USMLE format and scoring: three steps, and a new Step 1 layout from May 2026
The USMLE has three steps. Step 1 has been pass/fail since January 2022, Step 2 CK reports a numerical score, and Step 3 is a two-day exam required for full licensure. For exams taken on or after May 14, 2026, Step 1 moved to fourteen 30-minute blocks of up to 20 questions.
Last checked October 2026. Based on test-prep and study guides summarizing USMLE’s published information. Block structure confirmed on usmle.org. Step 2 CK’s passing standard has been 218 since July 1, 2025 (previously 214), and Step 3’s is 200, as reported.
The three steps
| Step | What it tests | Format and scoring |
|---|---|---|
| Step 1 | Foundational medical sciences | One eight-hour day, up to 280 questions, reported pass or fail |
| Step 2 CK | Clinical knowledge and decision-making | One nine-hour day, 316 questions; since May 7, 2026, sixteen 30-minute blocks of 18 to 20 questions. Numerical score; passing standard 218. |
| Step 3 | Independent practice | Two-day exam, with Day 1 multiple choice (Foundations of Independent Practice). Passing is required for full licensure. |
As described by guides summarizing USMLE.
Step 1 format change
Before May 14, 2026, Step 1 was seven 60-minute blocks with no more than 40 questions each. For exams on or after that date it is fourteen 30-minute blocks with no more than 20 questions each. The total of up to 280 questions and the eight-hour session are unchanged, and the exam is delivered on new test software. If you rehearsed with an older layout, switch to the new one.
Scoring
Step 1 is reported pass or fail. A guide says the old passing standard equals 196 on the previous three-digit scale, and that USMLE says future reviews will not be reported as a three-digit score. Step 2 CK keeps a numerical score, and guides describe it as the most important exam for residency applications, especially for international medical graduates.
Common questions
Do I need Step 1 before Step 2 CK?
USMLE lets eligible students take Step 1 and Step 2 CK in either order, though most take Step 1 first and some medical schools set their own rules. Passing both is required before Step 3. See which order to take the Steps.
Is there still a Step 2 CS?
No. The Clinical Skills exam was permanently discontinued in 2021.