USMLE Step 1

The USMLE Step 1 (more commonly just Step 1) is the first part of the United States Medical Licensure Examination. It assesses whether medical school students or graduates can apply important concepts of the sciences basic to the practice of medicine. US medical students typically take Step 1 at the end of the second year of medical school. Graduates of international medical schools must also take Step 1 if they want to practice in the US.

Format
The exam is an eight-hour single-day computer-based test composed of seven 50-question sets (350 multiple-choice questions in total). Each section is one hour long, allotting a minute and twelve seconds for each question. The test taker is permitted 45 minutes in total for the whole day for the purpose of breaks that can only be taken between sections. There is a 15 minute tutorial at the beginning of the exam, which the test-taker can choose to skip, and have the time added to the break time. If the taker finishes any section before the alloted 1 hour time limit, the remainder of the time is added to break time. The test is administered at Prometric testing sites around the world.

Subjects
Step 1 is designed to test the knowledge learned during the basic science years of medical school. This usually includes Anatomy, Biochemistry, Histology, Physiology, Neuroscience, Psychology, Genetics, Pathology, Microbiology, Pharmacology, Molecular Biology, Immunology and Statistics. Epidemiology, Medical Ethics and questions on Empathy are also emphasised. The exams are dynamically generated for each individual test taker, so though the general proportion of questions from each subject is relatively the same for each person, some test takers report that certain subjects are either emphasized or deemphasized on their particular exam.

Scoring
The USMLE phased out the use of a percentile based system in 1999. A score report is given as a three-digit and two-digit score. The 3-digit score is calculated using statistical procedures that ensure that scores from different years are on a common scale and have the same meaning. The 2-digit score is derived from the 3-digit score, it is not a percentile. It is used in score reporting to meet requirements of some medical licensing authorities that the passing score be reported as 75. Those who take the exam on or after January 1, 2007, will need a score of 185 to pass in the exam. The national yearly average is approximately 215 with a standard deviation of 20. In recent administrations, the mean score for U.S. and Canadian first-time test takers was 218 and the standard deviation was 23. Many residency programs have cutoffs for Step 1 scores below which applicants are unlikely to be interviewed.

Effect on Residency Matching
The USMLE score is just one of many factors considered by residency programs in selecting applicants. The median USMLE Step 1 scores for graduates of U.S. Medical Schools for various residencies are charted in Figure 4 on page 11 of "Charting Outcomes in the Match" available at http://www.nrmp.org/matchoutcomes.pdf

Preparation
Most students set aside approximately one month in order to prepare for Step 1. Most medical schools build this study period into their curriculum as a "vacation" period between the second and third years. While text books and review books are a large part of preparation, commercial test-prep services and software are extensively used. Steps 2 and 3 of the USMLE are considered easier to prepare for, leading to the adage that the preparative work for Steps 1, 2, and 3 respectively are "two months, two weeks, two pencils."

Uses of test
Students in American medical schools take this test at the end of their second year of medical school and it is usually required for progression into the third year of medical school. The test is standardized and it allows medical students to be directly compared with each other on a national basis although the creators of the USMLE wish that scores not be used for this purpose. Performance on this test is one of the selection criteria used in the NRMP match program for residencies. A favorable score on this test indicates that the medical student has grasped the core scientific knowledge imparted during the basic science years.