USMLE Step 3 Overview and Structure

The USMLE Step 3 exam assesses student’s ability to apply medical knowledge and the understanding of clinical and biomedical science essential for unsupervised practice of medicine.

Test Overview

The USMLE Step 3 is the last in a series of USMLE exams that candidates must pass in order to qualify to practice medicine in the United States. 

This 2-day computerized exam asks you to answer approximately 500 multiple-choice items on the first day and a half of testing.

The exam concludes with a half-day consisting of approximately 9 open-ended computer-based case simulations (CCS).

The Step 3 exam focuses on patient management (45-55% of the questions). Other "physician tasks" tested include: 

• History and physical (8-12%)
• Lab and diagnostic studies (8-12%)
• Diagnosis (8-12%)
• Prognosis (8-12%)
• Pathophysiology (8-12%)

In addition to "physician tasks," each question also falls into one of three clinical encounter frames:

• Initial workup (20-30%)
• Continued care (55-65%)
• Emergency care (10-20%)

Multiple Choice Sections

• Divided into blocks of 25-50 items
• 30-60 minutes to complete each block
• Detailed clinical situations provided for each item, frequently accompanied by pictorial material and laboratory
• Questions in a Step 3 block all belong to the same clinical setting

There are four settings in which you could encounter a patient in a block:

1. Satellite health center
2. Physician's office
3. Hospital
4. 5Emergency department

You will be told which clinical setting you will be asked to encounter at the beginning of each block. You should also be provided with the necessary information about the resources available in that setting.

Computer-based Case Simulations (CCS)

Making up the last 3 hours and 45 minutes of testing the Computer-based case simulations (CCS) are a new testing format. You will be assessed using multiple patient cases evaluating physical and history and examination information, select initial therapies, order diagnostic tests, and manage the patient as he/she responds to your clinical interventions.

Question Formats

In the multiple-choice section you will encounter three question formats:

1. Single Best Answer
   These are the most commonly used items, and typically have four or five answer choices. You will be asked to select the one best response
2. Multiple Item Sets
   In multiple item sets there is a scenario followed by a number of questions
3. Case Clusters
   In case clusters, several questions all relate to an initial vignette. However, new information is added as the case unfolds from item to item. You must answer the questions in the order since the case changes from one item to the next.

Scoring

• You will receive a score for the multiple-choice section based on the correct answers you gave.
• Scoring of the CCS is based on the actions you have taken, their timing and sequencing, whether the patient was subjected to unnecessary testing or placed at risk due to the actions you have taken.

Your USMLE Step 3 score report will include:

• Two and three-digit scales
• A pass/fail designation
• A graphical performance profile

You normally need to answer between 55% and 65% of questions correctly to achieve a passing score. The minimum passing score for Step 3 is 184.