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This is it — the final examination in the three-step series separating med school grads from licensed doctors who can practice medicine without supervision.
If you’d like an overview of eligibility, registration, scheduling, structure, content, and scoring, see my overview of the U.S. Medical Licensing Exam (USMLE) Step 3. As I mention there, this exam tests whether the examinee can apply medical knowledge deemed essential to the unsupervised practice of medicine. It is administered over two days, is entirely computer-based, and features a mixture of multiple-choice questions and clinical simulations.
As the Step 3 overview explains, you’re only eligible to take this part of the exam after passing Step 1, Step 2 CS, Step 2 CK, and graduating from medical school. You’ll probably end up taking the test at a point in your residency during which you’ve got some study time (often during research or vacation).
Though there’s a common tongue-in-cheek saying in the medical community — “two months, two weeks, two pencils” — to refer to the prep time required for Steps 1, 2, and 3, respectively, Step 3’s recent expansion to a more rigorous two-day format requires at least a few weeks of study time for most examinees. Plus, competitive fellowships do care about scores on Step 3. So if you want to get into that subspecialty fellowship you’ve got your eye on, you’ll need to do more than just pass.
Here’s how to prepare so you can ace this ultimate exam.
Step 3 study resources fall into three main categories:
Each year, USMLE.org offers free practice test items for Step 3, including a tutorial, an overview, and question blocks. The blocks can be timed to simulate the high-pressure exam experience. Use this resource as your starting point for studying so you can quickly learn how to navigate the computer system and get comfortable with the style of questions.
Live courses offer structured classroom lectures and preparation materials. Most are run by private companies, similar to other USMLE and MCAT prep courses. The traditional test prep companies, Kaplan and Princeton Review, offer USMLE Step 3 courses in addition to question banks and books. There are many other options for live courses, too, some of which test-takers find more effective, including Dr. Red’s Step III Reviews and CCS Workshop and Premier Review.
Please note that you do not need to take a live course to excel on the USMLE Step 3. Courses are best for students who perform well given structure, a defined program, and a set schedule. When choosing a course, take note of the timeline, study materials, teachers’ backgrounds, class sizes, and success rates.
Question banks are essential for USMLE Step 3 preparation. Most Step 3 examinees even believe they’re more important than books. They provide hundreds of questions and lots of flexibility: Test-takers can — with or without an active timer — simulate full tests, practice blocks within the exam, isolate questions by category, and get explanations for every answer. Many examinees are tripped up by the CCS questions, as these differ in format significantly from typical multiple-choice questions. Gaining familiarity with the Primum software and understanding how to complete the CCS are keys to success in the USMLE Step 3.
Though question banks trump book preparation for most Step 3 examinees, there may still be a place for reviewing Step 3 boards in print. Here are the most popular options:
Gearing up for the test, you should think as much as you can about balancing efficiency and thoroughness. This is important throughout the test, but nowhere is it as crucial as on the computer-based care simulations. As I noted in my overview of Step 3, test-takers are allotted either 10 or 20 minutes of time for each simulation, but the cases themselves can cover weeks or months of simulated time as you manipulate the clock, moving with patients from the emergency department to the inpatient ward to their homes. You are responsible for ordering everything for each patient — lab tests, radiology, medications, IV fluids, and procedures — in addition to providing patient education and prevention counseling.
Though the USMLE has kept quiet about exactly how Step 3 CCS cases are graded, it is clear that shrewd management is key. Failure to order specific tests or treatments, a lack of efficiency in patient care, and the decision to order inappropriate or dangerous tests or treatments can all result in a lower grade. Timing and sequence of care matter. You’ll need to find the sweet spot between working quickly and working carefully on this whole exam.
Once you’ve absorbed this large-scale advice (and decided whether or not to take a course and which materials you’ll use to study), you should employ the following preparation strategies:
As the test day arrives, here are some tips to help you ace USMLE Step 3:
Though you’ll have to wait up to eight weeks for score reports to come in, you’ll probably find out in fewer than four. And as I mentioned in my last article, the pass rate in 2015 for graduates of U.S. and Canadian medical schools was 96 percent, so be confident in your abilities.