USMLE® Step 1: What You Need to Know

Anna Piazza - Feb 07, 2019
Images of the AMBOSS USMLE Step 1 Study plan and an histology image.

Update:  On January 26, 2022, the USMLE®  Step 1 exam became pass/fail. This means you are no longer dependent on the previous three-digit score. Read the official USMLE announcement here.

For many of you, the USMLE® Step 1 is approaching and, over the next few months, you’ll be solidifying your study strategies and trying to build up your confidence. 

There’s already plenty you know about Step 1: You know that of the three Step exams it has been considered the most difficult and the most likely to impact your medical school career. However, as Step 1 moves to pass/fail, students will no longer need to aim for an astronomically high 3-digit  score to succeed. With that said, it’s still vital to be as prepared as you can for Step 1.




But even knowing this, a lot of Step 1 can feel like a mystery—particularly as the impact of the exam moving to pass/fail is not yet known. Let’s take a look at some aspects of the exam so you can be prepared and feel confident on exam day

About the USMLE Step 1 exam

First, the basics: “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.” That’s over two years’ worth of material and diagnostic know-how you’ve likely covered in class by this point, and which you’ll have to review and master over the next few months.

Second, some hard facts concerning the pass/fail rate: In 2017, 96% of the 21,353 medical students from MD programs in Canada and the US who took the exam the first time passed. That’s reassuring news, as it means you’re likely to pass the exam on your first attempt.

If I only need to pass, should I study less?

While the pressure may be off getting a super high score, performing well on Step 1 will still have a major impact on the rest of your medical school career. Your Step 1 knowledge base will dictate both your Step 2 score and your performance in shelf exams. And as the Step 2 score is likely to become much more important, this means your Step 1 prep will influence your choice of specialty and, ultimately, the residency programs you match with.

This is why we recommend studying for Step 1 with the intention of performing as well as you possibly can. If you put in the work now, you’ll save yourself a lot of time and headaches in the long run.

What if I fail Step 1?

Failing Step 1 doesn’t mean you won’t graduate from your program and it definitely doesn’t mean your medical career is over. When the time comes to apply to residency programs, just remember that your Step 1 performance is only one piece of the puzzle.

Students who fail Step 1 do have the opportunity to retake it up to four more times, but failing and retaking it does remain on your “record.” So, should it happen to you, take it as an opportunity to reflect on your career goals, and do some course-correcting. Continue working hard throughout the rest of your med school years, aim to do well on the Shelf and remaining Step exams, and build a good reputation both in the classroom and on the wards. Leon McDougle, MD, MPH, professor of family medicine and associate dean for diversity and inclusion at the Ohio State University College of Medicine in Columbus offers a hopeful message: "Work with your faculty and education specialist to increase your likelihood to pass on the second attempt…[b]e encouraged. Keep moving forward. The journey continues."

And there is another reason to be hopeful: recent data from the AAMC shows “that a majority of US MD applicants who fail the USMLE Step 1 exam on the first attempt still go on to a residency.

How should I prepare for Step 1?

Many of you will be taking Step 1 in spring or summer and will want to know how to achieve the highest possible score. With this in mind, let’s take a look at the best way to study for it.

Studying for Step 1 is a highly personal experience. What will work for you may not work for someone else and vice versa. However, you can still take inspiration and guidance from those who have already taken it. Take Ugo Udogwu, a fourth-year student we spoke to last year who generously shared her Step 1 prep advice. Her tips include: 

  • “It’s a marathon, not a sprint.” 
  • Trust your process once you’ve figured out a plan.
  • Make sure you take advantage of “dedicated time” if your university offers it. 
  • Go through lots and lots of questions using a resource that meets all your needs (like AMBOSS).

In short, do your due diligence and you’ll be just fine. Step 1 is a difficult and important exam, but by going in with a clear head and measured expectations, you’ll come away feeling confident. 


For more in-depth insight into taking the Step 1 exam, check out our webinar with AMBOSS Chief Editor and Physician, Zebulon Tolman. 


*Edited for correction