The exam format

Know the structure before you plan.

FeatureBefore May 14, 2026On or after May 14, 2026
BlocksSeven 60-minute blocksFourteen 30-minute blocks
Questions per blockUp to 40Up to 20
Session length8 hours8 hours
Break timeAt least 45 minutesAt least 55 minutes
Optional tutorial15 minutes5 minutes

Source: USMLE Step 1 exam page. Time per question stays about 90 seconds in both formats.

workspace_premium What changed in 2026

For a full before-and-after comparison, including the new test software, Step 2 CK changes, and the planned 2029 move to designated testing dates, see USMLE Step 1 changes in 2026: what’s new and what to expect.

Pacing within a block

Small checks prevent a rushed finish.

StartUp to 20 questions, 30 minutesHalfwayAim to be near question 10 at 15 minutesHard questionMake a best guess, flag it, move onLast 3 minutesAnswer every remaining questionSpare timeReturn to flagged questions
Block pacing. Shorter blocks mean less time to recover from a slow start, so check the clock early.

Working each question

Use the same steps every time.

Helpful habitsRead the last line firstPredict the answer before optionsEliminate clearly wrong choicesChange an answer only for a clear reasonFlag and move onCostly habitsRereading the whole stemOverthinking zebrasLeaving questions blankChanging answers on a hunchDwelling on a hard blockvs
Question habits. Each block is independent; let a hard one go when it ends.

Breaks and logistics

Plan the day like a long shift.

  • Budget breaks: plan short breaks every few blocks and a longer one for food. Skipping the optional tutorial adds its time to your breaks.
  • Food and water: bring easy snacks and drinks for the breaks.
  • Identification: bring the identification the USMLE Bulletin requires, with your name matching your scheduling permit.
  • The day before: light review only, prepare your bag, and sleep normally.
  • Arrival: arrive early to allow time for check-in and security.

Worked example

Recover from a slow start.

functions Worked example — behind at the halfway point

Fifteen minutes into a 30-minute block, a student has finished only 7 of 20 questions after spending too long on two hard vignettes. What should they do?

  1. At 90 seconds per question, about 10 should be done at 15 minutes, so they are about 3 questions behind.
  2. Make a best guess on the current hard question, flag it, and move on.
  3. Read the last line first on each remaining question to speed up.
  4. Make sure every question has an answer before time runs out, then return to flags if time allows.

Answer. Guess, flag, and speed up so that no question is left blank; revisit flagged questions only with spare time.