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Step 1 has traditionally been the gateway exam to residency until the announcement that it will be a pass/fail exam. This decision was made to take pressure off of students so they can spend more time focusing on their actual medical school coursework and other interests instead of preparing for an exam that ultimately has little correlation with clinical skill.

Whether Step 1 being pass/fail achieves this purpose is still to be determined. It inevitably shifts the focus of residency applications to other areas, and only time will tell if Step 2 CK takes over as "the new Step 1” as some have already begun to speculate. 

In the meantime, students are left wondering how to tackle Step 1, an exam with so much prior hype and anticipation, specifically trying to answer the inevitable question:

How much time do I really need to study for a pass/fail Step 1?

The answer is almost certainly less than you needed to when it was scored, but not as little as you might think.

The truth of the matter is that Step 1 is still a monster of an exam. It is easily the most challenging of Step 1, Step 2, and Step 3. The total raw body of knowledge on this exam—and rote memorization—exceeds any other exam a medical student has taken and will take until their medical boards.

Getting a passing score on Step 1 is no walk in the park for this reason. Students still need a strong pre-clinical foundation to build on and significant practice doing UWorld questions, reading First Aid, and building on their foundation to achieve even a passing score.

Moreover, as medical schools shift away from pre-clinical curricula in response to the changing Step 1, medical students might find themselves even less prepared to take on this examination. 

How does this translate into hours of studying? It depends.

A traditional Step 1 studying schedule takes place over at least six weeks with students studying upwards of 100 hours a week, culminating in hundreds of hours. Depending on a student’s foundation, such a time commitment may be barely enough to even pass the exam.

Some students have historically struggled to pass the exam even with multiple attempts. And for students who would have been in that position, the kicker is now any examinee gets a maximum of four attempts to pass compared to six in the past. 

So, what is the conclusion here? All together, Step 1 becoming pass/fail certainly reduces the amount of studying most students will do, but not to a degree that Step 1 can be brushed off.

Step 1 continues to be an incredibly challenging test with the highest fail rate of the USMLEs. Being prepared for Step 1 can also improve clinical performance down the line as well as performance on other USMLEs, where Step 1 content is still fair game.

Students should still plan to block out at least four weeks of dedicated full-time studying for Step 1 to ensure that they are able to pass on their very first attempt. For more information on the pass/fail Step 1 exam, see our Step 1 pass/fail FAQ post.


Photo by Sarah Noltner on Unsplash

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Leo Wang

Leo Wang is a USMLE tutor and blog author.
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