USMLE Step 3

The purpose of the USMLE Step 3 exam is to gauge your expertise in handling patients independently. In other words, it tests your command over the application of the medical principles in an unsupervised setting. That is why, after clearing the Step 3 USMLE, you get the license to practice medicine in USA.

Unlike the USMLE Steps 1 & 2, the committee that creates the ‘test items’ for the Step 3 Exam are representatives of the medical profession. They may be academic or non-academic. But they are experts. 

USMLE Step 3 test centers

You can appear in the Step 3 USMLE in the Prometric test centers located only in the US by paying the exam cost.

Step 3 cost 

The USMLE Step 3 price can be checked on the FSMB official website. How much does Step 3 cost? At present, the Step 3 fee is $895 (around 67K INR).

USMLE Step 3 Eligibility 

As discussed elsewhere, you need to have passing scores in USMLE Step 1 & 2 to appear in Step 3. For IMGs, the Institution from where they did their MBBS must feature in the WDOMS. The WDOMS should mention that the College/University meets the ECFMG eligibility criteria. Can you take Step 3 in Medical school? The answer is no. When can you take Step 3? Generally, aspirants go for Step 3 USMLE registration during the first year of their Residency so that they can get their license during their 2nd year.

Step 3 requirements by state can be found on the FSMB website

USMLE Step 3 Application Process

Do keep in mind that you have the convenience of scheduling the test 6 months in advance. Also, if you are unable to appear during these 6 months, you may apply for a Step 3 eligibility extension. However, there is a fee associated with this privilege.

In case you fail to appear again, you will have to register for Step 3 again. The application fee, however, is non-refundable. In other words, you will have to pay it again. Also, you will have to repeat the application process too.

How to apply for USMLE Step 3? You can acquaint yourself with the application process at login.

How to sign up for USMLE Step 3? For registration, you will have to go to the FSMB official website.

Ideal Time to appear in USMLE Step 3

Firstly, you have the privilege of not choosing to take this 2 days long Exam on consecutive days. Ideally, you should take the NBME Step 3 during the first year of your residency. Statistically, the months of May through July and November through December are popular choices to register for Step 3.

USMLE Step 3 Syllabus

USMLE Step 3

Change is an important characteristic of the entire USMLE procedure. In Step 3 curriculum and question pattern, you can expect a lot of variation. The test accommodates new topics regularly. Also, the emphasis of the test may change. Even the syllabus coverage may change.

Firstly, the clearance of the USMLE declares you fit to practice in the US without supervision. Secondly, Step 3 is the final step in the procedure. So, the test items naturally are set in practical clinical backdrops. While answering the questions, you must know that the NBME wants you to make decisions as if you have a full-fledged, hi-tech hospital at your disposal.

However, the test assumes that you are still a general practitioner without any specialization. This is true in spite of the fact that you may be in your specialist training when you take the test. 

Types of doctor-patient interaction

This interaction may be in 3 different circumstances.

In the Ambulatory scenario, you have to handle cases set in your office as a doctor or at the OPD of a hospital, etc. There may be test items in which the scenario is that you are starting the treatment of a patient another doctor has been treating. Also, you may have to treat a patient over the phone.

Another scenario may be where you are treating a patient in an inpatient facility. In other words, the hospital or rehabilitation facility in question has admitted the patient. You have the option of admitting the patient if you deem fit. Also, you may have to examine a patient under post-operative care or in the psychiatric ward.Then, there is the critical scenario of an emergency. It will require you to take decisions in urgency.

This account should give you an idea of what to expect. For more information, click here.

USMLE Step 3 format

Unlike the other Steps, the Step 3 exam format spreads over a period of 2 days. On Day 1, the FIP takes place. The FIP stands for Foundations of Independent Practice. The Day 2 format is for the ACM that expands to Advanced Clinical Medicine. A lot becomes clear from the names of the Exams themselves.

USMLE Step 3 question pattern 2023

How many questions are in USMLE Step 3? The FIP has a total of 232 MCQs which form 6 blocks. Each block contains 38-39 test items or Step 3 questions which you have a maximum of 60 minutes to complete. So, the duration of the FIP is 7 hours with 15 minutes of tutorial and a minimum of 45 minutes of break.

The ACM takes a total of 9 hours to complete. It has 180 MCQs. Then, there are Case Simulations. There are 13 such Computer-based Case Simulations (CCS).

The MCQs appear in 6 blocks of 30 test items each. Then, there is the 5 min tutorial and the customary minimum 45 min break. The USMLE Step 3 CCS section of the ACM has a 7 min tutorial. Of the 13 CCS test items, a few have a time limit of 10 min while others have 20 min. There is a separate minimum 45 min break here too.


In the FIP, the focus area is the depth of awareness of the aspirant regarding basic science & medicine. Also, the FIP establishes, through testing, your skills of disease diagnosis and management. This includes checking how good you are at taking patient history, examining the patient physically, and using diagnostic studies to reach a conclusive inference.

You may expect some additional question types that didn’t exist earlier. For instance, the test may require you to answer test items based on scientific abstracts. In addition, you may expect a few interesting test items leaning on pharmaceutical advertisements.


The USMLE tests your expertise in applying your understanding of health and disease under the aegis of proper patient management. Most importantly, the ACM focuses on how well you understand the changes in the manifestation of an illness over time. Your ability to give a correct prognosis and advice regarding the maintenance of health is also under scrutiny. Also, your faith in yourself in making medical decisions is an important scoring area.

The CCS is more about history taking & physical examination and reaching a logical diagnosis followed by giving medical advice.

USMLE Step 3 score report time 

How long does it take to get the Step 3 score? You get the Step 3 score within 4 weeks of testing. However, every year, the questions in reserve undergo modifications. This generally happens in the month of February.
Therefore, those who have appeared in Step 3 in January or February 2023, will receive their results on March 16, which, of course, is a Wednesday.

USMLE Step 3 passing score

The current passing score for Step 3 is 198.

USMLE Step 3 pass rate

You can get a rough idea about how hard is Step 3 by knowing what is the pass rate for Step 3. In 2020, 90% of the IMGs who appeared for the first time in Step 3 passed, while, only 57% of the repeaters passed.

USMLE Step 3 Sample Questions 2023 

Solving lots of Step 3 practice questions is always beneficial. Download and solve Sample Questions Step 3,- PDF


USMLE® is a joint program. The Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) are co-sponsors. None of the trademark holders have affiliation with MOKSH Academy or this website.

ACGME® is a registered trademark of the Accreditation Council for Graduate Medical Education.

The ECFMG® is a registered trademark of the Educational Commission for Foreign Medical Graduates.

The Match® is a registered service mark of the National Resident Matching Program® (NRMP®). The NRMP has no affiliation with MOKSH Academy.

Electronic Residency Application Service (ERAS®) is a program of the Association of American Medical Colleges. It has no affiliation with MOKSH Academy.

Test names and other trademarks are the property of the respective trademark holders. None of the trademark holders have an affiliation with MOKSH Academy or this website.