How many questions are on USMLE Step 1?
USMLE Step 1 has up to 280 multiple-choice questions, taken in one 8-hour day. Since May 14, 2026 they come in fourteen 30-minute blocks of up to 20 questions each, with at least 55 minutes of break time. Before that date it was seven 60-minute blocks of up to 40. The total cap of 280 did not change.
In more detail
280 is a ceiling, not a fixed count. USMLE says the number of questions per block varies by exam form and never goes above 20 (40 before May 14, 2026), so your test can have fewer than 280. Some questions are unscored pretest items, and nothing on screen tells you which, so treat every one as counted.
The time works out to 420 minutes of testing, which is 90 seconds per question if you get the full 280. The rest of the 8 hours is break time and a 5-minute optional tutorial. Break time is a pool, not a fixed lunch slot: finishing a block early adds the time you saved to it. Under the old format the pool was 45 minutes plus a 15-minute tutorial.
Step 1 has been pass or fail since January 26, 2022, and USMLE does not publish a number of correct answers you need to pass. Results are reported against a fixed standard on a score scale, so counting how many you got right during the exam tells you little. Plan for steady pacing across the whole day instead.
Step 1 format before and after May 14, 2026 (USMLE)
| Before May 14, 2026 | On or after May 14, 2026 | |
|---|---|---|
| Blocks | 7 | 14 |
| Time per block | 60 minutes | 30 minutes |
| Questions per block (maximum) | 40 | 20 |
| Questions in total (maximum) | 280 | 280 |
| Minimum break time | 45 minutes | 55 minutes |
| Optional tutorial | 15 minutes | 5 minutes |
| Testing day | 8 hours | 8 hours |
Step by step
- 1
Look up the format for your test date on usmle.org, because the blocks changed on May 14, 2026.
- 2
Practice in timed blocks of 20 questions in 30 minutes, which is 90 seconds per question.
- 3
Near the end of your prep, do two or three blocks in a row, then one full day of 14 blocks so the 8 hours are not new to you.
- 4
Decide your break plan ahead: when you eat, when you stretch, and that finishing a block early adds break time.
- 5
Flag a question and move on if it stalls you for more than 2 minutes, and use the last minutes of a block to go back to the flagged ones.
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More questions
How long is USMLE Step 1?
One testing day of 8 hours. About 7 hours of that is question time (fourteen 30-minute blocks), and the rest is break time and a short optional tutorial.
How many questions do you need to get right to pass Step 1?
USMLE does not publish a number or a percentage. Step 1 is pass or fail, scored against a fixed standard on a scale, and different exam forms have different questions. Aim for a clear margin above the passing line on official practice tests.