Overview

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. It is the final examination in the USMLE sequence leading to a license to practice medicine without supervision. 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 content reflects a> Three stages of clinical encounters INITIAL WORKUP CONTINUING CAREURGENT INTERVENTIONPatient encounters characterized by initial assessment and management of clinical problems among patients seen principally in ambulatory settings for the first time. These encounters may also include new problems arising in patients for whom a history is available.Patient encounters characterized by continuing management of previously diagnosed clinical problems among patients known to the physician and seen principally in ambulatory settings. Encounters focused on health maintenance are located in this frame.
Also included are patient encounters characterized by acute exacerbations or complications, principally of chronic, progressive conditions among patients known to the physician. These encounters may occur in inpatient settings. Patient encounters characterized by prompt assessment and management of life-threatening and organ-threatening emergencies, usually occurring in emergency department settings.
Occasionally, these encounters may occur in the context of a hospitalized patient. Clinical problems include ill-defined signs and symptoms; behavioral-emotional; acute limited; initial manifestation and presentation of chronic illness.Clinical problems include frequently-occurring chronic diseases and behavioral-emotional problems. Periodic health evaluations of established patients are included here.Clinical problems include severe life-threatening and organ-threatening conditions and exacerbations of chronic illness.Physician tasks emphasized include data gathering and initial clinical intervention. Assessment of patients may lead to urgent intervention.Physician tasks emphasized include recognition of new problems in an existing condition, assessment of severity, establishing prognosis, monitoring therapy, and long-term management.Physician tasks emphasized include rapid assessment of complex presentations, assessment of patients' deteriorating condition, and prompt decision making.

Content Outline and Specifications

Content Description

The content description that follows is not intended as a curriculum development or study guide, but rather models the range of challenges that will be met in the actual practice of medicine. It provides a flexible structure for test construction that can readily accommodate new topics, emerging content domains, and shifts in emphasis. The categorizations and content coverage are subject to change. Successful completion of at least one year of postgraduate training in a program accredited by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association should be helpful preparation for Step 3.

Content Outline

All USMLE examinations are constructed from an integrated content outline, which organizes content according to general principles and individual organ systems. Test questions are classified in one of 18 major areas, depending on whether they focus on concepts and principles that are important across organ systems or within individual organ systems. Sections focusing on individual organ systems are subdivided according to normal and abnormal processes, including principles of therapy.

USMLE Step 3 Structure. Step 3 is a two-day, 17-hour exam, making it more than twice as long as Step 1. Step 3 includes at least 100 more multiple choice questions (MCQs) than Step 1 as well as Computer-based Case Simulations (CCS). The CCS cases are the most striking difference between Step 3 and the other USMLE Step exams. The practice session is a maximum of 4 hours and includes brief tutorial sections for both the multiple-choice question blocks and the Primum® Computer-based Case Simulation (CCS) blocks, three blocks of multiple-choice items totaling 96 questions, and four CCS cases. Additional time is not available for the practice session.

Table 1: Step 3 MCQ Test Content Specifications*

System	Range, %*
General Principles of Foundational Science**	1–3
Immune System, Blood & Lymphoreticular System, and Multisystem Processes/Disorders	6–8
Behavioral Health	4–6
Nervous System & Special Senses	8–10
Skin & Subcutaneous Tissue	4–6
Musculoskeletal System	5–7
Cardiovascular System	9–11
Respiratory System	8–10
Gastrointestinal System	6–8
Renal/Urinary & Male Reproductive Systems	4–6
Pregnancy/Childbirth & Female Reproductive System & Breast	7–9
Endocrine System	5–7
Biostatistics & Epidemiology/Population Health & Interpretation of the Medical Literature	11–13
Social Sciences: Communication Skills/Ethics/Patient Safety	7–9

* Percentages are subject to change at any time.
** The general principles category for the Step 3 MCQ examination includes test items concerning normal processes not limited to specific organ systems. These test items are typically related to normal development. Categories for individual organ systems include test items concerning those normal and abnormal processes that are system-specific.

Table 2: Step 3 CCS Test Content Specifications
Categories in bold are covered in CCS cases; categories not in bold are not covered.

System

General Principles of Foundational Science
Immune System
Blood & Lymphoreticular System
Behavioral Health
Nervous System & Special Senses
Skin & Subcutaneous Tissue
Musculoskeletal System
Cardiovascular System
Respiratory System
Gastrointestinal System
Renal & Urinary System
Pregnancy, Childbirth, & the Puerperium
Female Reproductive & Breast
Male Reproductive
Endocrine System
Multisystem Processes & Disorders
Biostatistics & Epidemiology/Population Health, & Interpretation of the Medical Literature
Social Sciences

Physician Tasks/Competencies

An additional organizing construct for Step 3 design is physician tasks and competencies. More information about the physician task and competencies outline is available. Items are constructed to focus on assessing one of the following competencies:

Medical knowledge/scientific concepts: Applying foundational science concepts
Patient care: Diagnosis
Patient care: Management
Communication and interpersonal skills
Professionalism, including legal and ethical issues
Systems-based practice, including patient safety
Practice-based learning, including biostatistics and epidemiology

Table 3: Step 3 MCQ Physician Tasks/Competencies Specifications

Competency	Range, %	Step 3 Foundations of Independent Practice (Day 1)	Step 3 Advanced Clinical Medicine (Day 2)
Medical Knowledge: Applying Foundational Science Concepts	11–12	√
Patient Care: Diagnosis	33-36	√	√
History/Physical Exam	5-9	√
Laboratory/Diagnostic Studies	9-12	√
Diagnosis	6-10	√
Prognosis/Outcome	8-11	√
Patient Care: Management	32-35	√
Health Maintenance/Disease Prevention	6-11	√
Pharmacotherapy

Step 3 Ccs Mac Download