How to Master the USMLE Step 3 CCS

How to Master the USMLE Step 3 CCS

How to Master the USMLE Step 3 CCS

Learning how to master the USMLE Step 3 CCS (commonly misspelled as USMLE Step 3 CSS) is an important piece of being able to pass/excel in the Step 3 exam. As the CCS Cases portion on the exam is roughly 25% of your total grade for the 2 day test, this is not a portion of the test that you should ignore as this can be the difference between passing and failing and having to retake a 2-day test. 

There are some good resources out there that can be helpful and provide good information for managing clinical cases. However, if you have not practiced using a real-time simulator, then you may struggle on test day learning to navigate the software and to understand how it works. The USMLE provides 6 cases for you to study, but most find this insufficient amount of material to be able to master the USMLE Step 3 CCS. Many people are unaware of the nuances of the program such as: how to order; how to advance time; patient updates; ordering a physical exam; importance of preventative care; the meaning of when the case ends before the maximum allowable time, and more.

You can read about these things, but until you actually practice on real software, it is likely that you will not fully understand how the program works, and you definitely do not want to try to “figure it out” during test day. You are already strapped for time, so learning how to navigate the software should be the least of your problems. In addition to helping learn how the real test day works, the program will also teach you good clinical skills on how to diagnose and treat 101 different clinical scenarios which will prepare you for test day.

Try our program out by clicking here and try out two free cases. 

Release of Version 4.9.1

We have released version 4.9.1. What’s new:

  • Improved logging feature to log more events
  • Improved memory management of the program

Enjoy. If you’d like to download the latest version, you can do so here.

New versions are free to paid customers.

If I meet a patient in the Emergency Room, and it’s not emergent, can I just refer the patient to their PCP?

If I meet a patient in the Emergency Room, and it’s not emergent, can I just refer the patient to their PCP?

If I meet a patient in the Emergency Room, and it's not emergent, can I just refer the patient to their PCP

The answer to this question is No!!! This may come as a shock to everyone, but the USMLE Step 3 CCS Cases portion of the exam is not real life. While coming to the ER with high cholesterol is typically not treated in an emergency room setting, if someone comes to emergency room, you treat EVERYTHING YOU CAN FIND! You are the generalist and once you meet this patient, you do everything for them in all types of settings including emergency room, inpatient, ICU, and office settings. This is not realistic, but knowing the Krebs cycle is not used very much in clinical practice and is fairly useless in real life, but it’s frequently tested on the USMLE (Not on Step 3, but you get the point we’re making).

If you don’t believe us, here’s a quote taken directly from the USMLE website: “In the generalist role, you must manage your patient in both inpatient and outpatient settings. Sometimes this may involve management in more than one location—initially caring for a patient in the emergency department, admitting the patient to the hospital, and discharging and following the patient in the outpatient setting.” The reference is located here.

So, to summarize, if you can find it, you treat it. It’s important to get consults for specialist if needed, but if it’s a problem that can be managed by a typical generalist, then for the sake of your grade, treat every problem and do not assume that “they will follow-up with their PCP.” YOU are their PCP!

We hope that it is helpful. If you feel you need more practice on the USMLE Step 3 CCS Cases portion of the exam, you can try out our two free practice cases here

“Your Performance on the Case Simulations Could Affect Whether You Pass or Fail”

Your Performance on the Case Simulations Could Affect Whether You Pass or Fail

This is a direct quote taken from the USMLE referenced here. The full quote is as follows:

“For Step 3, your performance on the case simulations will affect your Step 3 score and could affect whether you pass or fail. The proportional contribution of the score on the case simulations is no greater than the amount of time you are given to complete the case simulations.” 

This seems like an obvious statement, “yeah, if you fail CCS, you could fail the entire step 3 exam.” However, it states that the CCS portion of the test is graded in proportion to the rest of the test by the amount of time given for the CCS Portion. So lets do some math here:

Day #1 – 6 x 60 min blocks of MCQ = 360 min.
Day #2 – Total is approx 9 hours (9 hrs x 60 min = 540 min). 6 x 45 min blocks of MCQ = 270 min. There is a 5 min tutorial at the beginning and a 7 min tutorial for CCS cases and 45 min of breaks. 540 total time – 270 MCQ – 12 min tutorials – 45 min breaks = 213 min. We will round down to 210 min as it says “the second day is approximately 9 hours.” So total test time (not including breaks/tutorials) for both days is 840 min. The percentage that your grade if proportional to the other days from CCS Cases is 210/840 = 25% of your grade. So, we can estimate that the CCS Cases is 25% of your total grade for the entire Step 3 test. 25% is a significant portion of your grade, so you should be prepared for this.

Reading and studying CCS will not be sufficient. Even excellent students who are very knowledgeable can get tripped up if they are not familiar with how the program operates and how the program works in advancing time and getting results. The only effective way to prepare for the CCS portion of the test is to practice with real cases. We of course are biased in saying that since we offer 101 real cases that you can study. You can download 2 free cases to try out our program here.

Change in passing score for USMLE Step 3

Step 3 Change Minimum Passing Score

In Dec 2019, the USMLE announced that it has changed the minimum passing score again from 196 to 198 for the USMLE Step 3 exam effective as of January 1, 2020. In Dec 11, 2015, the USMLE changed the minimum passing score from 190 to 196. The reasons that are given for the change is that residency directors are seeing the USMLE Step 3 as a pass/fail exam, so apparently, the USMLE is feeling that it should raise the minimum passing grade. Other things were mentioned that justified the change such as “trends in examinee performance” and “precision of pass/fail classifications.” It might be that too many people were scoring higher, so they wanted to adjust the grading downward. There has been discussions to make the USMLE Step 3 Pass/Fail completely, but then again, these discussions have been going on for years and years.

Therefore, there is less leeway to “get by” on the multiple choice portion of the test and neglect the step 3 simulation part the exam. It is getting more and more important to be prepared for both sections. We are of course biased in our recommendations that you use our program to study for the USMLE Step 3 CCS portion of the test. You can try out our trial version and download it here:

It does seem that there seems to be a grade creep over the years. The minimum score has increased by 8 points over the last 5 years, So, we might be doing a similar post in 2025 saying that the minimum passing grade has increased to 200. We recommend that you keep your testing skills sharp and not even get close to the not-passing rate. This is an obvious statement, but many students either get too overconfident or are too busy with residency duties that they do not prepare adequately for Step 3. This can be very embarrassing if you fail, and now there are 2 points less in your padding for passing.Study hard!