doctor’s note if you need to have something with you like insulin)

– You will be given 7 blocks of 46 multiple-choice questions each

– You have 60 minutes to complete each block

– Questions are randomized for content within and between blocks, so there is no “theme” to any given block of questions

– There are several different versions of the test in any given administration cycle, so your test will likely be different from your colleagues’

– Some questions will contain only a stem or vignette, others will have images associated with the stem, and a few may have video and/or audio components

– When you finish a block, you can either take a break or move on to the next block

– You are allotted one hour of cumulative break time at the beginning of the exam

– You can accumulate more break time by finishing blocks early

– You can ONLY take breaks between blocks (i.e. you CANNOT pause)

– If time expires before you finish a block (or the exam), the software will automatically exit the block (or session)

– Once you exit a block, you will not be allowed to go back

– When you are done for the day, you may leave

Step 1 is scored on two scales: the 2-digit scale and the 3-digit scale. State medical boards receive both scores and commonly use the 2-digit score to determine if you passed for licensing purposes. The passing score on the 2-digit scale is always 75. Residency programs will receive only your 3-digit score. The 3-digit scale is set so that the mean score in a given administration cycle is approximately 220 with a standard deviation of approximately 20. This ensures that almost all scores fall between 140 and 260. The passing score for this year is 188 on the 3-digit scale. The latest Charting Outcomes 2011 shows the mean Step 1 score for U.S. Seniors and Independent Applicants is 226/219.

Finally, you have 6 chances to pass the USMLE Step 1. This includes incomplete attempts where you either don’t finish the test in the allotted time or leave the test before you have finished. If you do not pass by your 6th attempt, you will no longer be able to register for subsequent exams. Some medical schools may require you to repeat portions of your preclinical curriculum if you fail more than once. This is to ensure that you get a solid chance to learn the material before trying again. On a related note, once you receive a passing score…your score is your score. Unlike the MCAT or the SAT, you will not be able to make subsequent attempts to improve your score. These are all reasons to make absolutely sure that you’ve prepared well for your first attempt.

Now that you know what lies ahead, you can relax and focus on your preparation.



8 thoughts on “Surviving Step 1: Format, Scoring & Attempt Limits”

  1. Sure is! Our writer, who took the exam, challenged himself by working to complete his practice blocks in 50 minutes. He accidently wrote 50 in his post instead of 60.

  2. Question: Tao Le’s webinar presentation through this website (slides still posted I think) said there were 48 questions per block…. was that a typo or has the format changed?

    Also, they dont report the 2 digit score any more do they?

  3. re-phrasing that – you already mentioned they dont report the 2 digit, sorry – my point is that NO ONE ever sees the 2 digit anymore right? Not even the state boards? I could be wrong but thats what I thought..

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