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Get to Know USMLE Step 3: Scoring, Format, and Content

You are now only one step away from getting licensed to practice medicine independently. The USMLE Step 3 is vital in your dream journey of becoming a doctor. But before you even start preparing for the exam, it is crucial to understand it. Hence, in this article, we will get an overview of the USMLE Step 3, its scoring, exam format, and content outline.

What Is The USMLE Step 3?

USMLE Step 3 assesses your knowledge and skills for providing independent care to patients in an ambulatory setting. The last step in the USMLE sequence will allow you to practice medicine without supervision.

Examination materials are prepared by examination committees that represent a wide range of medical specialties. Among the members of the committees are academic and non-academic expert practitioners, as well as state medical licensing board members.

Step 3 tests your ability to perform as a generalist medical practitioner in the United States. The test items and cases simulate the clinical situations you may encounter as a general yet undifferentiated physician in a specific setting.


To be eligible to take Step 3, you should have fulfilled the following requirements-

  • Gotten passing scores in Step 1 and Step 2 CK. AND
  • An MD or DO degree from a US or Canadian medical school accredited by the LCME or COCA or a medical degree from a college recognized by the World Directory of Medical Schools as satisfying the ECFMG eligibility requirements and obtaining ECFMG certification in the same level of the MD degree from a school outside of the US and Canada, AND

It is also recommended that you complete at least one year of post-graduate training in an authorized US graduate medical education program that complies with state board licensing requirements.

Exam Format:

The USMLE Step 3 consists of Multiple-Choice Questions (MCQs) and Computer-based Case Simulations (CCS). It is a two-day exam in which you will be tested on the Foundations of Independent Practice (FIP) on the first day and Advanced Clinical Medicine (ACM) on the second.

Step 3 Day 1: Foundations of Independent Practice (FIP)

The first day includes 232 MCQs divided into 6 blocks of 38-39 questions. You will be given 60 minutes to complete each block of test items. It will be a 7-hour exam, including the 45-minute break time and 5 minutes of the optional tutorial.

You can increase your break time by finishing the block or the optional tutorial before time.

Step 3 Day 2: Advanced Clinical Medicine (ACM)

The second day is a 9 hours long exam consisting of about 180 MCQs and 12 CCS. It includes a 5-minute optional tutorial followed by 180 multiple-choice items split into 6 blocks of 30 items. You will have 45 minutes to complete each block of test items.

It also includes 13 case simulations, for each of which you will have a maximum of 10 or 20 minutes of real-time. Also, you will have a minimum of 45 minutes for break time.

Content Outline:

The exam requires you to assume the role of an undifferentiated general practitioner. You are a member of an independent group practice affiliated with several managed care organizations. There are regularly scheduled hours at your office.

You can enroll patients in a regional hospital with 400 beds, which serves the urban and rural areas. Diagnostics, radiology, and therapeutics are available at the hospital, including intensive care units and cardiothoracic surgery. In addition, a labour and delivery suite is available.

A fully equipped emergency department adjoins the hospital, and a medical evacuation helicopter service is available for emergency transfers to regional trauma centers.

Although you do not have special privileges at the hospital, you may request a consultation with a physician of any specialty.

The content outline of USMLE Step 3 concerning the physician competencies is as follows:

Day 1: Foundations of Independent Practice (MCQ)

CompetencyRange, %
Medical Knowledge: Applying Foundational Science Concepts11 - 12
Patient Care: Diagnosis33 - 36
History/Physical Exam5 - 9
Laboratory/Diagnostic Studies9 - 12
Diagnosis6 - 10
Practice-based Learning & Improvement11 - 13
Communication / Professionalism / Systems-based Practice & Patient Safety7 - 9

Day 2: Advanced Clinical Medicine (MCQ)

CompetencyRange, %
Patient Care: Diagnosis33 - 36
Prognosis/Outcome8 - 11
Patient Care: Management32 - 35
Health Maintenance/Disease Prevention6 - 11
Pharmacotherapy9 - 13
Clinical Interventions5 - 9
Mixed Management6 - 11

Computer-based Case Simulations (CCS):

Patient Care: Diagnosis
History/Physical Exam
Laboratory/Diagnostic Studies
Patient Care: Management
Health Maintenance/Disease Prevention
Clinical Interventions
Mixed Management
Surveillance for Disease Recurrence

Passing Score:

The scores of the USMLE exams range from 1 to 300. The minimum score required for you to pass Step 3 is 198.


You are now just one step away from getting the license to practice as a physician without supervision. You need to be certain that you are well-prepared for the exam day.

If you plan to start your USMLE Step 3 preparation, you should check out our USMLE Step 3 Course and Qbanks. Expert doctors specifically created these to make your USMLE preparation journey incredibly simple. Our courses will help you pass Step 3 on your first attempt.