Answering key questions about the USMLE Step 3 exam

By George Saliba | Fact-checked by Barbara Bekiesz
Published April 13, 2022

Key Takeaways

  • United States Medical Licensing Examination (USMLE) Step 3 is USMLE’s final exam leading to a medical license that will permit residents to practice medicine without supervision.

  • The first day focuses on Foundations of Independent Practice and Advanced Clinical Medicine, and the second day features Computer-Based Case Simulations.

  • According to USMLE, 97% of test-takers passed Step 3 in 2020.

Medical residents are typically eager to pass the United States Medical Licensing Examination (USMLE) Step 3, as it’s USMLE’s final exam, which results in a medical license that permits residents to practice medicine without supervision.[]

However, medical residents may have questions about Step 3’s content, duration, and intensity when compared with Step 1. As the American Medical Association (AMA) explains, “When juxtaposed with the USMLE Step 1 and Step 2 exams, Step 3 is a more comprehensive exam and tests more in-depth clinical knowledge and decision-making.”[]

How long is the test?

Administered over 2 days, the Step 3 examination consists of about 500 multiple-choice questions and 13 case simulations that ask the test-taker to assess a patient, and then respond with appropriate diagnostic tests and therapies.[]

What is covered on day 1?

The first day’s test consists of 232 multiple-choice items centered on Foundations of Independent Practice (FIP). One hour is allotted to complete each “block” of about 40 questions over about 7 hours, which includes a 45-minute break.

USMLE indicates that FIP explores “basic medical and scientific principles essential for effective health care” and “diagnosis and management” in areas specifically outlined by USMLE such as:

  • Epidemiology/population health

  • Biostatistics

  • Communications and interpersonal skills

  • Medical ethics

  • Systems-based practice

  • Patient safety

  • Physical examination

  • Diagnosis

  • Diagnostic studies[]

Related: Post-residency transitions: Choosing your next steps

What can I expect on day 2? 

Day 2 of the exam explores Advanced Clinical Medicine (ACM) via 180 multiple-choice items over 9 hours, with 45 minutes to complete each of the six blocks of 30 questions.[]

The second test day also features 13 Computer-based Case Simulations (CCS); each must be completed in 10 or 20 minutes.[]

For the ACM portion, USMLE says the test day “focuses on assessment of the ability to apply comprehensive knowledge of health and disease in the context of patient management and the evolving manifestation of disease over time.”[]

USMLE outlines content areas including:

  • Diagnosis and management

  • Prognosis and outcome

  • Health maintenance and screening

  • Therapeutics

  • Medical decision-making

  • History and physical examination

  • Diagnosis

  • Use of diagnostic studies

What is the CCS portion?

USMLE indicates that the test taker’s responsibility in the CCS portion is to act as a primary care physician and maintain responsibility for the “patient” without assuming other healthcare providers such as nurses “will write or initiate orders for you when a patient is admitted to a facility or transferred for a surgical procedure.”[]

These responsibilities may include, but are not limited to, handling life-threatening emergencies, treatment regimens, and “ordering laboratory tests, imaging studies, and diagnostic procedures.”[]

Related: Acing rounds: Keys to success as a resident

What is a passing score?

Test takers may be curious about what percentage of people actually pass Step 3. According to USMLE, 20,343 people took the medical degree (MD) exam in 2020, with 97% passing. For the doctor of osteopathic medicine (DO) test, 95% of test takers passed in 2020.[]

What if I have other questions?

USMLE’s website explores common questions ranging from “How do I manage a patient?” and “How do I write/cancel orders?” to “How do I see order results?” and “What kind of feedback do I get while caring for the patient?” The answers to these and other common questions are clearly answered on USMLE’s website.[]

What this means for you

As USMLE Step 3 is a crucial conduit for practicing medicine without supervision, residents will want to familiarize themselves with the exam’s overall design and specific topics.

USMLE’s website is a comprehensive resource for addressing the exam’s details and common questions, particularly those associated with the ins and outs of computer-based patient treatment/management simulations.

Related: Best step 3 strategies from those who've been there
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