USMLE Step 3: All You Need to Know

May 13, 2024
4 min read


Reviewed by:

Luke Hartstein

Former Admissions Committee Member, NYU Grossman School of Medicine

Reviewed: 5/13/24

Ready for the final step of the USMLE? Read on to learn everything you need to know about Step 3 of the USMLE, from test format to study tips!

If you’re ready to take your Step 3 USMLE exam, you’re one step away from US medical licensure. This is an exciting time, but it’s also time to study hard between your busy resident schedule. 

In this article, we’ll cover everything you need to know about the USMLE Step 3 exam to ensure you’re well-prepared for test day. We’ve included test format, length, study tips, pass rates, and more in this complete guide. 

Let’s get started!

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USMLE Step 3 Format

Unlike Step 1 and 2, Step 3 is a two-day exam that runs a total of sixteen hours. The test consists mainly of multiple-choice questions (MCQs) and computer-based case simulations, which you’ll need to practice beforehand to learn the format. 

Day one of Step 3 is a seven-hour testing session (with one 45-minute break) in which you’ll have to answer 232 multiple-choice questions. The questions (also known as “items”) are divided into six one-hour blocks, consisting of 38-39 MCQs each.

Day two of Step 3 is a nine-hour testing session, with a 45-minute minimum break permitted. On day two, you will answer 180 MCQs that are divided between six 45-minute blocks of 30 items each. There are also 13 case simulations on the second day, for which you will be given 10-20 minutes each. A short CCS tutorial is offered before the case simulations begin.

There will be a five-minute optional tutorial at the beginning of your test on both days. Although it is recommended to watch it, you should already be well-versed in the test format by using the interactive testing experience offered by the USMLE. 

USMLE Step 3 Schedule

The USMLE Step 3 Prometric scheduling process involves several key steps and considerations to ensure a smooth testing experience:

  • Registration and Scheduling Permit: Register for Step 3 through the FSMB to get your Scheduling Permit. You'll need this to book your exam with Prometric.
  • Scheduling: Head to the Prometric website to schedule your exam online. Make sure you have a valid email and phone number handy for confirmation and communication.
  • Appointment Changes: Avoid fees by making any changes to your appointment at least 46 days before your test date. Within 45 days, there's a fee for changes.
  • Required Documents: On exam day, bring your Scheduling Permit and a valid, unexpired government-issued ID with your photo and signature. If your name doesn't exactly match, certain variations are okay.
  • Arrival Time: Aim to arrive at the testing center at least 30 minutes before your appointment. Late arrivals might not be allowed in, and showing up more than 30 minutes late could mean no entry at all.
  • Biometrics: Expect biometric checks, like fingerprinting, as part of the security process. It's standard for USMLE exams.

Follow these steps, have the right documents, and be on time for a smooth experience with your Step 3 exam.

What Is On the USMLE Step 3?

The purpose of Step 3 is to assess your ability to apply your knowledge of medicine, biomedical science and clinical science in an unsupervised medical setting. Essentially, Step 3 is a major turning point in assessing your ability to be an excellent physician without the safety of the classroom or the guidance of senior physicians.

As you know, Step 3 is the final exam in your journey to medical licensure. Because of this, it’s a large exam that is jam-packed with as much critical information as possible. There are a total of 412 multiple-choice questions and 13 case simulations on the Step 3 exam that are spread across two days:

Day 1: Step 3 Foundations of Independent Practice (FIP)

The first day of your exam is 7 hours in length and focuses on basic medical and scientific principles. This includes the following content areas:

  • Foundational sciences
  • Biostatistics
  • Epidemiology/population health
  • Medical literature
  • Social sciences (communication, interpersonal skills, medical ethics, systems-based practice, and patient safety)
  • Diagnosis and management (history, physical examination, diagnosis, and use of diagnostic studies)

The first day consists of 232 multiple-choice questions. To get a better idea of what these MCQs will look like, refer to the Step 3 testing experience. The format of each MCQ will vary, so it is important to understand the software before your test. 

Day 2: Step 3 Advanced Clinical Medicine (ACM)

Day 2 of the USMLE Step 3 exam focuses on your ability to apply your knowledge of health and disease with the added factors of patient management and the development of an ailment over time. This includes the following content areas:

  • Diagnosis and management (particularly focused on prognosis and outcome)
  • Health maintenance and screening
  • Therapeutics
  • Medical decision-making
  • Knowledge of history and physical examination
  • Diagnosis, and use of diagnostic studies 

Unlike day one, day two consists of both multiple-choice questions and computer-based case simulations. Case simulations are available for review on the Step 3 testing experience, and there will be a brief tutorial before they begin on the day of your test. 

You’re getting ready to practice medicine independently in residency. Step 3 aims to not only test your scientific knowledge but also determine your patient management skills. The test is also aimed at a generalist US medical practice to encompass many specialties. Each question has been specifically designed to translate to many types of physicians. 

In the words of the USMLE, “Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care.” To adequately prepare yourself and gain a greater understanding of what types of questions to expect on your Step 3 USMLE exam, be sure to review the interactive testing experience multiple times before test day.

USMLE Step 3 Passing Rate

The USMLE Step 3 exam pass rate was 90% in the most recent test cycle. Below is a table describing USMLE 2022 and 2023 pass rates in detail:

Examinees from US/Canadian Schools 2022 Number Tested 2022 Percent Passing 2023* Number Tested 2023* Percent Passing
MD Degree 22,336 97% 22,405 97%
1st Takers 21,633 98% 21,703 97%
Repeaters** 703 76%† 702 77%†
DO Degree 100 96% 104 95%
1st Takers 98 96% 100 95%
Repeaters** 2 4
Total 22,436 97% 22,509 97%
1st Takers 10,993 91% 11,500 92%
Repeaters** 1,294 64%† 1,264 64%†
Total 12,287 89% 12,764 89%

Source: USMLE

As you can see from the table above, most students can pass Step 3 of the USMLE easily. As long as you study, take the test at the right time, and are adequately prepared, you shouldn't have any problems passing your exam. 

When Should You Take the USMLE Step 3?

Most students take Step 3 of the USMLE after the first year of residency. You’ll want to make sure that you’ve had experience working and studying as a resident before taking Step 3, so while you may wait a bit longer to take the test it is not recommended to take the exam earlier. 

How To Prepare for the USMLE Step 3

Here are a few study tips for the USMLE from our experts. 

1. Know the Format

The most important tip to remember heading into your Step 3 exam is to know the format and realize that this exam is not like the previous two. The exam is significantly longer (two days in length) and consists of both multiple-choice questions and case simulations. 

The questions on your Step 3 exam will be presented to you in many different ways, so it’s crucial to review the interactive testing experience several times leading up to your exam. Getting familiar with what to expect will help reduce stress and heighten your chances of acing the exam. 

2. Establish Your Study Timeline 

Before choosing your test date, make sure to create a comprehensive study schedule that incorporates your busy life in residency. You should allow several months (we recommend at least six) to study for your USMLE before taking it. If you set your exam date after creating your study schedule, you’ll certainly have enough time to study before test day. 

3. Practice Computer-Based Case Simulations

Case simulations are an important part of your exam that should not be neglected while studying. The USMLE provides several practice case simulations for you to study before your exam, but there are plenty of other resources online as well. Be sure to familiarize yourself with how these types of questions work and how the cases will be presented before your test.

Start preparing today with our USMLE Practice Questions Quiz with free sample questions and answers!

How to Register for Step 3

To register for Step 3, here's what you need to do:

  • Timing: Make sure you apply after your graduation date. Applying before will result in cancellation and fee forfeiture.
  • Application Fee: It's $925 for 2024. Pay with American Express, MasterCard, or Visa.
  • Eligibility Extension: If necessary, request a 3-month extension within 25 days after your original eligibility period ends. There's a $70 processing fee.
  • Test Accommodations: Request these in writing when you submit your Step 3 application. Check the USMLE website for details.
  • Score Recheck: If you want your Step 3 score rechecked, submit a request along with $80 within 90 days of the score report release. Changes are rare.
  • Name Change/Correction: Your ID and Scheduling Permit names must match exactly. Log in to correct it and provide evidence of the change.

Follow these steps, and you'll be all set to register for Step 3.

FAQs: USMLE Step 3

Here are our answers to some of the most frequently asked questions about the exam. If you’re preparing for your Step 3 exam and have questions for an experienced USMLE tutor, consider setting up a consultation with one of our experts.

1. What Is the USMLE Step 3 Exam?

Step 3 of the USMLE is the final of three exams required for medical licensure in the US.

2. Is the USMLE Step 3 Required for Residency?

No, most students take the USMLE Step 3 exam after their first year of residency. However, Step 2 of the USMLE is often required for admission to a residency program. 

3. Is the USMLE Step 3 Hard?

Yes, Step 3 of the USMLE is longer than both previous exams (two days in length) and consists of 412 multiple-choice questions as well as 13 case simulation questions. However, you shouldn’t have a hard time with the exam if you are well-prepared. The test has an overall pass rate of 90%. 

4. How Long Is the USMLE Step 3?

Step 3 is a two-day examination. The first day of testing includes 232 multiple-choice items divided into six blocks of 38-39 items; 60 minutes are allotted for completion of each block of test items.

Final Thoughts: USMLE Step 3

The USMLE Step 3 exam should not present too much of a challenge if you are adequately prepared for the test. By now you’ll have already taken two USMLE exams, so you may feel rather prepared already. However, step 3 provides new challenges, so it’s important to get familiar with the new exam format. 

Also, you’re one step away from medical licensure, so make sure to give yourself a pat on the back and celebrate once you’ve completed your exam!

Good luck!

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