1) The USMLE exam has 3 steps - Step 1, Step 2 (with 2 parts), and Step 3. Step 1 and 2 are required to obtain ECFMG certification. 2) Step 1 is a one-day, 8-hour exam with 322 multiple choice questions covering basic sciences. The average score is 222 with a passing score of 188. 3) Preparation for Step 1 requires months of study using resources like First Aid, UWorld question bank, and costs $1000-$1500 total.