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Indiana University School of Medicine
Indiana University School of Medicine
Medical Student Portal

Step 1 Guide: Class of 2026

Step 1 has been pass/fail since January 2022. Historically, the median Step 1 score at IU School of Medicine has been higher than the national median for Step 1 scores. This means that our curriculum prepares you very well for the Phase 2 clinical curriculum and successful completion of Step 1.

To help you prepare for Step 1, the Office of Student Affairs has created the below timeline for the 2023-2024 academic year, which includes required dates and recommendations to assist with your preparation.

Questions?

Questions about Step 1 preparation may be directed to Abigail F. Klemsz, MD, PhD, assistant dean for student affairs and director of advising.

Timeline

August 2023: Prepare for Step 1

Based on our experience with previous medical school classes, the best preparation for Step 1 is to learn as much as possible and perform to the best of your ability in all your Phase 1 courses. MSE will provide Step prep sessions to enhance your Step 1 preparation. A full schedule will be released before the fall semester. Students are encouraged to review Step 1 information in the 2026 Roadmap.


January 8, 2024: Take the Comprehensive Basic Science Exam (CBSE) – required

This examination helps to give you an idea of the amount of Phase 1 curriculum you have mastered and retained. We have administered the CBSE before ERMD for many years, thus know what scores predict success on Step 1 at this point, just prior to completion of Phase 1. This examination is used as a guide when deciding on the intensity and duration of your Step 1 study period. The result of this exam will help to predict if you will be fully prepared to take Step 1 by the April 3 deadline or if you will most likely additional preparation time. This exam will be in person on your campus and is required.


February 23, 2024: Classes end


February 24, 2024–April 2, 2024: Dedicated Step 1 Study Period


April 3, 2024: Step 1 Deadline

This deadline applies to all students regardless of their schedule or plan of study.

Comprehensive Basic Science Exam (CBSE)

The CBSE will be used to help determine your plan of study.

Based on years of data, we know that scores on the CBSE taken in January are highly predictive of Step 1 performance. We have developed the following plan to help you gauge your readiness for Step 1 and to support you in your Step 1 preparation. Our goal is that all students are ready to take and pass Step 1 without an extended delay in their curriculum progression.

  • All Phase 1 Year 2 students will be scheduled to take the CBSE on Monday, January 8, 2024, in person on their campus as a proctored and timed exam. The total time for the exam is 5 1⁄2 hours.
  • Students’ CBSE scores are released to the school and students will need to meet with their lead advisor that week to receive their CBSE score and discuss their study plan.
  • Students scoring above 60% should feel confident that their study plan is appropriate, and they will take Step 1 on or before April 3, 2024.
  • Students scoring 51–60% should meet with their lead advisor, the learning strategist, and tutors to adjust their study plan to be ready to take Step 1 on or before April 3, 2024. Students should also consider enrolling in the Step Up: Step 1 Structured Preparation Program.
  • Students who score 50% or below are at the highest risk for failing Step 1. To allow students the maximum amount of time to prepare, students who score 50% and below will be scheduled for a vacation month in rotation 1 (R1) of Phase 2 to be used for additional study time. We strongly recommend enrolling in the Step Up: Step 1 Structured Preparation Program.

Using the CBSSA as part of your exam preparation

All students will receive one voucher (purchased by the school) for a practice exam, the Comprehensive Basic Science Self-Assessment (CBSSA). This will be distributed before the beginning of the dedicated study period to help students gauge their readiness for Step 1. Students should plan to take this self-assessment a few weeks before their Step 1 date.

  • Students should score 70–74% on two assessments prior to taking Step 1. The CBSSA can be used as one of these assessments. Students who are not meeting that goal should meet with their lead advisor and the learning strategist to discuss their study plan.
  • Students who scored 50% or below on the CBSE and improve to 70-74% on two assessments can schedule their Step exam by April 3, 2024, maintaining their R2–R12 schedule and allowing them to schedule an elective in R1. However, a core clerkship cannot be added back to R1.

Step 1 Delays

Not all students will be ready to take Step 1 by the April 3, 2024, deadline. This is okay, and we are here to help! We highly recommend enrolling in the school's Step 1 Structured Preparation Program or another structured program. A structured program provides accountability and takes the hard work out of figuring out by yourself the best way to raise your exam score within a particular amount of time.

  • Students who plan to take Step 1 after the April 3, 2024, deadline should plan to take Step 1 no later than May 29, 2024.
  • Students will be required to sign a Step 1 Delay Agreement by March 27, 2024. Without a Delay Agreement, students will be required to take Step 1 by April 3, 2024.
  • Sometimes CBSSA scores go down causing students to rethink their study plans. If you scored above 50% on the January CBSE and are not scoring 70-74% on your practice exams during dedicated, you may choose to delay the Step 1 exam. Your R1 clerkship will be moved to the fourth year. For some students this will be a four-week clerkship that is moved, for others an eight- week clerkship. Students in this situation will also be required to sign a Step 1 Delay Agreement by March 27, 2024.
  • All students are required to complete the preparation requirements for Phase 2 (all onboarding and compliance requirements) and all curricular elements (including Interprofessional Education, Orientation to Clerkships, Transitions 2, Sessions to Enhance Physician Success) scheduled for most of the month of April of 2024 no matter when they take, or plan to take, their Step 1 exam. This should be taken into consideration when creating study plans.

Extended Step 1 Delays

We hope that all students will be able to take Step 1 by May 29, 2024. However, sometimes students will need additional time to become fully prepared to pass Step 1.

  • Students who are not prepared to take Step 1 by May 29, 2024, will need to submit a plan for an extended delay to the Student Promotions Committee.
  • Summer enrollment will be held until the student re-enters the curriculum.
  • When enrollment is held, financial aid is not available per federal regulations.
  • Students submitting an extended exam delay plan should plan to enroll in an immersive Step 1 review course if they are not already enrolled in such a program.
  • Students must take and pass Step 1 in order to enter their clerkships.

The following dates are deadlines for taking Step 1 to return to full enrollment:


August 3, 2024 Deadline

Students will have R2-R4 clerkships dropped from their schedule. Students must take Step 1 by August 3, 2024, to allow for a score to be available to return for Sessions to Enhance Physician Success (STEPS) on August 23, 2024. The student will not have summer enrollment and will not be enrolled for fall until Step 1 is taken and passed. The addition of 3 clerkships to their Phase 3 year will most likely delay graduation by a year. The addition of 4 clerkships to their Phase 3 year will definitely delay graduation by a year. Without summer enrollment, students are not eligible for financial aid or malpractice insurance. School health insurance will end on July 31.


November 30, 2024 Deadline

Students will have R2-R8 clerkships dropped from their schedule. Student must take Step 1 by November 30, 2024, to allow for a score to be available for return to R9. Students will not have summer or fall enrollment and will not be enrolled for spring until Step 1 is taken and passed. Without enrollment, students are not eligible for financial aid or malpractice insurance. School health insurance will end on July 31. Graduation will be delayed by a year.

Failure to take Step 1 by November 30, 2024, will result in dismissal by the Student Promotions Committee which can be appealed. Please see the student handbook for more details about this process.


Step 1 flow chart. After the Jan 8 CBSE, students are split into three categories: <50% results in elective/vacation in R1. 51-60% results in CBSAA during dedicated study time. >60% results in step 1 on April 3.

Step 1 Timeline and Deadlines
August

Preparing for Step 1:
Enroll in the Step 1 Canvas Course
Purchase Question Bank
September

Step 1 registration information sent in MD Student News
Register for Step 1
November Step Prep Program
Attend Session
January 8, 2024 CBSE
Required attendance
Results determine your R1 schedule
January Step Prep Program
Attend Session
February Class end
February 24-April 2, 2024 Dedicated Study/Step Prep Program
Attend Session
March 26, 2024 Phase 1 Year 2 remediation exams
March 27, 2024 Deadline to sign a delay agreement
April 3, 2024 Step 1 deadline for all students
May 29, 2024 Deadline for students with a one-month Step 1 delay
August 3, 2024 Extended delay deadline for August 23rd return.
No summer enrollment
November 30, 2024 Final Step 1 deadline
No summer or fall enrollment

Frequently Asked Questions

The Comprehensive Basic Science Examination (CBSE) is a practice examination for Step 1. It is available only to institutions and given in a proctored setting. The exam contains 200 items and lasts 5 hours and 15 minutes (includes a 15-minute optional break).

The Comprehensive Basic Science Self-Assessment (CBSSA) is also considered a practice examination for Step 1 but is taken on your personal computer at your chosen location. A CBSSA is comprised of four sections composed of 50 questions each. You have 1 hour and 15 minutes to complete each section and 5 hours total for the whole exam. Students should take these practice exams at the standard pace to better simulate exam conditions.

The United States Medical Licensing Examination® (USMLE®) is a three-step examination for medical licensure in the United States. It is sponsored by the Federation of State Medical Boards (FSMB) and National Board of Medical Examiners (NBME).

The USMLE assesses an examinee’s ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills. These skills constitute the basis of safe and effective patient care. Health care consumers throughout the nation enjoy a high degree of confidence that doctors who have passed all three steps of the USMLE have met a common standard.

Step 1 is the first of three exams that you will take. Step 1 is a one-day examination. It is divided into seven 60-minute blocks and administered in one 8-hour testing session. The number of questions per block on a given examination form may vary but will not exceed 40. The total number of items on the overall examination form will not exceed 280. You will register for Step 1 in the fall and you will receive registration instructions at that time.

Find more information about Step 1.

Students who have performed well in their courses typically perform well on the CBSE. We encourage you to reach out to your Lead Advisor or the Learning Strategist to discuss strategies for keeping your performance in this range.

Some students design their study schedules to allow for a break over the holidays. Other students choose to continue their study schedule through the holiday break. Please work with your lead advisor to discuss your progress as you approach the CBSE.

Students who need to remediate a course will automatically be scheduled for a one-month delay, which means they should plan to take Step 1 after the initial April 3 deadline.

Students will automatically be enrolled in curriculum to prepare them for Phase 2. These include Interprofessional Practice and Education (IPE), Transitions 2, Sessions to Enhance Physician Success (STEPS), and Orientation to Clerkships (OTC).

We have studied IU School of Medicine students for many years and our evidence shows that students perform better on clerkships when Step 1 is completed before Phase 2. Phase 2 is challenging and requires all of your attention. Completing Step 1 before starting clerkships allows you to focus all of your attention on the next phase of your training.

Our students are very well prepared to take Step 1. We are proud that our school Step 1 average has been above the national average for many years and last year we had only a very small number of students who did not pass the first time.

We anticipate receiving the majority of Step 1 scores before the start of the first clerkship. If a failing score is received before the start of clerkships, you will not begin clerkships and will receive help creating a plan for success on your next attempt on Step 1. Students whose scores are received after the start of the first clerkship will have the option to remain in their current clerkship or withdraw from the clerkship to begin preparing for their second attempt.

When students fail Step 1, their score is reported to the Student Promotions Committee. Students will be required to provide their study plan for retaking Step 1 to the Student Promotions Committee for their next scheduled meeting. The Student Promotions Committee will very likely require that students retake Step 1 within 3 months of receiving their failing score. The school requires that students retake and pass the Step 1 exam before returning to their clerkships.

Students must retake Step 1 by November 30, 2024 to allow for a score to be available for return to R9. Students will have clerkships through R8 dropped from their schedule. Students will not have enrollment until Step 1 is taken and passed. Without enrollment, students are not eligible for financial aid or malpractice insurance. School health insurance will end on July 31.

Failure to retake Step 1 by November 30, 2024, will result in dismissal by the Student Promotions Committee which can be appealed. Please see the student handbook for more details about this process. The committee may set an earlier deadline in some cases. Students should plan on being provided only two opportunities to pass Step 1 as a third attempt is not guaranteed.

First, be kind to yourself. It is normal to feel anxious about things that are very important to you. Also, know that you are not alone. The student affairs team is here to support you! We believe in you! We also understand that preparing for this exam can be a source of stress and can create anxiety and feelings of being overwhelmed. We believe that it takes a strong network of support to get through all of the phases of medical school and have worked hard to create that support for you.

Mental Health Services are available to work with students on many issues such as test anxiety that might interfere with exam performance. All of their services are confidential. You can log into the Mental Health Services patient portal to schedule appointments, access virtual care or communicate with the department, or contact the program coordinator at 317-278-2383 to set up a time to meet with any of the providers.

Please do not hesitate to reach out to anyone on our team at any time with questions or concerns that you have. You are not alone. We are here to help you succeed!

Questions about Step 1 preparation may be directed to:

Abigail F. Klemsz, MD, PhD
Assistant Dean for Student Affairs
Director, Advising
Medical Student Education
Van Nuys Medical Sciences Building, Room 164F
635 Barnhill Drive
Indianapolis, IN 46202
317-274-1963
aklemsz@iu.edu