USMLE® Step 3

Move USMLE Step 3 to pass-fail to boost residents’ well-being

Brendan Murphy , Senior News Writer

AMA News Wire

Move USMLE Step 3 to pass-fail to boost residents’ well-being

Jun 12, 2024

For resident physicians, time and money are commodities in short supply. The United States Medical Licensing Examination (USMLE) Step 3 and Comprehensive Osteopathic Medical Licensing Exam of the United States (COMLEX-USA) Level 3—most frequently taken during the first year of graduate medical education—can prove costly in both.

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The price tag for taking the Step 3 exam—including registration fees and necessary study resources—runs at least $1,400, according to a resolution introduced at the 2024 AMA Annual Meeting by the AMA Resident and Fellow Section. In addition, residents often must use their vacation and personal time off to prepare for and take USMLE Step 3 and COMLEX-USA Level 3. The USMLE Step 3 exam itself takes place over two days and includes 16 hours of total test-taking time.

The resolution adds, “preparing for Step 3 on top of clinical duties during residency may detract from on-the-job learning and patient care, especially for trainees who pursue fellowships, as Step 3 scores are a component of the application process.”

Osteopathic resident physicians experience similar burdens when taking COMLEX-USA Level 3.

To reduce residents’ these burdens that contribute to burnout, the AMA House of Delegates adopted new policy to support:

  • Changing the USMLE Step 3 and COMLEX-USA Level 3 from a numerically scored examination to a pass-fail examination.
  • Changing USMLE Step 3 and COMLEX-USA Level 3 from a two-day examination to a one-day examination.
  • The option to take USMLE Step 3 after passing Step 2 Clinical Knowledge (CK), or take COMLEX-USA Level 3 after passing Level 2-Cognitive Evaluation (CE) during medical school.

The AMA also will “advocate that residents taking the USMLE Step 3 or COMLEX-USA Level 3 exam be allowed days off to take the exam without having this time counted for paid time off or vacation balance.”

“Preparing for and taking these exams is time-consuming, costly, and stressful,” said Aliya Siddiqui, MS, a member of the AMA Board of Trustees. “As medical graduates and residents are embarking on their careers and juggling heavy workloads, they are being forced to use valuable time off to take these exams. Making changes to the testing process will only increase the time that new physicians are able to spend learning in clinical settings with patients.”

The AMA Thriving in Residency series has guidance and resources on navigating the fast-paced demands of training, maintaining health and well-being, handling medical student-loan debt, and other essential tips about succeeding in graduate medical training. Those tips include insight on how to balance rotations and Step 3 exam prep from former residents and a detailed how-to on the complexities of navigating state medical licensure.

Learn more about how the AMA is helping resident physicians build the future of medicine and AMA member benefits for resident success.

Read about the other highlights from the 2024 AMA Annual Meeting.