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 independent management of patients, including initial workup, continuing care, and emergency care.
EXAM AT A GLANCE
Format
Day 1: 232 multiple-choice items in 12 blocks
Testing time
55
minutes
Sections
3
Delivery
Prometric test center
Cost
$955 USD (2026–2027)
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What the exam covers
Foundations of independent practice (day 1 emphasis)
Advanced clinical medicine (day 2 MCQ)
Computer-based case simulations (CCS)
About the USMLE Step 3 exam
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.
- Format
- Day 2: 180 multiple-choice items in 9 blocks plus 13–14 CCS cases (10 or 20 minutes of real time each).
- Testing time
- 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)
- Passing score
- Minimum passing score 200 (three-digit scale, in effect since January 1, 2024)
- 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)
Official exam page· Details verified August 2026
Exam details can change. Always confirm current requirements, fees, and exam policies with the certification provider before registering.
How to prepare
01
Apply through the FSMB and schedule two consecutive (or jurisdiction-allowed) Prometric days.
02
Review biostatistics, ethics, and systems-based practice — heavily tested on day 1.
03
Practice CCS cases until ordering labs, imaging, and follow-up on the clock feels automatic.
04
Use a Step 3 question bank for ambulatory, emergency, and inpatient management vignettes.
05
Sit a self-assessment; the passing score is 200, but CCS performance is part of the total.
FAQ
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.
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