Is Step 1 still pass/fail?

Yes. Since January 2022 the USMLE reports Step 1 as pass or fail, with no three-digit score.

Which practice exams should I take for Step 1?

Use the NBME self-assessments and the Free 120. Start with an older form for a baseline and save the newest forms (NBME 25 and up) for the last weeks, since they are built most like today's exam.

How do I know I am ready to take Step 1?

Several recent practice exams in a row should be clearly above the passing line, with a Free 120 in your final week that agrees. One passing score on its own is not enough.

What should I do if my practice scores are borderline?

List every concept you missed on your last two forms, learn each one together with the look-alike that fooled you, and keep taking timed mixed blocks. If you can move your date, do it rather than sit while borderline.

Do I need a tutor to pass Step 1?

Many students pass on their own. A tutor helps most when scores have stalled near the line, because they can read your practice exams with you and find the pattern in your misses.

Step 1

How to Pass Step 1: A Plain Plan for the Pass/Fail Exam

Step 1 is pass/fail, so the goal is no holes, not a perfect score. Here is how to use practice exams, review your misses and know when you are ready.

Nov 13, 2026 · 8 min read · IvyMed

The short version

Pass/fail rewards having no holes, so spread your time across every system instead of polishing your favorite one
Take a practice exam early, then one every week or two in dedicated, and watch the trend, not one score
Review every miss by naming the concept and the look-alike that fooled you
Sit when several recent practice exams are clearly above the passing line, not when one barely is

What passing Step 1 really takes

Since 2022 Step 1 is reported as pass or fail. A very high score in one subject does not make up for a missing one, so the job is to close holes across every system.

A fail just under the line and a pass can be only a few questions apart. That means every concept you lock in counts, and the students who pass are usually the ones who kept finding and fixing small gaps right up to test day.

Get a baseline early

Take one full practice exam before dedicated starts, even if you feel unready. It shows which systems are weakest and gives you a number to improve on.

Older NBME forms or a Free 120 work well for this. Save the newest forms for later, when you want the closest match to today's exam.

Free 120 explanations Hardest NBME forms, ranked

Build your calendar around practice exams

In dedicated, take a practice exam every one to two weeks, timed and in one sitting. Fill the days between with mixed question blocks and review of what the last exam exposed.

Go from older forms to newer ones. NBME 25 and up are built most like today's pass/fail exam, so the newest ones belong in your last few weeks.

What's on each NBME form A 6-week Step 1 study schedule

Review every miss concept by concept

Getting the right letter is not the goal of review. For each miss or guess, name the concept being tested, learn how it works, then learn the look-alike you picked instead.

Concepts repeat across forms far more often than questions do. If you can explain the concept and tell it apart from its look-alike, you will get the next version of it right too.

NBME 26–34 explanations, concept by concept How to review missed questions faster

Know when you are ready

Look at your last few practice exams together. If they are steadily and clearly above the passing line, you are in a good spot. If one score passed and the others did not, you are not ready yet.

Take a Free 120 in your final week as a last check. If you are still borderline and can move your date, moving it is almost always better than hoping.

The trend matters more than one number

One good score can be a lucky form. Three scores in a row above the line is a pattern you can trust.

If you are close, do this

When you are just under the line, a few focused weeks usually do more than starting over:

List the concepts: write down every concept you missed on your last two practice exams.
Learn each one with its look-alike: one or two lines on how it works and how to tell it apart.
Mix your blocks: do timed, mixed-system blocks so you practice switching topics like the real exam.
Get a second pair of eyes: a tutor who reads your practice exams with you can spot the pattern in your misses faster than you can alone.

Ivy Step 1 Insights Why buzzwords don't work anymore

Your next step

Learn the concepts behind NBME 26–34

Every concept from the newest Step 1 practice forms, taught in our own words with its look-alikes.

Questions students ask

Is Step 1 still pass/fail?: Yes. Since January 2022 the USMLE reports Step 1 as pass or fail, with no three-digit score.
Which practice exams should I take for Step 1?: Use the NBME self-assessments and the Free 120. Start with an older form for a baseline and save the newest forms (NBME 25 and up) for the last weeks, since they are built most like today's exam.
How do I know I am ready to take Step 1?: Several recent practice exams in a row should be clearly above the passing line, with a Free 120 in your final week that agrees. One passing score on its own is not enough.
What should I do if my practice scores are borderline?: List every concept you missed on your last two forms, learn each one together with the look-alike that fooled you, and keep taking timed mixed blocks. If you can move your date, do it rather than sit while borderline.
Do I need a tutor to pass Step 1?: Many students pass on their own. A tutor helps most when scores have stalled near the line, because they can read your practice exams with you and find the pattern in your misses.

Like how we break these down? Our tutors teach the same way.

Ivy Step 1 tutors go concept by concept with you, find the gaps your practice exams keep exposing, and build your plan around your test date. It starts with a free strategy call.

Book a free Step 1 strategy call