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USMLE Step 3

STEP 3 assesses whether you can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care. Step 3 emphasizes selected physician tasks, namely, evaluating severity of patient problems and managing therapy. Assessment of clinical judgment will be prominent.
  • Clinical problems involve mainstream, high-impact diseases. Provision is made for less common but important clinical problems as well.
  • Test items and cases are patient centered, starting with a description of a clinical encounter (vignette). Both the multiple-choice items and case simulations pose action-related challenges that require clinical decisions or judgment.
  • Emphasis is on ambulatory patient encounters; however, inpatient encounters of significant complexity and reflecting contemporary trends also are represented.
  • Provision is made for incorporating applied basic science concepts, especially as they relate to justification for prognosis or management. It is assumed that basic science and clinical fundamentals have been assessed adequately in the prerequisite Step 1 and Step 2 examinations.
It is a two-day computerized test in clinical medicine consisting of mulitiple-choice questions and computer-based case simulations (CCS). You must complete each day of testing within 8 hours. The first day of testing includes approximately 350 multiple-choice questions divided into blocks of 25 to 50 questions that have to be completed within 30 to 60 minutes. There is a maximum of 7 hours of testing on the first day, plus 45 minutes of break time and a 15-minute optional tutorial. The second day of testing includes approximately 150 multiple-choice questions and computer-based case simulations (CCS). The questions are divided into sets of 25 to 50 questions; each set takes from 30 to 60 minutes and must be completed within 3 hours. After answering the multiple choice questions there is a CCS tutorial for which a maximum of 30 minutes is allowed. The CCS tutorial is followed by approximately 9 case simulations using new, proprietary simulation software called PRIMUM. The case simulations are presented in 1 or more cases per block and 3 hours, 45 minutes are allotted for them. The allotted break time for the second day is also 45 minutes. Taking Step 3 before residency is critical if the IMG is seeking H1B visa and is a bonus that can be added to the application for residency. Step 3 is also required for a full medical license in the US and can be taken during residency for this purpose.
Step 3 Specifications:
Physician Task:
1) 8 –12 % Obtaining History and Performing Physical Examination
2) 8 –12 % Formulating Most Likely Diagnosis
3) 8 –12 % Evaluating Severity of Patient’s Problems
4) 8 –12 % Applying Scientific Concepts and Mechanisms of Disease
5) 45-55 % Managing the Patient
i) Health Maintenance
ii) Clinical Intervention
iii) Clinical Therapeutics
iv) Legal and Ethical Issues
6) Clinical Encounter
7) 20 -30% Initial Work-ups
8) 55-65% Continued Care
9) 10 – 20% Emergency Care
Eligibility: Most states require that applicants have completed one, two, or three years of post-graduate training (residency) prior to applying for Step 3 and permanent state licensure. The exceptions are the 11 states: Arkansas, California, Connecticut, Florida, Louisiana, Maryland, Nebraska, New York, South Dakota, Texas, Utah, Washington & West Virginia, which allow IMGs to take Step 3 at the beginning of or even before residency. So if you don’t fulfill the prerequisites to take Step 3 in your state of choice, simply use the name of one of the 11 states in your Step 3 application. You can take the exam in any state you choose regardless of the state that you mentioned on your application. Once you pass Step 3, it will be recognized by all states.
Basic eligibility requirements for the USMLE Step 3 are as follows:
· Obtaining an MD or DO degree (or its equivalent) by the application deadline
· Obtaining an ECFMG certificate if you are graduate of a foreign medical school or successfully completing “fifth pathway” program (at a date no later than the application deadline)
· Meeting the requirements imposed by the individual state licensing authority to which you are applying to take Step 3.
Application materials: Step 3 applications can be found online at and must be submitted to FSMB. Step 3 is administered only in the US.
Eligibility Period: A three month period of your choice.
Fees: The fee for the 2005 Step 3 is $625 for all state medical boards with the exception of those boards listed below.
Iowa $675
Mississippi $725
South Dakota $775
Vermont $660
Retaking: In the event you failed the test, you can reapply and select an eligibility period that begins at least 60 days after the last attempt. You cannot take the same Step more than three times in any 12-month period.
Test Delivery: The NBME software, known as FREDTM, will replace the Prometric software in USMLE Step 3 in the fall of 2004. Installation of FRED for USMLE Step 3 will be phased in over several weeks in October 2004. If you schedule to take the Step 3, with a test date during the month of October, you should familiarize yourself with both the Prometric test delivery software and FRED.
The FRED software allows you to highlight and strike out item text as well as create annotations to items. Please note that the annotation feature allows you to record brief notes to yourself about individual items; it is not intended as a way to communicate to USMLE staff members. There is no additional time granted for use of the additional features provided by FRED, so you should closely monitor examination time when using these features.
The change to the FRED software will be accounted for in scoring the examination results, so that scores will be comparable to the Prometric software. Because of this change, along with other changes in the Step 3 test item pool, it will be necessary to delay the reporting of scores of some examinees for an additional 3-4 weeks beyond the normal turnaround period. The normal turnaround period for Step 3 examinees is 4 to 6 weeks. All efforts will be made to minimize these delays.
Score Reporting: The score report consists of two scores- a two digit and a three digit score. Both scores reflect your overall performance on the examination. The number of test items you answered correctly is converted to two equivalent scores, one on a 3-digit score scale and one on a 2-digit score scale. Both scales are used for score reporting purposes. The new minimum passing score for Step 3 is 184 implemented in April, 2004.
Statistics: For 2000 and 2001, the pass rates for first-time takers from LCME-accredited US and Canadian medical schools were 95% and 94%, respectively, whereas for non-US graduates/students, the pass rate is 61%. For 2002 and 2003, the pass rates for first-time takers who were graduates of MD-granting US and Canadian medical schools were 95% for both years, whereas, for non-US graduates/students, the pass rate is 68%.
Books Recommended:
a) Crush Step3: The Ultimate USMLE Step3 Review
b) NMSReview for the USMLE Step 3 (Book + CD-ROM)
c) Appleton & Lange's Review for USMLE Step 3
d) Medical Boards Step 3 Made Ridiculously Simple
e) Kaplan Medical USMLE Step 3 Q book
f) Blueprints Computer-based Case Simulation Review: USMLE Step 3
g) Mosby's USMLE Step 3: Comprehensive Review
h) Swanson’s Family Practice Review
i) Washington Manual of Medical Therapeutics
Step 3 Courses available:
a) Center-Prep USMLE Step 3 - Kaplan
b) Live Prep for USMLE Step 3 - Kaplan
c) Med Pass USMLE Step 3 - Kaplan
d) Deluxe Prep USMLE Step 3 - Kaplan
e) UMKC Institute for Professional Preparation
MCQs and CCS for Step 3:
a) USMLE-World
b) Q bank USMLE Step 3 - Kaplan
c) Kaplan Medical USMLE Step 3 Q book
d) Exam Master On-Line - USMLE Step 3
e) American Family Physician Clinical Quiz

USMLE Step 3


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The United States Medical Licensing Examination (USMLE) is a three-step examination for medical licensure in the United States. The Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) sponsors USMLE.
The Three Steps of the USMLE
Step 1 tests the important concepts of basic sciences basic to the practice of medicine. It also places special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Step 1 ensures mastery of the sciences that provide a foundation for the safe and competent practice of medicine. It also tests the scientific principles required for maintenance of competence through lifelong learning.
Step 2 CK tests the medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision. It also includes emphasis on health promotion and disease prevention. Step 2 CK ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills.
Step 2 CS tests your capacity to practice and provide good medical service in real-life situations. It also tests your communication skills.
Step 3 tests your medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care.


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