USMLE® Step 3 Exam Guide

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What is the USMLE?

USMLE® stands for the United States Medical Licensing Examination® and is comprised of a series of exams—Step 1, Step 2 CK, Step 2 CS, and Step 3. All medical students and graduates must pass each of these exams to obtain medical licensure in the United States. The USMLE is sponsored by the National Board of Medical Examiners® (NBME®) and the Federation of State Medical Boards (FSMB).

The USMLE’s purpose is to assess whether you can integrate and apply the knowledge, values, and skills you have gained in medical school. Successful completion of the USMLE helps demonstrate your competency as a soon-to-be practicing physician to licensing authorities.

What is on the USMLE Step 3?

The USMLE Step 3 is the final examination in the USMLE sequence. It assesses whether you have the medical knowledge necessary to deliver general medical care without supervision. Compared to the previous Step exams, Step 3 places a greater emphasis on patient management, including initial workup, continued care, and emergency care.

The Step 3 exam is administered over two days, each with a different aim:

1. Day 1 of 2: Step 3 Foundations of Independent Practice (FIP) assesses your knowledge and application of basic medical and scientific principles. Tested areas include:

  • Biostatistics, epidemiology, and population health
  • Interpretation of the medical literature
  • Communication and interpersonal skills
  • Medical ethics, systems-based practice, and patient safety
  • History taking and interpretation and physical examination
  • Differential diagnosis and use of diagnostic studies

Step 3 FIP features only multiple-choice items.

2. Day 2 of 2: Step 3 Advanced Clinical Medicine (ACM) assesses your ability to apply a comprehensive knowledge of human health and disease to patient management at initial disease presentation and over time with evolving disease manifestations. Tested areas include:

  • Health maintenance and screening
  • History taking and interpretation and physical examination
  • Differential diagnosis and use of diagnostic studies
  • Medical decision making and management
  • Therapeutics
  • Prognosis and outcome

Step 3 ACM features both multiple-choice items and computer-based case simulations.

How long is the USMLE Step 3?

The USMLE Step 3 is administered over two days, which may be scheduled as consecutive or non-consecutive test days.

1. Day 1 of 2: Foundations of Independent Practice (FIP)

  • Multiple-choice items only
  • 7-hour testing session
  • Six 60-minute blocks
  • Approximately 38-39 items/block and 232 items total

2. Day 2 of 2: Advanced Clinical Medicine (ACM)

  • Multiple-choice questions and computer-based case simulations
  • 9-hour testing session
  • Six 45-minute blocks of multiple-choice items, with 30 items/block and 180 items total
  • 13 computer-based case simulations lasting 10-20 minutes each

When should I take the USMLE Step 3?

To be eligible to take the USMLE Step 3, you must have passed the Step 1, Step 2 CK, and Step 2 CS exams and have either:

Medial graduates typically sit for the USMLE Step 3 during postgraduate residency training; many take the exam during their intern year of residency. Your exact timing may differ based on the duration and type of residency program you are completing.

When should I start studying for the USMLE Step 3?

Because most residents do not receive a dedicated period to prepare for Step 3, they tend to study alongside residency work. We recommend setting up a study schedule early on to help you pace yourself for studying throughout your residency rotations.

How do I study for the USMLE Step 3?

Start by familiarizing yourself with the 2020 USMLE Bulletin of Information, which contains essential information such as eligibility requirements, test scheduling, exam procedure, and score reporting. To study for the USMLE Step 3, most people use a question bank (QBank) alongside a comprehensive review book.

We recommend our USMLE Step 3 QBank, the number one test prep resource for medical graduates. Our QBank is at or above the difficulty level of both the multiple-choice questions and the computer-based case simulations you will see on the Step 3 exam.

How is USMLE Step 3 scored?

The USMLE Step 3 is scored on a 3-digit scale ranging from 1 to 300, with most residents scoring between 196-256. In 2018, the mean Step 3 score was 226 for first-time takers attending US and Canadian medical schools.

What is the USMLE Step 3 passing score?

The USMLE program provides a recommended minimum passing score, which is reviewed and adjusted periodically. The current USMLE minimum passing score for Step 3 is 198.

How soon will I get my USMLE Step 3 results?

It typically takes 3-4 weeks to receive your USMLE Step 3 score.

How many times can I take the USMLE Step 3?

You may take the USMLE Step 3 no more than six times, including incomplete attempts. The USMLE program has announced that the total number of attempts may be reduced from six to four times as early as January 2021.

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