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What Do I Need to Know for the USMLE Step 3?

Find out all of the relevant content categories for Step 3 studying, Step 3 pass rates, popular exam dates, and more.

The USMLE Step 3 is the final examination in the USMLE series and tests medical students on their ability to apply biomedical and clinical knowledge. Step 3 emphasizes patient management and ambulatory settings. Below we explain the structure of the exam and list the distribution range of content areas tested on Step 3.


Step 3 takes place over two separate days. The first day of the exam is called Foundations of Independent Practice (FIP), and the second day is called Advanced Clinical Medicine (ACM). The second day includes Correlations and Clinical Scenarios (CCS) or “Case Simulations.”

Day 1: FIP

Multiple Choice Items: 233
Blocks: 6
Items per Block: 38 to 40
Time per Block: 60 minutes
Break time: 45 minutes
Total Test Time: Approximately 7 hours

Day 2: ACM

Multiple Choice Items: 180
Blocks: 6
Items per Block: 30
Time per Block: 45 minutes
CCS Case Simulations: 13
Time per Case: 10 or 20 minutes (maximum)
Break time: 45 minutes
Total Test Time: Approximately 9 hours

Content Areas

Below we list the topics and the distribution range for items that include those topics on Step 3. Case Simulations will draw from the topics listed under Organ Systems only. Case Simulations typically involve scenarios that require reasoning about urgent intervention, continuing care, or initial workup. For more details on Step 3 cases, see descriptions listed here.

General Principles of Foundational Science 1% – 3%

Organ Systems 80% – 85%

  • 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, & Puerperium
  • Female Reproductive System & Breast
  • Male Reproductive System
  • Endocrine System
  • Multisystem Processes & Disorders

Biostatistics & Epidemiology 14% – 18%

Preparing for Step 3

To see the most popular Step 3 books, lecture series, question banks, and flashcards, visit Below we answer frequently asked questions regarding Step 3 preparation.

How long do most students study for Step 3?
According to Cram Fighter’s statistics, students study for Step 3 for 67 days on average. During this time, students complete 1352 questions on average.

When are the most popular months to take Step 3?
The top three months among Cram Fighter users for taking Step 3 are (in order of popularity) May, June, and August. For a complete list, visit our page on the most popular months for taking Step 3.

What is the pass rate for Step 3?
In 2015, the pass rate among students at U.S. and Canadian schools was 98%.

About the Author

Erica Forrette is the former Director of Marketing at Cram Fighter.