Step 1 Announcements

Bulletin of Information

The USMLE Bulletin of Information is a compilation of all the facts and details about the USMLE. Before you apply for any of the three steps of the USMLE, you must become familiar with the bulletin.

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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.

Step 1 is a one-day examination. The testing day includes 322 multiple-choice items divided into 7 blocks of 46 items; 60 minutes are allotted for completion of each block of test items. On the test day, examinees have a minimum of 45 minutes of break time and a 15- minute optional tutorial. The amount of time available for breaks may be increased by finishing a block of test items or the optional tutorial before the allotted time expires.

Content Description


Step 1 consists of multiple-choice questions prepared by examination committees composed of faculty members, teachers, investigators, and clinicians with recognized prominence in their respective fields. Committee members are selected to provide broad representation from the academic, practice, and licensing communities across the United States and Canada. 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.

Step 1 is constructed from an integrated content outline that organizes basic science content according to general principles and individual organ systems. Test questions are classified in one of these major areas depending on whether they focus on concepts and principles that are important across organ systems or within individual organ systems.

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, and molecular 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.

The Step 1 content outline describes the scope of the examination in detail but is not intended as a curriculum development or study guide. It provides a flexible structure for test construction that can readily accommodate new topics, emerging content domains, and shifts in emphasis. The categorizations and content coverage are subject to change. Broadly based learning that establishes a strong general understanding of concepts and principles in the basic sciences is the best preparation for the examination.

For more information on Step 1 Content....

Content Outlines

NOTE: Examinees who test during or after mid-May 2014 may wish to refer both to the content outline below and to the USMLE Content Outline used for all Step 1 examinations administered after mid-May 2014. As announced in April 2014, the differences between the two outlines are small.

  1. General Principles

  2. Hematopoietic and Lymphoreticular Systems

  3. Central and Peripheral Nervous Systems

  4. Skin and Related Connective Tissue

  5. Musculoskeletal System

  6. Respiratory System

  7. Cardiovascular System

  8. Gastrointestinal System

  9. Renal/Urinary System

  10. Reproductive System

  11. Endocrine System

  12. Immune System

Test Question Formats

Step 1 consists of multiple choice questions with only one best answer. Each question will be structured with a statement or question followed by three to eleven response options, each labeled with a letter (e.g: A, B, C, D, E) and arranged logically or alphabetically. Some response options will be partially correct, but only one option will be the best and correct answer. A portion of these questions will also involve the interpretaion of graphs and images.

The questions are prepared by examination committees composed of faculty members, teachers, investigators, and clinicians with recognized prominence in their respective fields. Committee members are selected to provide broad representation from the academic, practice, and licensing communities across the United States and Canada.

Strategies for Answering the Test Questions

  • Read each question carefully. It is important to understand what is being asked.
  • Try to generate an answer and then look for it in the option list.
  • Alternatively, read each option carefully, eliminating those that are clearly incorrect.
  • Of the remaining options, select the one that is most correct.
  • If unsure about an answer, it is better to guess since unanswered questions are automatically counted as wrong answers.

Example Question

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?

  • Acute blood loss
  • Chronic lymphocytic leukemia
  • Erythrocyte enzyme deficiency
  • Erythropoietin deficiency
  • Immunohemolysis
  • Microangiopathic hemolysis
  • Polycythemia vera
  • Sickle cell disease
  • Sideroblastic anemia
  • b-Thalassemia trait

(Answer: D)

Sequential Item Sets

A single patient-centered vignette may be associated with two or three consecutive questions about the information presented. Each question is linked to the initial patient vignette but is testing a different point. Questions are designed to be answered in sequential order. You are required to select the one best answer to each question. Other options may be partially correct, but there is only ONE BEST answer. You must click "Proceed to Next Item" to view the next item in the set; once you click on this button, you will not be able to add or change an answer to the displayed (previous) item.