USMLE Step 3 is the final exam in the sequence. It is a two-day exam that adds Computer-based Case Simulations (CCS), assesses whether you can practice medicine without supervision, and carries a passing standard of 200. This guide covers eligibility, applying, the two-day format, content, scoring and planning. Facts come from usmle.org, read on October 31, 2026.
Step 3 at a glance
| Day | 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. |
| Passing standard | 200, for exams administered on or after January 1, 2024 |
Step 3 is administered only in the United States and its territories.
Who can take Step 3
- You must have passing results on Step 1 and Step 2 CK.
- You must hold an MD or DO degree, or the equivalent from a medical school outside the U.S. that is listed in the World Directory of Medical Schools.
- International medical graduates must also hold valid, unexpired ECFMG certification. See the ECFMG guide.
- USMLE recommends at least one postgraduate training year that meets state licensing requirements, so many examinees take Step 3 during residency.
How to apply
U.S. students and graduates apply through NBME (MyUSMLE), and those from schools outside the U.S. apply through FSMB. The listed fee for 2026 and 2027 is $955. Step 3 eligibility and state-board requirements can interact, so read the Bulletin and your board's rules before you pick a date. See FSMB and state licensure and the seven-year rule.
What Step 3 tests
USMLE says Step 3 content reflects a data-based model of generalist medical practice in the United States. The multiple-choice systems ranges include:
| Area | Share |
|---|---|
| Biostatistics, epidemiology/population health, and interpretation of the medical literature | 11-13% |
| Cardiovascular | 9-11% |
| Nervous system and special senses | 8-10% |
| Respiratory | 8-10% |
| Pregnancy, childbirth, female reproductive and breast | 7-9% |
| Social sciences: communication, ethics and patient safety | 7-9% |
| Immune, blood and multisystem | 6-8% |
| Gastrointestinal | 6-8% |
| Musculoskeletal | 5-7% |
| Endocrine | 5-7% |
| Behavioral health | 4-6% |
| Skin | 4-6% |
| Renal/urinary and male reproductive | 4-6% |
| Human development | 1-3% |
| Competency | Share |
|---|---|
| Patient care: diagnosis | 33-36% |
| Patient care: management | 32-35% |
| Practice-based learning and improvement | 11-13% |
| Medical knowledge | 11-12% |
| Communication, professionalism, systems-based practice and patient safety | 7-9% |
Biostatistics carries more weight here than on any other Step; see biostatistics and epidemiology.
Computer-based Case Simulations
On Day 2 you manage simulated patients rather than choose an answer. The cases assess medical knowledge, diagnosis, management, communication and professionalism, and systems-based practice. Our guide to CCS covers timing and preparation, and UWorld lists a CCS review among its Step 3 materials.
Scoring and results
The passing standard is 200. Performance across both days contributes to the result. See USMLE passing scores, attempt limits and results and transcripts.
Planning Step 3
These are planning suggestions, not official guidance.
- Check your state board's requirements and any time limit on completing the Steps.
- Choose a window that fits your training schedule, because it is a two-day exam and needs protected time.
- Take a practice exam, such as the NBME Step 3 self-assessment.
- Practice CCS with the official materials until the interface is routine.
Read the complete USMLE guide, the complete Step 2 CK guide and the Step 3 exam page.