What Is USMLE Step 1, Anyway?

I’ve been tweeting things like USMLE, Step 1, ginormous exam, boards and ohmygoshimfreakingout a lot lately and today it occurred to me that a good number of my followers are not in medicine and may have absolutely no clue what I’m talking about. I wrote a little about USMLE in my Medical Education in the US post, but I thought I’d share a bit more detail about the reason behind why I won’t be tweeting next Friday, as I’m sure my absence will be painfully obvious (addicted, me? oh, stop it).

Original Photo Courtesy of Flickr Creative Commons User: WaltStoneburner

United States Medical Licensing Exam – Step 1
There are 3 Steps taken over the course of one’s medical education, the first, which is what I am about to take, is after your second year* of medical school. This exam is basically a final over what you learn your first two years.


$525 for the exam itself, additional if you take a review course. Most choose to take some sort of review course, but not everyone. A good chunk of my classmates chose Doctors In Training, which is basically as inexpensive as they come at $770 (or approximately the amount of money I have spent on caffeine and ibuprofen in the past 6 weeks).


322 Questions divided into 7 blocks of 46 questions
60 minutes alloted per block, 15 minutes for tutorial, 45 minutes for break time
Total – 8 hours


  • Anatomy
  • Biochemistry
  • Histology
  • Physiology
  • Neuroscience
  • Psychiatry
  • Genetics
  • Pathology
  • Microbiology
  • Pharmacology
  • Molecular Biology
  • Immunology
  • Statistics
  • Epidemiology
  • Medical Ethics

Passing: 188
National Average: 221 with a Standard Deviation of 24 (for 2010 test-takers)

So, you just have to pass, right? Right.

Well, kind of…

We are required to pass in order to progress on to third year, this is true. However, the score on this exam is heavily weighted for residency applications. There are a lot of other things that go into residency apps but…let’s just put it this way…Step 1 is not the one you want to blow.

When you finish Medical School you do a residency in your chosen specialty…assuming you are accepted into it. Here’s some average USMLE Step 1 scores for US Seniors accepted to various residency programs in 2009:

  • Dermatology – 242
  • Family Medicine – 214
  • Emergency Medicine – 222
  • General Surgery – 223
  • Obstetrics/Gynecology – 220
  • Orthopaedic Surgery – 239
  • ENT Surgery – 241
  • Pediatrics – 219

Average scores will obviously vary from program to program, with those affiliated with bigger name hospitals and research institutions tending to have averages that are a bit higher.

The problem with quoting all these averages and determining the score you “need” from them is that most second year medical students have no idea what they want to go into and, to avoid not being competitive for something they end up enjoying, are under a lot of pressure to get the best score possible (which, I mean, we’re medical students…I think it’d be safe to say we’d all put that pressure on ourselves even if we were planning to graduate and become Stay-At-Home-MDs).

So, that’s what I’m up currently up against and it’s also the reason I’ve been using Twitter to study with other nerdy med students by tweeting things like “Acid Fast organisms, go!” and discussing everyone’s responses. So, if you’re not a geeky medical nerd in your 2nd year of med school and you’re still following me come June 17, thanks, you’re kind of awesome.

Next Friday, while my sister-in-law is delivering our brand new little niece (with the help of a talented Obstetric surgeon who was likely sitting right where I am not so long ago), I’ll be clogging my external auditory meatuses (quick med geeks, name the associated embryonic structure!) with squishy earplugs, parking my rear in a chair for 8 hours and praying that my contact doesn’t fall out**. Happy thoughts welcome!

Now, if you’ll excuse me, I have some studying to do…

Original Photo Courtesy of Flickr Creative Commons User: Wysz
*Some schools have recently gone to a slightly different schedule, where the first 2 years are condensed to 1.5 years…I’m not sure when they take their exam).

**True Story: My contact fell out the day of my med school interview at the school I now attend. I had to leave the presentation (being given by the Dean of Admissions, no less) to go to the admissions office and find someone to take me to where all the interviewees luggage was stored. Then I had to shift through 40 people’s stuff to find my suitcase, rummage through random clothes & shoes until I got to my extra contacts (look at me thinking ahead – extra contacts, check) and then find a bathroom so I could wipe the scary black streaks created by mascara and contact solution off my very red cheeks. 

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7 Comments + Add Comment

  • Great post!! At my school, we have 1.5 years of preclinicals, then 1 year of rotations, then we take step 1 in the middle of our 3rd year. For me that works out to next January. Eeeek! Kinda already freaking out about it. Danielle, you're going to rock!!!

  • I wish my MCAT classes were $770 :/ I supposed they could have been if I had chosen a smaller company than Kaplan. Then again, the MCAT isn't $525.

    Good luck on your exam!

  • Good luck Danielle!! you're going to do amazing! =)

  • Thanks Marianne for letting us know about that! I was curious. :)

    Mingle – LOL. I know how you feel! We all paid for the MCAT and MCAT prep to get to this point! If you take the Kaplan Step 1 class it's cost is $3400. I chose the Doctor's In Training course bc it was inexpensive & had good reviews. I think it's been very helpful. I also left out the cost of the question bank my school bought for all of us, which was about $400, most students end up paying for that out of pocket. I also didn't include the two $60 practice exams I bought.

    However, I totally remember feeling sick having to pay so much for MCAT classes (I was so blessed as to have my parents who were willing to help and it still made me ill). As an aside, I feel that this less costly course helped me light years more than my outrageous MCAT prep course (a part of that, though, is probably having learned how to study more efficiently since the MCAT days). Thanks for commenting here! I'm off to check out your blog, now. :)

    Emma – Thanks so much, I surely hope you are correct!

  • BCM's much the same as Marianne's school. We have 1.5 years of preclinicals (we achieve this by shortening breaks and probably cramming in more material per week), and after that, we're on our own as to when to take Step 1.

    Most people wait until the middle of 3rd year (Feb-Apr), taking a month or two off from rotations to study. The advantage to this strategy is that most people will have finished the medicine and surgery rotations before taking Step 1, which helps a lot in terms of solidifying preclinical material. Having the psych rotation under your belt helps as well, since it forces you to learn all the psych drugs well. Neurology is also a popular one to relearn all the pathways. Some people also manage to squeeze in family medicine.

    Some people do choose to take Step 1 earlier, depending on their clinical schedule, personal preferences, etc. We have a lot of choice, which is nice. :-)

  • Thank you for taking the time to write this post on the USMLE Step 1. I feel a lot better having gotten a little peak at what's wait for me in two years. :)

  • This is a really great post! Very thorough.

    After taking the exam, I now see the benefit of taking it after you've started your rotations. There was a surprising amount of practical clinical knowledge assumed in some of the questions.

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About The Author

I'm an ObGyn. I started this blog as a medical student (some would call that doctor school) and now I'm working as an Ob/Gyn, which is seriously the coolest job ever. I'm a twin mom and recently added a baby brudder to the mix. My life story through November 2010 can be viewed here. The events in the many years following can be summed up as wedding bells, books, exams, babies, and doctoring. I started this blog in hopes of landing a role in a Lifetime movie so I could quit medicine and move to Hollywood, but that hasn't happened...so if you wouldn't take medical advice from Angelina Jolie, you shouldn't take it from me. I may not even be a real person. In fact, I'm probably a spambot. Or possibly a 15 yo boy blogging from a dingy basement. If you're really interested you can read more about me here. If you have any questions or want to guest post contact me.

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