How to Study for USMLE Step 3

How to Study for Step 3

So you’ve passed Step 1 and Step 2, and you feel prepared to take Step 3 without studying.


While Step 3 is not the most imperative USMLE, it is pricey and long-winded with emphasis on different areas than the other exams.

The USMLE Step 3 is a normalized, pass/fail test, so you do not need to work as hard to get a high score compared to the first two.

If you want to pursue a fellowship or specialize in the medical field, the Step 3 exam has a high importance level (62% of programs cite it as a factor for selecting candidates for interviews).

Let’s dive into how to study for the USMLE Step 3.

USMLE Step 3 Format

The USMLE Step 3 exam takes two days. The first day has 233 multiple-choice questions sectioned into blocks of 38-40 questions. You have six blocks and 60 minutes to complete each one. In the middle of your testing session, you will have a 50-minute break. The first day ends at around seven hours of testing.

While the first day resembles Steps 1 and 2, the second one has a new component. You start with 180 multiple-choice questions taken over six 45-minute blocks of 30 questions.

After, you answer standardized digital case simulations. You get 13 case simulations with 10-20 minutes to complete them. After that, you receive a 45-minute official break and can use the instructional period for more time.

Keep in mind that you do not need to take the two days consecutively. While most want to get the test over with, you can schedule your two testing sessions as far apart as you want. We recommend that you take them closer together to minimize the study time for the second part.

The subjects covered on USMLE Step 3 are as follows:

  • Behavioral health: 4-6%
  • Biostatics, epidemiology, population health, interpretation of medical literature: 11-13%
  • Cardiovascular system: 9-11%
  • Endocrine system: 5-7%
  • Gastrointestinal system: 6-8%
  • General principles of foundational science (typical developmental processes not specific to organs): 1-3%
  • The immune system, blood, lymphoreticular system, multisystem processes, and disorders: 6-8%
  • Musculoskeletal system: 5-7%
  • Nervous system and special senses: 8-10%
  • Pregnancy, childbirth, breast health, and female reproductive system: 7-9%
  • Renal, urinary, and male reproductive system: 4-6%
  • Respiratory system: 8-10%
  • Skin and subcutaneous tissue: 4-6%
  • Social sciences, communication skills, ethics, patient safety: 7-9%

The test also covers some physician tasks, such as:

  • Applying foundational medical and scientific concepts: 11-12%
  • Communication and interpersonal skills
  • Legal and ethical professionalism
  • Patient care, diagnosis: 33-36%
    • Diagnosis: 6-10%
    • History and physical exam: 5-9%
    • Laboratory and diagnostic studies: 9-12%
    • Prognosis and outcome: 8-11%
  • Patient care, management: 32-35%
    • Clinical interventions: 5-9%
    • Health maintenance and disease prevention: 6-11%
    • Pharmacotherapy: 9-13%
    • Mixed management: 6-11%
  • Practice-based learning: 11-13%
  • Systems-based practice: 7-9%

Making a Study Plan

Before you can make your study plan, you need to schedule your test date. Try to predict your schedule for the upcoming months and see where you will have a lighter workload to devote extra time to study.

Setting a date gives you a deadline and helps you stay on track. Open-ended test dates can encourage procrastination, so you may never get around to taking Step 3.

This exam favors family and internal medicine, so you can take it near the end of your intern year if you are going into primary care. Otherwise, you will want to take it soon after Step 2 to ensure you retain the information.

Whenever you decide to take Step 3, you will need to devote between two weeks and one month to study for the exam. Those who take it closer to Step 2 will not need to study as hard as those who put it off.

Figure out if you want to take the two days back-to-back or separated by a few days to a week. Any more than that, and you may need to start studying again. Taking them consecutively could lead to burnout, but separating them could get you distracted from the subject.

You will need to decide the best strategy for you. Everyone is different, and both options have their advantages and disadvantages.

Find Your Resources

There are tons of resources to study for USMLE Step 3. The best and most up-to-date ones are online, so you do not need to scrounge around for Step 3 prep books. We have reviewed three excellent options for your studying.


Without a doubt, UWorld is the most comprehensive resource to prepare for USMLE Step 3. UWorld has a question bank with over 1,800 practice questions and 50 clinical case simulations (CCSs).

The sample questions cover real-world scenarios to cover the most commonly seen concepts on the exam. UWorld updates the question bank regularly to ensure the information stays relevant. Also, practicing physicians write the content based on what they experience in the medical field.

Each question has in-depth explanations about why answers are incorrect. Furthermore, UWorld provides the concepts surrounding vital clinical topics. It complements the written information with illustrations that help you visualize, comprehend, and master the topics.

You can explore their performance tracking modules to see where your strengths and weaknesses lie. It also lets you compare with peers to scope out your competition.

Some other resources on UWorld include:

  • Flashcards with personalized spaced repetition to help you retain concepts
  • Customizable exams that target your weaknesses
  • Question flagging for easy review later on
  • Performance graphs that let you track your changes and compare them with others
  • Note-taking capabilities to help you understand crucial topics
  • Compatibility across multiple devices, like smartphones, laptops, and desktop computers

Besides the expansive collection of multiple-choice questions, UWorld has CCSs to test your diagnosing, treating, and monitoring abilities. In addition, you can use software that closely resembles the one used on the official exam to familiarize yourself with the interface.

UWorld lets you read over 40 classic CCSs covering various specialties to expose you to the most types of questions. You can also practice with more than 50 interactive cases that resemble those on the exam.

Each case has detailed explanations that cover the ideal clinical approach, time management, and scoring.

We recommend paying the extra fee for the clinical cases to adjust to the format. On the exam, they appear in a non-intuitive way that may confuse you if you have not seen them before.

The case scenario presents you with a patient with a complaint, and you ask for information, imaging, and studies to gain more knowledge to diagnose. You can fast-forward to see test results, and you will need to cover a course of treatment until you reach a final diagnosis.

UWorld emphasizes epidemiology and biostatistics, so it has a separate module for an additional cost to master these subjects. You can perform step-by-step calculations, interactively learn key concepts, read comprehensive explanations that cover multiple questions, and use vignettes to practice applying the information to the exam.

UWorld is not a free resource, but it bases its pricing tiers on how many days you plan to use it. You can also inquire about discounts for institutions.

Official USMLE Practice Materials

The official United States Medical Licensing Examination website has practice materials for Step 1, Step 2, Step 3, and Step 3 CCS.

For Step 3, you can access PDFs with general information and a content description, and sample test questions. The website lets you register for a USMLE Practice Session that lets you adjust to the Prometric testing center environment. You will need to pay a fee for the session.

USMLE also has an instructional video to teach you how to use the Primum software to run a case study. You can download sample case studies from the practice materials, and review some feedback on them to get an understanding of the grading system.

If you want to use the official software, we implore you to go through USMLE. While UWorld has a comparable interface, you can use the real one.

Most USMLE resources are free, but they are not as comprehensive as UWorld. If you want to save money on another practice exam from UWorld, you can use these questions to prepare.


The last resource to consider is BoardVitals. This website costs less than UWorld and provides access to over 1,450 questions. You get comprehensive explanations for each of the questions and answers, targeted questions based on your weaknesses, and mobile app access with the paid plans.

BoardVitals recommends their three-month “Prepare” option, which gives you a 100% pass guarantee, access to their Ask a Clinician program, and the ability to start up to six months after your purchase. The six-month “Master” program has the same amenities.

All plans let you personalize your practice tests based on the subject, time yourself to simulate the testing environment, compare your performance with others across the nation, and track your scores with reports and analytics.

If you want a general review of the subjects on the USMLE, you may benefit from BoardVitals. However, BoardVitals does not cover the case simulations, so you will need to use it as a supplementary resource.

Keep Practicing

Once you have chosen your resources, you need to practice away. Complete as many questions as possible, untimed to test your knowledge and timed to test your performance. Take notes on what you learn as you read the explanations, emphasizing your weak spots.

Also, you will want to review biostatistics with extra care. Each section has between six and eight questions, with three to four being from pharmaceutical advertisements. Make sure you fully understand the number needed to harm (NNH), the number needed to treat (NNT), bias, and the odds ratio.

A lot of people find the interface the most daunting part of the CCS section. You will want to work through example cases as you study. Find one related to the subject you are practicing to give you experience with the platform and answering the questions. Try not to save them all for the weekend before your exam.

Wrapping Up

The study habits you developed in high school will need updating throughout your academic career. Instead of devoting all of your time to studying, you will need to find a free period during your busy day of residency to study for the USMLE Step 3.

Cultivating study habits filled with practice, note-taking, and repetition will prepare you best for this exam. You can work through thousands of practice questions and take exams tailored towards your weaknesses to become the best possible test-taker.

We highly recommend investing in a UWorld subscription to study for the USMLE Step 3 as it covers all of the question types you will see without needing any supplementary resources.

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