Exam format
- Day 1 - Foundations of Independent Practice (FIP): ~232 MCQs in six 60-minute blocks; foundational sciences and their clinical application.
- Day 2 - Advanced Clinical Medicine (ACM): ~180 MCQs in six 45-minute blocks plus 13 Computer-based Case Simulations (CCS) of 10–20 minutes each.
- Both days at Prometric centers; typically taken 1–14 days apart.
Eligibility for IMGs
To apply for Step 3 as an IMG you must have:
- An MD or equivalent from a school listed in the World Directory of Medical Schools;
- Passing scores on USMLE Step 1 and Step 2 CK;
- ECFMG Certification.
Some US states require additional documentation depending on where you register for the exam.
When to take Step 3
- Before residency: supports H-1B visa sponsorship (which typically requires a Step 3 pass). Uses graduating-year study momentum.
- During PGY-1: most common. Intern-year exposure across services reinforces Day 2 content.
- Early PGY-2: allowed but less common; delays full licensure eligibility.
Preparation resources
- UWorld Step 3 QBank (MCQ + CCS module).
- USMLE-Rx or AMBOSS Step 3 review.
- Free official CCS practice software from the USMLE program.
- Master the Boards Step 3 for structured content review.
What CCS actually tests
Computer-based Case Simulations put you in a virtual clinic or emergency setting where you order tests, prescribe treatments, and advance simulated time. CCS rewards structured workup, appropriate location changes (ward, ICU, home), and timely reassessment. Practice with the official free software before test day - the interface is unusual and time-sensitive.