State College of Medicine, UCSF School of Medicine, University of Wisconsin School of Medicine and Public Health, Baylor College of Medicine, Weill Cornell Medical College, Perelman School of Medicine at the University of Pennsylvania, Vagelos College of Physicians and Surgeons at Columbia University, Stanford School of Medicine, University of Michigan, Yale School of Medicine, Roy J. and Lucille A. Carver College of Medicine at the University of Iowa and New York University School of Medicine have instituted these changes, requiring completion of the exam in the third year of medical school. Format The exam is currently an eight-hour computer-based test taken in a single-day, composed of seven 60-minute blocks of questions with a maximum of 40 multiple-choice questions per section and 280 for the exam. One hour is provided for each section, allotting an average of a minute and thirty seconds to answer each question. Between test sections, the test taker is allotted a cumulative 45 minutes (during the test day) for personal breaks. (There is a 15-minute tutorial at the beginning of the exam, which the test-taker can choose to skip and have that time added to break time.) If the taker finishes any section before the allotted one-hour time limit, the unused time is added to the break time total. The test is administered at any of several Prometric computer testing sites. Starting in 2022, the USMLE Step I examination will be reported as Pass/Fail rather than a three-digit score. Subjects Step 1 is designed to test the knowledge learned during the basic science years of medical school as applied in the form of clinical vignettes. This includes anatomy, behavioral sciences, biochemistry, microbiology, pathology, pharmacology, and physiology, as well as to interdisciplinary areas including genetics, aging, immunology, nutrition, and molecular and cell biology. Epidemiology, medical ethics and questions on empathy are also emphasized. Each exam is dynamically generated for each test taker; while the general proportion of questions derived from a particular subject is the same, some test takers report that certain subjects are either emphasized or deemphasized. Scoring Currently, students receive a score of pass or fail following sitting for the Step 1 examination. In 1999, the USMLE phased out the use of a percentile-based system in favor of a three-digit and two-digit scaled scoring system. In October 2011, two-digit scaled scores were no longer reported to any parties besides the examinees. In April 2013, the two-digit