USMLE Step 3: applying, the two days, CCS and scores

How to apply for Step 3

1. Check you’re eligible: passing results on Step 1 and Step 2 CK, plus an MD or DO degree. If your school is outside the U.S., you also need a valid ECFMG Certificate.
2. Apply with NBME through MyUSMLE if you went to a U.S. school. NBME took this over from FSMB on January 26, 2026. If your school is outside the U.S., apply with FSMB at usmle.fsmb.org.
3. Pay the $955 fee and choose a three-month eligibility period. Step 3 runs year-round, but only in the U.S. and its territories.
4. When your scheduling permit arrives, book both days with Prometric. Seats go first come, first served.

When to take it

You don’t have to be in residency. USMLE recommends you’ve finished, or nearly finished, at least one year of accredited U.S. postgraduate training, and says Step 3 is usually taken in the first or second year of training.

Watch the clock on your license, too. Most state boards want all three Steps passed within seven years of passing your first one. Check FSMB for your state’s rule.

The two days

If you sit Day 1 but not Day 2, the exam may be reported as incomplete, and incomplete attempts count toward the limit.

How CCS cases work

Each case puts you in charge of one patient. You type orders for tests, treatments and procedures, move the patient between settings, and move the simulated clock forward. A case can cover minutes or weeks of patient time, but each has a real-time limit, and spare minutes don’t carry over.

Order drugs by a specific generic or brand name. Drug classes aren’t accepted, you don’t enter doses, and you can’t order anything as needed. Once you advance the clock, your orders can’t be undone. You can practice on six sample cases in the Step 3 interactive testing experience on usmle.org.

Step 3 scores and percentiles

Your report gives a three-digit score, pass or fail, and how each area compares with your overall result. The CCS cases count toward the score. The 200 pass mark has applied since January 1, 2024. USMLE is reviewing it in November 2026, and any change would start January 1, 2027.

The table below is USMLE’s norm table for first-time takers from LCME-accredited schools who tested in 2023-2025. The average was 227 each year, with a standard deviation of 15. USMLE says a Step 3 score can’t be compared with a Step 2 CK score.