How I Scored a 258 on USMLE Step 3 While Figuring Out How to Be an Intern

  • /Reviewed by: Amy Rontal, MD
  • By now, you’ve probably heard from everyone around you how challenging your intern year is going to be. Learning how to put in orders, dose medications, stay awake for 27 hours at a time, and just how to function when working 80 hours a week is a steep learning curve. So how are you supposed to study for another Step exam at the same time? Believe me, it can absolutely be done! You just might need to be more proactive in planning out your study time in advance.

    Evaluate your past Step studying experiences.

    The first step is to reflect on what type of test taker you have been so far. Are you someone who only needed to do the UWorld questions a few times to prepare for Step 1? Did you have to do a lot of content review before Step 2CK? And what is your goal score for Step 3? If you are someone who has done well on previous Steps by just reviewing UWorld, you can likely do the same thing for Step 3. If you are someone who struggled with or failed Step 1 or 2CK, you may need to plan for more in-depth content review prior to the exam.

    Decide whether or not you need to supplement with a review book.

    One way to do this is to take one of the NBME or UWorld Self-Exams to get a sense of your knowledge base. There are 2 of each, so you can reserve the remaining exams to assess your progress as your go. If you think you need more content review, Step Up to Medicine is still one of the best review resources for the medicine on the test. First Aid for Step 3 is not as good as your Step 1 version, but it will cover the basics of all of the other specialties on the test.

    Be realistic about your time commitment.

    Remember when you could take 2 months off to dedicate to studying for Step 1? Unfortunately, there is no way that you will be able to dedicate the same amount of time to Step 3 while working a full intern schedule. Take a look at your schedule and plan to do 5-10 UWorld questions per day during hard rotations (e.g. ICU months) and 20-40 questions per day on lighter ones (e.g. outpatient or elective months). Lighter rotations would also be the time to plan for more dedicated review of content if necessary. Be prepared to forgive yourself if you get a bit off schedule and allow yourself time to catch up on your days off.

    Make sure to do UWorld at least once.

    This rule still holds for Step 3. UWorld is the best preparation for the exam. Luckily, there are fewer questions this time around (about 1500). For those with more difficulty with standardized exams, you may want to plan to do UWorld twice.

    Learn the CCS format, tips, and tricks.

    This is the part of the exam that is unlike anything you’ve done so far. It took me a few tries just to figure out how to move patients to different locations and move the clock forward (let alone diagnosing and treating the patient!). I would advise doing all of the CCS cases, less for the content than to get comfortable with the software. Learn what orders should be submitted for every patient (i.e. for some reason pulse oximetry is a separate order from the vitals) and how certain orders are phrased in the software. And don’t forget to always put in an order to counsel the patient (e.g. on smoking cessation, medication adherence, pregnancy, etc.).

    In the end, studying for Step 3 will likely be spaced out over multiple months depending on your intern schedule. But with a bit of planning, you will rock it and be done with your last ever Step exam!