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!

We got a makeover!

We got a Makeover!

As you may have noticed, we got a makeover! We redesigned our site to update the look and make things easier and simpler. As typical for technology updates, it didn’t go as smooth as we would have liked. If you had any trouble with our site over the last two days, we apologize, but all the issues should have been resolved.

We hope you like the new look. Happy Holidays!

Release of version 4.8.1

We have released Version 4.8.1! What’s new:

  • We have updated the internal “engine” of the program.
  • We have made some bug fixes and made the program compliant with the new security requirements of OS X Catalina.
  • We took out the trash and mowed the lawn. 

This version is not as exciting as our last one as we have been making more internal improvements rather than features. We will continue to made improvements as time goes on.  As usual, updates are free to paid users. You can download the update here. Enjoy! We are actively working on the program and will continue to offer updates and improve the program. 

What happened to the final diagnosis window in your program?

What happened to the final diagnosis window

We have posted about this before, but we continue to receive e-mails about this question: What happened to the final diagnosis window? The official USMLE Step 3 CCS Cases program has removed this window. It was never graded, and it created a lot of angst with students about whether they got the right diagnosis or not, thinking that this would be the majority of their grade. In actuality, it was never graded at all. This was never a secret as they stated this from the beginning, but many students felt that it was a very important part of the program and put a lot of emphasis on this. 

In order to avoid confusion about what is and isn’t graded, the official test has removed this window. That means that you will not free-hand text the diagnosis into a pop-up window anymore. When you click “Exit case” or the allotted time runs out, then the case will end. We feel that this is a good thing to avoid confusion. To be consistent, we have also removed the final diagnosis input window, so if you are using our newer versions, you will see that this has been removed.  If you are using an older version, you will still see this pop-up, but if you don’t want to bother to upgrade, you can just leave it blank, and it still will not affect your grade as this was never graded at all.

Other things that we predict that will change in the future is the consult pop-up “reasons for consultations” which are also not graded. This is likely to be eliminated in the future as well. We will keep you posted if this does eventually get eliminated.

If you would like to try our program or upgrade your current program, you can go to our download page located here.

Thanks for reading.

You will be graded on timing as well as diagnosis/treatment


A common comment that we receive (sometimes more of an accusation) goes something like this: “Hey! I moved the patient to the ER, and I got marked off that I didn’t move the patient to the ER, so your program isn’t working right, and this is outrageous! You have offended me, my family, and my ancestors!”

What we have to explain is that on the test and our program, you will be graded on the timing of your orders. By timing, we mean that you order the correct diagnosis tests and treatments within a reasonable time. If you wait too long, you will be marked off. It’s kind of like “too little too late.” For example, lets say someone has a raging bacterial infection. You wait until the patient is on the brink of death, and THEN you start the correct antibiotic. Obviously, this isn’t good medication care, and you would be marked off for this.

In our program (and the real test), if you move a patient to the correct location (ICU, inpatient unit, ER, etc), but your timing was too slow (meaning that the patient has worsened before you moved the patient to the correct location), you will get marked off for providing slow care. Usually, the penalty isn’t a harsh one for being too slow unless the case is an emergency situation in which time is of the essence. If you are slow in these cases, you will likely not pass the case.

So, it’s okay! The entire program is designed to help you intervene with the correct diagnostic tests and procedures in the appropriate amount of time so that you will perform well on the test. Just learn from the feedback and improve your performance on the next case practices.

Happy practicing! You can practice 2 free cases located here. If you like what you see, you can purchase the full program that includes 101 cases.

Thanks for reading.