Step 1 Guide: Class of 2027

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. CBSSA’s are comprised of 4 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 eight-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 an unscheduled block month in rotation 1 (R1) of Phase 2 to be used for additional study time. Students in this situation will also be required to meet with a Student Affairs dean and sign a Step 1 delay agreement no later than March 26, 2025.

Students who plan to apply for accommodations for Step 1 are encouraged to apply as early as possible. The NBME can take a minimum of 60 business days (three months) to review applications for accommodations. Reach out to Beth Tidball at btidball@iu.edu for help with your application for accommodations.

Students may request a one-time-only, contiguous three-month extension to their eligibility period. The fee for an extension is $70 per registration. The request and fee must be submitted no later than one month after your current eligibility period expires.

Instructions from NBME

To submit a request, log in to your account on NLES, click on the “Full Details” link for your exam, and click the “Extend Eligibility Period” button in the “Apply” box. If you have an appointment scheduled during your current eligibility period and need to reschedule the appointment for your extended eligibility period, you must cancel or reschedule with Prometric. Requesting an extension of your eligibility period does not cancel a scheduled appointment. A fee may be charged by Prometric if you change your appointment, depending upon how much notice you provide when making the change. See the appointment change fee schedule on the USMLE website for detailed information.

If you cancelled your appointment within 45 days of the scheduled test date or did not test as scheduled, you need to call Prometric as directed on your scheduling permit and pay a fee to Prometric to reinstate your eligibility record before you submit your request for an eligibility period extension. NBME will issue a revised scheduling permit two to three business days after processing your request and notify you by email. Upon receipt of your revised scheduling permit, you may contact Prometric to schedule an appointment.

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.

IU School of Medicine 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 small number of students who did not pass the first time.

We anticipate receiving most 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 three months of receiving their failing score. IU School of Medicine requires that students retake and pass the Step 1 exam before returning to their clerkships. 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.

Nov. 29, 2025, deadline: Students must retake Step 1 by Nov. 29, 2025, 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 Nov. 29, 2025, 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. Log in to 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.

• USMLE website and bulletin for all official information on Step 1.

• Tutors are free to students. Find information on searching for a tutor.

• The Ruth Lilly Medical Library has Step 1 test prep resources.

• Overview of the Step 1 self-assessments

• Free 120 website 

• Truelearn

• USMLE Bullets

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