Step 3 Content Description

Examination Format

Step 3 consists of multiple-choice items and computer-based case simulations, distributed according to the content blueprint. The examination material is prepared by examination committees broadly representing the medical profession. The committees comprise recognized experts in their fields, including both academic and non-academic practitioners, as well as members of state medical licensing boards.

Step 3 is a two-day examination. You must complete each day of testing within 8 hours. The first day of testing includes 336 multiple-choice items divided into 7 blocks of 48 items each. There will be 60 minutes of time allowed for completion of each block of test items. There is a maximum of 7 hours of testing on the first day. There is also a minimum of 45 minutes of break time and a 15-minute optional tutorial. Note that the amount of time available for breaks may be increased by finishing a block of test items or the optional tutorial before the allotted time expires.

The second day of testing includes 144 multiple-choice items, divided into 4 blocks of 36 items. These blocks will take 45 minutes. The total time allotted for these blocks is 3 hours. The second day also includes a Primum® Tutorial and instructions for which approximately 15 minutes are allowed. This is followed by 9 case simulations, for which 4 hours are allotted. There is an optional survey at the end of the second day, which can be completed if time allows. To download the tutorial and practice materials for Primum, click on USMLE Practice and Orientation Materials.

A minimum of 45 minutes is available for break time. The timing and structure of the Step 3 testing days may change without notice; please refer to the USMLE website for the most up-to-date information.

Multiple-choice items

One-best-choice formats are used. Items may stand alone or may be sequenced together as a case or set of 2 to 3 items. It will be useful to study the descriptions in Test Item Formats and to complete the Tutorial and Sample Tests. Test items present detailed clinical situations, usually from the patient's perspective. The presentation may be supplemented by one or more pictorials, or audio or video. Assessing the patient's situation in the context of his or her environment or family is an important element of many Step 3 questions.

As is done for the actual examination, the sample test items are arranged in blocks that are organized by one of the three Clinical Settings. During the time allotted to complete the test items in a block, examinees may answer the items in any order, review responses, and change answers. After exiting a block, no further review of items or changing of answers within that block is possible. Policies regarding review of test questions may be changed without notice. The most current policies are provided at the USMLE website. The computer interface includes, among other features, clickable icons for marking questions to be reviewed, automated review of marked and incomplete items, and a clock indicating the time remaining in the block and in the examination. Practice with the sample multiple-choice items on this CD will provide examinees with a realistic understanding of the computer interface and timing of the examination.

A sample Laboratory Values table of frequently ordered laboratory tests, including Standard International conversions, is available in each test item block as a button that retrieves the table for easy viewing.

Primum Computer-based Case Simulations (CCS)

You will manage one case at a time. Free-text entry of patient orders is the primary means for interacting with the format. Buttons and check boxes are used for advancing the clock, changing the patient's location, reviewing previously displayed information, and obtaining updates on the patient.

At the beginning of each case, you will see the clinical setting, simulated case time, and introductory patient information. Photographs and sounds will not be provided. Normal or reference laboratory values will be provided with each report; some tests will be accompanied by a clinical interpretation. To manage patients using the Primum CCS software, it is essential that you complete the tutorial and sample cases provided on the CD. A brief description of the interface of one case simulation is provided in the Primum Tutorial.