What’s on the USMLE Step 1?

  • /Reviewed by: Amy Rontal, MD
  • Find out all of the relevant content categories for Step 1 studying, our stats on Step 1 exam dates, and study plans.

    After completing your basic science courses and two years of medical school, you have probably learned more about medicine than you ever thought possible. So how much of this is going to be on the test?

    You may want to know the structure of the USMLE Step 1 and the tested content areas to help you build a study plan. Below we explain the structure of the exam and list the distribution range for content areas. We also share some of our statistics on how long students study on average and what month students choose to take Step 1.


    Step 1 is divided into 7 blocks of multiple choice questions. Each multiple choice question has at least 4 answer choices. One and only one answer choice is correct. For examples, see the USMLE Step 1’s Sample Questions. You have the option to take a 15-minute tutorial prior to taking the exam. Break time may exceed 45 minutes if you finish early on one or more blocks.

    Total Testing Time: 7 hours and 45 minutes
    Time per Block: 60 minutes
    Break Time Allotted: 45 minutes
    Total Multiple Choice Items: No more than 280
    Items per Block: No more than 40

    Content Areas

    Test questions are divided among two dimensions: systems and processes. You will find a range next to each topic that tells you the distribution range for the amount questions you can expect.


    General principles: 15%–20%

    Organ systems: 60%–70%

    • Immune
    • Hematopoietic/lymphoreticular
    • Nervous
    • Skin/connective tissue
    • Musculoskeletal
    • Respiratory
    • Cardiovascular
    • Gastrointestinal
    • Renal/urinary
    • Reproductive
    • Endocrine

    Multisystems 15%–20%

    • Multisystem Processes and Disorders
    • Biostatistics, Epidemiology, and Interpretation of Medical Literature
    • Social Sciences

    For a breakdown of specific topics tested under each organ system, see the USMLE’s official Content Outline.


    Normal structure and function: 10%–15%

    Abnormal processes: 55%–60%

    Principles of therapeutics: 15%–20%

    Biostatistics, Social Sciences and General Principles: 10%–15%

    How should I prepare for Step 1?

    To see the most popular Step 1 textbooks, lecture series, question banks, and flashcards, visit blueprintprep.com/medical/med-school/study-schedule/study-stats. For information on NBME Step 1 self-assessments, see nsas.nbme.org.

    How long do most students study for Step 1?

    According to Cram Fighter’s statistics, most students study for 100 days.

    The top three months among Cram Fighter users for taking Step 1 are (in order of popularity) June, April, and May. For a complete list, visit our page on the most popular months for taking Step 1.

    About the Author

    Erica Forrette is the former Director of Marketing at Cram Fighter.