USMLE Step 3 Percentiles: How Do I Get My Best Score?

If you're thinking about USMLE Step 3 percentiles, let's first take a moment: Congrats on making it to Step 3! You’ve already taken USMLE Step 1 and Step 2 CK, so you have a general idea about what to expect on test day. However, USMLE Step 3 is a bit different. Not only is it the last test in the series, it assesses how prepared a resident is to begin practicing medicine on their own. To perform well on Step 3, you must have strong foundational knowledge in the medicinal sciences, and you must be able to apply that knowledge in practical, patient-centered situations.

Our Best Advice for You

Our biggest piece of advice is: don’t underestimate Step 3! Just because you’ve passed Step 1 and Step 2 CK, and the end seems near. But, don’t let your guard down just yet. Given the timing of Step 3, many students are in focused clinical specialties where they are not seeing the breadth of the material. Therefore, you need to consciously focus on your weaknesses. You don't want them to hold you back from passing Step 3 on test day.

Now let's explore all that you need to know to master the USMLE Step 3 percentiles! 

Change in the Minimum Score to Pass USMLE Step 3

The recommended USMLE Step 3 minimum passing score has changed from 196 to 198. This change went into effect for examinees who took a Step 3 examination on or after January 1, 2020. Now what does sitting for USMLE Step 3 look like?

What to Expect: Sitting the USMLE Step 3 Exam

USMLE Step 3 is a two-day exam:

Day 1

The first day of testing is 7 hours long, including 45 minutes of break time and a 5-minute optional tutorial. On the first day, you will encounter 232 multiple-choice questions, divided into 6 blocks of 38-39 questions each. You get 60 minutes (or one hour) to complete each block. Your overall break time can be more than the allotted 45 minutes if you finish a one-hour block early.

Each day of testing focuses on specific content. The first day focuses on a few content areas including:

  1. Assessing your knowledge of diagnosis and management through a patient’s history, physical examination and use of diagnostic studies. 
  2. Biostatistics and epidemiology.
  3. Practical application of foundational sciences.
  4. Interpreting medical literature. There are also some newer question formats, like those based on academic paper abstracts and pharmaceutical advertisements.

In addition, there will be questions that require you to demonstrate your interpersonal skills. You'll need to show your ability to communicate clearly and effectively. Also, your knowledge of medical ethics, system-based practice, and patient safety will need to be evident.

A significant part of mastering the biostatics, epidemiology/population health questions will depend on your ability to interpret medical literature. You will need to understand:

  • the type of study;
  • the core objective of the study;
  • the statistical significance of the results; and
  • the limitations of study. 

The key is understanding the different types of studies: cohort study, case study, and randomized controlled clinical standard (which is the gold standard of clinical studies).

Day 2

The second day of testing includes multiple-choice questions and computer-based case simulations (the infamous CCS). The test day is about 9 hours long.

There is a 5-minute optional tutorial followed by 180 multiple choice questions. These questions are divided into 6 blocks of 30 questions each. You get 45 minutes to complete each block. 

There is also a 7-minute CCS tutorial, followed by 13 case simulations. You will get 10-20 minutes to complete each one. Break time is a minimum of 45 minutes.

The content-focus of the second day is assessing your ability to apply medical knowledge to patient management. You will need to demonstrate your knowledge by diagnosing a patient’s presentation. This means knowing the related health and disease management: specifically prognosis, health maintenance and screening, and possible therapies. Like Day 1, Day 2 will assess your ability to apply your knowledge to a patient’s history and physical examination, and use of diagnostic studies to determine diagnoses.

How to Score High: USMLE Step 3 Percentiles

1. Finalize a Test Date

Having a definitive test date will get you to commit to a study timeline. This is because you know exactly how much time you have to study for the exam.

Most examinees who take Step 3 have a lot going on. Whether you’re an intern or in your final year of medical school, your time is important. Plus, you may not have as much energy to give to Step 3. Setting a test date will help you to be efficient and focused as you work towards that test date. You will also avoid problems like inefficiency, lackluster progress, and procrastination.

We recommend selecting a test date that doesn’t require you to travel to a testing center that’s far away from your home base. But, sometimes this isn’t something you can control. Test dates fill up and you may have to travel more than you’d like to take USMLE Step 3. However, the sooner you select a test date, the better your chances of getting a test center location near you. And, you will maximize the time you have to execute your study plan.

Carefully consider your schedule when you select a test date. Make sure that the date you pick is around a time when you have a lighter workload. This is because not only will you need some time to prepare for Step 3, you also need to take off two days to complete it. You should not pick a test date that falls around the same time as some of your more challenging rotations.

While Step 3 is a two-day exam, you don't have to take both days one after the other. You can either take both parts of the exam back-to-back and finish up the exam in two days. Or, you can decide to have a break between both days. This is a scheduling decision you need to make, and it's a personal choice.

2. Take Practice Tests and Thoroughly Review Missed Questions

Since you're taking USMLE Step 3, then you are already familiar with UWorld. It’s an excellent resource for practice questions. We recommend that you go through its Step 3 question bank at least once - twice is even better. If you get the chance to review the question bank for a second time, you should take that into account when estimating your performance. You will perform better the second time around. However, don’t get so confident that you fail to be honest with yourself about whether you understand the concepts.

The key is making sure you fully understand why you got a question wrong. You need to identify the knowledge gap that led you to getting each question wrong. Then, review that concept until you understand it perfectly. If you are consistently missing easy to medium questions or scoring below a 70% on UWorld blocks, then you are not ready to take USMLE Step 3.

Some Pitfalls That You Need to Navigate

There are various pitfalls to avoid as you seek to use UWorld correctly. Doing a lot of questions but not knowing where you are going wrong can lead to a plateau. If you are consistently scoring below a 70% on UWorld blocks: STOP! We strongly suggest setting up a session with a tutor at Medlearnity so that we can give you valuable feedback.

You should take into account various factors, such as:

  • Is this your second time going through the question bank?
  • Are you capitalizing on all of the learning that can be gained from every question?
  • Are you utilizing the right study methods and techniques to retain what you learn?

Practice questions are the most important part of any study plan. But, it’s important to use them correctly and efficiently. If you have exhausted UWorld, AMBOSS is the next go-to question bank.

All of this prep is important for the multiple-choice portion. However, you shouldn’t underestimate or neglect the CCS portion. CCS presents its own challenges and you should make time to practice CCS cases separately.

3. Get Familiar with Computer-Based Case Simulations (CCS)

Computer-based Case Simulations (CCS) differentiate Step 3 from the other USMLE exams. As stated before, you complete CCS cases on the second day of the USMLE Step 3 exam. The CCS portion of the exam makes up approximately 1/3 of the overall exam weight. So, this section should not be underestimated!

In addition to the practical application of medical knowledge, it requires strong familiarity with the software. The best way to ensure that you won’t be caught off-guard with these cases is to get acquainted with the CCS software. You need to know how you will be timed and scored. Know how to maneuver the CSS simulation software so that you’re comfortable using it on test day. We suggest doing this early in your study period so that you get as much practice as possible. Make sure you have gone through all the questions in CCS. They are available on the official USMLE website.

4. Don’t Neglect Your Weaknesses

We know it's tempting to focus on your best subjects. But, that will not help you to ace the USMLE Step 3 percentiles. Don’t neglect your weakest subjects (for example, biostatistics). Given the timing of Step 3, many students are in focused clinical specialties. So you may not see the breadth of the material in action. Therefore, be sure to focus on improving your performance in your weaker subjects. This will help you to get the best score to pass USMLE Step 3.

Common Questions about USMLE Step 3 Preparation

1. Using a Question Bank versus Covering the Material

We recommend that you prioritize completing your UWorld USMLE Step 3 question bank. Make sure that you thoroughly review any missed questions. But, you will need material to review to refresh your memory and/or strengthen your understanding of a given topic.

Therefore,  you should buy a textbook to guide your USMLE Step 3 study sessions. There’s really no gold standard for study materials. Step-Up to USMLE Step 3, First Aid for the USMLE Step 3, and Master the Boards USMLE Step 3, are a few helpful resources. You should use them to supplement your weaknesses and as a guide as you go through the question bank.

2. The Best Way to Use Practice NBMEs

We recommend that you take a practice NBME when you first start studying for USMLE Step 3. You won’t know whether you’re improving if you don’t know your baseline score.

Taking a practice NBME will also highlight your weaknesses. This will let you know what areas you should first target in your study sessions. Depending on your test date and study time frame, schedule your next practice NBME so that it’s three weeks from your first one. Track your progress and identify your weaknesses. Then, continue to go through the UWorld question bank for USMLE Step 3. You can also turn to AMBOSS if you need more questions.

Ace Your USMLE Step 3 Exam!

You should do all that you can to get your best score in the USMLE Step 3 percentiles. We have been in your shoes, and we have done exceptionally well in Step 3 and beyond. You don't have to prepare for this final round alone. Let our team of expert physicians guide you in the best ways to approach your problematic topics and master them. We are here to help you successfully cross the threshold into practicing medicine. So book your free 1-hour session today to see how we can help you achieve this dream. 

About the author 

Medlearnity Staff

Medlearnity is an elite tutoring and consulting company that specializes in medical school and residency test preparation, coursework, and admission applications. We pride ourselves on offering the highest quality medical tutoring and consulting in the industry, which starts with our incredibly accomplished, experienced and compassionate tutors who deeply care about student success. For over 8 years, we have helped hundreds of aspiring doctors accomplish their goals on USMLE, COMLEX, Shelf Exams and NBME, Residency Board Exams, Residency Admissions, MCAT, Medical School Admissions, and Medical Coursework.

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