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Sean and Sahith were instrumental in helping me turn things around after my Step 1 fail. I had just one month to prepare for my retake, and with their guidance, I passed.
Sarah W.
The Step 1 Free 120 is the set of official sample questions USMLE gives away. The current booklet, updated April 2026, has 119 questions in six blocks, and the online interactive version adds one more item with audio findings, which is where the name comes from (USMLE sample questions). It costs nothing, it is written by the people who write the exam, and it is the closest thing to the real interface you can sit at home.
It is also short and has no score report. This guide covers which version to use, how to time it, when to take it and how much to read into the result.
Official Step 1 practice at a glance
| Topic | Official rule | Source |
|---|---|---|
| NBME practice exams | Comprehensive Basic Science Self-Assessment (CBSSA): seven forms from $62, four sections of 50 questions, with an estimated probability of passing Step 1. | NBME: CBSSA |
| The Free 120 | 119 sample questions in the booklet (updated April 2026): five blocks of 20 and one of 19, with an answer key. The online interactive version adds one item with audio findings. | USMLE: Step 1 sample test questions (PDF) |
| Passing standard | Pass or fail since January 26, 2022; USMLE says examinees typically must answer about 60% of questions correctly to pass. | USMLE: results and scoring |
Use the version that matches your test date
USMLE runs two interactive versions. If your exam is before May 14, 2026, use the current Step 1 interactive testing experience; if it is on or after May 14, use the new one, which has the 30-minute blocks and updated tools of the new format (USMLE). The PDF is the same questions on paper and is handy for a second look at a question, not for the timed sitting.
Run the interactive version on the device and browser you would use for a real exam. The on-screen tools, the lab values window and the highlighter are part of what you are practising.
How to time it
The booklet gives its own timing: up to 30 minutes for each 20-question block and 28 minutes 30 seconds for the 19-question block, close to three hours in all (USMLE booklet).
| Block | Questions | Time |
|---|---|---|
| 1 to 5 | 20 each | 30 minutes each |
| 6 | 19 | 28 minutes 30 seconds |
| Total | 119 (plus 1 audio item online) | 2 hours 58 minutes 30 seconds |
That is the same 90 seconds a question you get on test day, where fourteen 30-minute blocks fill an 8-hour session (USMLE Step 1). Sit all six blocks in one go with short breaks, at the time of day your exam starts. USMLE itself warns that most examinees feel more time pressure on the real exam (USMLE), so treat any minutes left over as a cushion, not a sign you can slow down.
When to take the Free 120
Most students save it for the last week before the exam, often about three days out. By then content review is done, and a fresh set of official questions tells you whether your timing and reading hold up. Taking it too early wastes the one set that sounds exactly like USMLE.
Some students split it: two or three blocks early in dedicated to learn the interface, the rest in the final week. That works if the early blocks stay untouched in your memory, which is harder than it sounds.
Before the Free 120, your scored checkpoints should be NBME’s Comprehensive Basic Science Self-Assessment forms, which report an estimated probability of passing (NBME CBSSA). Use the Free 120 to confirm, not to decide.
What your percentage means
The Free 120 has no official score conversion. You get a percent correct from the answer key and nothing else. Step 1 is pass or fail, and USMLE says examinees typically must answer about 60% of questions correctly to pass (USMLE scoring), but sample-set percentages and exam percentages are not the same measure, so do not convert one to the other.
Read the result alongside your CBSSA trend. A Free 120 percentage that sits in line with passing CBSSA results is reassuring. A sharp drop is a reason to look at timing and fatigue before you assume a knowledge gap.
Review it question by question
The answer key gives letters, not explanations. Review every question, including the ones you got right, and sort each miss:
- Knowledge: you did not know the fact or mechanism. Add it to your final-week list.
- Reading: you knew it but missed the clue in the stem, often the age, the timing or a lab value.
- Reasoning: you narrowed to two and chose the weaker answer. Write down why the right one wins.
- Timing: you rushed the last questions in a block. Check whether misses cluster at the end.
If most misses are reading and timing, the last days should go to timed blocks, not more content. For a full plan see the Step 1 study schedule, and for the exam layout the Step 1 format guide.
Going over it with a tutor
In a review session we go through your Free 120 blocks with you: which clue you used, whether you committed to an answer before the options, and how you broke ties between the last two. Bring your CBSSA reports too, so the final-week plan comes from all of your data.
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