USMLE Step 3

Patient Management Skills

Minimum score to pass 190
# of questions 480 multiple-choice and 9 clinical simulations (all computerized)
Duration 16 hours ( 2 days)
Additional information Most states require passing scores on Step1, Step2CK and Step 2CS before taking Step3. Sixteen state borads allow IMGs to take USMLE Step3 before beginning their residency program.

Test Overview

The USMLE* Step 3 is the third in the series of three USMLE exams that candidates must pass in order to qualify for medical licensure in the United States. It is a 2-day computerized examination with approximately 480 multiple-choice items administered over the first day and a half of testing. These items deal with clinical situations typically encountered by a generalist physician. The exam concludes with a half-day consisting of approximately 9 open-ended computer-based case simulations (CCS).

The Step 3 exam focuses primarily on patient management (45-55% of the questions). Other "physician tasks" tested include history and physical (8-12%), lab and diagnostic studies (8-12%), diagnosis (8-12%), prognosis (8-12%), and pathophysiology (8-12%). In addition to "physician tasks," each question also falls into one of three clinical encounter frames: initial workup (20-30%), continued care (55-65%), and emergency care (10-20%).

Multiple Choice Sections

The multiple-choice part of the test is divided into blocks of 25-50 items. You will have 30-60 minutes to complete each block. Detailed clinical situations are provided for each item and are frequently accompanied by pictorial material and laboratory data. Unlike Steps 1 and 2, in which questions in a block do not relate to each other in any way, the questions in a Step 3 block all belong to the same clinical setting. Items in each block represent one of four settings in which you could encounter a patient:

  1. Satellite health center
  2. Physician's office
  3. Hospital
  4. Emergency department

At the beginning of each block, you are told which clinical setting you are dealing with and are given information about what sort of resources are available in that setting.

Computer-based Case Simulations (CCS)

Computer-based case simulations (CCS) are a new testing format on the Step 3 exam and comprise the last 3 hours and 45 minutes of testing. Multiple patient cases are used to assess your ability to evaluate history and physical examination information, order diagnostic tests, select initial therapies, and manage the patient as he/she responds to your clinical interventions. The CCS format assesses your clinical judgment in a more "realistic" way than multiple-choice questions do.
The Step 3 patient simulations are delivered using NBME's PrimumTM Software, which allows simulation of physician/patient encounters in a variety of settings. You manage the case without prompting, typing in a variety of diagnostic and treatment options. The software recognizes thousands of possible entries that you can type into the order sheet and is programmed with results for any intervention or test you choose.

As you move the case clock forward, you receive the results of the tests you ordered and the patient's status changes based on the underlying medical problem and in response to the specific management decisions made. Acute cases may need to be managed in a short period of case time, whereas patients with chronic problems will require management over months of simulated time.

Question Formats

There are three question formats used in the multiple-choice sections of Step 3:

Single Best Answer

These items, which are the most commonly used, typically have four or five answer choices. You will be asked to select the one best response. Some negatively phrased items are used. In these items, the negative word or phrase is capitalized for emphasis (e.g., LEAST, NOT, EXCEPT).

Multiple Item Sets

In multiple item sets there is a vignette followed by several questions. The items are designed to be answered independently of one another and focus on different aspects of the case presentation.

Case Clusters

In case clusters, as in multiple item sets, several questions all relate to an initial vignette. However, in case clusters, new information is added as the case unfolds over time from item to item. It is imperative that you answer the questions in the order given since the case changes from one item to the next; you need to answer each item based only on the information revealed about the case up to that point.


Scoring of the multiple-choice sections is based on the total number of questions answered correctly. Scoring of the CCS is based on the actions taken, their sequencing and timing, and whether the patient was subjected to unnecessary testing or therapy or placed at serious risk as a result of your action or failure to act.

The USMLE Step 3 is scored and reported on two-digit and three-digit scales. Your score report will also include a pass/fail designation, as well as a graphical performance profile. The minimum passing score in 2013 for Step 3 is 190. To achieve a passing score, you typically need to answer between 55% and 65% of the questions correctly (the percentage required to pass can vary based on difficulty of your individual test "form"). It is anticipated that, at least initially, performance on the CCS cases will count for LESS than its percentage of testing time (i.e., less than 25%).

With the new computer exam, you should receive your score within 2-4 weeks of your test date. This did not occur for the first group of Step 3 test-takers (Nov '99-Spring '00), as the USMLE needed to accumulate sufficient data before they could release the first set of scores. Those candidates had to wait as long as 6 months to receive their results. Also, please keep in mind that Step 3 is administered through the individual state medical boards and that score reporting procedures can vary by state.

USMLE Step 3 preparation curriculum is based on a framework of exam-style content in a case-based format. To accommodate a variety of study needs and available study time, we offer our high-yield review led by our Kaplan’s expert faculty either live or on video.
Most states require passing scores on Step1, Step2CK and Step 2CS before taking Step3. Sixteen state borads allow IMGs to take USMLE Step3 before beginning their residency program.


Step 3 Course Elements

ALL of these Step 3 Courses include the following:

  • 2 Volumes of Lecture Notes
  • Qbook with Practice questions and test-taking strategy guide (850 questions
  • Step 3 Review and comprehensive NEW CCS Review and Strategy (200 questions)
  • 5 subject-based assessment tests with explanations (250 questions)

What's new to Step 3?

  • Three volumes of Lecture Notes (instead of two):
    • Internal Medicine and Neurology
    • Gynecology/Obstetrics, Surgery, and Psychiatry/Ethics
    • Pediatrics
  • High-yield color image section for Ophthalmology, Dermatology, and X-rays
  • Foundations for Step 3 with additional review notes for each specialty
  • Over 3,660 dynamic slides developed to compliment content presented by our expert faculty
  • Over 500 questions updated, rewritten, and improved
  • Over 58 hours of new video lecture
  • All video re-filmed in high definition and stored on media servers rather than DVDs
  • Thirty cluster questions and twenty multimedia questions added

USMLE Step 3 Courses options

Live Online Lectures

4-weeks program of more than 100 hours of high-yield interactive live lectures presented by our expert faculty.

Live Online gives you the optimum blend of structure and flexibility. That means you can study with our best teachers no matter where you are.

These lectures offer a dynamic, interactive learning envi­ronment with our expert faculty members giving you the most relevant content and insight into the Step 3 exam. including CCS strategic review. Whats included :

  • 100+ hours of online lectures with award-winning faculty
  • 100+ hours of on-demand video lectures covering foundational clinical sciences
  • Qbank with 900+ exam-like questions
  • Diagnostic exam to identify individual strengths and weaknesses + 5 assessment exams
  • 2 volumes of 2020 lecture notes in print and ebook, with easy-to-understand color images and tables
  • Membership to private Facebook community with access to medical advisor

Step 3 Live Onlne Lectures

4 months

In Center Courses

Currently not available.

If you are unable to travel to one of our live lecture sites, we offer center-based courses at over 150 Centers in North America. You’ll receive access to over 58 hours of video lectures allowing you the flexibility to review the material at your own pace and the ability to focus on areas in which you may need more review. CCS strategy review is included as well as Diagnostic test of 150 questions with performance analysis and Study Plan.
A complete set of lecture notes and Qbook with 850 practice questions with explanations.

Step 3 Center Prep Courses

3 months

Step 3 Live Online


Standard Tuition Price

Course Length: 4 weeks

Course Features: Live Online Lectures per schedule

Step 3 On Demand Prep


Standard Tuition Price

Course Length: 3 months

Course Features: On Demand Prep
(online video-based training)

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*On Demand  * QBank

Use all possibilities offered. Attend Free Live Online Events and lessions. Try FREE access to  On Demand course and QBank. Improve your readiness for USMLE exams or simply help your medical curriculum.