High-Yield Content Areas for Step 1

2024 USMLE Step 1 Content Area Question Distribution:

https://www.usmle.org/sites/default/files/2024-01/NBME_USMLE_Infographic_final.pdf

This infographic provides a detailed breakdown of the content areas tested on the USMLE Step 1 exam, helping you understand which subjects are most heavily represented. The document categorizes the exam’s focus across various scientific principles and organ systems, giving you a clearer picture of how to prioritize your study. It shows the relative percentage of questions for each topic, such as General Principles, Biochemistry, Pharmacology, and Systems-based subjects like Cardiovascular, Renal, and Respiratory.

Why it’s important for Step 1 preparation:
This guide helps you allocate study time to areas that are more heavily weighted on the exam, so you can target your efforts more effectively.

USMLE Content Breakdown

Step 1 Physician Tasks/Competencies Specifications

Competency	Range, %*
Medical Knowledge: Applying Foundational Science Concepts	60–70
Patient Care: Diagnosis	20–25
History/Physical Examination
Diagnosis
Communication and Interpersonal Skills	6–9
Practice–based Learning & Improvement	4–6

Foundational Science content is distributed throughout the organ systems based on disease process/diagnosis.

Step 1 Test Content Specifications

System	Range, %
Human Development***	1-3
Blood & Lymphoreticular/Immune Systems	9-13
Behavioral Health & Nervous Systems/Special Senses	10–14
Musculoskeletal, Skin & Subcutaneous Tissue	8-12
Cardiovascular System	7-11
Respiratory & Renal/Urinary Systems	11-15
Gastrointestinal System	6-10
Reproductive & Endocrine Systems	12–16
Multisystem Processes & Disorders	8-12
Biostatistics & Epidemiology/Population Health	4–6
Social Sciences: Communication and Interpersonal Skills	6–9

The Human Development topic includes Normal Age-Related Findings and Care of the Well Patient. The remaining content from the General Principles category has been distributed to other organ system categories based on disease process/diagnosis.

Step 1 Discipline Specifications

Discipline	Range, %
Pathology	44–52
Physiology	25–35
Pharmacology	15–22
Biochemistry & Nutrition	14–24
Microbiology	10–15
Immunology	6–11
Gross Anatomy & Embryology	11–15
Histology & Cell Biology	8–13
Behavioral Sciences	8–13
Genetics	5–9

USMLE Question Distribution vs UWorld QBank

I did a little analysis of the question breakdown to lower my anxiety and have a clear picture of what the Step 1 exam is assessing us on:

Step 1 Content Area and System Specifications

Content Area	Low Range, %	Top Range, %	Average Range, %
Foundational Concepts	60%	70%	65%
Diagnosis	20%	25%	23%
Communications	6%	9%	8%
Evidence-Based Medicine	4%	6%	5%

2023 Content Area by System

System	Low Range, %	Top Range, %	Average Range, %
General Principles	12%	16%	14%
Behavioral & Neuro	9%	13%	11%
Reproductive & Endocrine Systems	9%	13%	11%
Pulmonary & Renal Systems	9%	13%	11%
Hematology & Oncology	7%	11%	9%
Multisystem Processes	6%	10%	8%
Musculoskeletal Systems (MSK)	6%	10%	8%
Cardiovascular System	5%	9%	7%
Gastrointestinal (GI) System	5%	9%	7%
Biostatistics	4%	6%	5%
Human Development	1%	3%	2%

2024 Content Area by System

System	Low Range, %	Top Range, %	Average Range, %
Hematology/Oncology/Immune	8%	13%	11%
Behavioral/Neuro	10%	14%	12%
Musculoskeletal/Dermatology (MSK/Derm)	7%	12%	10%
Cardiovascular System	6%	11%	9%
Renal/Pulmonary Systems	10%	15%	13%
Gastrointestinal (GI) System	5%	10%	8%
Reproductive/Endocrine Systems	9%	13%	11%
Multisystem Processes	11%	16%	14%
Biostatistics	4%	6%	5%
Communications	6%	9%	8%

Content Areas by Discipline for Step 1

Discipline	Low Range, %	Top Range, %	Average Range, %
Pathology	44%	52%	48%
Physiology	25%	35%	30%
Biochemistry & Nutrition	14%	24%	19%
Pharmacology	15%	22%	19%
Anatomy & Embryology	11%	15%	13%
Microbiology	10%	15%	13%
Behavioral Sciences	8%	13%	11%
Histology & Cell Biology	8%	13%	11%
Immunology	6%	11%	9%
Genetics	5%	9%	7%

Content Areas by System for Step 1

By System	low range %	top range %	Average %	Ave Qs per Exam
Human Development	1%	3%	2%	6
HemeOnc/Immune	8%	13%	11%	29
Behavioral/Neuro	10%	14%	12%	34
MSK/Derm	7%	12%	10%	27
Cardio	6%	11%	9%	24
Renal/Pulm	10%	15%	13%	35
GI	5%	10%	8%	21
Repro/Endo	9%	13%	11%	31
Multi	11%	16%	14%	38
Biostats	4%	5%	5%	13
Social Sciences	6%	9%	8%	21
GenPrinciples	12%	16%	14%	39

Step 1 to UWorld Question Ratio Analysis

Content Area	% in Step 1	# in Step 1 (280)	# in UWorld Bank	Focus Suggestion
Pathology (General Principles)	6.72%	18.82	39	Focus – Major++ but fewer UWorld questions
Behavioral Sciences	11%	29.4	139	Moderate focus – Plenty of UWorld coverage
Biostatistics	5%	14	118	High focus – Relatively few Step 1 Qs vs UWorld
Communications	8%	21	107	Focus – High ratio, key to exam success
General Principles	14%	39.2	241	High focus – Core topic but low UWorld Qs
Biochemistry	19%	53.2	156	Major focus – High Step 1 importance
Neuro Pathology	6%	14.78	119	Moderate focus – Covered well in UWorld
Endocrine/Reproductive Pathology	5.5%	14.78	64	Focus – Few UWorld Qs, important system
Hematology/Oncology Pathology	5%	14.78	92	Focus – Relatively lower UWorld coverage
Pulmonary/Renal Pathology	4.5%	12.1	150	Moderate focus – Well covered in UWorld
Multisystem Processes	14%	37.8	23	High focus – Very few UWorld Qs, major system
Genetics	7%	19.6	106	Moderate focus – Balanced coverage
Immunology	9%	23.8	132	Moderate focus – Adequate UWorld coverage
Histology & Cell Biology	11%	29.4	46 combined	Focus – Lower UWorld coverage
Histology			29
Cell Biology			17
Physiology	30%	84	268	Moderate focus – Well represented in UWorld
Pathology (Overall)	48%	134.4	830	Deprioritize – Overhyped in UWorld
Pharmacology	19%	53.2	546	Deprioritize – Overhyped in UWorld
Pathophysiology	--	--	475	Deprioritize – Overrepresented in UWorld
Microbiology	13%	35	347	Deprioritize – Overrepresented in UWorld

Notable Highlights:

Pathology (48%): Estimated number of pathology-related questions from the system based on Pathology's overall representation (48%).
Physiology (30%): Estimated number of physiology-related questions from the system based on Physiology’s representation (30%).
Pharmacology (19%): Estimated number of pharmacology-related questions from the system based on Pharmacology’s representation (19%).
Biochemistry (19%): Estimated number of biochemistry-related questions from the system based on Biochemistry’s representation (19%).
Hematology/Oncology/Immune: A high-yield system with an estimated 30.8 questions, with a major focus on pathology (~14.8 questions).
Behavioral/Neuro: A combined high-yield area with an estimated 33.6 questions, split between behavioral and neuro topics, with significant pathology (~16.1) and physiology (~10.1).
Renal/Pulmonary: Expected to have around 36.4 questions, with the majority focusing on pathology (~17.5 questions) and physiology (~11.2 questions).
Reproductive/Endocrine: Another important system with 30.8 questions, focusing heavily on pathology (~14.8 questions)

Suggestions and Prioritization

My suggestion is to focus on the areas that have the highest percentage on Step 1 and the lowest number of questions in the Q bank. Prioritize those because those are your high yield areas for step. I would say those are the quickest to get exposure on because there aren’t as many. If anything, do them multiples times because they can only ask you questions on concepts so many ways. UWorld has invested a lot of money into creating a resource like this (to also make money off of all of us) so might as well make their money work for us! If you know these like the back of your hand, then you are setting yourself up for success.

High Focus Areas:

Biochemistry (53.2 Step Qs / 156 UWorld Qs): Given its significant Step 1 weight and manageable UWorld coverage, this should be a priority.
Multisystem (37.8 Step Qs / 23 UWorld Qs): Very few UWorld questions, but a major system in Step 1. Study hard on this.
Communications (21 Step Qs / 107 UWorld Qs): High relevance and relatively fewer UWorld Qs, so ensure this is a focus.
General Principles (39.2 Step Qs / 241 UWorld Qs): Core to exam success but underrepresented in UWorld. Give it high priority.
Pathology (General Principles) (18.82 Step Qs / 39 UWorld Qs): Another core topic with a low number of UWorld questions; needs focused attention.
Endocrine/Reproductive Pathology (14.78 Step Qs / 64 UWorld Qs): Fewer UWorld questions compared to its Step 1 importance; should be emphasized.

Moderate Focus Areas:

Behavioral Sciences (29.4 Step Qs / 139 UWorld Qs): Well-covered but important for Step 1; keep reviewing, but it’s balanced.
Neuro Pathology (14.78 Step Qs / 119 UWorld Qs): Important system but moderately covered in UWorld.
Pulmonary/Renal (12.1% Step Qs / 150 UWorld Qs): Moderate focus; well-covered in UWorld.
Immunology (23.8 Step Qs / 132 UWorld Qs): Decent coverage in UWorld but still important.
Genetics (19.6 Step Qs / 106 UWorld Qs): Fairly balanced coverage but worth reviewing.
Histology & Cell Biology (29.4 Step Qs / 46 combined): Focus more on these topics due to fewer UWorld questions.

Deprioritize:

Pathology (Overall) (134.4 Step Qs / 830 UWorld Qs): Well-represented in UWorld; study but avoid overdoing it.
Pharmacology (53.2 Step Qs / 546 UWorld Qs): Overhyped in UWorld; deprioritize, though still significant.
Pathophysiology & Microbiology: Both areas are overrepresented in UWorld compared to their Step 1 weight, so study selectively.

Key Focus Areas:

Biochemistry, General Principles, and Communications: High impact on Step 1 but moderate UWorld coverage.
Multisystem Processes: Very few UWorld questions but essential to Step 1.
Pathology (General Principles): Core topic for Step 1 success but low UWorld coverage.

By focusing on these areas, you can optimize your study time to match Step 1 expectations while avoiding spending too much time on overrepresented areas in UWorld.

Suggested UWorld Study Blocks Progression

First Pass: With all the Subject Selected, work your way through the left column of the systems section. Do all of them first.

What UWorld practice Questions I did to prepare for Step 1:

Mixed Blocks of all subject - General Principles Questions:
- Biochemistry (General Principles)
- Genetics (General Principles)
- Microbiology (General Principles)
- Pathology (General Principles)
- Pharmacology (General Principles)
All Subject: Biochemistry (156) Questions
All Subject: Genetics (106) Questions
All Subject: Histology (29) Questions
All Subject: Biostatistics (121) Questions
All Subject: Immunology (131) Questions
All Subject: Embryology (74) Questions
All Subject: Behavioral Science - Social Sciences > Communications (107) Questions
All Subject: Behavior Sciences – Psych (179) Questions
Miscellaneous (Multisystem) (23) Questions
All Subject – Dermatology (100) Questions
Mixed blocks of all Subject – Reproductive Questions
- Female Reproductive System & Breast (79)
- Male Reproductive System (52)

I spend most of my time for the first week, cranking out all the questions above in those sections. I wanted to get a good grasp of what was expected of me for the exam. The purpose of this was to get exposure to the concepts in the context that they would be tested not to test whether I knew it all but whether I have seen any of this before. This isn’t to test you; it is to train you for the test. So, think of this as getting your reps in practice.

Suggested UWorld Mixed Blocks

After I finished a first pass of all the questions mentioned above, and also taking a practice exam to see where I was actually at, I proceeded to create blocks of questions based on the suggested content area distribution for the test and where my gaps lied. I spent most of my time in the “high yield/low question count” areas first.

Note: Focus on the QBank Questions with Specific Intentions Based on Official NBME Breakdown

UWorld 10-20 Question Blocks Suggestions and Priorities:

Content Focus	Block
General Principles + Multisystem - Mixed or Path	Block 1
"4Ps: Path, Pathophysiology, Physiology, Pharmacology – Endocrine, Reproductive, Hematology/Oncology, Neuro"	Block 2
Behavioral Sciences – Psych and Sociology	Block 3
Biostatistics/Communications	Block 4
Biochemistry, Immunology, Histology, Cell Biology (Mixed)	Block 5
"4Ps: Path, Pathophysiology, Physiology, Pharmacology – Cardiology, Renal, Pulmonary, GI"	Block 6
Genetics, Microbiology, Embryology, Anatomy (Mixed)	Block 7
Biochemistry, Pharmacology, Physiology, Microbiology (Mixed)	Block 8

Block Suggestions After Taking the Exam:

Content Focus	Block
General Principles + Multisystem	Block 1
4Ps: Cardiology, Renal, Pulmonary	Block 2
4Ps: GI, Endocrine, Reproductive (M+F)	Block 3
Neuro, Hematology/Oncology, Rheumatology	Block 4
Behavioral Sciences (Psychology, Sociology – No Comm)	Block 5
Communications + Biostatistics	Block 6
Microbiology + Histology	Block 7
Biochemistry + Immunology	Block 8