Surviving Step 1: Test Format & Scoring

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 and how it is scored.

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 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 only contain 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 1 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
  • 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)
  • 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 only receive 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.

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


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