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.

What is the overall passing rate of those who take the USMLE Step 3?

What is the overall passing rate of those who take the USMLE Step 3?

The USMLE publishes annual data about the passing rate of each test per year. Those who go to US/Canadian School and are taking the test for the first time have a 97% average pass rate. US/Canadian School candidates who are repeating the USMLE Step 3 test have a 73% pass rate overall.

Those who go to non-US/Canadian Schools have a 88-90% pass rate for 1st time takers. Those who are taking the test again have a 59-60% pass rate.

From these overall pass rates, you can see that it is important to pass the USMLE Step 3 on the first try. It’s true that you may say that the repeat pass rate is so poor because it is measuring those who are poor performers and will continue to struggle with standardized tests. While this is true, we feel that the psychological impact of failing a test for the first time can decrease future performance.

We recommend that students take the USMLE Step 3 seriously and study to avoid having to retake the test which can lead to further issues. A big part of the USMLE Step 3 is the CCS Portion of the test. The best way to prepare for the USMLE is to actually practice simulated cases which will be similar to what you will see on test day.

We recommend that you try our free 2 cases located here, so you can see how the step 3 CCS cases will be presented on test day and what you will be required to know and how your performance will be measured.

How long do I have to complete all the Step 3 CCS Cases on test day?

CCS Cases ends early

The CCS Portion is on day 2 of the 2 day test. The second day will consist of:

Step 3 Section  
Max Time allotted
Multiple Choice Tutorial   5 minutes (Optional)
Block 1 – Multiple Choice   45 minutes (30 MCQ)
Block 2 – Multiple Choice   45 minutes (30 MCQ)
Block 3 – Multiple Choice   45 minutes (30 MCQ)
Block 4 – Multiple Choice   45 minutes (30 MCQ)
Block 5 – Multiple Choice   45 minutes (30 MCQ)
Block 6 – Multiple Choice   45 minutes (30 MCQ)
CCS Tutorial   7 minutes (Optional)
5 x 10 min cases*   50 minutes
8 x 20 min cases*   160 minutes
Break time   45 min
Total Time   537 min (approx 9 hrs)


*Note that the 10 min and 20 min cases are mixed together. You will not have 5 x 10 min cases and 8 x 20 min cases. There is a total of 13 total cases that you will see. It is also possible depending on the day to have a different mix of 10 min and 20 min cases, but the above breakdown is a possible scenario. The 45 min break time will be interspersed throughout the entire 9 hour day. You of course can finish early if you do not utilize all the available time given.

For those looking just for a short answer, you have 3 hours 30 min total time allotted just to complete the CCS Cases. You may not use the entire time (some cases will finish earlier than the allotted time if you have completed them successfully).

Our program has a good mix of 10 min and 20 min cases to practice from. You can try two cases for free here. Check us out.

How many orders are there on the USMLE Step 3 CCS cases?

This is a common question. There are 20,000+ orders on the USMLE Step 3 CCS cases portion of the exam. This means essentially that there are infinite combinations of orders that can be done for each test. However, one thing that can trip people up is that there are many different ways of ordering the same thing. For example, you can order a CMP by typing in one of the following: CMP; or metabolic panel 14; or panel 14; or comprehensive metabolic profile; or Chem 14; etc.

So, there are a number of ways to order the exact same thing. When you finish ordering it, it will come up on your order sheet as the same order. For example, if you order CMP, the order will come up on your order sheet as “Comprehensive metabolic profile.” If you order Chem 14, it will also come up on your order sheet as “Comprehensive metabolic profile.” So, all roads lead to Rome here.

In the test there are about 2400 unique orders meaning that the rest of the 20,000+ are orders that are “duplicate” as described above. This is convenient because there are many ways to skin a cat and people know the same thing by different names. This allows different backgrounds and training to get the same order.

Some programs that help you prepare for the CCS portion of the test do not have all the different order combinations. They only have the “unique” orders; some don’t even have all the different unique orders. This means that you will have to learn how to order something in the practice version which may or may not even be on the real test.

Our program contains all the 20,000+ orders that you will see on the real test. This way you will be able to get used to having the ability to order different tests/treatments the same way as it will appears on test day and not having to worry about learning one way for practicing and then trying to remember to do it differently on test day.

If you’d like to try out our program, you can download 2 free cases here.

Below is an image of the order sheet:

USMLE Step 3 Course

USMLE Step 3 Course

We receive questions on how to effectively study for the USMLE Step 3 CCS portion of the exam. We have a 101 case USMLE Step 3 Course that will have you prepared to effectively diagnose and treat all the most commonly seen cases on the CCS Portion of the test. This is the most effective USMLE Step 3 Course because you actually practice real cases instead of just reading about cases and how to do it.

Our case simulator is nearly identical to the real test, so that you can study and become accustomed to the exact software that you will be using on test day. This way you can focus on doing the correct diagnostic testing, correct physical exam, and correct treatment and not having to worry about how the software works or what to expect on test day.

Our customers have told us that this was a major relief because using the software is not that intuitive. It definitely takes practice to get used to how the software works, so we recommend that you try our program and see two free cases on exactly how the software will work to help you prepare for the USMLE Step 3 CCS Cases portion of the exam.

You will notice that when you try out program that it has all the orders that you will see on the real test, it has the flow of the program that you will see on the real test and it has the same layout and format that you will see on the real test. This is a real advantage to get used to how it will work on test day.

We recommend that you try out our program and download it here (For PC/MAC). There is no obligation; try it and see how you like it. You can also check out our customer feedback at the homepage of our website.