Is Step 1 The Hardest Exam In The World?

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When exam season comes around, your friends may ask you, “Is Step 1 the hardest exam in the world?” I’m sure several medical students know about this nerve-racking exam and become uneasy when it’s time to take it.

The United States Medical Licensing Examinations (USMLE) are the most challenging and essential exams medical students take if they want to proceed with their fields. I know how much time you spend studying and reviewing for this test, so exam week is always hectic for you.

The USMLE has three parts: Step 1, Step 2, and Step 3. All medical students, local or foreign, must take these tests in different schooling years.

Is Step 1 the hardest exam in the world (1)

Which USMLE Step Exam Is The Hardest?

The most challenging exam depends on your studying strengths, but several medical students claim the USMLE Step 1 exam is the most difficult to pass. The Step 1 exam has a 93% passing rate for first takers, which is significantly lower than Step 2 (99%) and Step 3 (98%).

(How these numbers change with the new pass/fail model of Step 1 has yet to be seen.)

Part of what makes Step 1 particularly challenging is that it’s the med student’s first encounter with a USMLE exam. This lack of experience can heighten anxiety levels.

The USMLE Step 1 exam has eight sections, and the testing lasts eight hours. It’s a multiple-choice test covering general science subjects medical students learned from their early education, so they may feel an information overload when they study for this exam.

The USMLE Step 2 Clinical Knowledge (CK) exam is much simpler. It’s a one-day multiple-choice test that lasts for nine hours.

The USMLE Step 3 test lasts for two days, with a total time of 16 hours. This final exam determines if you can practice medicine unsupervised in an authentic setting.

Starting in January 2022, Step 1 changed its grading system. Instead of giving scores, it’s now about passing or failing.

This might sound good because you just need to pass, not aim for super-high scores. But here’s the catch: this change could make students less motivated to study hard, and that might result in fewer people passing the test.

So, while the rules have changed, the challenge is still there. So make sure to not let your guard down.

[Free Download] Want to have everything you need to be a top student on your medical journey? Get FREE access to our Med School Success Handbook to get 60+ tips including the best study, time management, mindset tips you need to be a top student. Download it here. 

Why Is USMLE So Difficult?

Medical students will take several exams while they’re in school, but the USMLE tests are the most difficult. The Step 1 test is the most difficult of the three, and here are some reasons why this test series is the most challenging one in medical school.

Extensive exam range

The USMLE exams are time-consuming and only allow minimal 45-minute breaks during sessions. These tests have several questions, and the topics are usually randomized, making this exam difficult for medical students.

Wide topics

These exams require students to study several materials in preparation; the Step 1 test alone requires you to review ten medical disciplines. Medical students need to dedicate significant time to their study sessions.

Study time

You might think studying for these exams is simple as they align with your medical schooling, but you must take the USMLE Step 1 test at the end of your second year. This timing means you must review for the USMLE while studying other materials for medical school and balancing internships.

Challenging multiple-choice questions

Most USMLE tests are multiple-choice, so you might think this feature simplifies the exam. However, the answers on the test are all close to being correct, so they are designed to lead you into choosing the wrong answer.

Is Step 1 the hardest exam in the world (2)

Is Step 1 The Hardest Exam In The World?

Exam difficulty is subjective, but data suggests the Step 1 exam is the most difficult of the USMLE tests. You take this test when you’re not accustomed to 8-hour long sessions and study several topics for the exam.

This test has a 93% passing rate for the first attempt and a 78% passing rate for international medical students.

Program directors previously considered the Step 1 test results as a determiner for resident selection, but now it’s relegated to a pass-fail exam, making the Step 2 exam more essential.

The time, topics, and scoring system make medical students feel like the USMLE Step 1 is the most challenging exam they will take during medical school. It would be best to start studying early to prepare for this difficult test.

P.S. Step 1 is harder than MCAT? Find out by clicking here.

How Hard Is USMLE Step 1?

The USMLE Step 1 test is the first significant exam medical students will take while they’re in school. This exam lasts eight hours and has 280 multiple-choice questions divided into eight sections.

The Step 1 test covers general science areas medical students studied during their pre-med years. These are the ten disciplines you must review for your Step 1 exam:

  • Biochemistry and Nutrition
  • Behavioral Science
  • Genetics
  • Histology and Cell Biology
  • Gross Anatomy and Embryology
  • Microbiology
  • Pathology
  • Immunology
  • Pharmacy
  • Physiology

Medical students often feel overwhelmed when they prepare for the USMLE Step 1 test. However, proper time management and a good reviewer can help you get a high score and secure a quality residency program.

[Free Download] Want to have everything you need to be a top student on your medical journey? Get FREE access to our Med School Success Handbook to get 60+ tips including the best study, time management, mindset tips you need to be a top student. Download it here. 

Which Is Harder, Step 1 Or Step 2?

Statistics show that the USMLE Step 1 exam has a lower passing rate than the Step 2, meaning students generally find it more complicated than the second exam. Factors like substantial study topics and short time limits impact the Step 1 exam difficulty.

The USMLE Step 2 test focuses more on clinical work and how the student will respond to specific situations, so this subject matter may be more straightforward as the students rely more on common sense.

Before, program directors considered the Step 1 exam the most essential factor to determine residency clinics, but since this test became a pass-fail material, the Step 2 test is more critical for medical students.

Is Step 1 Actually Hard?

The USMLE Step 1 exam is challenging as it covers broad topics in a randomized manner, so students always fear they will fail this test. The last 2021 test results showed that 7,800 failed the exam on their first try.

Don’t lose hope! You can always retake the exam in the future, but you may have to change your study habits.

Let’s see why students fail their first Step 1 exams:


The USMLE Step 1 test is something you should gradually study; you can’t memorize all the information the night before the test. You should start reviewing halfway into your first year in medical school.

Using low-quality study resources

Avoid using low-yield study resources, as these won’t help with your studying. Try to focus on resources like UWorld or First Aid, as they provide flashcards for spaced repetition learning.

Here are the actual resources that have helped me and other students for Step 1 prep: Best Step 1 Resources

Avoiding NBME practice exams

The NBME, or National Board of Medical Examiners offers excellent practice exams with similar content to the actual Step 1, 2, and 3 tests. These exams can also predict the passing rate for your upcoming examinations.

Take this practice exam when you begin your study period, and continue taking it every one to four weeks after.

Personal matters

Sometimes, unexpected situations in life can impact the time you need to take an exam. Health problems, family emergencies, or lack of preparation can affect your test mindset. You can push back the test and take it later rather than force it and get a low score.

In this YouTube video, I shared the three Step 1 mistakes that students make and how to avoid them.

Is Step 1 the hardest exam in the world (3)

How To Improve Your Studying For The Step 1 Test

You know factors that can affect your performance during the exams, so how can you improve your study habits? Here are some tips you can follow:

Tip #1 Do “Active” Studying

This study technique means you rewrite topics in your own words and create flowcharts to explain concepts. This method is more effective than passive studying, like copying notes and memorizing textbook content.

Tip #2 Do “Deliberate Practice” While Studying

It would be best to focus on your weak areas when you study, and deliberate practice ensures you address these spots. You can incorporate practices to ensure you benefit from your studies:

  • Overview: Get a general idea about the topic.
  • Outline: Determine where a topic begins and ends to get more structure.
  • Organize: Deconstruct the topic and focus on specific information.
  • Memorize: Repeat and study the information you’ve recorded.
  • Apply: Reconstruct the information and relate how the different topics fit together.

Tip #3 Don’t Rely On Memorization Alone

The Step 1 exam is designed to evaluate your ability to think critically and apply medical knowledge to real-world scenarios, rather than simply recall memorized facts.

Instead of merely memorizing, use active learning strategies, such as taking notes, creating flashcards, and explaining concepts to others.

Practice applying concepts to real-world situations. This can be done by doing practice questions or working on case studies.

By following these tips, you can develop a deeper understanding of the material and be better prepared for the boards.

[Free Download] Want to have everything you need to be a top student on your medical journey? Get FREE access to our Med School Success Handbook to get 60+ tips including the best study, time management, mindset tips you need to be a top student. Download it here. 

Tip #4 Prioritize Practice Questions Over Reading Material

Most people who study for the Step 1 exam focus on reading a lot of chapters and spreading that out over a few weeks. But this is not the best way to improve your score. The best way to improve your score is to do a lot of practice questions.

You should try to spend about 60% of your study time doing practice questions. This could be UWorld, flashcards, or any other type of question bank. The other 40% of your time can be spent reading, gathering materials, and watching videos.

P.S. Are you looking for the best question banks? Click here to get a list of the top question banks for Step 1 and how to use them.

Tip #5 It’s Okay To Break Your Study Schedule Sometimes

It’s important to have a study schedule, but it’s also okay to break it sometimes.

Back then, I usually start studying at 8:00 AM, but sometimes I wake up at 7:30 AM and I’m not feeling ready to study. So I just go back to sleep for a couple of hours. Sure, it messes up my study schedule a little bit, but it’s worth it to get enough sleep.

An extra hour of studying is not going to make you score better on the test. But if you’re not getting enough sleep, it will hurt your score.

So make sure you’re getting enough sleep, eating healthy foods, exercising, and taking breaks when you need them.

For more Step 1 tips and tricks, check out this article: Acing The USMLE: Step 1 Tips And Tricks Guide


The USMLE tests are highly stressful for medical students, but is Step 1 the most challenging exam in the world? Several factors impact your performance in this test, and it’s the most difficult among the three USMLE evaluations.

However, proper timing and study approach can increase your chances of passing this exam. Remember to take it when you feel ready; don’t stress if you fail the first try. You can always try again after adjusting your study routine.

Whenever you’re ready, there are 4 ways I can help you:

1. The Med School Handbook:  Join thousands of other students who have taken advantage of the hundreds of FREE tips & strategies I wish I were given on the first day of medical school to crush it with less stress. 

2. The Med School BlueprintJoin the hundreds of students who have used our A-Z blueprint and playbook for EVERY phase of the medical journey so you can start to see grades like these. 

3. Med Ignite Study ProgramGet personalized help to create the perfect study system for yourself so you can see better grades ASAP on your medical journey & see results like these. 

4. Learn the one study strategy that saved my grades in medical school here (viewed by more than a million students like you). 

We hope you learned some helpful exam advice from this article! Did you like this post? You can read our other content for medical students:

Until the next one my friend…

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