USMLE Step 1 Requirements & Prerequisites
Everything you need to know before registering for the USMLE Step 1, eligibility, cost, format, and what to expect on exam day.
Cost
$665
Provider
NBME/FSMB
Validity
7 years for licensing
Available
USA
Education
Check official exam requirements
Experience
3-5+ years of professional experience typically required
Specific Requirements
- There is no coursework requirement, no minimum grade and no experience requirement for Step 1. What USMLE requires is a category of enrolment, both at the time you apply and on the day you test. You must be a medical student officially enrolled in, or a graduate of, a US medical school leading to the MD degree accredited by the LCME; or a student or graduate of a US medical school leading to the DO degree accredited by COCA; or a student or graduate of a medical school outside the United States that is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements and that meets ECFMG's other criteria. International medical graduates must have an accepted Application for ECFMG Certification before applying for their first Step exam, and their name of record with FSMB must exactly match their name of record with Intealth. Since January 2026, students and graduates of LCME and COCA-accredited US programmes register through NBME's MyUSMLE Portal, and everyone else registers through FSMB. Individuals who graduated from Canadian medical schools on or after 1 July 2025 are treated as international medical graduates. If you are dismissed from or withdraw from medical school you lose eligibility immediately, even while appealing, and failing to report a change in status can be treated as irregular behaviour. Anyone already licensed by a US medical board on the basis of other examinations, such as FLEX, MCCQE, NBME Parts or COMLEX-USA, may not be eligible at all.
Number of Questions
280 multiple-choice items maximum. In the format used from 14 May 2026, that is up to 20 items in each of fourteen blocks; in the earlier format it was up to 40 items in each of seven blocks.
Duration
420 minutes of testing time inside one 8-hour session. Exams on or after 14 May 2026 use fourteen 30-minute blocks; exams before that date used seven 60-minute blocks. The 8-hour day also contains a minimum of 55 minutes of break time and a 5-minute optional tutorial in the newer format, or 45 minutes of break and a 15-minute tutorial in the older one. Finishing a block or the tutorial early adds the unused minutes to your break bank.
Question Format
Single-best-answer multiple choice built on a patient-centred vignette, with four or more lettered options and exactly one best answer, Items requiring interpretation of graphic and tabular material, including lab panels and physiological tracings, Items requiring identification of gross specimens, microscopic pathology slides and normal histology, Items with associated audio findings, such as heart and lung sounds, which is why the headphone sound check must be run before or during the tutorial, Biostatistics and epidemiology items on study design, research ethics and regulatory issues, Communication items that ask for the most appropriate initial statement by a physician
Passing Requirement
USMLE states that on the three-digit scale the Step 1 passing standard is 196, and that examinees typically must answer approximately 60 per cent of items correctly to achieve a passing score. USMLE has said that future reviews of the Step 1 passing standard will not be reported in terms of a three-digit score.
How It Is Delivered
Computer-based at Prometric test centres, with biometric check-in. Step 1 is administered worldwide, unlike Step 3, which is offered only in the United States and its territories. There is no online-proctored, at-home option.
Languages Offered
English
Visit the official NBME/FSMB certification page
Create an account and select your exam
Choose a test center or online proctoring option
Pay the exam fee and schedule your date
Score Scale
Pass or fail only, for every exam administered on or after 26 January 2022. USMLE results were historically reported on a three-digit scale and Step 2 CK and Step 3 still are, at minimum passing scores of 218 and 200 respectively, but Step 1 examinees receive no number.
Score You Need
USMLE states that on the three-digit scale the Step 1 passing standard is 196, and that examinees typically must answer approximately 60 per cent of items correctly to achieve a passing score. USMLE has said that future reviews of the Step 1 passing standard will not be reported in terms of a three-digit score.
How It Is Calculated
The standard is criterion-referenced, not curved: USMLE states that no predetermined percentage of examinees will pass or fail, because passing depends on reaching a fixed proficiency level. Statistical equating keeps that level constant across different forms, which is why the percentage of items you must answer correctly varies from form to form. Scoring is compensatory across systems; there is no per-domain minimum. Wrong answers carry no extra penalty, and unanswered items are scored as wrong.
When You Get Results
There is no unofficial result at the test centre. USMLE's results page says results are typically available within four weeks of the test date and the Bulletin of Information says two to four weeks; both add that various factors can delay reporting and that you should allow at least eight weeks when choosing a test date. Scores are processed continuously and reported weekly. You get an email from your registration entity, NBME for US students and graduates or FSMB for international medical graduates, and the score report stays on that entity's site for about 365 days before you must pay for a transcript instead.
In raw terms: USMLE publishes no raw-to-scale conversion table for Step 1. The only raw figure it gives is that examinees typically must answer approximately 60 per cent of items correctly to pass, and it states that this percentage varies by Step and from form to form.
- Two forms of valid ID (one government-issued with photo)
- Appointment confirmation email
- For online proctoring: webcam, microphone, clean desk, stable internet
What are the prerequisites for the USMLE Step 1?
There is no coursework requirement, no minimum grade and no experience requirement for Step 1. What USMLE requires is a category of enrolment, both at the time you apply and on the day you test. You must be a medical student officially enrolled in, or a graduate of, a US medical school leading to the MD degree accredited by the LCME; or a student or graduate of a US medical school leading to the DO degree accredited by COCA; or a student or graduate of a medical school outside the United States that is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements and that meets ECFMG's other criteria. International medical graduates must have an accepted Application for ECFMG Certification before applying for their first Step exam, and their name of record with FSMB must exactly match their name of record with Intealth. Since January 2026, students and graduates of LCME and COCA-accredited US programmes register through NBME's MyUSMLE Portal, and everyone else registers through FSMB. Individuals who graduated from Canadian medical schools on or after 1 July 2025 are treated as international medical graduates. If you are dismissed from or withdraw from medical school you lose eligibility immediately, even while appealing, and failing to report a change in status can be treated as irregular behaviour. Anyone already licensed by a US medical board on the basis of other examinations, such as FLEX, MCCQE, NBME Parts or COMLEX-USA, may not be eligible at all..
How much does the USMLE Step 1 cost?
The USMLE Step 1 exam costs $665. This includes the exam fee only, study materials are additional.
How do I register for the USMLE Step 1?
Visit the official NBME/FSMB certification page → Create an account and select your exam → Choose a test center or online proctoring option → Pay the exam fee and schedule your date
What should I bring to the USMLE Step 1?
Two forms of valid ID (one government-issued with photo). Appointment confirmation email. For online proctoring: webcam, microphone, clean desk, stable internet.
Ready to prepare for USMLE Step 1?
Get the complete exam guide with study plan, tips, and practice questions.
View USMLE Step 1 Guide