Step 1 assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Step 1 ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning. Step 1 is constructed according to an integrated content outline that organizes basic science material along two dimensions: system and process. Step 1 is a one-day examination. 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 may vary, but will not exceed 40. The total number of items on the overall examination form will not exceed 280. Practice materials, which include Sample Test Items (PDF) and web-based Tutorial and Practice Test Items, as well as other informational materials, are available at the USMLE website. Examinees must also read the USMLE Bulletin of Information. IMPORTANT: The term item is used to describe a test question in any format.

You must run the web-based Tutorial and Practice Test Items to become familiar with the test software prior to your test date .

run the web-based Tutorial and Practice Test Items to become familiar with the test software . The tutorial provided at the beginning of the Step 1 Examination has fewer screens and less detailed information than the Step 1 web-based Tutorial and Practice Test Items on the USMLE website.

The web-based Tutorial and Practice Test Items on the USMLE website include items with associated audio findings. Become familiar with how these types of test items function before your test date. Please visit the USMLE website often to view announcements, regarding changes in the test delivery software, and to access updated practice materials. You must obtain the most recent information before taking any USMLE examination.

Step 1 consists of multiple-choice questions 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. 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 graphic and tabular material, to identify gross and microscopic pathologic and normal specimens, and to solve problems through application of basic science principles. The content description is not intended as a curriculum development or study guide. It provides a flexible structure for test construction that can readily accommodate new topics, emerging content domains, and shifts in emphasis. The categorizations and content coverage are subject to change. Broad-based learning that establishes a strong general understanding of concepts and principles in the basic sciences is the best preparation for the examination.

Beginning in October 2020, Step 1 examinations will include an increased number of questions that assess communications skills. The tables below provide information on the content weighting for Step 1 examinations administered before and after October 2020. All USMLE examinations are constructed from an integrated content outline, which 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 across organ systems or within individual organ systems. Content weighting for these topics is provided in Table 1 below. Sections focusing on individual organ systems are subdivided according to normal and abnormal processes, including principles of therapy. In most instances, knowledge of normal processes is evaluated in the context of a disease process or specific pathology. While not all topics listed in the content outline are included in every USMLE examination, overall content coverage is comparable among the various examination forms that will be taken by different examinees for each Step. Table 1: Step 1 Test Specifications* Before October 20, 2020 On or After October 20, 2020 System Range, % Range, % General Principles** 13-17 12–16 Blood & Lymphoreticular/Immune Systems 7-11 7-11 Behavioral Health & Nervous Systems/Special Senses 9-13 9–13 Musculoskeletal, Skin & Subcutaneous Tissue 6-10 6-10 Cardiovascular System 6-10 5-9 Respiratory & Renal/Urinary Systems 9-13 9-13 Gastrointestinal System 5-9 5-9 Reproductive & Endocrine Systems 9-13 9-13 Multisystem Processes & Disorders 7-11 6-10 Biostatistics & Epidemiology/Population Health 5-7 4-6 Social Sciences: Communication and Interpersonal Skills 3-5 6-9 * Percentages are subject to change at any time.

** The General Principles category for the Step 1 examination 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. Physician Tasks/Competencies An additional organizing construct for Step 1 design is physician tasks and competencies. Each test item is constructed to assess one of the competencies listed in Table 2. Click here for detailed information about the physician tasks and competencies outline. Table 2: Step 1 Physician Tasks/Competencies Specifications* Before October 20, 2020 On or After October 20, 2020 Competency Range, % Range, % Medical Knowledge: Applying Foundational Science Concepts 52–62 60–70 Patient Care: Diagnosis 20–30 20–25 Patient Care: Management 7–12 0** Communication and Interpersonal Skills 2–5 6–9 Practice–based Learning & Improvement 5–7 4–6 * Percentages are subject to change at any time.

** Test items related to management will be covered in Step 2 CK examinations. Finally, each Step 1 examination covers content related to traditionally defined disciplines and interdisciplinary areas listed in Table 3. Table 3: Step 1 Discipline Specifications* Before

October 20, 2020 On or After

October 20, 2020 System Range, % Range, % Pathology 45–52 44–52 Physiology 26–34 25–35 Pharmacology 16–23 15–22 Biochemistry & Nutrition 14–24 14–24 Microbiology 11–15 10–15 Immunology 7–11 6–11 Gross Anatomy & Embryology 11–15 11–15 Histology & Cell Biology 9–13 8–13 Behavioral Sciences 8–12 8–15 Genetics 5–9 5–9 * Percentages are subject to change at any time.