Get to Know USMLE Step 3: Format and Content

What is the Format of USMLE Step 3? How Many Questions Are There?

Unlike Step 1 and 2, the format of USMLE Step 3 is a bit different. It is split up into 2 separate test days. You can do both test days on back-to-back days, or on nonadjacent days. Per the USMLE website the first day of testing (called Foundations of Independent Practice, FIP) consists of a 5-minute optional tutorial and “232 multiple-choice items divided into 6 blocks of 38-39 items” in 60-minute blocks with an additional 45 minutes of break time. This day of testing is very much akin to Steps 1 and 2 in terms of structure.

The second day of testing (called Advanced Clinical Medicine, ACM) consists of “180 multiple-choice items, divided into 6 blocks of 30 items” in 45-minute blocks. This is followed by 13 case simulations each of which are to be completed in 10 or 20 minutes of real time. The second day also has a 5-minute optional tutorial and 45 minutes of break time. 

What Content is Covered in USMLE Step 3?

The last step of the USMLE series is a very broad exam. Essentially all topics learned during medical school as well as more advanced clinical management acquired during a typical intern year of residency are fair game. That includes basic sciences, preclinical studies, clinical experiences, and additional subjects like biostatistics and medical ethics. You’ll also be tested on interpreting medical literature.

You can expect the following subjects to make an appearance:

• Basic science topics in biochemistry and genetics
• Basic medical topics from preclinical studies including physiology, pathology, pathophysiology, pharmacology, and microbiology.
• Subjects from clinical experiences, including internal medicine, surgery, pediatrics, OBGYN, emergency medicine, family medicine, neurology, psychiatry, and others.
• Biostatistics
• Social sciences
• Medical ethics
• Epidemiology

How Long Should I Study for Step 3? And What Do I Study?

For the other USMLE exams, most students take a “dedicated” study period of 4 weeks or longer. However, most test-takers study for Step 3 amidst the hectic chaos of residency, and taking any kind of prolonged “dedicated” study period is impossible.

While the USMLE Step 3 is sometimes seen as lower stakes, this exam still requires your attention because of its unique format. It is longer than any of the previous USMLE exams and covers a broader range of content. As such, we recommend you carve out 1-2 hours per day during your work week and perhaps more on your weekend day(s) off at least for 2-3 months. Adjust your schedule based on rotation demands. It will also be to your advantage to maximize your clinical learning (for patient care as well as for this test!) on the rotations you’re on. For example, if you’re a surgery intern you may need less time studying for the surgery questions given your day-to-day clinical learning. In this case, you may need to devote more time to learning internal medicine during your time off. And vice versa.

Resources to Cover All USMLE Step 3 Content

We know you are busy and don’t have a lot of time to commit to studying. That’s why it’s so important to pick the right resources to maximize the efficiency of your studying. These are the 4 basic types of resources we recommend:

Question Bank

For most people, doing questions will be your main source of studying for this exam. Our advice is to direct your learning based on the questions you encounter. UWorld is still the gold standard for this final USMLE exam as well. As of the time of writing this article, their Step 3 question bank has about 1900 questions. You can expect the same depth of explanation from each question as from their Step 1 and 2 question banks. A benefit of UWorld is the ability to create customized question blocks for FIP or ACM test days. Allocate time daily for 20-40 questions during work days and additional blocks on days off before your exam.

Case Simulations to Get Used to USMLE Step 3 CCS Format

While you’re already an expert at multiple choice boards questions from all the previous exams, USMLE decided to throw in a curve ball to the USMLE Step 3 format in the form of case simulations. These are unlike any questions you’ve encountered before and need proper preparation. There are two main resources to prepare for this (UWorld and CCS Cases). You should definitely get one to help you prepare for these cases.

Long-term Retention

Not everyone is a fan of spaced repetition, but there is good evidence that it works well, especially for studying across a longer amount of time. This is especially applicable for USMLE Step 3 content because most test-takers will not be able to take a “dedicated” study period for it. If you kept up all your reviews from the monstrous 20-30 thousand card decks from Step 1 and 2 and want to continue to reinforce that material, kudos to you. If you let those cards lapse or are starting brand-new, you’re in good company. You will not have the time to go through thousands of cards in preparation for this exam.

Our advice is to either make or selectively choose a few cards from premade decks based on questions you miss in your question bank each day. This way you won’t be overwhelmed with the number of cards. The added advantage of incorporating a flashcard-based tool into your study repertoire is that you can find little pockets of time to knock out some cards during your busy workday in between rounds, consults, etc. Multiple tools exist for spaced repetition including Anki, UWorld flashcards, and others.

Reference Text, Videos, Sketches, Etc.

Hope you saved your books, videos, etc. from your days of Step 1/2 and shelf exam studying! As you study for Step 3, you will encounter lots of material you have already learned but now forgot. It’s generally better to reference a resource you’re already familiar with from the past as you’ll likely save some time going over that resource again compared to reading/watching something new. Our advice in general is to reference these resources as needed based on the questions you encounter in your question bank. However, if you know you never learned a subject matter well the first time, you may want to consider re-learning that material in a more systematic way. For example, if you did poorly on your psychiatry shelf, you can carve out time to go through the OnlineMedEd psychiatry videos. The decision to systematically review an entire content area such as this should be individualized to the test-taker.

USMLE Step 3 Format and Content: Conclusion and a Few Final Tips

Preparing for the USMLE Step 3 requires a unique approach due to its format and comprehensive content. With the exam split into two separate test days, it’s important to understand the structure and topics covered. Remember to carve out a couple of hours per day to study for this exam!

Choosing the right resources is crucial, and we recommend four basic types of resources. Make sure to select a comprehensive QBank (we recommend UWorld for this), case simulations, a flashcard tool for spaced repetition, and materials to reference content.

While self-studying is possible, some individuals may benefit from additional support and guidance. Elite Medical Prep offers USMLE Step 3 tutoring that can provide personalized assistance tailored to your needs. Our experienced tutors can help you navigate the exam’s challenges and ensure you are well-prepared. Schedule your complimentary consultation today to hear more about how Elite Medical Prep’s 1-on-1 tutoring can help you succeed. Good luck on your USMLE Step 3 journey!