Step 3


Step 3 consists of multiple choice and computer based simulations to assess a medical student or graduate’s application of their medical knowledge and understanding of biomedical and clinical science in managing patients in an unsupervised setting. The results of this exam demonstrate their ability to independently provide a standard of care to their patients. Step 3 is the final component of the USMLE exam series.

Examination Content

The Step 3 examination is organized in three organizing dimensions:

  • Normal conditions and disease categories (normal growth and development, basic concepts, and general principles)
  • Clinical encounter frame (initial work up, continuing care, urgent intervention)
  • Physician task (applying scientific concepts, formulating a diagnosis based on history, physical exam, and lab findings, and managing the patient).

Clinical encounter frames are common clinical scenarios physicians may encounter. They range from nonemergency problems, to the continuity of care, to life-threatening emergency situations encountered in emergency departments, clinics, offices, care facilities, inpatient settings, and on the telephone. Each test item, in an encounter frame, represents one of the six physician tasks. For example, initial care encounters emphasize taking a history and performing a physical examination. In contrast, continued care encounters emphasize decisions regarding prognosis and management.

Test Length and Format

Step 3 examinees test using two formats: multiple choice questions and Primum computer-based case simulations (CCS), a testing format that allows you to provide care for a simulated patient.

Step 3 has approximately 480 multiple-choice test items, divided into blocks of thirty-five to fifty items. You will have forty-five to sixty minutes to complete each of these blocks. There are approximately nine computer based case simulations, with one case in each block. You will have a maximum of twenty-five minutes to complete each of these blocks. Step 3 is administered in two eight hour testing sessions.

Step 3 case simulations must be taken in the order presented. After you exit the case or session or when time expires, you can no longer review test items or cases, change answers, or collect additional information.

Eligibility Criteria

To be eligible for Step 3, prior to submitting your application, you must:

  • obtain the MD degree (or its equivalent) or the DO degree,
  • pass Step 1, Step 2 CK, and, if required based upon the rules referenced below, Step 2 CS,
  • obtain certification by the ECFMG or successfully complete a “Fifth Pathway” program if you are a graduate of a medical school outside the United States and Canada (information on Fifth Pathway programs is available in ECFMG’s Information Booklet, and
  • meet the Step 3 requirements set by the medical licensing authority to which you are applying.




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