You need to answer approximately 60% of questions correctly to pass USMLE Step 1. That number isn’t fixed, though. The exact percentage varies slightly from one version of the exam to another, depending on the difficulty of the specific questions you receive.
Why the Passing Percentage Isn’t Exact
Step 1 doesn’t use a single cutoff like “get 168 out of 280 right and you pass.” Instead, the USMLE uses statistical procedures to account for small differences in difficulty between exam forms. If your version of the test happened to include harder questions, you could pass with a slightly lower raw percentage correct than someone who took an easier form. This equating process ensures that the level of knowledge required to pass stays consistent regardless of when or where you sit for the exam.
The result is that 60% is a reliable benchmark, not a guarantee. Some forms may require a touch above that mark, others a touch below. Planning your preparation around needing roughly 60% correct gives you a realistic floor, but aiming well above it provides a comfortable margin.
How Step 1 Is Scored Now
Since January 26, 2022, Step 1 results are reported as pass or fail only. Before that date, examinees received a three-digit numeric score, and the minimum passing score was 196. That number still technically defines the passing standard on the old scale, but the USMLE no longer reports it to examinees. Future reviews of the passing standard won’t reference a three-digit score at all.
The USMLE Management Committee periodically reviews the passing standard and can adjust it. A review was scheduled for December 2024. Because the standard is based on a defined level of medical proficiency rather than a curve, no predetermined percentage of test-takers is designed to pass or fail in any given year.
What the Exam Looks Like
For exams taken before May 14, 2026, Step 1 consists of seven 60-minute blocks within a single 8-hour testing session. Each block contains up to 40 questions, and the entire exam contains no more than 280 items. Starting May 14, 2026, the structure shifts to fourteen 30-minute blocks with up to 20 questions each, though the total testing time remains the same.
Not every question on the exam necessarily counts toward your score. Standardized tests typically include a small number of experimental or pilot questions that are being evaluated for future use. You won’t know which ones those are, so you need to treat every question as if it counts.
Current Pass Rates
The pass/fail format hasn’t made the exam dramatically harder or easier for most US medical students. Based on 2025 performance data for first-time test-takers from US schools, 93% of MD students and 89% of DO students passed Step 1. These rates have remained relatively stable, suggesting that the 60% threshold is well within reach for students who complete a standard medical school curriculum and dedicate focused time to board preparation.
What 60% Means for Your Prep
A 60% target on practice exams can be misleading if you treat it as a comfortable goal. Practice question banks and self-assessments vary in difficulty, and test-day nerves, fatigue over an 8-hour session, and unfamiliar question formats can all shave points off your performance. Most students who pass comfortably score well above 60% on their practice tests in the weeks leading up to the exam.
The questions themselves aren’t straightforward recall. Step 1 emphasizes applying basic science concepts to clinical scenarios, which means you can know the underlying fact but still miss the question if you misread the clinical setup. Building a buffer above the minimum gives you room for those moments when a question tests an area you didn’t review as deeply or presents information in an unexpected way.
If your practice scores are hovering right around 60%, that’s a signal you’re near the threshold but not safely above it. Most preparation resources suggest seeing consistent scores of 65% or higher on timed, exam-length practice sessions before sitting for the real thing.