All the Basics About the USMLE Step 3

All the Basics About the USMLE Step 3
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Dr. Suzanne M. Miller profile
Dr. Suzanne M. Miller February 9, 2016

The USMLE Step 3 is the final licensing exam in the demanding path to becoming a doctor. Learn more about this portion of the test from Noodle Expert Dr. Suzanne Miller.

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To become a doctor, all you need to do is . . .

. . . complete a curriculum of pre-med requirements, ace the MCAT, finish four years of medical school, do a multi-year residency, and possibly take on a fellowship, as well.

And at some point before the end of your residency, you’ll need to pass the final part of the comprehensive three-step medical licensing exam. (You’ll already have taken — and passed — Step 2 CK, Step 2 CS, and Step 1 during medical school."

While this involved process is certainly not easy, you can get through it successfully if you know what to expect and how to prepare for it. To that end: Let’s talk Step 3.

Step 3 of the United States Medical Licensing Examination (USMLE) is the final portion of the exam series that’s required for anyone wanting to practice medicine in the United States.

A two-day, computer-based test, Step 3 examines a student’s ability to apply knowledge essential to practicing medicine without supervision — the sort of thing that a general (and as yet undifferentiated) physician might encounter in an ambulatory or hospital setting.


The Step 3 exam takes place after a student has obtained a medical degree. Before submitting an application to take this portion of the exam, the potential test-taker must satisfy the following eligibility requirements:

(Please note: Fifth Pathway certificates may be used to meet Step 3 eligibility requirements for applications submitted through December 31, 2016. As of 2017, Fifth Pathway certificates will not be accepted, and Step 3 eligibility will require ECFMG certification for graduates of foreign medical schools.)

Registering and Scheduling

Everyone taking Step 3, regardless of the type of medical degree earned, applies through the Federation of State Medical Boards website. As of 2016, Step 3 costs $830. Additional costs may apply for those taking the test in a different country, or for those who need to change the date or location of their tests after these have been set.

When registering for the exam, test-takers must select a three-month block during which they would like to sit for the test. Once their registrations are processed by FSMB, examinees receive a scheduling permit including instructions on how to make an appointment at a Prometric test center. Prometric test centers (which can be found in many countries) allow individuals to schedule exams up to six months in advance. Scheduling is made on a first-come, first-served basis, so it’s in your best interest to respond to Prometric as soon as you receive your permit.

The USMLE recommends taking Step 3 after (or at least near) the completion of at least one year of postgraduate training in a U.S.-accredited graduate medical education program that meets state board licensing requirements — this training is usually called a residency.

Structure and Content

As mentioned above, Step 3 is a computer-based, two-day examination.

Day 1

Known as “Step 3 Foundations of Independent Practice" (FIP), the first day of the test focuses on assessing basic medical and scientific knowledge essential to providing effective healthcare.


  • Seven hours long with an optional five-minute tutorial
  • Approximately 260 multiple-choice questions divided into six 60-minute blocks
  • Roughly 43–44 questions per block
  • 45 minutes of break time, though test-takers can get additional breaks by skipping a five-minute tutorial or finishing blocks early


  • Application of foundational sciences
  • Understanding of biostatistics, epidemiology, and population health, plus interpretation of relevant medical literature
  • Application of social sciences, including communication and interpersonal skills, medical ethics, systems-based practice, and patient safety
  • Knowledge of medical diagnosis and management (with a particular focus on knowledge of history and physical examination, diagnosis, and the use of diagnostic studies)
  • Understanding of scientific abstracts and pharmaceutical advertisements

Day 2

Known as “Step 3 Advanced Clinical Medicine" (ACM), the second day assesses the examinee’s ability to apply knowledge in the context of patient management and the ways in which diseases evolve over time. The second day is itself divided into two smaller parts: multiple-choice questions (MCQ) and computer-based care simulations (CCS).


  • Nine hours long with an optional five-minute tutorial
  • 198 multiple-choice questions divided into six 45-minute blocks
  • 33 multiple-choice items per block
  • Seven-minute CCS tutorial
  • 13 case simulations, each of which lasts either 10 or 20 minutes
  • 45 minutes of break time, though test-takers can get additional breaks by skipping a five-minute tutorial or finishing blocks early
  • Optional survey at the conclusion of the test


  • Assessment of knowledge of diagnosis and management particularly focused on prognosis and outcome, health maintenance and screening, therapeutics, and medical decision-making
  • Knowledge of history and physical examination, diagnosis, and use of diagnostic studies
  • Multiple-choice questions and computer-based case simulations

Cases may fall into any of these categories:

  • Immune system
  • Blood and lymphoreticular system
  • Behavioral health
  • Nervous system and special senses
  • Skin and subcutaneous tissue
  • Musculoskeletal system
  • Cardiovascular system
  • Respiratory system
  • Gastrointestinal system
  • Renal and urinary system
  • Pregnancy, childbirth, and the puerperium
  • Female reproductive system and breast
  • Male reproductive system
  • Endocrine system
  • Multisystem processes and disorders


Step 3 scores range from 1–300. The minimum passing score in 2015 was 196. In 2014, examinees from the U.S. and Canadian medical schools had a 96-percent pass rate; the same year, those from schools outside the U.S. and Canada had an 83-percent pass rate.

The score report includes information on both the examinee and the test results among all takers in a given year.


  • Pass or fail
  • Three-digit score
  • Graphical performance profile for each testing category


  • Passing score
  • Mean score
  • Standard deviation

Scores for Step 3 are usually available three to four weeks after testing, but the USMLE recommends allowing eight weeks in case of irregularities.

Follow this link for more guidance on preparing for the USMLE and launching your medical career.

About the Editor

Tom Meltzer spent over 20 years writing and teaching for The Princeton Review, where he was lead author of the company's popular guide to colleges, before joining Noodle. He has been managing editor of the website for over four years.

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