Intro to Step 1 of the USMLE

I took my diagnostic practice test today, which is one of the NBME exams. (NBME is the National Board of Medical Examiners, the organization that adminsters the medical boards.) I am happy to report that I am already well above the passing mark at this point. Even if I didn't study at all between now and July 1, I'd almost certainly pass the test. Of course, I want to score higher than I am right now, but it's still a huge relief to know that I am starting from this point!

For those of you who are not familiar with the USMLE (United States Medical Licensing Exam), here's a brief primer on it. There are three parts of the USMLE, which are called Step 1, Step 2 and Step 3. (Step 2 actually has two parts, but we won't get into that right now.) Step 1 is usually taken after the second year of medical school, Step 2 is usually taken in the fourth year of medical school (or possibly the fifth year for CCLCM students), and Step 3 is taken after the first year of residency. I'm going to mainly talk about Step 1 since that's where I am in the process.

Step 1 is a test of basic science knowledge. Some of the most important subjects that are tested include pathology, pharmacology, microbiology, biochemistry, and physiology. Other subjects that can show up include anatomy, embryology, psychology, epidemiology, cell/molecular biology, and histology. The test is eight hours long, including one hour total for break time. It is taken on a computer, but it is not adaptive (every question counts the same as every other). There are seven sections of 48 questions each, and you are given one hour per section. Once you finish a section, you cannot go back to that section. A passing score on Step 1 is currently 185 on the three digit scale. The average score for allopathic medical students (people working toward an MD) is around 220. No one knows what the maximum score is.

Step 1 is important to medical students because many competitive residency programs use it to screen out applicants. The next obvious question you are probably wondering is what constitutes a "good" score on Step 1. The answer to this question is highly subjective, and it also depends on what field you are trying to enter. My personal opinion is that any score above the mean is a good score (220+), and any score above 230 is a highly competitive score for most specialties.