What Does USMLE Step 1 Cover – Full Insight

Step 1 is a determining factor in any medical student’s residency application and seeing that you have made your way here, chances are you want to ace your Step 1 pretty hard! Before you go to your study table, I think it’s important to start with the basics – what does USMLE Step 1 cover? 

In this post, you will learn what are the disciplines and content that makeup Step 1 and decide how to study for Step 1!

What is USMLE Step 1?

The United States Medical Licensing Examination (USMLE) Step 1 is a computer-based examination that assesses your understanding of the basic and integral sciences and whether you are capable of applying these in a clinical setting to ensure the safe and competent practice of medicine.

Step 1 gives emphasis on the concepts and mechanisms fundamental to health, disease, and modes of therapy. 

It divides basic science material into two dimensions: system and process, while also taking into coverage the different sciences essential in the study of medicine.

How Long Is USMLE Step 1?

Step 1 is composed of seven 60-minute blocks with questions in the form of multiple choice. The number of items in one block will not exceed 40, but it may still vary. Overall, the number of items will not exceed 280. 

These questions are tailored by professors, investigators, clinicians, doctors, and healthcare professionals across the United States and Canada who are recognized in their respective fields and specializations.

It is a one-day examination and the testing session takes over the course of 8 hours. You are also provided with a 15-minute computer tutorial and a 45-minute break that you get to schedule yourself. 

Prometric test centers are available worldwide for the USMLE Step 1 to be taken by American and Canadian medical students. The examination is usually taken by the end of your second year in medical school.

FYI: Are you up for studying for Step 1 already? Check out our step by step guide to accompany you through the entire process here.

What Does USMLE Step 1 Cover?

The USMLE Step 1 is modeled after a content outline which organizes the items according to general principles and different organ systems, namely: 

• Immune system
• Blood and lymphoreticular system 
• Nervous system and special senses
• Behavioral health
• Skin and subcutaneous tissue 
• Respiratory system
• Renal and urinary system
• Gastrointestinal system 
• Cardiovascular system 
• Musculoskeletal system 
• Female reproductive system 
• Male reproductive system
• Endocrine system 
• Multisystem processes & disorders

The individual organ systems further divide into two scopes: 

• 1. Normal structure, function, and processes
• 2. Abnormal processes which concern health maintenance, screening, diagnosis, management, risks and prognosis. 

Step 1 also focuses on the principles of therapy for these individual organ systems.

General Principles Covered In USMLE Step 1

With regards to the normal structure, function, and processes of the organ systems, you are most likely going to encounter items that evaluate your knowledge on these in the context of a disease process or specific pathology.

The general principles section of the examination includes items about the normal and abnormal processes which are not limited to the particular organ systems mentioned above.

Some of the most common topics in the general principles category include: 

• Biochemistry and molecular biology
• Biology of cells 
• Human development and genetics 
• Biology of tissues in response to disease 
• Pharmacodynamic and pharmacokinetic processes 
• Microbiology 
• Normal age-related findings.

Step 1 not only tests your general knowledge on the basic sciences but also assesses how you are going to carry out physician tasks and competencies in a clinical setting with the right attitude and mindset. 

Two of the most important tasks usually conquered in the field of medicine are diagnosis and management. You will be tested on the fundamentals of these two dimensions.

Diagnosis and Management Concepts In USMLE Step 1

The process of diagnosis includes obtaining and predicting the medical history of patients, physical examinations, selecting and interpreting laboratory and diagnostic studies, formulating the diagnosis, and determining the prognosis or outcome. 

As for the management dimension, it consists of health maintenance and disease prevention, selecting and monitoring pharmacotherapy, and clinical interventions or treatment.

It is also important for you to know the basics of how to communicate and foster relationships with patients, gather and provide information to patients, support emotions, enable patient behaviors, make decisions, and use an interpreter. 

Step 1 encourages you to learn systems-based practice (in health systems, public health, community, and schools)  including patient safety and develop practice-based learning. 

In addition, you must understand and apply principles of professionalism, legal and ethical issues in interaction with patients, in relation to death and dying, and in dealing with physicians and other health professionals. 

It is important to take into account the occupational, cultural, psychosocial, and environmental considerations the medical field brings upon to both healthcare professionals and patients.

Bonus: Want to learn more on how to crush Step 1? Check out our free step-by-step masterclass to help you get a 250+ on Step 1!

Subjects Covered On USMLE Step 1

In terms of subjects, what does USMLE Step 1 cover? 

You must be able to study the following disciplines as it is covered by Step 1:

• Anatomy
• Physiology
• Biochemistry
• Pharmacology
• Pathology
• Microbiology
• Embryology
• Behavioral sciences
• Biostatistics 
• Epidemiology or Population Health

Step 1 also takes the following interdisciplinary topics into account:

• Genetics
• Ethics
• Nutrition
• Aging
• Immunology
• Molecular and cell biology

Test questions are grouped into one of the 18 main fields, based on whether they are centered on concepts and principles that are relevant across organ systems or within individual organ systems.  

Test items comprising Step 1 usually requires you to interpret graphic and tabular material, identify microscopic and gross pathologic and normal specimens, and apply basic science concepts, principles, and mechanisms to clinical problems. 

Each item tests not only your knowledge on basic science but your reasoning skills, as well.

FYI: Studying for Step 1 is not as easy as it seems, but with the right material to guide you throughout the whole process, it takes off a little bit of weight from your shoulders.

Percentage of Subjects in USMLE Step 1

Let’s quickly breakdown the percentage of subjects in USMLE Step 1 based on both systems and processes.

Systems

The content of the items in Step 1 is broken down into the following percentages in terms of individual organ systems.

System	Range
General Principles	13-17%
Respiratory and Renal / Urinary Systems	9-13%
Behavioral Health and Nervous Systems / Special Senses	9-13%
Reproductive and Endocrine Systems	9-13%
Blood and Lymphoreticular / Immune Systems	7-11%
Multisystem Processes and Disorders	7-11%
Musculoskeletal, Skin and Subcutaneous Tissue	6-10%
Cardiovascular System	6-10%
Gastrointestinal System	5-9%
Biostatistics and Epidemiology / Population Health	5-7%
Social Sciences: Communication and Interpersonal Skills	3-5%

Processes 

As for the processes, it is partitioned in accordance to the percentages shown below.

Processes	Range
Normal Structure, Function, and Processes	10-15%
Abnormal Processes	55-60%
Principles of Therapeutics	15-20%
Psychosocial, Cultural, Occupational, and Environmental Consideration	10-15%

Physician Tasks and Competencies

The following table shows the break down of test items for physician tasks and competencies.

Competency	Range
Medical Knowledge: Applying Foundational Science Concepts	52-62%
Patient Care: Diagnosis	20-30%
Patient Care: Management	7-12%
Practice-based Learning and Improvement	5-7%
Communication and Interpersonal Skills	2-5%

Disciplines and Interdisciplinary Areas

Step 1 also commonly covers content from different disciplines and interdisciplinary areas in the field of science. 

System	Range
Pathology	45-52%
Physiology	26-34%
Pharmacology	16-23%
Biochemistry and Nutrition	14-24%
Microbiology	11-15%
Gross Anatomy and Embryology	11-15%
Histology and Cell Biology	9-13%
Immunology	7-11%
Behavioral Sciences	8-12%
Genetics	5-9%

Take note that these percentages are always subject to change at any time. Still, it serves as a comprehensive guide for you to follow.

The information I provided you is based on the official website of USMLE and the content outlines (Systems & Processes; and Physician Tasks and Competencies) posted there. Visit the website for more updated information.

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So what does USMLE Step 1 cover? Hopefully this post helped answer questions on the various subjects, percentages, and breakdown for USMLE Step 1!

Enjoy this post? I’m sure you’ll love these additional posts on USMLE Step 1 here:

• Acing The USMLE: Step 1 Tips and Tricks Guide
• The Best Step 1 Resources
• Step 1 Is Now Pass-Fail
• What To Do If Your Step 1 Score Is Not Improving

Also, remember that rocking your USMLE Step 1 is possible and you can do just that by signing up for FREE Step 1 Masterclass here.

Or maybe you need a bit of help and support to push yourself up the ladder? If so, join Step 1 Academy now.