The Comprehensive USMLE Guide For Pakistani Medical Students (Part 4: Step 1 FAQs)

1. What is the Step 1 exam format?

The Step 1 exam is a computer-based test taken in a single day over an eight hour period. It’s a multiple choice question test that includes seven 60 minute blocks the number of questions per block varies but the number never exceeds 40. That’s an average of one minute and 18 seconds per question. The total number of questions is 280.

Test takers are allowed 45 total minutes during the test for personal breaks. If you finish any section before the allotted hour is up, you can add that time to your personal break total. Six breaks total are allowed. There is an optional 15 minute tutorial period at the beginning of the exam. If you choose to skip the tutorial you can add the 15 minutes to your total break time.

During the test, you are only allowed to bring soft foam earplugs into the examination room. Nothing else is allowed – no bags, electronics, phones, or even jackets are allowed. Be sure to check with the exam monitor prior to entering the test room for complete details.

2. How do I apply for Step 1?

Students or graduates of medical schools outside of the U.S. or Canada register with the Educational Commission for Foreign Medical Graduates (ECFMG). Tests are administered by appointment year round.

3. How much does the test cost?

Step 1 fee is $895 and ECFMG registration fee is $75.

4. What is covered in the exam?

Step 1 mainly covers basic scientific principles including anatomy, behavioral sciences, biochemistry, microbiology, pathology, pharmacology, and physiology. Interdisciplinary topics covered include genetics, aging, nutrition, immunology, molecular and cell biology, epidemiology, and medical ethics.

Some questions test your understanding of basic facts and definitions. But the majority deal with your ability to solve problems using basic scientific principles. For example, you’ll be asked to interpret graphs, identify gross and microscopic pathology and normal specimens, and apply concepts and principles relevant to individual organ systems.

5. When should I take the test?

That entirely depends upon you and your circumstances. Some IMGs appear for the exam in the start of their 5th year. Others a few months before the final proof. Some appear for it before house-job while some after their house job.

If you think you’ll be able to study with med school then i’d say giving the exam in final year is a good option you’ll save time (plus programs prefer fresh graduates) . similarly if you think once you’re done with MBBS you won’t be able to study or focus then again giving the exam in final year is worth it.  But if your financial circumstances are constrained then giving the exam after house job and saving up the money you earn is a good option. Similarly if you think you can’t cope with the stress of med school and MLE all at once, if you need some dedicated study time then prepping for the exam after the final prof is a good approach.

The timing depends entirely on your personality and circumstances. But never give the exam until you’re fully prepared because you get only one chance.

6. What is a competitive score?

Anything above 230 is a competitive score. 240 plus is considered an excellent score. Whereas anything above 250 is exceptional

7. When do I get my USMLE test results?

Scores for Step 1 are released each Wednesday. It usually takes three to four weeks for scores to be released. You will receive an email from the entity you registered with (in our case ECFMG) when your score is available. It will also be posted to that entity’s website. If you don’t receive an email within two months, it’s recommended that you contact the registration entity directly. The current pass rate is about 85%.

8. I passed Step 1 but am not thrilled with my score. Can I retake it to raise my score?

Unfortunately, the answer to this is no.

9. I didn’t pass the first time. Can I retake the exam?

Yes. You may take the USMLE Step 1 exam a maximum of three times within a 12-month period. Your fourth attempt must be at least 12 months after your first attempt, and at least six months after your most recent attempt. However if you haven’t passed in the first attempt then you might as well not give it a second time because there no chance you’ll get a residency if you haven’t cleared the exam with good scores in the first attempt.