On May 14, 2026, USMLE moved Step 1 to new test software and split the exam into fourteen 30-minute blocks. The questions, content, and total test length did not change. Here is a side-by-side comparison of the old and new format, everything else USMLE has updated, and how to adjust your prep.
Step 1: old format vs new format
The new format applies to anyone taking Step 1 on or after May 14, 2026.
| Feature | Before May 14, 2026 | On or after May 14, 2026 |
|---|---|---|
| Blocks | Seven 60-minute blocks | Fourteen 30-minute blocksChanged |
| Questions per block | Up to 40 | Up to 20Changed |
| Average time per question | About 90 seconds | About 90 secondsSame |
| Minimum break time | 45 minutes | 55 minutesChanged |
| Optional tutorial | 15 minutes | 5 minutesChanged |
| Test software | Previous interface | Updated interface with new toolsChanged |
| Testing session | One 8-hour day | One 8-hour daySame |
| Total items | Up to 280 | UnchangedSame |
| Content | USMLE content outline | UnchangedSame |
| Result | Pass/fail | Pass/failSame |
The 10 extra minutes of guaranteed break time are mostly offset by the 10 minutes taken off the optional tutorial. As before, finishing a block or the tutorial early adds the unused time to your break time.
What did not change
USMLE states that the exam content, total number of items, and overall length of the test remain unchanged. In practice that means:
- You study the same material, organized by the same USMLE content outline of systems and processes.
- Step 1 is still a one-day, 8-hour exam taken at a Prometric test center.
- Results are still reported as pass/fail, as they have been since January 2022.
- The average pace is still about 90 seconds per question.
What's new in the test software
USMLE describes the updated test delivery software, in place for all three Step exams since May 14, 2026, as including:
- An updated design and improved keyboard navigation
- A new settings menu
- The ability to adjust the contrast on each image
Step 2 CK changes
Step 2 CK changed on a slightly earlier date, May 7, 2026, with the same idea: more, shorter blocks.
| Step 2 CK feature | Before May 7, 2026 | On or after May 7, 2026 |
|---|---|---|
| Blocks | Eight 60-minute blocks | Sixteen 30-minute blocksChanged |
| Questions per block | Up to 40 | Up to 20Changed |
| Minimum break time | 45 minutes | 55 minutesChanged |
| Optional tutorial | 15 minutes | 5 minutesChanged |
| Testing session | One 9-hour day | One 9-hour daySame |
| Total items | Up to 318 | UnchangedSame |
Timeline of USMLE updates
- January 2022Step 1 results reported as pass/fail.
- May 7, 2026New Step 2 CK format: sixteen 30-minute blocks.
- May 14, 2026New Step 1 format: fourteen 30-minute blocks; updated software in place for all Step exams.
- June 1, 2026Test accommodation requests move into the MyUSMLE Portal, where examinees can track their status.
- June 4, 2026FSMB begins processing all USMLE transcript requests for the ERAS application season.
- January 2029Planned move to Designated Testing Dates, with fewer Step exam administrations each year. USMLE says details on applying and scheduling are still being released.
What to expect on test day
- More transitions: fourteen blocks mean thirteen points where you can take a break or move straight on.
- Faster clock checks: at about 90 seconds per question, aim to be near question 10 at the 15-minute mark of each block.
- Less recovery time: a slow start costs more in a 30-minute block, so guess, flag, and move on from hard questions.
- Break rules: going over your total break time is deducted from your testing time, so use the time summary to keep track.
- Results: USMLE says results may come two to four weeks after the exam but advises allowing at least eight weeks to be notified that your score report is ready.
For a full pacing plan, see the Step 1 test day strategy guide.
How to adjust your prep
- Practice in 30-minute blocks of 20 questions. Set your question bank to timed blocks of 20 to build the new rhythm.
- Take NBME self-assessments. They already use the same software as the real exam. See how to use NBME practice exams for Step 1.
- Try the interactive testing experience on usmle.org so the settings menu and image contrast tools are familiar.
- Plan your breaks before test day: when to take short ones and when to eat.
- Keep studying the same content. Nothing in the content outline changed; the Step 1 roadmap follows it system by system.
Frequently asked questions
What changed on USMLE Step 1 in 2026?
The block structure and the software. Step 1 now has fourteen 30-minute blocks of up to 20 questions, at least 55 minutes of break time, a 5-minute optional tutorial, and an updated interface.
Is Step 1 shorter now?
No. USMLE states the content, total number of items, and overall test length are unchanged. It is still one 8-hour session.
How many questions are on Step 1?
Each block has up to 20 questions. USMLE says the total number of items is unchanged; the previous format did not exceed 280.
Did the Step 1 content outline change?
No. The 2026 update changed how the exam is delivered, not what it tests.
When do the designated testing dates start?
USMLE plans to implement Designated Testing Dates in January 2029 and has said it will share more details as they become available.
Sources
- USMLE. Step 1 (format before and after May 14, 2026).
- USMLE. Step 2 CK (format before and after May 7, 2026).
- USMLE. Test delivery software updates in place for Step 1.
- USMLE. Updated timeline for USMLE's designated testing dates.
- USMLE. New USMLE accommodations request process is now live.
- USMLE. FSMB to process USMLE transcripts for the ERAS service starting June 4, 2026.
- USMLE. Break time.
Practice for the new format
Progress Note is a free, adaptive Step 1 question bank with cited explanations, spaced review, and a guided roadmap that follows the USMLE content outline.
Try free →