Computer-based Case Simulations (CCS) are the part of USMLE Step 3 in which you manage a simulated patient instead of answering a multiple-choice question. They sit on Day 2 of Step 3, after multiple-choice blocks. This guide covers what usmle.org says about the format and how to prepare.
Where CCS fits in Step 3
| Day | Name | Content |
|---|---|---|
| Day 1 | Foundations of Independent Practice | 232 multiple-choice items in 12 blocks of 18-20 items, 30 minutes per block; about 7 hours including 55 minutes of break and a 5-minute optional tutorial |
| Day 2 | Advanced Clinical Medicine | 180 multiple-choice items in 9 blocks of 20, 30 minutes per block, then a 6-minute CCS tutorial and 13 to 14 case simulations, each allotted a maximum of 10 or 20 minutes of real time; about 9 hours in total |
What CCS cases assess
The Step 3 content outline lists the competencies covered by the case simulations: medical knowledge and scientific concepts; patient care, including diagnosis (history and physical, laboratory and diagnostic studies, diagnosis, prognosis) and management (health maintenance, pharmacotherapy, clinical interventions, mixed management, surveillance for disease recurrence); communication and professionalism; and systems-based practice, patient safety and practice-based learning.
Preparing for CCS
- Use the official practice material. The USMLE site provides CCS orientation and practice cases so that the interface is not new on test day.
- Practice a consistent routine. Cases are timed, so rehearse gathering history, ordering and re-assessing in the same order each time.
- Use review tools as extras. Several question banks include CCS review. See UWorld, and compare options in study resources compared.
- Take a practice test for pacing. The NBME offers a Step 3 self-assessment; see NBME self-assessments.
Eligibility
To take Step 3 you must have passed Step 1 and Step 2 CK and be an MD, DO or equivalent. USMLE recommends at least one postgraduate training year. See the USMLE Step 3 guide and the seven-year rule for timing.