USMLE STEP ONE

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Hematology Oncology USMLE STEP 1 Review Sheet First Aid

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What is USMLE STEP 1?

USMLE STEP 1 is the first component of a series of national medical licensure exams commonly taken after completing your second year of medical school. As of this year, USMLE STEP 1 is considered a Pass/Fail Exam. USMLE STEP 2 is typically completed after 3rd year, while STEP 3 is completed during your residency trainin.

The test consists of
7 individual blocks of 40 questions per section. Testers are given 1 hour to complete each section and a total of 45 minutes of breaktime. If the user chooses to skip the optional tutorial at the beginning of the exam, they will be granted an additional 15 minutes (duration of tutorial) to usable breaktime. Breaks can be taken at the testers convenience after each section.

For example, on my test day I took the 1st and 2nd sections back to back before taking a 10 minute break. I then completed sections 3 and 4 before I took a long lunch (~25 minutes). After Lunch I had enough time to take a break after every subsequent section as the mental fatigue began to set in!

Total test time is
7 hours for testing sections plus 1 hour of breaktime/tutorial time. There is also a survey at the end which adds a few minutes to your testing experience!

Note: There are a total of 280 Questions that must be answered on test day, However, only 200 of them are graded! 80 of the questions asked are used by USMLE for analytical purposes to guage the quality of newly created questions. If you come across a ridiculously difficult or convuluted question, it's likely a "practice" question. Don't stress too much, and just keep moving through the exam! Answer every question as if its graded because you won't be able to tell which ones are practice and which ones are real.

Summary:

  • USMLE STEP 1 is taken after your 2nd year of medical school (some schools differ)

  • 7 Sections, 1 hour a piece, 40 questions a section, 280 total questions, 200 actually graded

  • 1 hour of breaktime (if you skip the tutorial) that can be used at your discretion

USMLE STEP 1 Pass/Fail Implications:

As of this year USMLE STEP 1 has been officially shifted to a "Pass/Fail" Grading Scale. The passing score is now officially 196 or higher which translates to roughly 62-63% of the questions correct on test day!

Why is this important? Well to start, it dramatically changes the amount of studying you need to complete. The good news is you need to spend substantially less time preparing for the exam in comparison to past test takes! This is not to suggest that you can blow it off and hold off preparation until dedicated. This exam still requires plenty of logged study hours to even get close to passing!

The bad news is that we (as future residency applicants) have lost another "objective" metric for residency programs to evaluate student performance. The original role of board scores was to standardize student education across all accredited medical schools and allow applicants from all different programs to compete against one another. For example, a student at a low tier allopathic medical school could compete against a higher tier allopathic program with more "name" recognition (Harvard, Penn, etc.). At face value you may assume that the Harvard applicant is a better student based on the programs exceptional reputation, however their board scores may not be as strong as anticipated. Because of this, residency programs cared more about your scores instead of the medical school you attended. If the low tier medical school applicant did fantastic on their boards, they would rank higher than the a low scoring Harvard applicant. Make sense? Good!

Now that we have lost this score, there has been a lot of speculation as to how residency programs are going to compare students. One of the most popular hypothesis is the likely
shift in weight to USMLE STEP 2 board scores, which is still a scored exam. The problem with this is that many students don't receive dedicated study time to prior to taking this exam, and more importantly your entire career may be put on hold with a single bad board score! Traditionally, if students performed poorly on STEP 1, they could potentially redeem themselves with a better STEP 2 score. Unfortunately, this is no longer the case as the focus has most likely changed to high performance on STEP 2.

Another concern is that residency programs may also value personal research, and individual academic performance at medical schools with higher weight than previous years. While this is highly speculative, it certainly adds to some applicant weariness amongst the student population, especially those who don't enjoy conducting research or have different medical school grading metrics. For example, how do we compare students from medical schools with exclusively pass/fail curriculum to students from programs with scaled scores? An excellent question that we will see unfold over the next couple years. 

Summary:

  • USMLE STEP 1 is Pass/Fail 

  • USMLE STEP 2 board scores are likely to be weighted heavier by residency programs

  • Research and Individual Medical School Class Rank/Grades may have greater value than in previous years