How to prepare for USMLE Step 1 and COMLEX Level 1 now that they are pass/fail

What changed when Step 1 and COMLEX Level 1 went pass/fail?

The score report changed, not the need to pass: USMLE Step 1 results for exams taken on or after January 26, 2022 show only Pass or Fail, and COMLEX-USA Level 1 results for exams taken on or after May 10, 2022 do the same. Both exams still have a passing standard you have to meet; you just no longer see how far above it you landed.

For the USMLE, the passing standard is 196 on the three-digit scale, but that number is never shown to you. A passing report shows only Pass. A failing report shows Fail, a graphic of how far your overall performance fell from the passing standard, and content-area feedback that compares you with examinees who passed by a small margin. Results are typically available within four weeks of your test date, though the USMLE advises allowing at least eight weeks to be notified.

For COMLEX, the NBOME's minimum passing score is a standard score of 400. Alongside Pass or Fail, Level 1 candidates receive a formative performance profile that compares overall and content-area performance with that of first-time test-takers who passed. Level 1 results usually arrive two to six weeks after the end of the testing window.

Both exams also changed shape in 2026. Step 1 exams on or after May 14, 2026 are split into fourteen 30-minute blocks of no more than 20 questions each, in one 8-hour session with at least 55 minutes of break time. COMLEX Level 1 now has 320 single-best-answer questions, down from 352, in eight sections of 40 across two four-hour sessions.

Why do Step 2 CK and COMLEX Level 2-CE matter more now?

Step 2 CK and Level 2-CE matter more because they are now the first exams in each licensing sequence that still report a three-digit score, which makes them the main standardized number residency programs can compare. Both report a score plus Pass or Fail; the USMLE passing standard for Step 2 CK is 218 for exams on or after July 1, 2025, and the NBOME's for Level 2-CE is 400.

The NRMP's 2026 Program Director Survey shows the shift. Among the factors program directors used to choose applicants for interviews, the Step 2 CK score and a Step 1 pass were both among those cited most often, and most responding programs required US MD applicants to have taken Step 2 CK before being considered for an interview. Only a small share of surveyed program directors responded, so treat the survey as a snapshot rather than a census.

For DO students, expectations vary more. Among programs that required a COMLEX Level 2-CE result, some required only a pass while others preferred or required a target score, and some programs also required US DO applicants to have taken USMLE Step 1.

So Step 1 and Level 1 are not a box to tick and forget: Step 2 CK and Level 2-CE build on the same foundational science. Sequencing also differs: the USMLE lets you take Step 1 and Step 2 CK in either order, but the NBOME requires you to pass Level 1 before you are eligible for Level 2-CE.

How do you build a dedicated study plan for a pass/fail Step 1 or Level 1?

Build the plan backward from your test date: take a baseline self-assessment, match your weakest areas to the official content outline, fill each day with timed question blocks and review, and schedule more self-assessments to track progress. Schools typically set aside a dedicated study period before the exam, and its length varies, so let your baseline and your school's calendar shape the plan rather than a number you heard from classmates.

If you are a DO student taking both COMLEX Level 1 and USMLE Step 1, plan for both exams' content outlines from the start. COMLEX tests osteopathic principles and practice, which the USMLE does not, and each exam has its own format and official self-assessment. If you would like a tutor to build and adjust this plan with you, ProMed United's Board Tutoring offers one-on-one USMLE and COMLEX tutoring.

1. Read the official exam pages: the USMLE Step 1 content outline or the NBOME's COMLEX-USA content specifications, plus the current format and break rules for your test date.
2. Take a timed baseline self-assessment, an NBME CBSSA for Step 1 or a COMSAE Phase 1 form for Level 1, before dedicated study begins.
3. Rank weak areas by both your results and their weight on the exam. On Step 1, pathology (45 to 55% of items) and physiology (30 to 40%) run through every organ system, so gaps there cost the most.
4. Set a daily rhythm you can sustain: timed, mixed question blocks, a careful review of every question, then targeted content review of the gaps those questions exposed.
5. Add spaced review, such as flashcards or a running error log, so material from your first week is still there on test day.
6. Space further self-assessments through the dedicated period, and keep a few buffer days before the exam in case the plan slips.
7. Check your school's deadlines and the exam's rescheduling rules early, so moving the date is a planned decision rather than a last-minute scramble.

How should you use question banks for Step 1 and COMLEX Level 1?

Use question banks as your main study tool rather than a final check: do questions timed and mixed across subjects, then spend as much effort reviewing them as answering them. Mixed blocks make you recognize the topic the way the real exam presents it, without a chapter title as a hint.

Match the current block format. Step 1 now uses 30-minute blocks of up to 20 questions, so practicing in 20-question, 30-minute blocks builds test-day pacing of about 90 seconds per question. COMLEX Level 1 fits 320 questions into two four-hour sessions, so steady pacing matters there too.

Review every question, including the ones you got right by guessing. For each miss, note why: a knowledge gap, a misread question, a reasoning error, or running out of time. The pattern in that log tells you whether you need content review, slower reading, or more timed practice.

Use the free official materials as well. The USMLE offers sample test questions and an interactive testing experience, including a new version for the updated test delivery software that Step 1 began using in 2026. The NBOME publishes practice resources and recommends getting familiar with the COMLEX-USA content specifications so you know what kind of content to expect.

Which self-assessments should you take for Step 1 and COMLEX Level 1?

Take the official self-assessment written for your exam: NBME's Comprehensive Basic Science Self-Assessment (CBSSA) for USMLE Step 1, and NBOME's COMSAE Phase 1 for COMLEX Level 1. If you are taking both exams, use both.

The CBSSA has 200 questions in four sections of 50, with 1 hour and 15 minutes per section in standard-paced mode; a self-paced mode stretches each section to 5 hours. NBME offers seven forms, priced from $62. Instead of a three-digit score, the report gives an equated percent correct score on a 0 to 100 scale (adjusted for differences in form difficulty), a likely score range, the Step 1 low-pass range for comparison, and an estimated probability of passing Step 1 within a week, from 1% to 99%.

COMSAE Phase 1 aligns with the Level 1 test specifications. It has 176 questions in four sections of 44, with a maximum of four hours in timed mode, which the NBOME describes as the closest match to COMLEX testing conditions. Three Phase 1 forms are available for student purchase at $60 each. The NBOME advises caution in using COMSAE results to predict COMLEX performance, so treat them as one signal alongside your question bank results.

Whichever you use, take it in one sitting, timed, and without notes. NBME says that self-paced timing, consulting resources, or retaking a form you have already seen makes the results less reliable for judging readiness.

How do you know you are ready to take Step 1 or COMLEX Level 1?

You are likely ready when your recent official self-assessments sit clearly above the passing range under real test conditions, not when one practice result barely clears it. NBME's CBSSA guidance compares your likely score range, the band your score would land in about two-thirds of the time if you retested (roughly 4 points either side), with the Step 1 low-pass range, meaning performance that passes, but only by a small margin.

Read the probability of passing carefully. NBME notes that a 90% estimated probability still means about 1 in 10 examinees with the same performance would be expected not to pass, that the estimate applies to testing within a week, and that the model is updated every year. It is not a guarantee.

For COMLEX Level 1, the NBOME advises caution in reading COMSAE as a predictor, so look for consistency across more than one COMSAE form and your recent question bank performance rather than leaning on a single result. NBME's guidance for CBSSA results reads like this:

• Likely score range completely above the low-pass range: you are likely ready.
• Partly within and partly above the low-pass range: still close to the minimum passing level; more preparation may be recommended, and two or more results like this may be more reassuring than one.
• Partly below the low-pass range: borderline, and you may still be at risk of failing; additional preparation is strongly recommended.
• Completely below the low-pass range: at risk of failing; additional preparation is strongly recommended.

What are the most common mistakes when preparing for a pass/fail board exam?

The biggest mistake is treating pass/fail as low stakes. Your USMLE transcript lists your complete examination history, the USMLE provides official results to ERAS and ResidencyCAS, and repeat takers pass at lower rates: in 2025, 93% of first-time Step 1 takers from US MD schools passed, compared with 71% of repeat takers from those schools, and 89% of first-time takers from US DO schools passed.

Attempts are limited too. The USMLE allows four attempts per Step, with no more than three in any 12-month period. The NBOME allows four scored attempts per COMLEX level and does not let you retake a level you have passed to improve your score. Other common mistakes:

• Aiming for the bare minimum. You cannot see your margin over the passing line on test day, and Step 2 CK and Level 2-CE build on the same foundation, so aim for a comfortable cushion.
• Taking self-assessments self-paced, open-book, or on a form you have already seen, which NBME says makes the results less reliable.
• Spending most of your hours rereading instead of doing and reviewing timed questions.
• Skipping smaller content areas. On Step 1, biostatistics and epidemiology make up 4 to 6% of items and communication and interpersonal skills 6 to 9%, and COMLEX adds osteopathic principles and practice.
• Practicing only in 60-minute, 40-question blocks after the 2026 format change, so test-day pacing feels unfamiliar.
• Moving the exam date without changing the plan. If self-assessments stall, change how you study, not only when you test.
• Overlooking your school's rules. Your school may set deadlines for taking or passing the exam before clerkships, so check them early.