USMLE Step 1

The USMLE Step 1 (more commonly just Step 1 or colloquially, The Boards) is the first part of the United States Medical Licensing Examination. It assesses whether medical school students or graduates can apply important concepts of the foundational sciences fundamental to the practice of medicine. US medical students, as well as Canadian medical students who wish to seek licensure in the US, typically take Step 1 at the end of the second year of medical school. Graduates of international medical schools (i.e., those outside the US or Canada) must also take Step 1 if they want to practice in the US. Graduates from international medical schools must apply through ECFMG, and the registration fee is $850. For 2016, the NBME registration fee for the test is $600, with additional charges for applicants who choose a testing region outside the United States or Canada.

Prior to 1992, the NBME Part I examination served as the staple basic science examination for medical students at the end of their second year. Upon the launch of the three-part United States Medical Licensing Examination, NBME Part I exam was carried forward in its new format, the USMLE Step 1 examination, which has since evolved to become an increasingly clinically-applied examination of the foundational sciences. The exam became computer based several years later. In May 2015, the USMLE began emphasizing of concepts regarding patient safety and quality improvement across all parts of the USMLE exam series, including Step 1.

In recent years and in part resulting from the American Medical Association's "Accelerating Change in Education" (ACE) Initiative, a number of U.S. allopathic and osteopathic medical schools have begun to consolidate the amount of time allocated in the 4-year curriculum for dedicated preclinical/classroom-based education in order to provide more time for clinical training and direct application of the foundational sciences to clinical medicine. As a result of this paradigm shift away from the 20th century "2+2" curriculum, students at many of these medical schools are now instructed to take the Step 1 exam following the core clerkship year, rather than at the conclusion of the preclinical curriculum, at which time students are also prepared to sit for the Step 2 CK exam. The effect of this variable timing for students sitting for the Step 1 exam is presently unknown.

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