• Dec 25, 2023   MOKSH Academy

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How is the USMLE Step 2 Exam different from the USMLE Step 3 Exam?

The United States Medical Licensing Examination (USMLE) is a critical series of exams for medical professionals pursuing their careers in the United States. Among these exams, USMLE Step 2 and USMLE Step 3 hold significant importance, but they have unique challenges and requirements. This guide will break down the key differences and similarities between USMLE Step 2 CK and USMLE Step 3. Also, discuss essential strategies for success.

Difference Between USMLE Step 2 CK and Step 3

The USMLE Step 2 CK (Clinical Knowledge) and Step 3 are both components of the United States Medical Licensing Examination, but they serve different purposes and have distinct characteristics:

Purpose This exam assesses a candidate's medical knowledge, clinical skills, and the application of clinical science principles. Step 3, however, is designed to evaluate a candidate's ability to independently apply medical knowledge and clinical skills. It tests the ability to make decisions regarding patient care, including diagnosis, treatment, and management. Step 3 is typically taken during a physician's residency training.
It assesses a candidate's readiness to provide patient care under supervision and emphasizes health promotion and disease prevention.
Exam Structure This one-day examination consists of eight 60-minute sections, with the number of questions per section varying (but at most 40). It has 318 questions, including breaks and an optional tutorial. Step 3 is a two-day examination. On the first day, there are 232 multiple-choice questions divided into six sections, totalling about seven hours.
The second day includes 180 multiple-choice questions divided into six sections, a 7-minute tutorial about case simulations (CCS), and 13 CCS cases. It has a total duration of approximately nine hours.
Content This exam covers internal medicine, paediatrics, surgery, obstetrics/gynaecology, psychiatry, and more. It assesses a candidate's clinical knowledge and skills. Step 3 evaluates a candidate's ability to apply extensive knowledge in the diagnosis, prognosis, health maintenance, treatments, and medical decision-making. It also includes case simulations (CCS) that test clinical reasoning and decision-making skills.
Eligibility To be eligible for Step 2 CK, candidates must have completed Step 1 and meet other requirements specified by the USMLE program. For Step 3, candidates generally need to be in or have completed at least one year of postgraduate training in a U.S. medical education program.

Similarities between USMLE Step 2 CK and Step 3

While the USMLE Step 2 CK and Step 3 are distinct exams with different purposes, structures, and content, there are a few similarities between them:

  • Part of the USMLE Sequence: Both Step 2 CK and Step 3 are the United States Medical Licensing Examination (USMLE) components. The USMLE is a standardized examination for medical licensure in the United States, and these two steps play a role in assessing a physician's readiness for independent practice.
  • Clinical Knowledge Assessment: Both exams assess a candidate's clinical knowledge and understanding of medical principles. While Step 2 CK focuses on clinical science principles and patient-centred skills in a supervised setting, Step 3 extends this assessment to applying knowledge in independent patient care situations.
  • Multiple Choice Questions: Both exams include multiple-choice questions (MCQs) as part of their assessment. Candidates must analyze patient cases and choose the most appropriate action or diagnosis.
  • Duration and Sections: Both exams have a fixed time and are divided into sections. Step 2 CK consists of eight sections, while Step 3 has multiple-choice question sections on both days. This structure helps evaluate a candidate's performance across clinical and medical scenarios.
  • Content Integration: Both exams integrate clinical knowledge and skills from various medical disciplines, such as internal medicine, paediatrics, surgery, psychiatry, etc. This ensures a comprehensive assessment of a candidate's medical proficiency.
  • Medical Licensure: Successful completion of both Step 2 CK and Step 3 is typically required for medical licensure in the United States. These exams are essential steps in becoming a licensed medical practitioner.

While Step 2 CK and Step 3 share some standard features, they serve different purposes. Step 2 CK measures if you're ready for supervised patient care, while Step 3 checks if you can practice medicine independently. People often take these exams at different times in their medical journey, with Step 2 CK usually during medical school or early residency and Step 3 during or after residency.

Why take the USMLE Step 3 exam before starting PGY-1 (your first year of medical residency)?

There are several compelling reasons to consider taking the USMLE Step 3 exam before beginning your PGY-1 (first year of medical residency):

  • Faster Path to H1B Visa and Green Card: The USMLE Step 3 exam can pave a quicker way to obtaining an H1B visa for residency, which is a fast track to achieving a green card for permanent residency.
  • Focused Learning: By taking the USMLE Step 3 exam earlier, you can skip studying subjects irrelevant to your chosen speciality during PGY-1.
  • Reduced Stress: Starting residency can be stressful, but having the USMLE Step 3 exam behind you can alleviate some of that pressure. It allows more time for research, specialized learning, and excelling in in-training exams.
  • Improved Residency Match Chances: Some residency programs may prefer candidates who have already passed the USMLE Step 3 exam since they don't have to cover the fees. This can enhance your chances of matching into your desired program.
  • Opportunity to Boost Scores: If you scored lower on USMLE Step 1 and USMLE Step 2 CK, the Step 3 exam offers an opportunity to improve your overall Step scores.

How Difficult is USMLE Step 3, and how much time it took to prepare?

Analyzing historical data reveals an interesting trend in the scores of the United States Medical Licensing Examination (USMLE) Step 3 compared to Step 1 and Step 2 Clinical Knowledge (CK). On average, people score lower on the USMLE Step 3 exam than the USMLE Step 1 exam and the USMLE Step 2 Clinical Knowledge (CK).

There's a reason behind this trend. Most medical professionals take USMLE Step 1 and Step 2 CK during medical school or after graduating. These exams are super competitive, and everyone works hard to do well. Since many people aim for top scores, it takes time to stand out.

Now, the USMLE Step 3 exam is different. It's typically taken during a doctor's residency training. Residency is known for being super demanding, with extended hours and lots of responsibilities. Because of this, residents often have less time to prepare for USMLE Step 3 compared to USMLE Step 1 and USMLE Step 2 CK. More USMLE preparation time can lead to higher average scores.

But here's the good news for Step 3 takers: because residents are so busy, there must be more competition. Not as many people are going for those top scores, so individuals have a better shot at doing well. This makes getting high scores on Step 3 more effortless than the earlier exams, which can be helpful during the challenging residency period.

USMLE Exam Day Strategies

To excel in your USMLE examination, consider these effective strategies:

  • Opt for a low-carb meal and consider some caffeine for alertness.
  • Bring soft silicone or foam earplugs in case of distractions.
  • Take short breaks before each exam block and use the restroom.
  • Avoid wearing metal items to the exam centre and opt for comfortable attire with pocket removal if necessary.
  • Skip the tutorials, but ensure your headphones are functional.
  • If a block has 38 questions, expect an abstract or pharmaceutical advertisement question.
  • Leave sequential questions and abstracts for the end.
  • Start by reading the last line and answer choices before going back to the top of the question.
  • Approach each question confidently and give it your best effort. Trust yourself!


In conclusion, Step 2 and Step 3 of the USMLE test are essential steps in the journey of a medical professional in the United States. While they come with challenges, understanding their formats, eligibility criteria, and strategic approaches can significantly enhance your chances of success. So, whether you're preparing for Step 2 or Step 3, remember that careful planning and effective strategies can make all the difference in achieving your goals, and you can achieve high in the USMLE examination.