USMLE Step 3
Offered by NBME / Federation of State Medical Boards (USMLE)
USMLE Step 3 is the final exam in the USMLE sequence and is required for a full, unsupervised medical license in the United States. It emphasizes...
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USMLE Step 3 exam at a glance
Format
Day 1: 232 multiple-choice items in 12 blocks. Day 2: 180 multiple-choice items in 9 blocks plus 13–14 CCS cases (10 or 20 minutes of real time each).
Duration
Two days — about 7 hours seated on day 1 (including ~55 minutes of break) and about 9 hours on day 2 (including at least 45 minutes of break)
Delivery
Prometric test center
Passing score
Minimum passing score 200 (three-digit scale, in effect since January 1, 2024)
Exam cost
$955 USD (2026–2027)
Validity
Passing all three Steps is required for licensure; individual state medical boards set additional requirements.
Prerequisites
MD or equivalent, passing Step 1 and Step 2 CK, and meeting FSMB eligibility (including any postgraduate-training rules your pathway requires)
About the USMLE Step 3 certification
USMLE Step 3 is the final exam in the USMLE sequence and is required for a full, unsupervised medical license in the United States. It emphasizes independent management of patients, including initial workup, continuing care, and emergency care.
It is a two-day exam: multiple-choice items on both days plus computer-based case simulations (CCS) on day 2. Apply through the FSMB. The 2026 software update began with Step 3 on March 10, 2026.
Who it’s for: Physicians who have passed Step 1 and Step 2 CK, typically during or after the first postgraduate year.
Official exam page· Details verified 2026-08
What the USMLE Step 3 exam covers
- Foundations of independent practice (day 1 emphasis)
- Advanced clinical medicine (day 2 MCQ)
- Computer-based case simulations (CCS)
How to study for the USMLE Step 3
- 1Apply through the FSMB and schedule two consecutive (or jurisdiction-allowed) Prometric days.
- 2Review biostatistics, ethics, and systems-based practice — heavily tested on day 1.
- 3Practice CCS cases until ordering labs, imaging, and follow-up on the clock feels automatic.
- 4Use a Step 3 question bank for ambulatory, emergency, and inpatient management vignettes.
- 5Sit a self-assessment; the passing score is 200, but CCS performance is part of the total.
USMLE Step 3 — frequently asked questions
When do people take Step 3?
Most U.S. graduates take it during intern year or shortly after. IMGs often take it before or during residency depending on visa and program rules. You must have passed Step 1 and Step 2 CK.
What is CCS?
Computer-based case simulations on day 2. You manage a virtual patient in simulated time — orders, monitoring, and follow-up — in 10- or 20-minute cases.