USMLE Step 1 Exam Guide 2025: Format, Syllabus, Score Requirements, and Preparation Tips

The United States Medical Licensing Exam

The USMLE Step 1 is the first major milestone for medical students dreaming of practicing in the U.S. It is also known as USMLE Part 1.

It is the first of three exams in the United States Medical Licensing Examination series. It's designed to test your understanding of the basic sciences, essential to the practice of medicine.

Think of it as your foundation check-up. Are your medical basics solid? If yes, Step 1 is your chance to shine.

Exam Format- 2025 Edition

Step 1 is a one-day computer-based exam. The exam duration is around 8 hours. It's divided into 7 blocks, each lasting 60 minutes.

• Each block can have up to 40 questions.
• In total, there’ll be 280 MCQs.
• You get 45 minutes of break time.
• There is also an optional 15-minute tutorial.

If you’re a first-time test taker, use the tutorial. It will help you to get acquainted with the format.

What does the USMLE Step 1 test?

The USMLE exams are not just about memorization. The Step 1 exam tests how well you can apply basic science in real-world clinical scenarios.

The USMLE Step One exam is more about understanding than memorizing. 

What is the Scoring System for USMLE Step 1?

Since 2022, the Step 1 result has been displayed as Pass/Fail.

This means:

• No more 3-digit scores.
• A passing score is at or above 196.
• You can retake the exam if you fail.

Competitive residency programs review your transcript. If you pass on your first try, it adds weight to your CV.

Who Should Take Step 1

Step 1 is the first USMLE step for International Medical Graduates or IMGs.

Usually, in the USA, second or third-year medical students take it after completing basic sciences. 

IMGs should be enrolled in a medical college listed under the World Directory of Medical Schools (WDOMS).

Also, your school must meet ECFMG certification requirements.

Registration Process for USMLE Step 1

Step 1: Eligibility Check

For U.S. and Canadian Students:

Be enrolled in or a graduate of a medical school accredited by the:

• LCME (for MD programs) or 
• COCA (for DO programs)

For International Students:

• Your medical school must be listed in the WDOMS.
• You must be outside the U.S. or Canada.
• You will apply through ECFMG- Educational Commission for Foreign Medical Graduates.

Step 2: Register for a USMLE ID

For IMGs:

For U.S./Canadian Students:

You’ll need the following documents:

• A valid email address
• Passport-sized photo
• A valid passport
• Government-issued ID

Step 3: Apply for an Eligibility Period

• Choose a 3-month eligibility window 
• You can take the test during this period
• Schedule your exam.

Pick a window that gives you enough time to prepare.

Step 4: Pay the Exam Fees

• U.S./Canadian Students: USD 670 
• IMGs: USD 1020 (INR 87,720)
• Fees for International testing centers: USD 205 (INR 17,630)

Pay online via credit card during the application process.

Step 5: Submit Certification Documents

Once submitted and verified, ECFMG will approve your application. Your Scheduling Permit will be emailed to you within a few weeks.

Step 6: Schedule Your Exam on Prometric

• Click on “Schedule My Test”
• Select USMLE as your exam
• Choose your preferred test center and available date
• Confirm the appointment and print the confirmation

Required Documents Checklist

What Happens After Applying?

• After scheduling, you can reschedule (with a fee) if needed.
• On exam day, arrive early.
• Bring your Scheduling Permit and a valid ID to the test center.
• Results are sent via email in about 3 to 4 weeks.

Timeline Overview

Final Tips

• Apply 2 to 3 months before your desired exam date.
• Keep scanned copies of all documents.
• Use only the official websites: 
• ECFMG
• NBME
• Prometric
• Don’t forget to practice with the USMLE sample tutorial before exam day.

Preparation Tips: How to Crush Step One

Start Early, Stay Consistent

Most students prep for 3-6 months. But the key is to be consistent with your preparation.

Top Resources for Step 1

• First Aid for USMLE Step 1 
• UWorld for the question bank
• Pathoma for pathology
• Sketchy for microbiology and pharma

Study Plan Example

1. Months 1- 2: Learn & revise with First Aid, watch Pathoma.
2. Months 3 - 4: Start UWorld and Sketchy. Also, start with Anki.
3. Months 5 - 6: Take practice tests and identify weak areas. Revise as much as you can. 

Also Read:  USMLE Step 1 Practice Questions & Exams 

Common Mistakes to Avoid

• Rushing through UWorld
• Ignoring review
• Memorizing without understanding

Practice Exams & Self-Assessment

Use NBME practice tests and UWorld self-assessments to know your readiness. Some popular ones:

• NBME Forms 25–27
• UWSA1 & UWSA2
• NBME Free 120, which is the official sample questions

If you’re consistently scoring above 65-70%, you’re likely exam-ready. 

The best way to prepare is by joining a USMLE Preparation Course. The structured format and routine assessment will help with an organized preparation plan. 

Test Day Tips

• Sleep well the night before.
• Carry a valid ID and confirmation email.
• Pack snacks and water.
• Use break time wisely.

Don’t panic if one block feels tough. Each block is scored separately.

Visual mnemonics and patient-based cases are very helpful.

How to Stay Motivated?

• Join a study group or online forum.
• Set weekly goals.
• Reward yourself after long sessions.

Final Thoughts: Make Step 1 Your Stepping Stone

USMLE Step 1 is a challenge, yes. But it’s also a huge opportunity to prove your knowledge and dedication.

You’re not alone in this journey. Thousands of students crack it every year. With the right strategy, resources, and mindset, you can too.

And Academically is here to guide every step of the way. With us, you’ll find:

• Successful alumni
• Expert teacher
• AI-Backed Mock Exams
• Personalized class
• Recorded and Live Sessions
• Document and Resume Help

And so much more. Connect today and explore all your options.

Your future in the U.S. healthcare system begins here.