Much like the original Star Wars and Back to the Future franchises, USMLE is a trilogy. From the humble beginnings of USMLE Step 1 to the feverish climax of Step 2, these exams tell the story of your heroic growth as a young doctor in training.
USMLE Step 3 has long represented the final hurdle in our hero’s journey to achieving independent licensure and defeating the credentialing empire. But like any good saga, there are a few surprises and a good twist along the way…
In this post, we break down the new USMLE Step 3 passing score, what a good score looks like depending on your goals, what’s tested on Step 3, and more.
USMLE Step 3 Scoring: New Passing Score
To defeat the enemy, we first must know the enemy. Step 3 has a couple of nuances that are important to be aware of as you prepare your studies.
First and foremost, it uses a numerical scoring system that is broken down into percentiles and a minimum passing score. It’s critical to pass Step 3 on your first attempt. Because passing Step 3 is often used for credentialing, a great deal is on the line.
In addition to its high price tag, each training institution and state defines how many attempts are allowable for granting an independent medical license. To avoid unnecessary stress, angst, and administrative hurdles, it’s best to pass it on the first attempt.
The priority is to pass. It’s important to know that passing scores change periodically.
In 2024, the passing score is 198-200, an increase from the previous passing score of 196.
The average score is around 230 and fluctuates every year.
These periodic adjustments to the minimum passing score are due to the raw number of points increasing per year on average as medical knowledge, educational approaches, and studying techniques advance. It’s a sort of inflation that is important to keep an eye on; occasionally, the governing bodies of the USMLE will force a “score correction,” which involves re-standardizing the scores. (The details on this are proprietary and intentionally vague).
The most important question is: Does the change matter?
For those who have consistently scored in the highest percentiles on standardized tests, this change may be helpful to know, but ultimately, it only moves the needle a little. For those who have struggled with standardized testing in the past, the nuances of USMLE Step 3 are vital because it’s also a unique test compared to other exams during medical school training.
What’s a Good Step 3 Score (and Does it Matter?)
What success looks like on Step 3 completely depends on the path of the physician.
A good score is the highest score you can achieve to optimize your goals. If your only goal is to pass and practice general medicine as soon as possible, then anything above the minimum passing score will be fine.
However, for many residents, higher scores are an opportunity to challenge themselves and subspecialize. Part of the question vetting process includes standardizing each item based on expert performance to discern an “acceptable” fail rate (the fail rate fluctuates around 10% of test takers in a given year).
So, while failing is clearly bad (and, in certain situations, can prevent you from obtaining a medical license), having higher scores indicates that you know as much as the experts in various fields of medicine across multiple subjects. Depending on your goals, this can be more or less relevant.
Having a competitive score comes into play in particular, for those who are interested in pursuing an optional fellowship to subspecialize after the initial year of residency. For some medical paths, subspecialization is the only way to enter the field you’re interested in.
For example, many doctor career paths require an internal medicine residency followed by a fellowship in a particular area of the body. These careers include cardiology, gastroenterology, pulmonology, and more.
We cover all of the internal medicine subspecialties with our guide: 8 Internal Medicine Specialties Explained.
Surgery is another path that offers many subspecialization options. For example, if you want to get into colorectal surgery, cardiothoracic surgery, trauma surgery, or surgical oncology, you must complete a general surgery residency followed by a fellowship to subspecialize.
We cover the many surgical subspecialties with our guide: 36 Surgical Subspecialties Explained.
For these scenarios and many more, applying for a fellowship is necessary.
Are Step 3 Scores Important for Fellowship Applications?
Having a good USMLE Step 3 score matters for fellowship applications, especially for competitive fellowships in desirable locations.
This makes sense because Step 3 is typically the most recent and intensive standardized test applicants have taken. In addition, certain specialties use specific standardized testing, which program directors can review.
Many factors at this stage are beyond your control, such as where you matched, the quality of your mentorship and connections, what areas you are most drawn to, etc. While other aspects of the fellowship application are also crucial—interviewing, personal statement, letters of recommendation, faculty networking, etc.— securing a high Step 3 score can remove one layer of uncertainty from the application process, as it’s a hard score for programs to easily evaluate.
What’s Tested on USMLE Step 3?
Step 3 differs from Step 1 and Step 2 CK because it is administered over two days.
The first day tests “Foundations of Independent Practice (FIP),” and the second day tests “Advanced Clinical Medicine (ACM).”
The first day is structured similarly to the other USMLE exams with 7 hours of testing that includes a 45 minute break. On the test, there are 232 multiple-choice items in 6 blocks (38-39 items within 60 minutes per block).
The second day is even longer. It’s 9 hours of testing (with a 45 minute break) that includes 180 multiple-choice items in 6 blocks of 30 items. Additionally, there are 13 case simulations (similar to a role-playing game), and each can take up to 10-20 minutes.
Although the case-based simulations are new, most of Step 3 reassuringly feels like an old hat to most residents. That said, many struggle with standardized testing and, at this point, are aware that extra support can go a long way. Med School Insiders is here to help by offering exam tutoring and fellowship application preparation.
Maximize Your Step 3 Score
Nervous about Step 3? Med School Insiders offers USMLE Step 3 tutoring and test prep that’s designed to optimize your studying and maximize your score. We’ll customize the most effective study plan for you based on your preferences, goals, and study style, and we’ll match you with a tutor who aced Step 3 themselves. We’ll make sure you have a solid foundation to launch from. Goodbye residency, hello medical licensure!
Not sure if a subpecialization is right for you? If you’re having trouble deciding or are second-guessing yourself, check out our So You Want to Be playlist, which takes a deep dive into the pros, cons, and training steps for every medical specialty.
