Practice exams are the best way to know whether you are ready for Step 1. In 2026 the exam moved to new test software with shorter blocks, so this guide starts with what changed, then covers when to take NBME self-assessments, how to take them, and how to review them for a pass/fail exam.
What changed for Step 1 in 2026
As of May 14, 2026, USMLE moved all Step exams to updated test delivery software. Step 1 now has more, shorter blocks. According to USMLE, the exam content, the total number of items, and the overall length of the test did not change.
| Step 1 feature | Before May 14, 2026 | On or after May 14, 2026 |
|---|---|---|
| Blocks | Seven 60-minute blocks | Fourteen 30-minute blocksNew |
| Questions per block | Up to 40 | Up to 20New |
| Minimum break time | 45 minutes | 55 minutesNew |
| Optional tutorial | 15 minutes | 5 minutesNew |
| Test software | Previous interface | Updated design, better keyboard navigation, settings menu, adjustable image contrastNew |
| Testing session | 8 hours | 8 hoursSame |
| Content and total items | Up to 280 items | UnchangedSame |
| Results | Pass/fail | Pass/failSame |
What NBME self-assessments are
NBME (National Board of Medical Examiners) co-sponsors the USMLE with FSMB. Its Comprehensive Basic Science Self-Assessment (CBSSA) is the self-assessment designed for students preparing for Step 1. Because NBME writes for the real exam, its self-assessments are the closest practice to the style and difficulty of Step 1 questions.
USMLE also offers free official practice materials, sample test questions, and an interactive testing experience that walks through the new interface. Check NBME's CBSSA page and USMLE's preparation page for current forms, formats, and fees, because these change over time.
When to take practice exams
- Baseline, early in dedicated study: shows where you are starting and which systems need the most time.
- Every 1–2 weeks during dedicated study: tracks progress and tells you whether your plan is working.
- About 1–2 weeks before test day: a final readiness check, with time left to fix any last gaps.
- Last few days: light review of weak areas and rest rather than another full exam.
Spacing exams apart matters more than the exact week. Each one should be followed by enough time to act on what it shows.
How to take them under 2026 conditions
A practice exam is only useful if it looks like the real thing. With the new format:
- Pace at about 90 seconds per question. In a 30-minute block of up to 20 questions, aim to be near question 10 at the 15-minute mark.
- Check the clock early in each block. Shorter blocks leave less time to recover from a slow start.
- Practice using breaks. Fourteen blocks means more transitions; decide in advance when you will take short and longer breaks.
- No notes, phone, or resources, and start at the same time of day as your real exam if you can.
- Learn the interface first. Use the official interactive testing experience so the new settings menu and image contrast tools are familiar.
For a block-by-block pacing plan, see the Step 1 test day strategy guide.
How to review a practice exam
The review is where you learn. Plan time for it on the day of the exam or the day after.
- Review every question, including the ones you guessed correctly.
- Log why each miss happened: a knowledge gap (did not know it, confused two concepts) or a test-taking error (misread, changed a right answer, ran out of time).
- Group misses by system and discipline. Several misses in one area are a signal to review it.
- Fix knowledge gaps with focused review and flashcards, then timed question blocks on that topic.
- Fix test-taking errors with timed practice and a consistent way of reading each question.
Judging readiness for a pass/fail exam
Step 1 results have been reported as pass/fail since January 2022. The goal is not a target score but a reliable pass.
- Look for a trend: several recent practice exams at or above the passing level, not one good result.
- Check weak systems: a large gap in a heavily tested system is risky even with a passing overall result.
- Talk to your school about rescheduling if recent results stay below passing. USMLE also advises allowing at least eight weeks for your score report when planning around deadlines.
Common questions
Did the Step 1 content change in 2026?
No. USMLE states that exam content, total number of items, and overall test length are unchanged. The blocks are shorter and there are more of them.
Do NBME self-assessments use the new software?
Yes. USMLE notes that NBME self-assessments and practice materials were already delivered with this software.
How much time do I get per question?
About 90 seconds on average, the same pace as the previous format.
Which NBME practice exam is for Step 1?
The Comprehensive Basic Science Self-Assessment (CBSSA).
Sources
- USMLE. Step 1 (exam format before and after May 14, 2026).
- USMLE. Test delivery software updates in place for Step 1.
- USMLE. Prepare for your exam.
- NBME. Comprehensive Basic Science Self-Assessment (CBSSA).
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