Step 1
Step 1 assesses whether you understand the basic-science foundations of medicine — the knowledge that underpins every clinical decision that follows. Since January 2022 it has been reported pass/fail, which changed how students study for it and how programs use it, but it did not lower the stakes of a first attempt.
Before 2022, Step 1 carried a three-digit score that residency programs used as a screening tool. Since January 2022, examinees receive only a pass or fail. At the same time, the passing standard was raised from 194 to 196 — a change whose effect is visible in the national data: the US MD first-time pass rate fell from 95% in 2021 to 91% in 2022 and has drifted to 89% in 2024, roughly doubling the failure rate compared to the scored era.
The exam itself still covers the basic sciences in broad terms — anatomy, physiology, biochemistry, pathology, pharmacology, microbiology, and the behavioral and social sciences that frame medical practice. The change was in how results are reported, not in what the exam measures: it remains the exam that certifies a student has mastered the foundations before entering the clinics.
Step 1 is typically taken after the preclinical years — most commonly at the end of the second year in traditional four-year curricula. Many schools gate the transition to clerkships on a Step 1 pass, and many students plan a dedicated study period after finishing preclinical coursework. Timing policies vary by school, so a school's academic calendar and its Step 1 policy are the two documents that determine when an individual student sits for it.
Pass/fail does not mean stakes-free. Failed attempts are reported to residency programs, and the 2024 NRMP program-director survey found that 77% of respondents consider failed Step attempts when deciding whom to interview. Step 1 no longer stratifies applicants by score — but a clean first attempt remains the expected baseline, and a failure must be explained.
National context (first-time takers): Step 1 US MD — 2021: 95%, 2022: 91%, 2023: 90%, 2024: 89%. US DO — 2021: 94%, 2022: 91%, 2023: 86%, 2024: 86%. Source: USMLE Performance Data (NBME), as summarized in AMA reporting.
Study design, resource strategy, practice-exam targets, failure-risk factors, and how schools support students — the full strategy guide lives on our companion site.
Open SI Step 1 →Passing standards, fees, eligibility rules, and attempt policies change over time — confirm the current rules at usmle.org and nbme.org.