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Reference: http://www.usmle.org/step-1/#question-formats

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Step 1 of the USMLE (United States Medical Licensing Examination) is the first part of the United States Medical Licensing Examination. It is open to medical school student and graduates to assess their ability to apply important concepts fundamental to the practice of medicine. While American medical students usually take USMLE Step 1 at the end of the second year of medical school, all graduates of foreign medical schools must take this exam is they intend to practice medicine in the United States.

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