What is the Step 3 Pass Rate & Passing Score?

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What’s the Step 3 pass rate? What score do you need to earn in order to pass? And how difficult is it to pass the exam?

In this post, we’ll explore some of the most frequently-asked questions about USMLE Step 3 and what makes it different (or the same!) from other Step exams.

What’s the Step 3 pass rate?

The Step 3 pass rate varies from year to year and is influenced by several factors, including the preparation level of the candidates and changes in the exam format or content. However, historically, the pass rate has been relatively high compared to the earlier Step exams, often exceeding 95%.

During 2023, the Step 3 pass rate for examinees from US/Canadian schools was 97%, while about 89% of IMGs and foreign graduates passed. These numbers are mostly unchanged from 2022 and 2021, which boasted similar passing rates.

What’s the Step 3 passing score?

To pass Step 3, candidates must achieve a minimum passing score, which is determined by the USMLE program. The Step 3 passing score is typically in the range of 196 to 198 out of a maximum possible score of 300. It’s important to note this passing score is subject to change, so candidates should always check the most recent information provided by the USMLE program.

In 2024, the Step 3 passing score is 198-200. See below the recent statement from the USMLE board:

“At its December 2023 meeting, the USMLE Management Committee, representing a national group of physicians in licensure, medical education, and current practice, and two public members, conducted a review of the USMLE Step 3 passing standard. It was decided that a two-point increase in the passing standard – used to determine a pass or fail outcome – will apply to Step 3 examinees testing on or after January 1, 2024.  On the three-digit score scale, the passing standard will change from 198 to 200.”

Basically, the exam standard has been raised so it’ll be ever so slightly more difficult to pass.

What’s a good Step 3 score and does my score matter?

First and foremost, it’s important to pass Step 3 on your first attempt. Failing it creates unnecessary stress as you’re only allowed one attempt within your eligibility period, there’s a hefty fee to reapply ($925), and you’ll need to pass for licensure and board eligibility. The average scores for Step 3 are around 230 for the past few years.

Scores above 240 are considered solid since you’ll be above the 70th percentile, and scores above 250 are excellent. Fellowships don’t solely focus on Step 3 scores and won’t accept you just because you got a 250. However, fellowship directors look at Step 3 scores as a component of your application and there are score thresholds. You should strive to do more than simply pass as a 240+ will be more impressive than a barely passing 204.

Does Step 3 matter for fellowship applications?

While Step 3 scores are generally not as important as Step 2 scores are, programs still use them to screen applicants. As previously mentioned, your Step 3 score likely won’t get you automatic acceptance into a fellowship. However, it’s an objective data point that PDs look at. So while a high score won’t necessarily make you, a failing score can certainly break you.

Data from last year’s fellowship and residency program directors’ survey shows that programs do consider scores. According to the data submitted by fellowships that completed the survey, over 70% of programs wanted a minimum passing Step 3 score for MD and DO applicants, while close to 20% had a target Step 3 score for applicants.

What makes Step 3 difficult?

Studying for Step 3 is difficult in large part because you’re required to study while maintaining your duties as a resident. Also, as a specialist in training, most of what you learn will be tested on your board exam but not the USMLE Step 3.

For instance, if you’re an orthopedic surgeon in training and taking Step 3, less than 10% of the exam deals with musculoskeletal issues, meaning 90% is generalized medicine that you don’t see on a day-to-day basis. Perhaps internists will have an advantage, but then they also need to worry about pediatrics and OB/GYN questions.

What’s the content of Step 3?

Step 3 assesses whether you’re prepared for the unsupervised practice of medicine (you won’t have your attending with you for the exam). It places special emphasis on patient management in both ambulatory and hospital settings.

Step 3 is designed to assess your knowledge of medicine as a whole, not your proficiency in any particular speciality. The examination material is supposed to broadly represent the medical profession, as opposed to a particular field within it. Click here to see what topics are on the exam, but please note that not all topics are tested on each and every exam, and not every examinee will take the same version of Step 3.

The content of Step 3 is supposed to model the challenges faced by physicians in the practice of medicine. The two-part exam covers questions and scenarios in various settings, from ambulatory to inpatient to the emergency department.

Step 3 has broad exam content, and yet, there are nuanced questions about everything from subacute rehabilitation, crisis intervention, and surgeries for patients of all ages. The exam is especially challenging for subspecialists who focus their training on a particular niche area of medicine, and may be easier for generalists and internists.

What are common challenges when taking Step 3?

As with any standardized national medical exam, the following challenges exist:

Time management
Clinical knowledge
Complex cases and test format (CCS cases)

Navigating these challenges requires effective study strategies, time management skills, support from peers and mentors, and sometimes seeking additional resources like tutoring services to address specific weaknesses and improve overall preparation.

Do I need a Step 3 tutor?

To ensure success on their first attempt, some candidates opt for Step 3 tutoring services. These services provide guidance and support tailored to the individual needs of each candidate.

Specifically, a Step 3 tutor can offer:

1. Personalized Guidance

Tutors can assess your strengths and weaknesses through diagnostic test reports and/or discussions, allowing them to tailor a study schedule specifically for you that can help you focus on areas where you need the most improvement.

2. Structured Study Plans

Step 3 tutors can help you create a structured study schedule that accounts for your other commitments (such as all of your residency duties) and provides a roadmap for covering all the necessary material before your exam date. This prevents procrastination and ensures that you stay on track with your preparation.

3. Targeted Review

Tutors can identify topics or concepts that you find challenging and provide targeted review sessions to strengthen your understanding. They may use various teaching methods, such as explanations, visual aids, or mnemonic devices, to help you grasp hard to understand concepts more easily.

4. Test-Taking Strategies

Step 3 tutors can teach you effective test-taking strategies, such as how to approach different question types or CCS cases.

5. Motivation and Accountability

Studying for a high-stakes exam like the USMLE Step 3 can be challenging, but having a Step 3 tutor provides motivation and accountability. Your tutor can keep you motivated during the preparation process and hold you accountable for sticking to your study schedule.

In addition, a Step 3 tutor can offer reassurance and build your confidence by providing positive feedback, tracking your progress, and highlighting areas where you’ve improved. This can alleviate test anxiety and help you approach the exam with a positive mindset.

Interested in getting matched with a Step 3 tutor that can help you pass with flying colors? Sign up for a free consultation!

Final Thoughts

Step 3 is a tough exam, but it’s the last USMLE exam you’ll have to take! We hope this information about the Step 3 pass rate, what constitutes a passing score, the content of the exam, and how you can benefit from Step 3 tutoring was helpful. If you think you’re in need of further assistance, please reach out to us. We can help you pass Step 3 and put USMLEs in your rearview mirror forever!

Looking for more (free!) content to help you through residency? Check out these other posts on the Rosh Review blog:

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By Mike Ren, MD

Mike is a driven tutor and supportive advisor. He received his MD from Baylor College of Medicine and then stayed for residency. He has recently taken a faculty position at Baylor because of his love for teaching. Mike’s philosophy is to elevate his students to their full potential with excellent exam scores and successful interviews at top-tier programs. He holds the belief that you learn best from those close to you in training. Dr. Ren is passionate about his role as a mentor and has taught for much of his life–as an SAT tutor in high school, then as an MCAT instructor for the Princeton Review. At Baylor, he has held review courses for the FM shelf and board exams as Chief Resident. For years, Dr. Ren has worked closely with the Office of Student Affairs and has experience as an admissions advisor. He has mentored numerous students entering medical and residency and keeps in touch with many of them today as they embark on their road to aspiring physicians. His supportiveness and approachability put his students at ease and provide a safe learning environment where questions and conversation flow. For exam prep, Mike will help you develop critical reasoning skills, and as an advisor, he will hone your interview skills with insider knowledge to commonly asked admissions questions.