USMLE Step 1

Download Step 1 Content description and sample test materials

INTRODUCTION

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.

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.

Sections focusing on individual organ systems are subdivided according to normal and abnormal processes, principles of therapy, and psychosocial, cultural, and environmental considerations. Each examination covers content related to the traditionally defined disciplines of anatomy, behavioral sciences, biochemistry, microbiology, pathology, pharmacology, and physiology, as well as to interdisciplinary areas including genetics, aging, immunology, nutrition, andmolecular and cell biology. While not all topics listed in the content outline are included in every examination, overall content coverage is comparable in the various examination forms that will be taken by different examinees.

EXAM CONTENT

Step 1 includes test items in the following content areas:

  • anatomy,
  • behavioral sciences,
  • biochemistry,
  • microbiology,
  • pathology,
  • pharmacology,
  • physiology,
  • interdisciplinary topics, such as nutrition, genetics, and aging.

Step 1 is a broadly based, integrated examination. Test items commonly require you to perform one or more of the following tasks:

  • interpret graphic and tabular material,
  • identify gross and microscopic pathologic and normal specimens,
  • apply basic science knowledge to clinical problems.

EXAM LENGTH AND FORMAT

The Step 1 is an 8 hour, computer-based exam in which Single One Best Answer Questions are asked. With the question asked, will be a list of 3 to 11 possible answers. Some of the possible answers may be partially correct, but you’ll have to choose the best one out of all the options.

For example:

A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure over the past 2 years. She has not yet started dialysis. Examination shows no abnormalities. Her hemoglobin concentration is 9 g/dL, hematocrit is 28%, and mean corpuscular volume is 94 m3. A blood smear shows normochromic, normocytic cells. Which of the following is the most likely cause?

(A) Acute blood loss

(B) Chronic lymphocytic leukemia

(C) Erythrocyte enzyme deficiency

(D) Erythropoietin deficiency

(E) Immunohemolysis

(F) Microangiopathic hemolysis

(G) Polycythemia vera

(H) Sickle cell disease

(I) Sideroblastic anemia

(J) Thalassemia trait

The correct answer being D.

The exam consists of approximately 350 questions which are divided into 7 sixty-minute blocks. Once you start a block, you can attempt the questions within it in any order you wish and can even change the answers, However, once you exit a block to move on to the next one, that block is sealed and you can no longer change the answers in it.

Official break-times are included within the 8 hours of this exam. In order to maximize your potential you need to make sure you don’t take breaks that are too long, or too early, or too late into the day. To this end, you must be thoroughly familiar with the rules governing these break times and try to simulate the exam at home before actually giving it. Sample CDs are available that contain 40 blocks of questions which you can use to simulate the exam several times over at home by solving 7 blocks in 8 hour periods. This will not only build up stamina, but also help you decide how best to manage your breaks in the exam.