The USMLE Step 1 (more commonly just Step 1 or colloquially, The Boards) is the first part of the United States Medical Licensing Examination. It assesses whether medical school students or graduates can apply important concepts of the sciences fundamental to the practice of medicine. US medical students typically take Step 1 at the end of the second year of medical school. Graduates of international medical schools must also take Step 1 if they want to practice in the US. Graduates from international medical schools must apply through ECFMG and the registration fee is $780.[1] From Fall 2011, the NBME registration fee for the test is $535, with additional charges for applicants who choose a testing region outside the United States or Canada.[2]
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The exam used to be an eight-hour computer-based test taken in a single-day, composed of seven 48-question sections with a total of 336 multiple-choice questions. Beginning May 15, 2010, the exam reduced the number of questions from 48 to 46 per section, for a total of 322 questions.[3] One hour is the time provided for each section, allotting an average of a minute and fifteen seconds to answer each question.[4] Between test sections, the test taker is allotted a cumulative 45 minutes (during the test day) for personal breaks. (There is a 15 minute tutorial at the beginning of the exam, which the test-taker can choose to skip and have that time added to break time.) If the taker finishes any section before the allotted one hour time limit, the unused time is added to the break time total.[5] The test is administered at any of several Prometric computer testing sites.
Step 1 is designed to test the knowledge learned during the basic science years of medical school. This includes 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.[6] Epidemiology, medical ethics and questions on empathy are also emphasized. Each exam is dynamically generated for each test taker; while the general proportion of questions derived from a particular subject is the same, some test takers report that certain subjects are either emphasized or deemphasized.
The USMLE phased out the use of a percentile based system in 1999. Examinees receive a three-digit score and a two-digit score; the latter of which is not a percentile. The three-digit score is a scaled score with a mean of 221 and a standard deviation of approximately 23 . The three-digit score is calculated using a statistical percentile that ensures that scores from different years are read on a common scale, since the exam is known to get progressively more difficult as the years go on. The two digit score is a scaled score that defines 75 as the minimum passing score, which is equivalent to a 188 on the three-digit scale. The three-digit score is more commonly used. As of October 3, 2011, USMLE began the process of eliminating the reporting of results on the two-digit score scale to any parties, including residency programs, other than the examinee and any state licensing authority to which the examinee sends results.
A score of 188 is needed to pass the test. At present, the national mean score is 221, with a standard deviation of approximately 23; an increase from the previous two means, which were 218 (standard deviation of 23) and 215 (standard deviation 20). Many residency programs use a "cutoff" score for Step 1, below which applicants are unlikely to be considered.
The USMLE score is one of many factors considered by residency programs in selecting applicants. However, at present, this test is the only standardized measure of all applicants. The median USMLE Step 1 scores for graduates of U.S. Medical Schools for various residencies are charted in Chart 6 on page 9 of "Charting Outcomes in the Match" available at http://www.nrmp.org/data/chartingoutcomes2011.pdf
Students in American medical schools take this test at the end of their second year of medical school, which is usually required for progression into the clinical third year. The test is standardized and thus allows for a direct comparison between medical students nationally, although the USMLE test scores were not designed for this purpose. Performance on this test is also one of the selection criteria used in the NRMP match program for residencies. A passing score on this test indicates that the medical student has grasped the core scientific knowledge taught during the 'basic sciences' years.