USMLE Step 3

The final test

Step three of the USMLE is a two day examination taken after graduation from medical school, typically during a residency training program. It assesses your ability to independently practice standard clinical medicine, so most of your preparation will review what you've learned as a medical student. You will be tested on your ability to manage patients in unsupervised settings, from initial evaluations to emergency environments and continuing care situations.

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The first day of testing is somewhat similar in structure to the USMLE Step One. Seven hours of tests are spread out over the day, with each block containing 25 to 50 questions to be completed in a period of 30 to 50 minutes. In total, there are about 350 questions (all multiple choice). During the day, you'll be given 45 to 60 minutes of break time.

The second day of testing is evenly divided between a set of multiple choice questions and a set of computer-based case simulations (CCS):

  • The multiple choice questions are grouped into sets of 35 to 50 questions - 150 in total. Each set is timed at 30 to 60 minutes, and the total block must be completed in three hours.
  • The CCS are preceded by a half hour preparation tutorial. Following the tutorial, you're run through nine case simulations, using software developed specifically for the USMLE. There are one or more cases in each block, and the total time allotted is three hours and 45 minutes.

More on the USMLE's Use of Computer-Based Case Simulations

In each computer-based simulation, you're given a virtual patient. You'll be able to request the patient's medical history, and from their medical examination you must order lab studies and prescribe medications and therapies.

The simulation allows you to move a virtual clock ahead when you feel that you've done enough for the patient. With the passage of time, you can move ahead to follow-up examinations, where the patients' situation may have changed according to their condition and interventions you've administered. Your overall management strategy is compared to that of experts, and you're scored on how close you come to an ideal treatment plan.

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