USMLE Step 1

USMLE Step 1In order to pursue MBBS in USA, you must understand USMLE Step 1 exam which is a competitive exam which you need to give at the end of Basic Science (3rd Year). USMLE Step 1 assesses whether you understand and can apply important basic sciences concepts used for the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. USMLE Step 1 exam tests your foundation for the competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning. The main testing dimensions of Step 1 are system and process.

Step 1 examination is conducted in just one-day. It is divided into seven 60-minute blocks and administered in one 8-hour testing session The number of questions per block on a given examination form will vary, but will not exceed 40. Overall examination will not have more than 280 questions.

Subjects covered in USMLE Step -1 Exam.

The USMLE Content Outline organizes content according to general principles and individual organ systems. Test questions are classified in one of 18 major areas, depending on whether they focus on concepts and principles that are important to organ systems or within individual organ systems.

Various Sections in USMLE step 1 subjects focusing on individual organ systems are subdivided according to normal and abnormal processes. The principles of therapy are also included in the course specifications. Various disciplines are covered in details in Step 1 examination such as:

  • Anatomy.
  • Behavioral sciences.
  • Biochemistry.
  • Biostatistics and epidemiology.
  • Microbiology.
  • Pathology.
  • Pharmacology.
  • Physiology.

The interdisciplinary areas as mentioned below are also covered in the Step 1 examination:

  • Genetics.
  • Aging.
  • Immunology.
  • Nutrition.
  • Molecular and cell biology.

The above list is just an indicative one and not all the topics listed are included in every USMLE examination. Overall content coverage is comparable in the various examination forms that will be taken by different examiners for each Step. It also includes subcategories of specific disease processes.

USMLE-1 does not have specific course curriculum but in general, is based on various systems and the processes (Normal Processes and Abnormal Processes). It is a highly practical test and theoretical knowledge is not enough. In most instances, knowledge of normal processes is evaluated in the context of a disease process or specific pathology. The contents of the course are subject to change.


The students who have opted for MBBS abroad (Or pursuing it in India) can buy our online coaching module for USMLE step 1. This way, you start your preparation for PG while completing MBBS. There are 2 options for the students studying MBBS in abroad.

  1. Online course (MD Guide for USMLE Step 1)
  2. Live Review Classes.

It provides a flexible structure for test construction that can readily accommodate new topics, emerging content domains, and shifts in emphasis. Broadly based learning that establishes a strong general understanding of concepts and principles in the basic sciences is the best way to prepare for the examination. So if you are dreaming of studying MBBS in USA, you must understand the first challenge that you are going to face!

Step 1 classifies test items along two dimensions, system and process, as shown in Table 1 below.

Step 1 Test Specifications.

Table 1: USMLE Step 1 Test Specifications.*

System Range
General Principles of Foundational Science** 15%-20%.
Immune System.

Blood & Lymphoreticular System.

Behavioral Health.

Nervous System & Special Senses.

Skin & Subcutaneous Tissue.

Musculoskeletal System.

Cardiovascular System.

Respiratory System.

Gastrointestinal System.

Renal & Urinary System.

Pregnancy, Childbirth, & the Puerperium.

Female Reproductive & Breast.

Male Reproductive.

Endocrine System.

Multisystem Processes & Disorders.

Biostatistics & Epidemiology.

Population Health.

Social Sciences.

Process Range
Normal Processes. 10%-15%.
Abnormal Processes. 55%-60%.
Principles of Therapeutics. 15%-20%.
Other. 10%-15%.

Further the Step 1 exam is organized by physician task and competency, as shown below.


Test items are constructed to assess one of the competencies listed below.

Table 2. USMLE Step 1 Specifications: Physician Task/Competencies.*

Competency. Range.
Medical Knowledge/Scientific Concepts. 55% – 65%.
Patient Care: Diagnosis.
· History/Physical Examination. Laboratory/Diagnostic Studies. Diagnosis·
20% – 30%.
Patient Care: Management***.

· Health Maintenance/Disease Prevention ·




Practice-based Learning and Improvement. 4%-8%.

* Percentages are subject to change at any time. See the USMLE Web site for the most up-to-date information.

** The general principles category includes test items concerning those normal and abnormal processes that are not limited to specific organ systems. Categories for individual organ systems include test items concerning those normal and abnormal processes that are system-specific.

*** The Step 1 examination includes management questions in only the categories listed in this table. It does not include questions related to clinical interventions, mixed management, or surveillance for disease recurrence. This category includes questions about normal structure and function that may appear in the context of an abnormal clinical presentation.

Approximately 10%-15% of questions are not classified in the normal processes, abnormal processes, or principles of therapeutics categories. These questions are likely to be classified in the general principles, biostatistics / evidence-based medicine, or social sciences categories in the USMLE Exam Content Outline.

What is USMLE Exam?

Step 1 consists of MCQ (multiple-choice questions) prepared by examination committees composed of faculty members, teachers, investigators, and clinicians with recognized prominence in their respective fields. There are many USMLE Step 1 books available on-line but Kaplan USMLE is most widely used by the students.

USMLE step 1 preparation is a tedious task and needs huge amount time, efforts and dedication with high-quality teaching and mentoring at the university. The university would provide you with USMLE step 1 books and test series. The test is designed to measure basic science knowledge. Some questions test the examinee's fund of information per se. But the majority of questions require the examinee to interpret the graphic and tabular material. Also, to identify gross and microscopic pathologic and normal specimens, and to solve problems through the application of basic science principles.

USMLE Step 1 Exam Focus and Strategies.

  • Organizes Basic Science contents on general principles and organ systems.
  • 18 different areas for creating test area.
  • Tests concepts and principles of organs & within individual organs.

How to Prepare for USMLE Step 1.

  • Read each question carefully. It is important to understand what is being asked.
  • Try to generate an answer and then look for it in the options list.
  • Alternatively, read each option carefully, eliminating those that are clearly incorrect.
  • Of the remaining options, select the one that is most correct.
  • If unsure about an answer, it is better to guess since unanswered questions are automatically counted as wrong answers.

USMLE Sample Question.

A single patient-centered vignette is associated with one question followed by four or more response options. The response options are lettered (ie, A, B, C, D, E). A portion of the questions involves interpretation of graphic or pictorial materials. You are required to select the best answer to the question. Other options may be partially correct, but there is only ONE BEST answer. This is the traditional, most frequently used multiple-choice question format on the examination. USMLE step 1 questions become very easy once you adapt to learning a practical and conceptual aspect of system and process.

The questions are prepared by examination committees composed of faculty members, teachers, investigators, and clinicians with recognized prominence in their respective fields. Committee members are selected to provide broad representation from the academic, practice, and licensing communities across the United States and Canada.

On passing Step 1 examination, you would be eligible for clinical rotation of 2 years at a teaching hospital. Always choose clinical rotation or clerkship instead of observership.

USMLE Step 1 Passing Percentage Ratio.

We can easily assess the passing percentage of USMLE steps by retrieving it from USMLE. It may be noted that those students who need to repeat the exam pass (40%) with lower % in comparison with those who take it for the first time (Around 90%). Also, those who studied in USA and Canada, the passing % s far higher than those who are international students appearing for this exam. Click here to understand the past performance in this exam in 2014-15! The results cover latest news up to February, 2016. This 280 marks exam lasting for 8 hours would be deciding the final destiny for you to practice medicine in USA.

Retaking the Exam.

One can retake the step 1 exam totally for a maximum of 6 times. However, in a year, the students can appear only for 3 times.