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 for content areas tested on Step 3.

Structure of the USMLE 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: About 7 hours

Day 2: ACM

Multiple Choice Items: 160
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: About 9 hours

Content Areas

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

Area Range
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, & the Puerperium
Female Reproductive System & Breast
Male Reproductive System
Endocrine System
Multisystem Processes & Disorders
Biostatistics & Epidemiology/Population Health, & Interpretation of the Medical Literature, Social Science 14%-18%

Preparing for Step 3

To see the most popular Step 3 textbooks, 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, most students study for Step 3 for 67 days. 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.

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