USMLE Step 1 exam guide
How the Step 1 day is built, what it costs and what changed in 2026, all in one place.
Step 1 at a glance
| Detail | Step 1 |
|---|---|
| Result | Pass or fail only |
| Test day | One day, an 8-hour testing session |
| Blocks | 14 blocks of 30 minutes each |
| Questions | Up to 20 per block, up to 280 in total |
| Breaks | At least 55 minutes in total, plus a 5-minute optional tutorial |
| Exam fee | US$ 695, plus a US$ 210 surcharge outside the US and Canada |
How the 8 hours add up
14 blocks × 30 minutes = 7 hours of question time. Add at least 55 minutes of break time and the 5-minute optional tutorial, and the testing session is 8 hours. Before 14 May 2026, Step 1 used seven 60-minute blocks of up to 40 questions. The total number of questions did not change, only the block structure.
Sources: usmle.org Step 1 and the software update notice, checked October 2026. Fees: fsmb.org and the ECFMG surcharge page.
Your day, hour by hour
- Optional 5-minute tutorialLearn the screen before the clock starts.
- 14 blocks of 30 minutesAnswer up to 20 questions in each block, about 90 seconds a question.
- At least 55 minutes of breaksUse them between blocks. Break time is shared across the day.
- No going backOnce a block is finished you cannot return to it, and an unanswered question counts as wrong.
Registering and fees
| Item | Amount |
|---|---|
| Exam fee | US$ 695 |
| International test delivery surcharge | US$ 210 (outside the United States and Canada) |
| Total outside the US and Canada | US$ 905 |
Sources: fsmb.org and the ECFMG surcharge page, checked October 2026. India adds its own tax; see the South Asia guide.
Try the official samples
USMLE sample questions
The exam makers publish sample questions and an interactive testing experience for Step 1, so you can see the real interface before test day.
Open on usmle.orgWhat changed in 2026
New software, shorter blocks, FSMB registration and higher surcharges, explained on one page.
Read the 2026 changesPast papers and syllabus
USMLE publishes no past papers, so prepare from the official content outline instead. It tells you how many questions to expect from each system and discipline.
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