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H1B Visa or J1 Visa is sponsored after the Interviews and after you match with a certain residency program. So the Visa issuing process starts after you match.

However, for programs to be able to sponsor you for H1B Visa they need to see that you passed USMLE Step 3. So it's better you take it before you go to the interview.

I didn't understand the last part of your post (changing Visa issue) please clarify.
 

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Expenses

i heard that any modification you do to your visa when you there like extend the duration or so , it means that next time you apply to visa they refuse to give it to you

so for taking step 3 before interviews thats really too complicated
so this year if i go did elective and take cs then when graduated go and take step 3 then go to interview then start residency

wow this is 4 times going to US

it is so expensive

what i can do?
You can take the CS and do the electives and take Step 3 and do the interviews all in one Visa (visitor's Visa B1/B2).

Then if you get matched the residency program will process for you the H1B Visa whether you are in US or back in your country.

But even with this one visit, it's certainly expensive like the cost of living, room renting, domestic flights to interviews, ...etc I'd say you need a minimum of $7,000 to do that.
 
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