USMLE Step 1 practice questions: a Step 1 qbank on the new 2026 format

On May 14, 2026 the USMLE moved Step 1 from seven 60-minute blocks to fourteen 30-minute blocks, with a maximum of 20 items per block instead of 40. The exam still contains up to 280 items in an 8-hour session, and the content did not change at all. What changed is your day: shorter blocks, more of them, minimum break time up from 45 to 55 minutes, and a 5-minute tutorial instead of 15. New test-delivery software came with it, including keyboard navigation and per-image contrast adjustment. Practising in 40-item blocks now trains a stamina pattern the real exam no longer asks for.

• Fourteen blocks of 30 minutes, up to 20 items each (was seven blocks of 60 minutes, up to 40 items)
• Still 280 items maximum in an 8-hour session, with unchanged content
• Minimum break time raised from 45 to 55 minutes, and it grows if you finish a block early
• Step 2 CK moved to sixteen 30-minute blocks on May 7, 2026

Every Step 1 outcome has been reported as pass or fail for exams taken on or after January 26, 2022. There is no three-digit score. A passing standard of 196 exists on the old scale, but you never see it and USMLE has said future standards will not be expressed that way. The practical effect is that grinding for an imaginary 250 is wasted effort. Pass comfortably, then move that energy to Step 2 CK, which is still scored on a 3-digit scale with a minimum passing score of 218 as of July 1, 2025, and which is now the main numeric filter programs use.

• Pass/fail for all exams on or after January 26, 2022, with no score reported
• Step 2 CK remains scored, minimum passing 218 effective July 1, 2025
• Step 2 CK first-time pass rates run about 98% for US MD students, so the score, not the pass, is what differentiates
• Four attempts per Step, lifetime, including incomplete attempts

The USMLE publishes content specifications as ranges, and they reward a specific study order. Pathology is the largest discipline at roughly 45 to 55%, followed by physiology at 30 to 40%. Note that the discipline percentages overlap by design and add to more than 100, so treat them as emphasis, not as slices of a pie. Applying foundational science concepts is 60 to 70% of the physician-task breakdown, which is why pure recall fails: the exam asks you to reason from a mechanism you understand to a patient in front of you.

• By discipline: pathology 45 to 55%, physiology 30 to 40%, pharmacology 10 to 20%, microbiology 10 to 20%
• By task: applying foundational science concepts 60 to 70%, diagnosis 20 to 25%
• Largest systems: reproductive and endocrine 12 to 16%, respiratory and renal 11 to 15%
• Biostatistics and epidemiology 4 to 6%, and it is the cheapest section to master

The mistake is treating a question bank as a scoreboard. Your qbank percentage is not a prediction, it is a study log. What matters is whether you can explain, out loud, why the distractor you chose was wrong, because Step 1 vignettes are constructed so that every wrong answer is a real disease that a careless reader would pick. Do timed, random blocks from the start, and now do them in 20-item chunks to match the actual exam. Review takes longer than the block. That is normal and it is where the learning is.

In 2025, first-time pass rates were 93% for students at US MD-granting schools, 89% for US DO students, and 75% for examinees from non-US schools. Repeaters fare far worse: 71%, 79% and 54% respectively. One methodology note matters if you are comparing years: starting in 2025, examinees from Canadian schools are grouped with non-US examinees, where previously they were grouped with US examinees. So a year-over-year comparison against 2024 is not like for like.

• US MD first-time takers: 93% pass (n=23,028)
• US DO first-time takers: 89% pass (n=4,623)
• Non-US school first-time takers: 75% pass (n=22,066)
• Repeat takers pass at 71%, 79% and 54% respectively, so the first attempt is the one that counts