How Many Questions Are on Step 1? 2026 Format, Length and Breaks

Short answer: if you test on or after May 14, 2026, Step 1 is a one-day, 8-hour exam split into fourteen 30-minute blocks, and no block has more than 20 questions. Before that date it used seven 60-minute blocks of up to 40 questions, with no more than 280 items in total. The pace did not change: both formats work out to about 90 seconds per question.

Step 1 format: before and after May 14, 2026

How long is Step 1?

Eight hours in a single session. The block time and the minimum break and tutorial allotments add up to exactly that. In the new format, 14 blocks of 30 minutes give 420 minutes of question time; add 55 minutes of break and the 5-minute tutorial and you reach 480 minutes. The old format got to the same total with 7 blocks of 60 minutes, 45 minutes of break, and a 15-minute tutorial.

Break time works as a pool you manage across the day. USMLE says the break allowance grows when you finish a block or the optional tutorial before its time runs out, so moving quickly through the tutorial when you already know the interface puts those minutes back into your breaks.

How much time do you get per question?

Thirty minutes for up to 20 questions is 90 seconds a question, the same rate as the old 60 minutes for up to 40. The difference is rhythm. You now reset every 30 minutes, which means twice as many block transitions and more natural points to stop for a short break.

Is Step 1 scored or pass/fail?

Pass/fail. For exams taken on or after January 26, 2022, USMLE reports Step 1 only as a pass or fail outcome. USMLE states that the passing standard is 196 on the three-digit scale, and that future reviews of the standard will not be reported as a three-digit number.

What does Step 1 cover?

USMLE builds Step 1 from an integrated outline organized by organ system, and also sets ranges by discipline and by physician task. The organ-system ranges are below.

By discipline, pathology (45–55%) and physiology (30–40%) lead, followed by nutrition (15–20%) and then gross anatomy and embryology, microbiology, and pharmacology (10–20% each). These ranges add up to more than 100% because many questions are classified under more than one discipline. By physician task, 60–70% of questions test applying foundational science concepts and 20–25% test diagnosis.

What the new format means for practice

• Practice in 30-minute blocks of about 20 questions, so the rhythm on test day feels familiar.
• Hold a pace near 90 seconds per question. Flag long vignettes and come back to them instead of stalling.
• Decide before test day after which of the 14 blocks you will take breaks, and keep some break time for the last few blocks.
• Use the free sample questions on USMLE's Step 1 materials page to get used to the official question style.

Check your readiness before you book

Step 1 has no three-digit score to predict, so readiness tools work with percent correct. The Free 120 Step 1 readiness check shows your Free 120 percent and its margin of error next to the low-pass range NBME draws on CBSSA reports. The NBME Step 1 score conversion reads a CBSSA Form 28–34 percent the same way.

For first-attempt pass rates, see USMLE pass rates. For when your result arrives, see the USMLE score release dates guide. Taking Step 2 CK next? Its format changed on May 7, 2026; see how many questions are on Step 2 CK.