How to do well on Step 3

Like I previously mentioned, if you're already in residency, Step 3 means a lot less for you. But anyways, we know medicine is made up of a bunch of overachievers so in case you want to do well, here are a few tips:

Books:
You don't really need any books, and there aren't any amazing Step 3 books. Master the Boards for Step 3, as well as First Aid seem to be decent text materials for the exam.

QBank:
All you need here is USMLE World. The structure, layout, and material is the best you'll get for the exam. The CCS layout is nearly identical to the real deal. Make sure you do as many of these cases as possible, as it'll prep you for the second day of the exam.

1. The first day is the ONLY day you'll see statistics. Make sure you study your stats, similar to those from step 2.

2. The clinical questions are often confusing, but the curve is very generous. The most difficult part of the exam is remembering what the guidelines are, versus what you have been doing on the wards during your residency. Real clinical practice doesn't always mirror the guidelines or recommendations.

3. Timing is more important on the first day. The second day will go by a lot quicker as the CCS cases shouldn't take you the full allotted time.

4. CCS. This is the part that worries test-takers the most as you have no idea what to expect. The key here is to do as many UW cases as possible to understand what sorts of things you need to order, and the flow of how things run in the system.
- Don't forget the basics. Labs, B-hCG, imaging. The history is useful, the physical less-so, unless there's a pertinent finding in there that would direct you to a diagnosis.
- The key is NOT the diagnosis! You only need to arrive at a differential, and use tests/imaging to narrow your differential. They almost always provide vague symptoms so that you come up with a wide differential. Abdominal pain, headache, chest pain, shortness of breath, cough. There will be a few 'buzzwords' or hints throughout the case to direct you, but they just want to make sure you can order the pertinent tests on patients with specific symptoms, and in the right order.


It's not difficult to pass if you understand what the test-makers are trying to ask. If you want to score >250, you'll need to hone down on the guidelines and have a deep understanding of diagnoses and management at a higher level. If anyone wants to discuss further on how to score >250, let me know.

 

Hi,

Thank you for the post on Step 3. I am taking the exam in a month and need to get a very competitive score as I'm not in residency yet (and need to make up for sub-par scores on previous exams). I have spent a considerable amount of time on UWorld and MTB, with special focus on Biostats. Please advice what I need to do to do really well on the Step 3. It's my only chance to secure residency, so any suggestions are most welcome. Thank you so much, once again.

 

@Dm3491 Thanks for the post!

Step 3 is a very interesting exam for multiple reasons.

Unlike Step 1 or Step 2, Step 3 is a 2-day exam. This makes test-taking stamina that much more important.

As mentioned above, the first day is made up of many ethical and stats questions. This is important because it's an easy way to set the foundation for a higher score by doing well here. Hard to prep for ethical questions, but easy to get all the stats questions correct with some prep. UW, First Aid, and other online resources can provide you the stats info needed.

The second day involves more clinical-based questions that involve more difficult diagnoses, or more commonly, differential diagnoses that require in-depth knowledge of diagnosis and management. Unfortunately, UW and MTB drop the ball a bit here. The best way to prepare is probably to encounter such patients first-hand. This is obviously not feasible for most, and especially not for you. So, I suggest you go through UW as many times as you have time to, and to really delve deeper with each UW question. Ask why/how/when and take close notes to identify key similarities and differences between diagnoses and management options

UW is fantastic for preparing for the case portion. Again, however, not seeing similar patients first-hand will add a level of difficulty that other test-takers may see as "easier." Unfortunately, you will just need to put in the extra hours of preparation up front and hope you see similar cases on the real thing to UW.

Good luck, make sure to post your experiences!

 

@orthopod, Thank you for your reply. This really helps. I'd like to ask you one more question in this regard. I understand a strong foundation of Basic Sciences is really essential for all the Steps, but do you have any specific high-yield topics in mind, that I could review from First Aid for Step 1?

Thank you, once again!

 

While everything is fair game, basic science topics are the least likely to show up on step 3. This is very low-yield, and if I were you, I'd focus on clinical guidelines and diagnostic testing, and management options when preparing. Step 3 is designed for residents, so basic science would probably be a waste of your time.

 

Yes, that makes sense. Thank you for your input. I will post about my test experience once I take the test.

 

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