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How to Study for Step 1 — 2024 USMLE Step 1 Exam Guide

• By Med School Insiders
• November 20, 2023
• Medical Student
• Testing , USMLE , USMLE Step 1

USMLE Step 1 was previously regarded as the most important test that future doctors take. Although USMLE Step 1 is now pass/fail, it is still an incredibly challenging exam that you shouldn’t take lightly. It is critical that you pass this test, and the testing skills you build during this time are what will serve you when it comes time for Step 2 and Step 3.

Our Step 1 guide will dig into what the pass/fail change means for students, the best resources to use, how to create a study plan, success strategies, and FAQs.

Scroll below for the following topics:

• What is USMLE Step 1?

Eligibility and Scheduling

• Step 1 Pass/Fail Transition
• Ideal Step 1 Study Books and Resources
• USMLE Step 1 Study Schedule: Pre-Dedicated and Dedicated
• Step 1 Prep Tips and Advice

What to Know About Test Day

• USMLE Step 1 FAQs

What Is USMLE Step 1?

The United States Medical Licensing Exam (USMLE) is a 3-part test designed to evaluate a student’s medical knowledge as well as their ability to apply that knowledge to patient care. Step 1 organizes basic science material along two dimensions: systems and processes. Special emphasis is placed on the principles and mechanisms that underlie health, disease, and modes of therapy.

USMLE Step 1 is a one-day exam that’s divided into seven 60 minute blocks. It is administered in one 8-hour testing session, which includes an optional 15-minute tutorial and 45 minutes of break time. While the number of questions per block may vary, they will not exceed 40. The total number of questions in Step 1 will not be more than 280. The current minimum USMLE Step 1 score to pass Step 1 is 196, and the maximum possible score is 300.

When Do Medical Students Take Step 1?

Students typically take USMLE Step 1 at the end of second year (MS2), USMLE Step 2 CK is typically taken at the end of third year (MS3) or during fourth year (MS4), and Step 3 is typically taken during the first year of residency .

Your eligibility comes from being enrolled at an accredited school. Technically, you can take the exam whenever you want, but your specific scheduling usually depends on your medical school’s policies.

Once you start down the path of preparing for Step 1, register for it at least six months in advance of your test date. This is because the test dates at the Prometric test centers open up six months in advance. As such, you want to get enough of a head start to ensure you get the date and location you want.

When registering, you will input all of your demographic information, including your medical school. They will then send your information to your med school to ensure you’re qualified. Once this is confirmed, you’ll receive a token to schedule your exam. Timing on this process will vary, with some schools taking multiple weeks to review your information and release your token, which is why it’s so important to get started early and be proactive.

Once you have your token, you can return to the original site where you registered and choose the eligibility window you want to complete it in. Your eligibility window is a three month period in which you can schedule your Step 1 exam anywhere in the country, as long as there are available dates.

The good thing about being early is you can move your test date within your three month eligibility period up to 45 days in advance of the test date without a fee. If you try to move it within those 45 days, you will be charged.

Your eligibility period cannot change. You can technically request a one-time eligibility period extension that falls directly after your current eligibility period, but you cannot re-pick your eligibility period outside of that window. These exams are $600 each, and you will not be refunded if you try to schedule an exam outside of your three months.

USMLE Step 1 Pass/Fail Transition

USMLE Step 1 officially became pass/fail on January 26, 2022. This change was conceived to decrease medical school burnout and improve the mental health and wellbeing of students, as Step 1 was widely regarded as the most important test a future doctor would ever take.

Step 1 was originally designed to help state authorities grant medical licenses, but over time, Step 1 scores became more and more important, especially when it came to applying to residency.

Scores started to be weighted so heavily that a low score meant you had no hope of pursuing a competitive specialty . For example, if you wanted to be a dermatologist but had a low Step 1 score, you would need to completely rethink the trajectory of your career and choose a less competitive specialty .

In the past, the first two years of medical school were spent studying for (and stressing out about) this monumental exam. Students would need to study so much that they would skip more and more classes the closer it came to exam time.

The stress was so notably destructive to the mental health of students that Step 1 was made pass/fail, as a pass/fail medical school curriculum has been shown to improve group cohesion and reduce stress. When you’re not focused on surpassing the accomplishments of your classmates, it’s easier to play nice and work together.

Step 1’s extremely narrow score standard deviation also did not accurately reflect two students’ differences in medical knowledge, which made a residency’s score filtering threshold largely arbitrary. Plus, studies have shown that Step 1 propagates racial disparities, as Black and Latinx students have, historically, received lower test scores than Caucasian students, which meant many Black and Latinx students were denied interviews for competitive specialties.

However, it must be noted that making Step 1 pass/fail does not reduce the competitiveness of the most competitive specialties. Students weren’t necessarily stressed out by Step 1 specifically; they were worried they wouldn’t be able to get into their most desired specialty. Making Step 1 pass/fail doesn’t alleviate this concern.

By making the exam pass/fail, there is also less incentive for students to do as well as they possibly can. When you lower the bar, people often aren’t willing to jump as high. This is problematic, as even just passing Step 1 is still challenging. There is a ton of content covered on the exam, and you still need to put in substantial effort just to pass.

Plus, in the past, if you didn’t do well on Step 1, you still had Step 2 CK to help improve your application. Changing Step 1 to pass/fail means much more pressure is now placed on Step 2 CK. If things don’t go well for you on Step 2 CK, you don’t have another exam to help bolster your qualifications. Only time will tell if this change helps or hinders students.

If you want to learn more about this important change, watch our video or read our guide: How USMLE Step 1 Pass/Fail is Changing Medical School .

USMLE Step 1 Books and Resources

The gold standard resources for USMLE prep are often referred to using the acronym UFAPS. This consists of UWorld, First Aid, Anki, Pathoma, and Sketchy.

First, there’s UWorld. This comprehensive question bank is often regarded as one of the highest-yield resources for all of the Step and shelf exams. The consensus among medical students is that the questions are very similar to the actual exam—both in content and difficulty.

Many students also find the explanations, diagrams, and tables that come with each question to be incredibly helpful when reviewing information for the exam.

Next, there’s First Aid. First Aid is a review book that covers everything you need to know for Step 1, including helpful mnemonics to memorize key information. Students often refer to it as the “Bible” for Step 1, as it is incredibly high-yield and contains all of the topics you need to know for the exam.

That being said, it lacks contextualization of key disease processes and doesn’t always go to the level of depth that you need to know for each topic, so you will need to supplement it with other resources.

Next is Anki. We’ve talked about spaced repetition time and time again on Med School Insiders, as well as the Med School Insiders YouTube channel, for good reason: it works. Given the breadth and depth of knowledge that you need to know for Step 1, there’s a delicate balance between retaining and forgetting information .

Anki is the go-to for spaced repetition in medical school. By reviewing information at increasing intervals, you can maximize retention while minimizing forgetting. There are a variety of different premade decks out there; however, the Anking deck is regarded by many students as the best for Step 1 prep. Unlike other premade decks, this one is constantly being updated, added to, and organized to work with the most common USMLE materials.

There are other premade decks out there students swear by, including Brosencephalon and Lightyear, which also integrate well with common USMLE prep materials. You can also make your own deck, which has the benefit of being more personalized to you and your weak areas; however, the biggest drawback of doing this is the inordinate amount of time needed to create hundreds or even thousands of cards.

Read our 13 Best Practices to Create Effective Anki Flashcards .

Next, we have Pathoma. Pathology is the foundation of medicine; a strong understanding of it is necessary to do well on Step 1.

According to many students, the gold standard for learning pathology for Step 1 is Pathoma.

This video lecture series breaks down everything you need to know about pathology and includes PDF notes to help you review the material.

Sketchy Medical

Lastly, there’s Sketchy Medical. Using Sketchy for micro can be incredibly helpful. They have offerings in other areas too, but most agree that micro and pharm are where Sketchy excels.

These topics are incredibly memorization-heavy, so things like flashcards are helpful; however, many students report that Sketchy micro and Sketchy pharm help make memorization even easier.

They use pictures and storytelling to teach you high-yield topics in a memorable way. Additionally, the videos are entertaining and easy to go through during breaks or downtime when you aren’t highly focused but still want to make the most of your time.

Practice Exams

Although they are not part of the UFAPS acronym, practice exams are another key component to your Step 1 prep. There are generally two resources recommended for your practice exams: the UWorld Self-Assessments and the NBME practice tests.

NBME Practice Tests:

The NBME is the same body that administers the Step 1 exam, and their practice tests are made up of old USMLE Step 1 test questions. As such, it is highly recommended to go through at least a few of these late into your prep as you prepare to take the real thing.

The NBME offers 7 self-assessment tests, including the Free 120 as well as 6 Step 1 self-assessment tests.

UWorld Self-Assessments (UWSA):

In addition to the NBME Practice Tests, there are the UWorld Self-Assessments.

Much like the UWorld question banks, these self-assessments are similar to what you can expect to see on the exam and can give you a good idea of how you’ll perform on the real thing.

Although these resources (UFAPS and practice exams) should make up the bulk of your Step 1 prep, other supplemental resources can be incredibly useful, both during your preclinical years and in the weeks leading up to Step 1.

Boards and Beyond

Boards and Beyond is a comprehensive resource that corresponds to the material covered in First Aid. It consists of video lectures and USMLE-style questions to help you learn the material that will be tested on Step 1.

Amboss is similar to UWorld in that it is a question bank with USMLE-style questions. It also has a clinical library that many students find helpful, especially during the clinical years of medical school.

Anecdotally, many students have said that the questions are more challenging than what you’ll experience with UWorld and less representative of the types of questions on the real exam.

The consensus also seems to be that the explanations of the answers are not as helpful as the ones you find on UWorld. Many students recommend Amboss as a supplementary resource to be used either before UWorld during the pre-dedicated period or after having gone through UWorld to help dial in areas of weakness.

That said, we’ve also heard from students who have had great success from using Amboss over UWorld, especially in recent years, as Amboss allows you to gather additional information directly on the platform.

Goljan Audio

Goljan audio lectures are ideal for learning and reviewing pathology during medical school, as the lectures are very easy to listen to during what would otherwise be downtime. You can listen to them while driving, walking, getting groceries, etc.

That being said, it does depend on how you value your time. If you find listening to the lecture is taking away from your limited recharge time, adjust when you listen to them. For example, Med School Insiders founder Kevin Jubbal says he tried listening to them at the gym for some time but stopped because it took any enjoyment out of the activity.

How to Study for Step 1: Pre-Dedicated & Dedicated Study Schedule

There are two phases to your Step 1 preparation. There’s the pre-dedicated period and the dedicated period. The pre-dedicated period consists of the months leading up to your exam. The dedicated period consists of the 4-8 weeks before your exam.

Pre-Dedicated Period

The goal of the pre-dedicated period is to build a foundation. We recommend taking a pass through First Aid and Pathoma at least once before your dedicated period. Resources such as Anki, Boards and Beyond, etc., can also help dial in the information from these two resources.

Some students have found success going through video lectures while reading along in First Aid and taking notes, then adding the Anki cards to their rotation to review. Maximize your time by watching Sketchy medical videos while you’re eating instead of watching TV. Consider these a form of low-stress studying you can do while taking a break from practice questions or video lectures.

Next, try to finish your first pass of the UWorld Question bank (or Amboss, but not both). Set a daily question quota so you can complete the entire question bank before dedicated starts.

Lastly, make sure you’re still maintaining your performance in medical school. Although preparing for boards is important, you still have to pass your exams and fulfill your other commitments.

Spend about one quarter to one third of your day keeping on top of coursework and lectures for medical school. Spend the remainder of your day going through UFAPS. Switch to nearly 100% focus on coursework in the days leading up to your school’s block exams so that you can make sure you do well.

If you can maintain this rhythm throughout your preclinical years, you will have a solid foundation of knowledge going into your Step 1 dedicated period.

Dedicated Period

Your dedicated study period often varies between 4-8 weeks, depending on your school schedule and policies.

Before jumping in headfirst, carefully choose your resources. The UFAPS protocol should be your core. You may also want to consider Goljan’s Audio Lectures for pathology. You can augment UWorld with Amboss, or if you prefer, you could use Amboss as your main resource instead of UWorld.

Try not to have too many resources during your dedicated study period. You will quickly become overwhelmed, as you won’t be able to get through all of them. Once you have your resources, creating a plan of attack is key.

Here’s an example of how you might break up your days.

Divide each day into three 4-hour studying blocks of morning, afternoon, and evening, with 5-10 minute breaks once per hour during each of these sessions. You can follow this structure 5-6 days of the week, such as Sunday-Friday, depending on your own study preferences and what else you have going on outside of medical school.

Intentionally schedule downtime, as you will need this as well. For example, every Friday evening could be blocked off for fun and relaxation, meaning you will not do any work Friday evenings. On your scheduled time off (Ex. Saturday morning), set aside time for groceries, laundry, and other errands.

Once you have your daily schedule determined, go back and prioritize your study materials to organize your weekly studying. If you’ve already built a solid foundation during your pre-dedicated period, go through First Aid and UWorld at least once during your dedicated period. Figure out how many pages of First Aid and questions of UWorld you need to get through each day to reach this goal. Again, depending on your preferences, you might choose to use Amboss instead of UWorld.

Sketchy micro and pharm videos are entertaining, so you can integrate these when you have a spare moment or during your downtime.

Choose any form of spaced repetition (i.e., Anki, physical flashcards) to help you remember weak topics/missed concepts. Create your own flashcards /Anki cards of the questions you miss in UWorld and continuously review these weak topics by keeping up with your Anki cards. If you stay mindful of the number of cards you create and don’t overdo it, you will have an efficient and effective way of reviewing the topics you truly need to focus on.

Lastly, for practice tests, we recommend taking one towards the beginning of your dedicated period for self-assessment purposes and the rest of them towards the end. These practice tests will help you get used to the USMLE question style, hone your endurance, and master your pacing. As you take the practice test, try to pick out the most important details that were needed to answer the question and consider what information was only put there to trip you up.

Avoid taking a practice test within the preceding 48-72 hours of your test, as you want to be fresh for the real deal. You should absolutely review your practice tests thoroughly and see why you got questions wrong.

We highly recommend taking the NBME Free 120 before your test. The reason for this is the material covered on this practice test is often very high-yield and sometimes questions can be repeated on the actual test. For students who battle with testing anxiety, the NBME offers this practice test in person at various Prometric testing facilities, which can really help reduce any nerves you may have.

For more details, read our guides: Leading up to the Dedicated Period and Dedicated Study Period Schedule .

USMLE Step 1 Prep Strategies

1 | don’t neglect step 1 because it’s pass/fail.

Yes, Step 1 is pass/fail now, but it’s still an incredibly difficult test that requires a passing score. Don’t make the mistake of neglecting this test, thinking only getting a pass will be easy.

Being relaxed about your studying not only risks you failing the test, but also makes it all the harder on yourself when facing the inevitable pressure of studying for Step 2 CK. Studying is a skill that you need to hone throughout your entire time in medical school. Understand that you won’t need to put the same amount of pressure on yourself as you might have before the pass/fail change, but understand passing Step 1 at all is no mean feat.

2 | Don’t Over Resource

UFAPS (UWorld, First Aid, Anki, Pathoma, and Sketchy) are tried-and-true Step 1 resources, with an option to focus on Amboss instead of UWorld, depending on your preference.

Do not start by doing Boards and Beyond, Osmosis, and First Aid all at once (or again for that matter). These resources are redundant together. Pick your core study resources and stick to those. Ensure that what you’re getting out of each isn’t a repeat of the other.

Students often make the mistake of thinking the more resources they can get through, the better. This is an impractical use of your time because you will end up going over the same material you’ve already learned multiple times. Plus, for each new resource you choose to use, there will be a new learning curve as you familiarize yourself.

At this point in your medical education, your time is extremely limited, so you must be efficient in how you study. Zero in on your weak areas early on, and continue to review the content you get wrong.

3 | Maintain Your Performance in Med School Courses

While Step 1 is extremely important, do not neglect your regular med school courses. Your academic performance is still of the utmost importance to your future medical career.

Create a study plan that accounts for your regular courses, and stick to it. This will be a continuing theme throughout your final years of medical school. You must build systems that help you balance exams, clinical hours, extracurriculars, your own wellness, and your regular studies in order to find success.

4 | Schedule a Simulated Step 1

Schedule a simulated Step 1. NBME Free 120 is the closest in terms of the kind of questions you’ll be asked as well as simulating the testing environment. The material covered on this test is extremely high-yield; there’s also a chance some of the questions asked could appear on your real test.

If you struggle with anxiety or simply want to be as prepared as possible, NBME offers this in-person practice test at various testing facilities. This will give you an authentic feel for what the exam will really be like. Ensure you schedule it close to exam day, at least a week or two before, so that you get into test mode. However, don’t schedule your practice test in the 48-72 hours before your real test, as you want to be as fresh as possible on the big day.

Do any and all practice exams as well, and make the experience as alike to the real test day as possible. Leave your home. Go to the library. Drive to the testing center and back. Mimic the realities of test day as much as you can so that when test day rolls around, you know you can do it because you’ve already done it before. It’s just like any sport; make it like game day so that the process feels automatic when you’re faced with the real thing.

5 | Prioritize Wellness

Now that Step 1 is pass/fail, you’ll be able to find more balance, but it’s still important to push yourself and learn the material to the best of your ability. While you will be studying quite a lot, remember that this is your time. Take ownership of it. What do you need to do to adequately prepare yourself?

Build time for wellness into your study schedule. Be intentional. Without time for rest and relaxation, you will burn yourself out and could end up failing Step 1. Finding time for rest is more important than cramming until the very last minute.

Develop and hone a personalized and solid morning routine and night routine to ensure you get quality sleep every night. Getting a good sleep helps your brain further process and retain information, so don’t sacrifice it.

When you schedule your test date, you will be emailed a confirmation number that you will need to present on the day of your test.

Ensure you show up early, as there will be a line to check in. When you check in, you will be fingerprinted, they will confirm you’re registered for the test, and you will get to store any snacks or valuables. Lockers are much smaller than your average high school locker, so be careful not to bring too many large snacks or drinks.

Another good reason to show up early is that most of the testing centers are also located in industrial areas or office buildings, which can be confusing as many of them look the same. You will likely be stressed enough without getting lost the morning of your test.

If you’re one of the first in the door, you’re one of the first to start, and one of the first to leave. This is important because it means you won’t be standing there with your anxiety.

You will be allowed 45 minutes of break time (which can be increased to an hour if you skip the tutorial), and it’s important to think about how you want to schedule those breaks. This is a personal decision, as everyone takes tests differently. Be aware that your fingerprints will be taken each time you step outside of the testing space and before you enter it, which will eat into your breaktime. Anything you bring into the testing space will be checked. You can bring your own earplugs, but the center will also provide these for you.

It’s going to feel like a testing cubicle. You will be assigned a seat with a blinder on either side of you. You will be given passcodes to get in and out of the space, and you are required to raise your hand before leaving your seat. You will be given some scratch paper or a dry erase board to make notes with.

If you finish a section early, keep in mind you don’t have to launch into the next section right away. You could take that time to collect your thoughts, take some deep breaths, and refresh yourself.

USMLE Step 1 Frequently Asked Questions

When can you view step 1 results.

You’ll receive an email saying your results are ready. Step 1 results are released every Wednesday. Depending on the time of year, results can be released in as little as two weeks to as much as eight weeks, but you’re most likely to receive your results within two to four weeks.

How Long is the Step 1 Exam?

Step 1 is a one-day exam that’s divided into seven 60-minute blocks and administered in one 8-hour testing session.

This includes an optional 15-minute tutorial and 45 minutes of break time. So, if you were to skip the tutorial and the breaks, which we do not recommend, the test would take you 7 hours.

Learn more: How Long is USMLE Step 1?

How Does Pass/Fail Work for Step 1?

As of January 26, 2022, Step 1 became pass/fail. You will not be given your specific test scores, and neither will residency programs. The current minimum score to pass Step 1 is 196, so if you pass, you at least scored 196 or higher.

Step 1 becoming pass/fail means that Step 2 will now be given more weight, as it will still be scored. Plus, other metrics like clerkship grades, Dean’s lists, class rankings, and letters of recommendation will also be given more weight. This means medical students will need to dedicate the time they save studying for Step 1 on Step 2 CK prep as well as maximizing their research experience and other extracurricular activities.

That said, while Step 1 becoming pass/fail changes some of the details, the overall picture is still the same: if you want to join a competitive specialty, you will need to outshine your peers.

Can You Retake Step 1?

You are able to retake Step 1 four times; however, you can only take Step 1 three times within a 12-month period. Your fourth attempt must be at least 12 months after your first attempt and at least six months after your most recent attempt.

Are There Consequences for Retaking Step 1?

One failure does not necessarily hinder your chances of being accepted to residency, but residency programs can see how many times you’ve taken the test. Residency admissions committees see each student they accept as an investment. If you’ve failed a Step exam before, it makes you a much riskier investment.

Additionally, timing is an issue for students who fail Step 1. It takes a lot of time and effort to prepare for this test to begin with, and now you’ll have to do much of that process over again. Your time in medical school is already extremely limited—adding on test retakes will pull from time you could be spending on your studies, extracurriculars, or wellness.

Gaining an ideal match into residency takes much more than good test scores. You’ll need quality letters of recommendation and an impressive list of extracurricular experience on top of rock solid grades. Any time spent retaking tests puts you at a notable disadvantage compared to other residency candidates.

Read our complete Residency Application Guide , which includes an ideal preparation timeline, success strategies, an application checklist, and mistakes to avoid.

Just like failing a clerkship, failing any Step exam is bad news. You can still recover from it, and you can still do well, but to state the obvious: do whatever you can to avoid failing Step 1 or any Step exam.

What Happens If You Fail Step 1?

If you fail Step 1, take a deep breath. It’s not the end of the world. You can retake the test.

If you fail, contact your school and your academic advisor right away. If you don’t know who to reach out to, ask peers a year ahead of you. The person they consulted about Step 1 should be the same person you will need to reach out to.

Failing Step 1 looks bad on the school too, so they want to help you succeed however they can. They may have additional resources, such as tutors, or they may help you rearrange your schedule so that you have more flexibility to study for your next test. Of course, this depends on the specific medical school and the resources they have available.

Learn more about USMLE Step 1 Tutoring options.

You have the option to retake it two more times within 12 months of your first attempt. If you need to, you can take Step 1 a fourth and final time at least 12 months after your first attempt and at least six months after your more recent attempt. However, do note that admissions committees can see how many times you’ve taken the test.

Failing Step 1 should be a notable wake-up call—what you are currently doing isn’t working and will not work throughout your remaining time at medical school. Take time to assess why you might have failed and determine what you must do to course correct. You do not want to risk failing a second time—just one failure makes you a less attractive residency candidate.

Read our guide: What Happens If You Fail Step 1 (and What to Do Next) .

What Are the Other USMLE Exams?

The other USMLE exams are Step 2 CK and Step 3. Step 2 CK is generally taken at the end of third year, and Step 3 is generally taken during the first or second year of residency.

How Much Does USMLE Step 1 Cost?

For students and graduates of medical schools located in the United States and Canada and accredited by the LCME or AOA, Step 1 costs $660 . For information about regional surcharges and taking Step 1 at international centers, email [email protected] or call 215-590-9700.

Optimize Your Prep With a USMLE Step 1 Tutor

Take your Step 1 prep to the next level and ensure yourself a passing score. Med School Insiders offers customizable USMLE Step 1 Tutoring to give you peace of mind. Each of our tutors aced the USMLE Step 1 exam by utilizing the Med School Insiders methodology, which means you will be able to learn from the best.

At Med School Insiders, we believe no two students are the same, which is why we emphasize one-on-one mentorship and relationship building with your tutor, a diagnostic process to evaluate where you can make the greatest improvements, as well as a custom approach designed specifically to suit your strengths, weaknesses, and personal habits.

Getting into residency is about a lot more than your Step 1 score. Med School Insiders can help you prepare a stand out residency application that will ensure a match at one of your top programs. We offer a number of Residency Admissions Consulting Services tailored to your needs, including personal statement editing , interview prep and mock interviews , and overall application editing.

We’re here to answer all of your questions and help you choose the path that best aligns with your interests and desired outcomes. It’s our goal to help you create a future that aligns with your vision.

For more advice straight from students who have been where you are before, read:

What I Wish I Knew Before Taking USMLE Step 1 and Don’t Make the Top 4 Mistakes I Made Studying for Step 1 .

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USMLE Study Guides

Study guides available at the library, step 1 - general, books by topic - anatomy, books by topic - behavioral science, books by topic - biochemistry, books by topic - microbiology/immunology, books by topic - neuroscience, books by topic - pathology, books by topic - pharmacology, books by topic - physiology.

• Subject Exams

Questions? Suggestions?

Official USMLE Information

• United States Medical Licensing Examination - Step 1 The official website of the United States Medical Licensing Examination
• Practice materials from USMLE.org Official tutorial and practice test items for multiple choice questions

Step 1 Apps

• USMLE Step 1 First Aid Q&A iPhone App Free. Comes with 48 questions. Complete set of 985 board-style questions available as in-app purchase for $44.99.
• USMLE Step 1 First Aid Q&A Android App Free. Comes with 25 questions. 985 board-style questions available as in-app purchase for $44.99.

Question Banks

• AMBOSS Question bank and interactive library. ($)
• ExamCircle New crowdsourced question bank. More than 1,200 questions. Co-founded by author of Crush Step 1. (Free)
• Kaplan Medical Step 1 QBank 2,200 QBank questions, 1 diagnostic test, 2 full simulated exams. (Free/$)
• Pathoma Pathology review online text and videos. (Free/$)
• Sketchy Medical A video library of narrated lectures that present microbes and drugs. ($)
• USMLEasy QBank Over 3,600 USMLE-format questions from McGraw-Hill. (Free/$)
• USMLE Rx Step 1 Qmax More than 3,000 questions. From the authors of First Aid. ($)
• UWorld Step 1 QBank Over 2,000 questions; very popular with UVM COM students. ($)

Online study materials

• Review Questions from AccessMedicine Create a custom quiz or flashcards from key texts in AccessMedicine, including Harrison's.
• Harrison's PodClass Discussions on key principles of internal medicine, around board-style case vignettes from Harrison’s Self-Assessment and Board Review ( print book available at Dana ).
• The Curbsiders Internal Medicine Podcast Featuring board certified Internists as they interview the experts to bring you clinical pearls, practice changing knowledge and bad puns.
• Ethics Talk Ethics Talk is a podcast aired by the American Medical Association, discusses questions of medical ethics with expert guests from across medicine. Episodes cover a wide range of topics, including gene editing, maternal mortality, medical-legal partnerships, and more.
• The Undifferentiated Medical Student Medical student Ian Drummond isn’t sure about which specialty he should pursue, so he is interviewing a physician from many of the 120+ medical specialties to help him decide. He asks each physician to discuss the content of their work, its scope, the typical workday, topics of interest in that specialty, and their decision-making process that led them to their chosen path.
• Clinical Problem Solvers Podcase from The Clinical Problem Solvers team of medical students, residents and physicians. Includes series on topic such as: Antiracism in Medicine, Women in Diagnosis, and Spaced Learning. Supporting content available on the CPSolvers website .
• AMA Doc Talk AMA Doc Talk, a series from the American Medical Association, features physicians and other health care leaders who share real-world experiences and findings about the ever-evolving health care landscape. Based on real-world learnings and anecdotes, each episode is centered around a topic related to delivering care to patients.

--------------------------

LCOM Students: I'd love to hear your podcast suggestions! Email me: [email protected] .

When possible, we have purchased e-books. Additional print study guides are available at the back of the library on shelves designated Dana USMLE . Some guides have a second copy available in the main book stacks or on Course Reserve .

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• Anatomy : review for USMLE, step 1 by Kurt E. Johnson, Frank J. Slaby, Ronald C. Bohn Call Number: QS 18.2 J67a 2012 Publication Date: 2012 Cover anatomy, histology and embryology
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Master 10 of the Toughest Step 2 CK Topics

Here at AMBOSS, we know just how busy the lead-up to the USMLE ® Step 2 CK exam can be. With clinical rotations and residency research, there is often little time for Step 2 prep. To help you out, our physicians have curated a list of 10 of the most challenging Step 2 CK topics so you can prioritize your study and take some of the pressure off! The topics include: 

• Principles of medical law and ethics
• Quality and safety
• Pain management
• Hyponatremia
• Child development and milestones
• Personality disorders
• Perioperative management  

10. Major neurocognitive disorder

What to expect on Step 2 CK  

The USMLE Step 2 CK exam integrates all of the knowledge you acquire during your first clinical experiences, packaging those insights into nuanced questions that assess your clinical judgment.

As a first step in developing a study approach, it’s a great idea to browse Step 2 CK’s content distribution . Reading this document will help you develop an understanding of the topics that will appear on the exam and the question formats that will be used to test these questions.

Nevertheless, not all topics are created equal. Some topics that appear on the Step 2 CK exam are commonly regarded as more difficult than others, and these topics can pose unique challenges to those studying for the Step 2 CK exam .

The nature of difficult Step 2 CK topics

Although Step 2 CK is a standardized exam, it is important to note that clinical experiences vary greatly from school to school and student to student. Because the clinical experiences will teach and reinforce much of the medical content featured on Step 2 CK, missing out on exposure to certain conditions can leave students unfamiliar with some test-ready knowledge.

This effect is further compounded by the fact that the Step 2 CK content is known for being more nuanced than USMLE Step 1. While the boundaries between Step 1 concepts are relatively clear, they are less so in Step 2 CK. In the latter, students will need to use clinical reasoning to produce highly educated guesses about long and nuanced questions.

Something to note is that many Step 2 CK questions present the user with multiple answer choices that are, in some way, ‘correct.’ The key challenge when solving Step 2 CK questions, then, is applying nuanced reasoning to determine the answer that is ‘most correct.’ The lack of clear-cut, black-and-white answer options is further complicated by the fact that students may not have experience with clinical scenarios that neatly follow the clinical guidelines.

Given the above factors, it can be said that difficult Step 2 CK topics often involve: 

• Complicated, multisystem diseases that appear in a wide range of clinical scenarios.
• Diagnostic and treatment algorithms with fine distinctions between alternatives.
• The blending of patient care principles and medical reasoning.

Ten challenging Step 2 CK topics

The following topics are known to provide test takers with challenges on exam day for the reasons mentioned above. While it’s not guaranteed that you’ll encounter an exam question about each and every topic, many of these topics involve fundamental concepts that are commonly included in a wide range of question types:

The NBME ® has been placing more and more emphasis on questions related to the conduct and interpersonal skills of care providers. It is difficult to approach these questions in a straightforward way because they often describe complex patient scenarios. On top of that, a test-taker’s intuition may not align with currently accepted standards and practices, so reviewing a text-based resource like the AMBOSS article before test day is one of the only effective ways to prepare.

Just like law and ethics, this topic is also appearing on Step 2 CK exams with greater frequency. Questions about quality and safety present unique challenges to test-takers because they relate to the abstract principles and practices that promote greater efficiency, transparency, and safety in medicine. One thing to watch out for in particular: discrepancies between your specific healthcare institution’s standards and those generally accepted by national bodies.

Pain is a very common trigger of diagnosis and treatment in all clinical settings. Consequently, being familiar with diagnostic features like quality, severity, and location can be useful in establishing a wide variety of diagnoses. On top of that, managing pain involves balancing several pharmacological and ethical concepts that can create dilemmas for care providers and test-takers alike. Questions regarding contraindications and side effects are common topics, so be sure to review these aspects by test day.

The pathophysiology of hyponatremia is undoubtedly complex, creating headaches for care providers during the diagnostic and treatment stages. Understanding both the renal and extrarenal causes of hyponatremia can help you make sense of associated findings at the diagnostic stage, while knowing the basics of volume status and fluid therapies can empower you to identify the safest and most effective treatment.

• Childbirth 

Childbirth is a hectic and multifaceted event with only one desired outcome but numerous pathways by which that can be achieved. As such, studying the timeline and management algorithms associated with childbirth can pay off. Reviewing the critical points where medical care can diverge is an effective way to review this topic.

A complex diagnosis commonly associated with outpatient visits, inpatient admissions, and nosocomial complications alike, properly tackling pneumonia-related questions requires an understanding of pharmacology, epidemiology, and microbiology. Of note, being familiar with the basic diagnostic groupings of pneumonia can simplify your test-day decision-making.

• Child development and milestones 

No two children follow the exact same growth and development trajectory, which can make it difficult to compare the child presented in a given vignette to the standardized milestones established as a general guide. Reviewing AMBOSS’ tables and charts related to this topic can help you develop a familiarity with the red flags worthy of your attention.

• Personality disorders 

Given the long and meandering vignettes associated with these questions, personality is a topic for which it can sometimes be difficult to distinguish pathological from idiosyncratic. Further complicating matters, personality disorders are separated by clear-cut clusters and divisions which the real-life patient scenario may not always obey. Nevertheless, reviewing the key features of each cluster can help you narrow down your options on test day.

• Perioperative management 

Because pre- and post-operative care is something all patients experience in one form or another, this is one of the most common surgical topics to appear on the exam. Nevertheless, the merits and demerits of each clinical approach can be difficult to keep straight and apply on test day. Reviewing the basics of fluid management, oxygen supplementation, and other core topics can help you make sense of vignettes associated with this topic.

• Major neurocognitive disorder

A sensitive topic that can be very difficult to manage in real-life patient situations, major neurocognitive disorder is also associated with Step 2 CK questions that can pose medical and ethical challenges alike. Reviewing the unique diagnostic features of each unique pathology can make these questions more approachable on test day.

Reviewing and rehearsing the topics above at various stages of your Step 2 CK studies will provide you with useful skills and insights for test day. No matter how complicated any one topic may seem, please try your best! We’re confident that you will be ready for test day.

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The Best Research Opportunities For IMGs

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Medical students, notably IMGs on the USMLE path, have plenty of research opportunities. These internships enrich classroom learning by fostering critical thinking and clinical judgment while offering a shot at contributing to science, but they also create important networking opportunities that can be valuable for residency matching. 

We previously discussed various research opportunities available for IMGs . However, it is crucial to choose a program that aligns with long-term goals, as options range from basic lab sciences to analyzing patient data and studying disease trends over time.

Summer internship programs explicitly designed for IMGs are available even at highly respected institutions like Harvard University’s Global Clinical Scholars Research Training Program.

Benefits of Participating in research while studying medicine

Partaking in medical research can greatly benefit a student’s study period – it deepens disease understanding and forms professional skills. Additionally, it sharpens analytical abilities, enabling students to comprehend complex science literature and diagnose challenging cases. 

It also offers an advantage in residency selection as programs highly value such experiences, thus broadening career paths. Moreover, it provides opportunities for global networking with professionals, potentially leading to future project collaborations and medical guidance.

Types of Research Available To Medical Students and IMGs

Each type of research offers distinct advantages and challenges that greatly enhance patient care and deepen our understanding of diseases. Here are a few types of research you can engage in.

Conducting clinical trial studies at universities/research labs

Conducting clinical trial studies at universities and research labs is a significant component of advancing medical knowledge. These institutions provide crucial environments for conducting rigorous, systematic investigations into novel interventions or therapies. 

Clinical trials are inherently multi-disciplinary, requiring diverse teams of clinicians, biostatisticians, and pharmacologists to collaborate to develop new disease treatments. Participants in these university-based trials often gain first-hand exposure to cutting-edge technologies and methodologies while contributing directly to advancing patient care procedures. Thus enriching students’ education and providing invaluable expertise in shaping an individual’s professional trajectory within medicine or scientific research domains.

Publishing Scientific Papers in Peer-reviewed journals

Publishing scientific papers in peer-reviewed journals is a critical aspect of medical academia that validates and disseminates your research findings. The process involves rigorous scrutiny by independent experts to ensure accuracy, credibility, and contribution to the existing knowledge base. It commands depth of understanding, meticulous application of research methodology, and clear articulation of conclusions drawn from data analysis. 

Achieving this milestone not only adds prestige to one’s professional portfolio but also significantly influences future investigations in the respective discipline while promoting collaborative opportunities for researchers globally – thereby fostering collective advancements within healthcare sciences.

Participating as a co-author or assistant author on existing projects

Participating in existing projects is an excellent starting point for IMGs and students in the field of research. This engagement offers an opportunity to understand the processes and methodologies used in clinical or experimental settings. It equips students with the necessary skills required for academic writing, including data interpretation, manuscript drafting, editing, and literature review. 

Additionally, this role fosters professional networking and enhances interpersonal competencies which are highly valuable during the residency match process. Furthermore, being credited as a co-author substantiates your contribution to the scientific community while significantly amplifying one’s research profile – ensuring higher visibility within the medical fraternity.

Carrying out independent surveys & qualitative research methods

Conducting independent surveys and utilizing qualitative research can optimize data collection by allowing researchers to gain detailed insights into specific topics. This approach enables one to understand human behavior, perceptions, attitudes, or experiences that are often missed out in quantitative studies. Independent surveys offer flexibility; they can be tailored towards a certain demographic group or topic of interest and deployed through various channels like online platforms or face-to-face interactions.

Shadowing experienced researchers within the field

It is an exceptional opportunity that provides aspiring medical professionals with direct insight into a research-oriented career. Shadowing allows one to observe first-hand how hypotheses are formulated, experiments designed, data interpreted, and results communicated effectively within the scientific community. 

Besides exposing participants to various methodologies and ethical considerations associated with research practices, this immersive learning experience enhances the technical skills in executing rigorous studies while fostering the critical thinking aptitude required for innovative problem-solving strategies. Additionally, it fosters relationships with experts, which can result in potential mentorships or collaborations – facilitating both professional development and academic growth.

Gaining experience through summer internships and fellowships programs

Gaining experience through summer internships and fellowship programs can be a transformative stepping stone for IMGs. These short-term experiences provide immersive exposure to various medical specialties, offering hands-on clinical training under the guidance of experienced mentors. IMGs have the chance to improve their technical skills and gain insight into advanced patient care in a variety of healthcare settings. The experience adds value to a candidate’s CV and helps them stand out during a residency match.

Common Challenges Faced by IMG When Pursuing Research Experiences

Pursuing research opportunities can be a complex journey for IMGs. They frequently encounter language and cultural barriers, significantly hindering their communication skills and adaptation to a new environment. Adjusting to unfamiliar dialects, especially scientific terminologies, and absorbing foreign customs often leaves them walking on shaky ground.

Finding professional contacts who could potentially guide them through these knotty issues is equally challenging due to geographical restraints and the lack of an established network. Compounding these challenges are financial limitations that emerge from expensive relocation or course fees despite available scholarships. These obstacles require resilience but become stepping stones toward success in their chosen field.

The landscape of research opportunities available to IMGs is vast. These extend from core laboratory-based scientific explorations to large-scale clinical trials or public health-related epidemiological studies. Programs specifically designed for such groups, like Harvard University’s Global Clinical Scholars Research Training Program, add immense value by providing a comprehensive learning experience under expert mentorship.

To make the most of these experiences, IMGs must choose projects that resonate with their career interests.

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How marketers can incorporate text-to-image generative ai tools.

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A recent Gartner study found that 63% of marketing leaders plan to invest in generative AI tools in the near term. This is unsurprising given the number of potential marketing uses, such as automating routine editing tasks, delivering personalized experiences at scale or employing predictive models. One important area of marketing where generative AI can have significant impact is the creative process. Indeed, creativity has proven to be Gen AI’s “killer use case” , with 15+ billion images created with AI between 2022 and 2023, a figure greater than the total number of photos on Shutterstock and equal to one-third of all the images ever posted to Instagram.

With the explosion of social media, marketing teams are having to create more content and deliver it quicker than ever. This increased pressure applies to both creatives and designers who produce final outputs, and marketing managers who strategize and are now finding themselves responsible for posting social media content with increased velocity. More media is required, more insight on what works is required, production time frames are shorter and more reactionary posts are needed. To cope with this heightened pressure to create more content, marketing leaders will need to find ways to be more efficient and productive.

Text-to-image generative AI models can help solve this problem by accelerating ideation and boosting productivity of marketing teams. To better understand such generative AI tools and how they could be used by marketing teams, I connected with Praveen Krishnamurthy, who is a Product Marketing Manager at Adobe and does research on this topic. Krishnamurthy explained, “these text-to-image tools allow users to edit or produce imagery by using textual prompts; they are easy to use and empower marketers to create rich imagery from scratch and to make complex edits quicker.”

When asked how the marketing teams can adopt these generative AI models to improve efficiency, Krishnamurthy indicated “my research identifies three contexts in which they can leverage these tools – automating repetitive editing tasks, rapid prototyping and idea generation. First, marketing teams could automate repetitive tasks in editing images. This includes aspects like background removal, background replacement, object removal, adding or inserting new objects, lighting adjustments and expanding the dimensions of images. Editing images to produce high-quality final output is time consuming and requires highly skilled designers. Generative AI can save invaluable time in this part of the production process.

Second, generative AI can also save you a ton of time in rapid prototyping. If your creative team has a visual concept designed, you’d often want to test and experiment with different colors and settings. For example, if you are considering a new packaging design, text-to-image generative AI tools can offer mock-ups of a variety of visual options to choose from, including multiple color schemes, typography and imagery, making it easier and quicker to assess and iterate with different ideas.

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Finally, if marketing teams have an initial idea or concept in mind, a text-to-image generative AI tool can give them a big boost by producing a diverse range of imagery that can spark their creativity. For instance, if you are working on a campaign focused on new eco-friendly packaging, you can start brainstorming by asking a text-to-image model to generate images that convey sustainability and eco-friendliness. The visuals so generated will serve as great conversation starters and accelerate the idea generation process.”

When asked to provide an example, Krishnamurthy pointed to Owen Jones, a creative agency working with some of the top global brands, as a company that has successfully adopted text-to-image generative AI for early ideation and generates rough drafts in seconds to determine whether their ideas will work.

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• Risk Factors
• Breast Cancer Resources to Share
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Screening for Breast Cancer

• Breast cancer screening can help find breast cancer early, when it is easier to treat.
• The US Preventive Services Task Force recommends that women who are 40 to 74 years old and are at average risk for breast cancer get a mammogram every 2 years.

Breast cancer screening means checking a woman's breasts for cancer before there are signs or symptoms of the disease. All women need to be informed by their health care provider about the best screening options for them. When you are told about the benefits and risks of screening and decide with your health care provider whether screening is right for you—and if so, when to have it—this is called informed and shared decision-making.

Although breast cancer screening cannot prevent breast cancer, it can help find breast cancer early, when it is easier to treat. Talk to your doctor about which breast cancer screening tests are right for you, and when you should have them.

Screening recommendations

The US Preventive Services Task Force is an organization made up of doctors and disease experts who look at research on the best way to prevent diseases and make recommendations on how doctors can help patients avoid diseases or find them early.

The Task Force recommends that women who are 40 to 74 years old and are at average risk for breast cancer get a mammogram every 2 years. Women should weigh the benefits and risks of screening tests (see below).

When Should I Start Getting Mammograms?

CDC's Dr. Lisa Richardson talks about the best time for women to start getting mammograms in this video.

Types of tests

A mammogram is an x-ray of the breast. For many women, mammograms are the best way to find breast cancer early, when it is easier to treat and before it is big enough to feel or cause symptoms. Having regular mammograms can lower the risk of dying from breast cancer. At this time, a mammogram is the best way to find breast cancer for most women of screening age.

Breast magnetic resonance imaging (MRI)

A breast MRI uses magnets and radio waves to take pictures of the breast. Breast MRI is used along with mammograms to screen women who are at high risk for getting breast cancer. Because breast MRIs may appear abnormal even when there is no cancer, they are not used for women at average risk.

Other exams

• Clinical breast exam: A clinical breast exam is an examination by a doctor or nurse, who uses his or her hands to feel for lumps or other changes.
• Breast self-awareness: Being familiar with how your breasts look and feel can help you notice symptoms such as lumps, pain, or changes in size that may be of concern. These could include changes found during a breast self-exam. You should report any changes that you notice to your doctor or health care provider.

Having a clinical breast exam or doing a breast self-exam has not been found to lower the risk of dying from breast cancer.

Benefits and risks of screening

Every screening test has benefits and risks, which is why it's important to talk to your doctor before getting any screening test, like a mammogram.

Benefit of screening

The benefit of screening is finding cancer early, when it's easier to treat.

Risks of screening

Harms can include false positive test results, when a doctor sees something that looks like cancer but is not. This can lead to more tests, which can be expensive, invasive, and time-consuming, and may cause anxiety.

Tests also can lead to overdiagnosis, when doctors find a cancer that would not have gone on to cause symptoms or problems, or even may go away on its own. Treatment of these cancers is called overtreatment. Overtreatment can include treatments recommended for breast cancer, such as surgery or radiation therapy. These can cause unnecessary and unwanted side effects. Other potential harms from breast cancer screening include pain during procedures and radiation exposure from the mammogram test itself. While the amount of radiation in a mammogram is small, there may be risks with having repeated x-rays.

Mammograms may also miss some cancers, called false negative test results, which may delay finding a cancer and getting treatment.

Where can I go to get screened?

You can get screened for breast cancer at a clinic, hospital, or doctor's office. If you want to be screened for breast cancer, call your doctor's office. They can help you schedule an appointment.

Most health insurance plans are required to cover screening mammograms every 1 to 2 years for women beginning at age 40 with no out-of-pocket cost (like a co-pay, deductible, or co-insurance).

Find a mammography facility near you.

Are you worried about the cost?‎

Breast cancer.

Talk to your doctor about when to start and how often to get a mammogram.

For Everyone

Public health.

Is college worth it? The answer for half of Americans is striking.

A college degree has often been sold as the key to a higher-quality, affluent life. But a new survey from the Pew Research Center suggests Americans have mixed views about that narrative – and data shows people without degrees have seen their earnings increase in the last decade.

Just 1 in 4 U.S. adults said it was extremely or very important to have a four-year degree if you want a well-paying job in the current economy. Forty percent of respondents said it wasn’t too important or important at all. 

Mirroring those trends, just 22% of adults said the cost of getting a bachelor’s is worth it even if it means taking out student loans. Nearly half said the cost is only worth it when students don’t have to go into debt. 

Graphics explain: How are college costs adding up these days and how much has tuition risen?

Given trends in the labor and economy – combined with skyrocketing tuition and student debt levels – the lackluster confidence among Americans isn’t surprising. For several decades until about 2014, for example, the earnings for young men without a degree trended downward. But the past decade “has marked a turning point,” according to the Pew analysis.

Workforce participation for these young men has stabilized and their earnings have risen. The share of them living in poverty has also fallen significantly. In 2011, for example, 17% of young men with just a high school diploma were living in poverty; in 2023, that rate dropped to 12%. Young women’s outcomes also improved in recent years.

The changing circumstances help explain why people's mindsets about the value of college have shifted. Roughly half of Americans, according to the Pew report, say a four-year degree is less important today than it was in the past to secure a well-paying job. A smaller percentage – about a third – say it’s more important now. 

The skepticism is more pronounced among conservative Americans than people who identify as Democrats or somewhat Democrat. Most Republicans (57%) said it was less important to have a four-year degree. Still, Americans from both parties are more likely to say the importance of a college degree has declined than to say it's increased.

The findings come as the Biden administration works to forgive certain borrowers’ federal student loan debt, which now totals more than $1.6 trillion. On top of barriers to covering tuition, college life has been altered this year by an uptick in culture war tensions on campus, from bans on diversity, equity and inclusion programming to student protests prompted by the Israel-Hamas war. These challenges have fueled debates about whether college is worth it.

Still, the research shows that earnings for degree holders have also trended upward. The income gaps between college graduates and those with just high school degrees or incomplete credentials have persisted. 

And while employment prospects for young men without a degree improved in the past decade, their median annual earnings remain below their 1973 adjusted levels.

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Is College Worth It?

As economic outcomes for young adults with and without degrees have improved, americans hold mixed views on the value of college, table of contents.

• Labor force trends and economic outcomes for young adults
• Economic outcomes for young men
• Economic outcomes for young women
• Wealth trends for households headed by a young adult
• The importance of a four-year college degree
• Getting a high-paying job without a college degree
• Do Americans think their education prepared them for the workplace?
• Is college worth the cost?
• Acknowledgments
• The American Trends Panel survey methodology
• Current Population Survey methodology
• Survey of Consumer Finances methodology

Pew Research Center conducted this study to better understand public views on the importance of a four-year college degree. The study also explores key trends in the economic outcomes of young adults among those who have and have not completed a four-year college degree.

The analysis in this report is based on three data sources. The labor force, earnings, hours, household income and poverty characteristics come from the U.S. Census Bureau’s Annual Social and Economic Supplement of the Current Population Survey. The findings on net worth are based on the Federal Reserve’s Survey of Consumer Finances.

The data on public views on the value of a college degree was collected as part of a Center survey of 5,203 U.S. adults conducted Nov. 27 to Dec. 3, 2023. Everyone who took part in the survey is a member of Pew Research Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. Address-based sampling ensures that nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories. Read more about the ATP’s methodology .

Here are the questions used for this report , along with responses, and the survey’s methodology .

Young adults refers to Americans ages 25 to 34.

Noncollege adults include those who have some college education as well as those who graduated from high school but did not attend college. Adults who have not completed high school are not included in the analysis of noncollege adults. About 6% of young adults have not completed high school. Trends in some labor market outcomes for those who have not finished high school are impacted by changes in the foreign-born share of the U.S. population. The Census data used in this analysis did not collect information on nativity before 1994.

Some college includes those with an associate degree and those who attended college but did not obtain a degree.

The some college or less population refers to adults who have some college education, those with a high school diploma only and those who did not graduate high school.

A full-time, full-year worker works at least 50 weeks per year and usually 35 hours a week or more.

The labor force includes all who are employed and those who are unemployed but looking for work.

The labor force participation rate is the share of a population that is in the labor force.

Young adults living independently refers to those who are not living in the home of either of their parents.

Household income is the sum of incomes received by all members of the household ages 15 and older. Income is the sum of earnings from work, capital income such as interest and dividends, rental income, retirement income, and transfer income (such as government assistance) before payments for such things as personal income taxes, Social Security and Medicare taxes, union dues, etc. Non-cash transfers such as food stamps, health benefits, subsidized housing and energy assistance are not included. As household income is pretax, it does not include stimulus payments or tax credits for earned income and children/dependent care.

Net worth, or wealth, is the difference between the value of what a household owns (assets) and what it owes (debts).

All references to party affiliation include those who lean toward that party. Republicans include those who identify as Republicans and those who say they lean toward the Republican Party. Democrats include those who identify as Democrats and those who say they lean toward the Democratic Party.

At a time when many Americans are questioning the value of a four-year college degree, economic outcomes for young adults without a degree are improving.

After decades of falling wages, young U.S. workers (ages 25 to 34) without a bachelor’s degree have seen their earnings increase over the past 10 years. Their overall wealth has gone up too, and fewer are living in poverty today.

Things have also improved for young college graduates over this period. As a result, the gap in earnings between young adults with and without a college degree has not narrowed.

The public has mixed views on the importance of having a college degree, and many have doubts about whether the cost is worth it, according to a new Pew Research Center survey.

• Only one-in-four U.S. adults say it’s extremely or very important to have a four-year college degree in order to get a well-paying job in today’s economy. About a third (35%) say a college degree is somewhat important, while 40% say it’s not too or not at all important.
• Roughly half (49%) say it’s less important to have a four-year college degree today in order to get a well-paying job than it was 20 years ago; 32% say it’s more important, and 17% say it’s about as important as it was 20 years ago.
• Only 22% say the cost of getting a four-year college degree today is worth it even if someone has to take out loans. Some 47% say the cost is worth it only if someone doesn’t have to take out loans. And 29% say the cost is not worth it.

These findings come amid rising tuition costs and mounting student debt . Views on the cost of college differ by Americans’ level of education. But even among four-year college graduates, only about a third (32%) say college is worth the cost even if someone has to take out loans – though they are more likely than those without a degree to say this.

Four-year college graduates (58%) are much more likely than those without a college degree (26%) to say their education was extremely or very useful in giving them the skills and knowledge they needed to get a well-paying job. (This finding excludes the 9% of respondents who said this question did not apply to them.)

Views on the importance of college differ widely by partisanship. Republicans and Republican-leaning independents are more likely than Democrats and Democratic leaners to say:

• It’s not too or not at all important to have a four-year college degree in order to get a well-paying job (50% of Republicans vs. 30% of Democrats)
• A college degree is less important now than it was 20 years ago (57% vs. 43%)
• It’s extremely or very likely someone without a four-year college degree can get a well-paying job (42% vs. 26%)

At the same time that the public is expressing doubts about the value of college, a new Center analysis of government data finds young adults without a college degree are doing better on some key measures than they have in recent years.

A narrow majority of workers ages 25 to 34 do not have a four-year college degree (54% in 2023). Earnings for these young workers mostly trended downward from the mid-1970s until roughly a decade ago.

Outcomes have been especially poor for young men without a college degree. Other research has shown that this group saw falling labor force participation and sagging earnings starting in the early 1970s , but the last decade has marked a turning point.

This analysis looks at young men and young women separately because of their different experiences in the labor force.

Trends for young men

• Labor force participation: The share of young men without a college degree who were working or looking for work dropped steadily from 1970 until about 2014. Our new analysis suggests things have stabilized somewhat for this group over the past decade. Meanwhile, labor force participation among young men with a four-year degree has remained mostly flat.
• Full-time, full-year employment: The share of employed young men without a college degree who are working full time and year-round has varied somewhat over the years – trending downward during recessions. It’s risen significantly since the Great Recession of 2007-09, with the exception of a sharp dip in 2021 due to the COVID-19 pandemic. For employed young men with a college degree, the share working full time, full year has remained more stable over the years.

• Median annual earnings: Since 2014, earnings have risen for young men with some college education and for those whose highest attainment is a high school diploma. Even so, earnings for these groups remain below where they were in the early 1970s. Earnings for young men with a bachelor’s degree have also trended up, for the most part, over the past 10 years.
• Poverty: Among young men without a college degree who are living independently from their parents, the share in poverty has fallen significantly over the last decade. For example, 12% of young men with a high school diploma were living in poverty in 2023, down from a peak of 17% in 2011. The share of young men with a four-year college degree who are in poverty has also fallen and remains below that of noncollege young men.

Trends for young women

• Labor force participation: The shares of young women with and without a college degree in the labor force grew steadily from 1970 to about 1990. Among those without a college degree, the share fell after 2000, and the drop-off was especially sharp for young women with a high school diploma. Since 2014, labor force participation for both groups of young women has increased.
• Full-time, full-year employment: The shares of employed young women working full time and year-round, regardless of their educational attainment, have steadily increased over the decades. There was a decline during and after the Great Recession and again (briefly) in 2021 due to the pandemic. Today, the shares of women working full time, full year are the highest they’ve ever been across education levels.

• Median annual earnings: Median earnings for young women without a college degree were relatively flat from 1970 until about a decade ago. These women did not experience the steady decline in earnings that noncollege young men did over this period. By contrast, earnings have grown over the decades for young women with a college degree. In the past 10 years, earnings for women both with and without a college degree have risen.
• Poverty: As is the case for young men without a college degree, the share of noncollege young women living in poverty has fallen substantially over the past decade. In 2014, 31% of women with a high school diploma who lived independently from their parents were in poverty. By 2023, that share had fallen to 21%. Young women with a college degree remain much less likely to be in poverty than their counterparts with less education.

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ABOUT PEW RESEARCH CENTER  Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of  The Pew Charitable Trusts .

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