Step 1 Guide

Updated for the Academic Year 2018-2019

Have you heard? IU School of Medicine Students score higher than the national average on USMLE Step 1. 98% of students pass step 1 on their first try. The Mentoring and Advising Program is here to support you and connect you with school resources.

2019 Step 1 Deadline

Students must take the exam prior by April 6.

Step 1 Practice Exams

August:  The school centrally provides all Phase 1 Year 2 students a voucher to take a Comprehensive Basic Science Self-Assessment (CBSSA) by the end of October to give them a baseline for their Step 1 preparation. 

January:  The school centrally provides the Comprehensive Basic Science Exam (CBSE) that is given as a timed and proctored exam to reflect the readiness of individual students for Step 1, well before their dedicated Step 1 study period in March. 

February:  The school centrally provides an additional CBSSA voucher for use by students to monitor their progress.

Review Sessions

The Mentoring and Advising Program works with student leaders to provide timely sessions to assist students in preparing for Step 1 throughout Year 2.

Sessions topics include information on:

  • Creating a study plan
  • Managing self-care
  • Addressing qbank questions and clinical vignettes
  • Using practice exam results to improve performance
  • Managing and garnering support for your study time (specifically for non-traditional students)
  • Managing dedicated study time
    • February 25 (date may change if snow days are used) 
    • 10 am – noon EDT/9-11 am CST in room EH 304/404
    • Zoom meeting room

Step 1 Resource Canvas Site

Students can self-enroll in the canvas site. The site was designed by IU School of Medicine faculty to enhance your preparation by providing you with:

  • Step 1 Study tips
  • Practice questions
  • Content summaries/overviews
  • An opportunity to ask questions in the Discussion tab
  • A site that is easy to navigate since it mirrors the organization of First Aid

Lead Advisor Timeline

November: Discuss the CBSSA fall score with the student and suggest study plans prior to the CBSE.

January: Discuss the CBSE score and encourage the student to adjust their study plan as needed. Discuss the possibility of applying for a delay.

March: Follow up with a student’s progress and provide vouchers after the student provides a voucher score. Discuss the possibility of applying for a delay for those students still not scoring in the passing range.


At no cost, students can work with tutors any time on:

  • Developing study plans
  • Understanding content
  • Improving their strategic approach to questions


Why do I have to take Step 1 before clerkships?

IU School of Medicine students are required to take and pass Step 1 as a graduation requirement prior to beginning Phase 2.  We have evidence students perform better on clerkships from the intensive study period and will be ready to apply that knowledge to the clinical settings. Completing Step 1 prior to starting clerkships also allows students to put this stressful exam behind them before starting this new and exciting next phase of their training. For students who anticipate taking a vacation month for their first clerkship, the deadline still applies.  In order to keep students on track to complete all of their requirements to graduate on time, we allow students to begin their clerkships after they have taken Step 1 for the first time, even and before their score is received. 

How do I delay Step 1?

In 2018, IU School of Medicine’s mean Step 1 score was 234 while the national mean was 230. We hope that this gives you confidence that your Phase 1 curriculum has prepared you well for Step 1. However, some students may not feel ready to take Step 1 by the deadline on Saturday, April 6, 2019

There are three reasons students can request a delay for Step 1:

  1. Remediation of P1Y2 course. Students who are remediating a course from the second year are automatically granted a delay of Step 1. Students who delay for this reason will take a vacation in their first month and will need to take Step 1 by May 11.
  2. Leave of absence. Students who are planning to take a leave of absence to improve their mental health or well-being will need to complete a LOA form, which requires the approval of the Lead Advisor and the senior associate dean or a designate. View the full policy here.
  3. Failing scores on practice exams. Students who are not passing Comprehensive Basic Science Self-Assessments (CBSSAs) can request a delay of Step 1 from the Ad Hoc committee. The committee will review the student’s scores and may provide recommendations such as attendance at a structured Step 1 prep program. Students should submit this request to Abigail Klemsz, MD, no later than April 1.

Students who delay Step 1 will have a vacation in their first month of third year, which will likely change the rest of their third year schedule. They will also be required to work with their Lead Advisor and the Learning Strategist to create a study plan to ensure progress in their exam preparation. The deadline for students who delay will be May 11.

All students who are granted a delay for Step 1 are still required to attend Transitions 2.

What happens if I fail?

IU School of Medicine students are very well prepared to take Step 1. We are proud that our school Step 1 average has been above the national average for many years and last year we had only a very small number of students who did not pass the first time that they took the exam. However, in anticipation that there may be a few students who fail, we have developed the following procedure. We would like to share this information with you not to create additional anxiety, but to be fully transparent and reassure you that we have a well thought out plan to assist you in case of this rare situation.

We anticipate receiving Step 1 scores on April 17 or 24. Since this is prior to the start of the first clerkship or on the third day of the clerkship, students will need to postpone starting their clerkships in the event they do not pass Step 1. Due to the postponement, the clerkship director and coordinator will be notified of that student’s schedule change when the score is received. Students whose scores are received on May 1 will have the option to remain in their clerkship or withdraw from the clerkship.   

School policy requires that students retake and pass the Step 1 exam prior to returning to their clerkships.  Students who fail their first attempt at Step 1 will be required to enroll in Readings in Advanced Foundational Sciences. This is a new, 0-credit professional development elective created to enhance understanding of key Phase 1 foundational science concepts through a combination of self-study and structured review. Students will follow a guided plan that they will develop with input from their lead advisor, the learning strategist, competency director, and/or Phase 1 curricular faculty. One of these individuals will be the student’s accountability partner for the duration of the elective. This elective was designed so that students can remain enrolled for the summer so that they can have time to study and also continue to receive financial aid.

Because students cannot start clerkships until they have a passing score, students will only be enrolled for fall 2019 once a passing score is received.  If the student is already enrolled, their enrollment will be cancelled.  Retroactive enrollment might occur based on when the passing score is received.  We need to inform you that without enrollment, students are not eligible for financial aid or malpractice insurance and are no longer on the school’s health insurance plan (if applicable) as of August 1, 2019. 

Students who do not feel prepared to take Step 1 by the deadline or who fail Step 1, should consider in consultation with their lead advisor whether a structured, off-campus, board preparation course would be helpful. Students who feel they need additional time to study for Step 1 should contact the Assistant Dean for Academic Advising, Abigail Klemsz, MD, by April 1.  All requests for additional time will be addressed on a case by case basis by the ad hoc Step 1 Committee.

What should I do if I feel overwhelmed?

The student affairs team is here to support you! We believe in you! But we also know that this is a very stressful time, so we have worked to make a lot of different resources available to help you. The Mental Health Services team is a great place to start. Many mental health care providers are available to work with students on issues such as test anxiety that might prevent them from performing well on exams. All of their services are confidential. You can visit their website or contact the program coordinator at 317-278-2383 to set up a time to meet with any of them.

What do I do if I have more questions?

Please do not hesitate to reach out to anyone on the MAP team at any time with questions or concerns that you have. Your success and wellness are our priority!

Specific questions about Step 1 preparation may be directed to:

Kristin Richey
Learning Strategist
Skype: kristinlively

Abigail F. Klemsz, MD, PhD
Assistant Dean, Academic Advising
Associate Professor of Clinical Pediatrics