USMLE Step 3
The USMLE Step 3 exam is not a requirement to enter into a residency. However, if a candidate has taken the exam, it may increase the likelihood of getting more interview calls and an H1B visa (this varies with the programs).
Eligibility
The eligibility criteria to take this exam vary from one US state to another. There are some state medical boards (e.g. Connecticut, New York) which allow candidates to take this Step after they get the ECFMG certificate.The subjects tested on this exam are similar to USMLE Step 2CK but the questions focus heavily on management of patients. This exam essentially tests the ability of the candidate to manage patients in an unsupervised primary care setting.
Exam Registration
The registration of Step 3 is through FSMB. The candidate is required to select a state medical board to register for the exam. If a candidate wishes to take the exam before the match then it is advisable to select a state board (e.g. Connecticut) which permits the exam to be taken after the candidate is ECFMG certified. Subsequent process is similar to registration of other steps.Once registered the applicant receives the Orange permit card which is used to register for the exam only by phone. Along with the permit the examinee will also receive a CD containing 3 blocks of sample questions and the software tutorial and practice Computer based case simulations (CCS).
Exam Design
Step 3 is a 2 day exam. The 1st day consist of 7 block containing 46 multiple choice questions each, to be finished in 8 hours (with 1 hour of break time).The 2nd day consists of 4 blocks of approximately 36-37 multiple choice questions to be finished in 45 minutes each.
After this the examinee has to solve 9 computer based case simulations (CCS) in 4 hours. Of the 9 CCS only 8 are scored. 1 CCS is for experimental purpose, however the candidate will not be given any information on which case is not being scored.
Each CCS lasts for 25 minutes. The examinee will be given an actual 20 minutes to manage the case and another 5 minutes to close the clinical encounter. This essentially means that during the first 20 minutes the examinee needs to take a history, perform physical examination, order relevant diagnostic tests and manage the patient in a simulated time period of hours to months depending on the case. Once 20 minutes are over, then 5 minutes are given to put the final orders (e.g continued medication & counseling). The cases tested here are the common cases seen by a primary care physician (e.g. MI, acute severe asthma, foreign body aspiration etc).