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USMLE Step 3: All You Need to Know

October 25, 2022
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”Luke

Reviewed by:

Luke Hartstein

Former Admissions Committee Member, NYU Grossman School of Medicine

Reviewed: 5/13/22

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!

Congratulations! 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 buckle down and study hard between your busy resident schedule. 

Here we go over 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.

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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:

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:

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 97% in the most recent test cycle. Below is a table describing USMLE 2020 and 2021 pass rates in detail:

USMLE Step 3 pass rates
Source: USMLE

As you can see from the table above, most students do not have difficulty passing Step 3 of the USMLE. 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 USMLE Step 3 study tips 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 Step 3 exam 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.

FAQs: USMLE Step 3

Here are our answers to some of the most frequently asked questions about the USMLE Step 3 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 admissions 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 97%. 

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 6 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. 

If you’re studying for the USMLE Step 3 exam and want some advice on how to get prepared, consider hiring a private USMLE tutor to assist you through your final Step exam. 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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