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.