What is Step 3 of USMLE?

The United States Medical Licensing Examination (USMLE) is a standardized test with three steps to assess physicians' knowledge and patient-centric skills. While step 1 focuses on testing the basic understanding of the candidate, step 2 tests clinical knowledge. But what is USMLE Step 3?

Step 3 of USMLE is the final stage in the comprehensive examination, after which candidates receive a license to practice medicine independently. It is a two-day test conducted by multiple medical committees comprising academic and non-academic practitioners and individuals from the state licensing board.

USMLE Step 3 tests the following:

• Application of relevant medical knowledge according to the situation
• Understanding of biomedical and clinical science
• Knowledge of patient management in ambulatory settings

Eligibility

For USMLE step 3 eligibility, candidates must first fulfill the general requirements in steps 1 and 2. In addition, here are the two prerequisites to be eligible for step 3 of USMLE.

• Candidates must secure passing scores in both step 1 and step 2 CK of USMLE
• The candidate must hold one of these degrees or their equivalent: an MD or DO degree from a US or Canadian medical institution accredited by LCME or COCA

Additionally, the examination committee recommends that before appearing for step 3, the candidate should have finished one year of postgraduate training in a US graduate medical education program. Applicants nearing the completion of the program are also eligible for USMLE step 3.

Candidates who have completed their postgraduate training from a non-accredited institute can check their eligibility for securing initial licensure as a physician. The physical licensing authority must then submit a request on your behalf to sponsor you for the examination.

The USMLE step 3 eligibility also depends on the frequency of the tests taken by the candidate. For instance, applicants who have appeared and not qualified for a step four or more times are ineligible to appear for any stage in the examination. Moreover, the maximum permissible number of tests taken within one year is three.

Registration Process and Fees

The Federation of State Medical Boards (FSMB) handles the registration for all stages of the examination, including step 3 of USMLE. The board offers a dedicated platform to register for step 3, along with the following features:

• Tracking the registration
• Printing scheduling permits and score reports
• Updating personal information

The USMLE step 3 registration begins with an online form where applicants must upload the Certificate of Identity (CID) form and fill in basic details like name and contact information. After verifying these details, the candidates can download the scheduling permit and the score report from the website.

While registering for step 3, candidates can choose to request test accommodation in writing.

Upon securing the scheduling permit, the next step is to schedule the examination. With Prometric, USMLE step 3 dates can be scheduled or rescheduled. Candidates must type out their name and candidate ID on the website to gain a list of available exam centers and the corresponding dates.

The USMLE step 3 application fee differs every year and is subject to the decision of the examination committee. For instance, the application fee is $915 for candidates looking to appear in 2023, while it was $895 in 2022.

Exam Pattern & Syllabus

The examination committee expects the candidates to be general physicians working unsupervised while appearing for the test. The committee aims to provide them with a real experience of the challenges and responsibilities that arrive with the role.

Step 3 of USMLE is a two-day examination. On the first day, candidates must answer 232 multiple-choice questions (MCQs). The questions are divided into six blocks, each containing 38 to 39 questions. Applicants are provided 60 minutes to complete questions in each block.

The first day focuses on the Foundations of Independent Practice and lasts for a total of seven hours. Of these, 45 minutes are scheduled for break time, and 5 minutes are set aside for an optional tutorial.

On the second day, examinees can utilize nine hours to answer a total of 180 MCQs on Advanced Clinical Medicine. These questions are divided into six blocks, with 30 questions in each. The second day also includes the following:

• 5 minutes for an optional tutorial
• 45 minutes of break
• CSS tutorial lasting for 7 minutes

Day two also comprises 13 case simulations, each allotted about 10 to 20 minutes. The examiners may also provide an optional survey if time permits.

USMLE Step 3 syllabus includes one of the 18 major areas in the integrated content outline. Some of the USMLE step 3 subjects are:

• General Principles of Foundational Science
• Immune System, Blood & Lymphoreticular System, and Multisystem Processes/Disorders  
• Behavioural Health   
• Nervous System & Special Senses     
• Musculoskeletal System
• Cardiovascular System
• Patient Care: Diagnosis
• Patient Care: Management
• Renal/Urinary & Male Reproductive Systems
• Pregnancy/Childbirth & Female Reproductive System & Breast
• Endocrine System
• Systems-based Practice/Patient Safety and Practice-based Learning

How is it Scored?

Candidates can check their USMLE step 3 results two to four weeks after the test. The step 3 score report comprises two important fields – one to declare whether the applicant has passed or failed and the other to display the three-digit score.

During the assessment of step 3, the examiners will focus on the candidate's performance in the case simulations. The USMLE step 3 total marks are capped at 300, and the minimum passing score changes periodically at the discretion of the examination committee.

However, it is estimated that approximately 60% of the questions must be answered correctly for candidates to secure a passing score.

Books to Prepare

Step 3 of USMLE is the most critical stage of the exam, deciding if applicants can secure a license to practice independently. Hence, it is recommended to refer to various sources to help prepare for the examination.

Some of the most popular titles to study USMLE step 3 subjects are as follows:

• Clinical Judgement: USMLE Step 3 Review by George Lee
• USMLE Step 3 Lecture Notes Bundle by Kaplan
• Master the Boards: USMLE Step 3 by Conrad Fischer (MD)
• First Aid for the USMLE Step 3 by multiple authors

Tips to Prepare

After clearing the initial two steps, step 3 of USMLE can seem challenging, especially since it lasts over two days. Additionally, candidates must answer a mix of MCQs and case simulations.

Here are some tips that can help boost preparation for the examination.

• Set an organized timeline to complete important topics comfortably before the exam date. Check for the percent weightage of each topic to separate the crucial topics from the rest.
• Learn and gain familiarity with triage and treatment. USMLE step 3 is a comprehensive examination that tests the overall preparedness of a candidate in theoretical and practical situations.
• Leverage question papers and practice tests from online platforms to access well-explained answers and understand the science behind answering questions.
• Don't just stick to theory. Practice case simulations online to enhance clinical reasoning and get used to the pattern of the test.