The three USMLE Steps.

Step by step

What each Step covers

Step 1 — the foundation exam

Step 1 covers the basic and foundational sciences of the preclinical years: anatomy, biochemistry, physiology, pathology, pharmacology, microbiology, and the behavioral sciences, all framed around the mechanisms of disease and how they connect to clinical presentations. It is typically taken after the preclinical curriculum, before or early in the clinical years.

Since January 2022, Step 1 has been reported pass/fail — no three-digit score appears on score reports. The intent was to reduce the score-focused pressure of the preclinical years and shift residency screening emphasis toward Step 2 CK. At the same time the passing standard rose from 194 to 196, and the first-time failure rate roughly doubled: US MD first-time pass fell from 95% in 2021 to 89% in 2024. Pass/fail does not mean low stakes. A fail is visible to residency programs, and the 2024 NRMP program-director survey found 77% of respondents consider failed Step attempts when deciding whom to interview.

Step 2 CK — the clinical exam

Step 2 CK (Clinical Knowledge) tests the clinical sciences: diagnosis, prognosis, disease management, health maintenance, and disease prevention across all the major disciplines. It is the exam most closely aligned with what you do on clerkships, and because Step 1 no longer produces a numeric score, Step 2 CK has become the primary scored differentiator in residency selection.

The numbers are strong for first-time US takers — 98% US MD first-time pass across the 2022–2024 cycles, with a mean score of 249 in 2023–24 — but the floor is rising: the passing standard was raised to 218 in July 2025. And the repeat-taker story is stark: pass rates drop to roughly 74% for US MD and 72% for US DO repeat takers. Passing on the first attempt is the single highest-leverage exam outcome in medical school.

Step 3 — the residency exam

Step 3 is the final exam in the licensing sequence, taken during residency. It assesses the ability to apply medical knowledge and understanding of biomedical and clinical science to the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. US MD first-time pass is about 97% (2023). Most residents sit it in the first or second year of training, while the knowledge base from the earlier Steps is still fresh.

National snapshot

First-time pass rates, by year

All figures are first-time taker pass rates — the share of examinees passing on their first attempt. First-time and overall (eventual) pass rates are different numbers; never compare them directly. Source: USMLE Performance Data via NBME; authoritative tables at usmle.org → Performance Data.

Years and figures above are from the shared national norms (2024–2025 vintage). For the most current numbers, check the current Performance Data tables at usmle.org.

Timing

Typical timing

• Step 1 — after the preclinical curriculum, usually between the second and third years. Schools set their own eligibility and readiness policies; many require a passing self-assessment score before authorizing a test date.
• Step 2 CK — during or after the core clerkships, typically in the third year or early fourth. Most students take it with enough lead time for a score to be available when residency applications are reviewed.
• Step 3 — during residency, commonly in the first year.

That sequencing is the norm, not the law: accelerated pathways, dual-degree programs, and leaves of absence all move it around. See exam timing by year for the planning principles, and always confirm current scheduling rules at usmle.org.