USMLE Step 3 Percentiles: What You Need to Know

USMLE Step 3 Percentiles: What You Need to Know

If you’re thinking about USMLE Step 3 percentiles, let’s first take a moment: Congrats on making it this far!

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. It is the last test in the series, and it assesses how prepared a resident is to begin practicing medicine on their own.

To perform well on Step 3, you must have a strong foundational knowledge of the medical sciences and be able to apply that knowledge in practical, patient-centered situations.

Our biggest piece of advice is: don’t underestimate Step 3! You have already gotten through Step 1 and Step 2 — the end is almost near, 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 focus consciously on your weaknesses. You don’t want them to hold you back from passing Step 3 on test day.

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

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What’s the Passing Score for 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.

What’s a Good Step 3 Score?

Any score above 230 is considered good. Mean scores usually rest slightly below 230. Scores above 240 are considered excellent because a score of 240 puts you in the 79th percentile of all test takers.

Interpreting Step 3 Percentiles

While considering your success based on your score gives a general idea of your rankings, percentiles often provide a more accurate picture of your success. For example, a score of 230 puts you in the 55th percentile, meaning you scored better than 55% of other test takers. A score of 240, just 10 points higher, puts you in the 79th percentile.

Does the Step 3 Score Matter?

Your Step 3 grading will not impact your medical licensing unless you fail because you likely have a residency before you take this Step. If you plan to apply for a fellowship, your Step 3 score matters a bit more because it can bolster your application to help you achieve a better spot. In that case, you should strive to do more than pass. A 230 or 240 will look much better than a barely passing score.

Whether you plan to apply for a fellowship or not, you should maintain the consistent study habits you developed for the earlier tests. Set aside time every day for a few months to study question banks and other focused materials. During heavier rotations, you may decrease your review time. Then, reserve more study time during lighter rotations. Creating a schedule can increase your chances of passing the exam on your first attempt.

What’s the Step 3 Pass Rate?

In 2021, 97% of test takers passed the examination. This number includes all United States and Canadian test takers. Over the past 10 years, the pass rate has varied only slightly. Some years had pass rates of 96%, while others had pass rates up to 98%.

Step 1 and Step 2 typically also have pass rates above 95%. These high pass rates come from dedicated study, so don’t assume that your previous studies and experience taking the earlier Steps will be enough to pass. Sticking to a strict study schedule will help you achieve success.

How Many Times Can You Fail Step 3?

Different states vary in their requirements for your initial medical licensure. Your best option is to look up your state on the Federation of State Medical Boards (FSMB) website or contact a state medical board. The number of attempts varies from about 2 per Step to an unlimited number depending on the state.

What to Expect When Taking USMLE Step 3

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 six 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. An assessment of 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. Interpretations of medical literature. 

There are also some newer question formats, like those based on academic paper abstracts and pharmaceutical advertisements. You will also be tested on questions covering your knowledge of medical ethics, system-based practice and patient safety.

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.

A significant part of mastering the biostatistics, 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, the statistical significance of the results and the study’s limitations.

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 six 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 expertise by diagnosing a patient’s presentation. To provide a diagnosis, you must know the related health and disease management: 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 diagnostic studies to determine diagnoses.

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4 Tips to Perform Your Best on USMLE Step 3

1. Finalize a Test Date

A definitive test date will get you to commit to a study timeline 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 valuable. 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 traveling to a testing center 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 the date you pick is around a time when you have a lighter workload. You will need some time to prepare for Step 3, and you will need to take two days off 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 take both parts of the exam back-to-back and finish the exam in two days. Or, you can decide to have a break between both days. This scheduling decision is a personal choice.

2. Take Practice Tests and Thoroughly Review Missed Questions

Since you’re taking USMLE Step 3, you are already familiar with UWorld. It’s an excellent resource for practice questions. We recommend 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 consider that 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 ensuring you understand why you got a question wrong. You need to identify the knowledge gap that led you to get each question wrong. Then, review that concept until you understand it perfectly. If you consistently miss easy to medium questions or score below 70% on UWorld blocks, then you are not ready to take USMLE Step 3. Once you begin to get UWorld passing scores, you can schedule a testing time.

Mistakes to Avoid When Preparing for USMLE Step 3

Many students misuse UWorld practice questions. Doing a lot of questions but not knowing where you are going wrong can lead to a plateau. If you consistently score below 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 suitable study methods and techniques to retain what you learn?

Practice questions are the most crucial 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 one-third 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 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. Learn how to maneuver the CCS simulation software, so 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. 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, focus on improving your performance in your weaker subjects. This concentration will help you to get the best score on USMLE Step 3.

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Common Questions About USMLE Step 3 Preparation

Should I Use a Question Bank or Focus on 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 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 3First 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 guide you through the question bank.

What’s the Best Way to Study With Practice NBMEs?

We recommend that you take a practice National Board of Medical Examiners (NBME) exam 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 test 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 you can to get your best score in the USMLE Step 3 percentiles, including talking to a USMLE Step 3 coach. We have been in your shoes and 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 weaker 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.

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About the author 

Akshay Goel MD

Dr. Goel is a body-trained radiologist and an expert in medical education and imaging informatics. He completed his Radiology Residency at Columbia University Medical Center and his fellowship at Weill Cornell Medicine. Dr. Goel has guided several students and doctors into successful careers over the past decade. He continues to help Medlearnity tutors optimize their educational methodology to drive the highest tutoring and admissions impact possible.

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