Step 3 is the final exam in the USMLE series of examinations. It is part of the licensing requirements for M.D.s, D.O.s, and FMGs to practice medicine in the United States.

It is considered as the final step in the series of medical licensure examinations. It generally is a pre-requisite of the majority of the state licensing boards.

USMLE Step 3 tests several concepts that are often required to provide general health care to a patient. USMLE Step 3 is a mandatory exam that needs to be passed in order to obtain license as a practicing physician. Some International Medical Graduates are required to pass USMLE Step 3 in order to obtain an H1 Visa.

USMLE Step 3 comprises Multiple choice questions (MCQs) and Clinical Case Simulations (CCS). 75% of USMLE Step 3 constitutes MCQs where as approximately 25% constitute CCS. A full description of the content of the exam can be found on the USMLE website.

USMLE Step 3 exams are delivered online and are available throughout the year to the examinees. The examinee needs to register via a state licensing board for this exam.

Examination Content

USMLE Step 3 examination tests on general topics that are required to understand and practice concepts of general medicine/ family medicine.

The following components are tested:

Normal conditions and disease categories (normal growth and development, basic concepts, and general principles)

Clinical encounter frame (initial work up, continuing care, urgent intervention)

Physician task (applying scientific concepts, formulating a diagnosis based on history, physical exam, and lab findings, and managing the patient).

Clinical encounter frames are common clinical scenarios physicians may encounter. They range from nonemergency problems, to the continuity of care, to life-threatening emergency situations encountered in emergency departments, clinics, offices, care facilities, inpatient settings, and on the telephone. Each test item, in an encounter frame, represents one of the six physician tasks. For example, initial care encounters emphasize taking a history and performing a physical examination. In contrast, continued care encounters emphasize decisions regarding prognosis and management.

Eligibility for USMLE Step 3

To be eligible for Step 3, prior to submitting your application, you must:

• Obtain the MD degree (or its equivalent) or the DO degree,
• Pass Step 1, Step 2 CK, and, if required based upon the rules referenced below, Step 2 CS,
• Obtain certification by the ECFMG or successfully complete a “Fifth Pathway” program if you are a graduate of a medical school outside the United States and Canada (information on Fifth Pathway programs is available in ECFMG’s Information Booklet.
• Meet the Step 3 requirements set by the medical licensing authority to which you are applying.

Preparation strategies for USMLE Step 3

Typically worldwide, examinees require two to three months to prepare for this exam, although in the US, examinees who are American medical school graduates commonly prepare for only a few days to a few weeks. (Hence the saying "Two months, two weeks, two pencils" regarding USMLE Step 1, 2, and 3 preparation, respectively.) An examinee is tested on their clinical skills, diagnostic acumen, decision making, treatment guidelines and follow up care. Examinees who are not comfortable preparing for this exam on their own may take review courses, either in person or through distance-learning services.