The majority of test items (50 to 60 percent) in Step 3 involve the management of continuing-care patients. For example, a longstanding patient with a history of repeated hospitalizations for asthma who presents with shortness of breath would be approached differently than if she were presenting for the first time to a clinic complaining of periodic dyspnea or if she presented to the emergency department with an acute asthma attack. More importantly, the encounter frame influences how you’ll proceed with management. The encounter frame determines the amount of history, as well as clinical and laboratory test results, that are available to you. Multiple-choice and case-simulation questions are presented in one of three clinical encounter frames: initial care, continuing care, and urgent care. Your interpretation of laboratory data, imaging, and elements of the presenting history and physical examination will assist you in selecting the correct management. The cases presented will include options that may all appear appropriate however, for the presented situation, there is only ever one correct answer. In Step 3, you are required to think beyond the diagnosis (which is often implicit in the question itself) and make decisions in management. This assessment of your clinical judgment distinguishes Step 3 from Step 2. Unlike the Step 2 exams, which emphasize diagnosis of medical conditions, Step 3 evaluates your ability to evaluate the severity of a patient’s condition and discern the most appropriate clinical management based on the presenting scenario. How can the Step 3 test all first-year interns if they are working in such varied subspecialty settings? The same concepts that medicine house-officers learn about managing a diabetic with heart failure can be equally applied to the postsurgical patient with heart failure. In addition, Step 3 will test your understanding of basic science correlations. Step 3 tests whether a physician not only can assimilate data and diagnose clinical conditions but also has acquired the ability to make clinical decisions about patient management in a way that ensures appropriate management in an unsupervised setting. Understanding this concept is key to this challenging exam. This test is not merely a more advanced and detailed version of the Step 2 CK or CS exams. After successfully completing the 3 steps of the USMLE, a physician is eligible to practice medicine in an independent, unsupervised setting (some period of U.S. The USMLE © Step 3 is the last in a series of 3 USMLE examinations that all physicians applying for a license to practice medicine in the United States are required to pass.
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