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How to Study for Step 3

Your intern year has started. You’ve been working as a clinician for a good number of months, and you feel like you are getting on your feet. But here comes USMLE Step 3 to throw a wrench into your spokes….

Why Step 3 doesn’t necessarily spell doom for your life

Step 1 and 2 were big, ugly bears. They demanded your undivided attention. You spent endless months studying – and that was literally all you did. The stress of aiming for high test scores was going to make or break you!

Now, when Step 3 is just around the corner, you might be tempted to abide by the conventional wisdom: Just pass. You might rationalize that your score isn’t going to get you a leg up on competition or make you shine on applications. Although you now just need to get a passing score to continue riding the train to attending-hood, you should aim higher.  Getting the most and the best out of the prep process will help you become a better clinician. In other words, you’re truly studying not just to pass the exam but also to become a skilled professional.

We have some good news: by this time, answers to multiple choice tests are no longer just chunks of text that read like a foreign language. They have practical application to the real-life actions you have been taking every day during your internship. “Lasix” is not just a drug in a textbook; it is the order that you are placing for your patients in acute decompensated heart failure. 

Whether it feels like it or not, you’ve been studying for Step 3 way longer than any other USMLE test. You are studying for it on a daily basis, simply by doing your best as an intern.

Getting the most and the best out of the prep process will help you become a better clinician.

Why Step 3 is not a piece of cake

Now for the flip side of the double-edged sword. You are an intern with a negative amount of free time. When are you going to prepare for a test if you barely have any time to sleep? Call shifts,  80 hour weeks and the scutwork won’t magically disappear to give you that precious prep time. 

On top of that, Step 3 isn’t merely the passive multiple choice test that you can breeze through. The Clinical Case Simulation (CCS) section demands interactive free-text answers and, dare I say it, true critical thinking. The $900 bill to take a test over a two day period doesn’t sweeten the deal either.

No matter how you cut this cake, Step 3 is a necessary evil that you must pass, and since time and good planning are essential,  let us help you build a plan to triumph over this final piece of the USMLE puzzle. We’ll even manage to squeeze in some time for you to sleep!

Timing is everything

Some eager medical students want to take Step 3 as soon as possible. I applaud the proactivity and desire to knock this test out immediately, but – shhh- there’s a way to make your life easier. Step 3 becomes way more approachable after a few months of intern level work. The questions on the test have a lot of alignment with the day to day practice of an intern. Naturally, the more all-encompassing disciplines (like internal medicine or general surgery) will afford you a better -balanced education than a surgical subspecialty. But the amount of medicine that you get entrenched in as an intern is magnitudes greater than what you see as a student. It’s been said that  the first 6 weeks of internship equated to the 4 previous years of medical school. Put simply, the more intern work you do, the easier the test will be. 

USMLE Step 3 requires a solid month of preparation, so for the sake of your sanity see if you can schedule it for the second half of intern year, during a time which might give you a chance to study (e.g. elective time or vacation). You don’t want to show up to the test center post-call during a 24 hour q3 stretch. Finding a bit of downtime to help you prepare will pay dividends. 

When to study and for how long?

Every student will need a different strategy and amount of time to prepare, based upon his or her initial fund of knowledge and daily schedule.  During the preparation process for Step 1, you received a generous 2-month break from any academic rigor, but Step 3 won’t give you that luxury. Thus, this exam requires time management skills you never knew you had. Usually I am not a big fan of “distracted studying” before rounds in a bunch of short disjointed spurts, but during intern year, this form of studying might be the only choice you have. Call shifts can be a great time to relegate yourself to a sleepless night, and knock out questions between phone calls from nurses. In addition, you might need to do your best to squeeze in a study session even on your day(s) off. Check out our post on maximizing your exam day performance. 

What resources to turn to?

A quick visit to our StudyStats page will give you the objective data regarding resources that students are using to prepare for Step 3. By far, the most common one is UWorld. You are probably familiar with the format from utilizing UWorld to prepare for  Step 1 and 2, so there is no learning curve to using the software. The amount of material UWorld provides is immense. Combined with all the practical knowledge you acquired during your intern year, UWorld’s blend of high quality questions and multiple in-depth CCS cases can serve as a stand-alone resource to prepare for the test. Check out our blog post on Step 3 review courses for our favorite contenders.

OnlineMedEd offers a different, more holistic approach to studying. If you are someone who needs constant switching of modalities (i.e., question banks, videos, flashcards), then congratulations – you’ve just found your perfect resource. The “Clinical” section of their platform has loads of videos–well produced mini-lectures that can certainly meet, if not exceed, the caliber of what you have received on a daily basis in medical school. Besides,  by mid-intern year, you might need a lecture or two to brush up on areas that you haven’t visited in a while. Another huge benefit is cost. You can access most of the content (with ads) for free. That being said, if you expect to utilize this resource heavily, it’s probably worth paying for. 

Some students/interns need to carry around a real paper book. I am one of these people. Electronics can be distracting with the ends of the internet at your fingertips, and there is definitely something special about holding a book in one’s hands and marking it up with a real highlighter and pen. Haven’t you ever felt the satisfaction of turning a page you just memorized, or closing the last page of the book you mastered? If you fall into this camp, Master the Boards: Step 3 by Dr. Fischer is a great resource use, and rightfully so. It’s well indexed, incredibly thorough, and covers just about everything you’ll likely see on the test. 

A final word

It is essential that you practice CCS cases! There is a strange language you will need to learn to excel at these cases.There is no substitute to running through as many cases as possible and repeating them frequently. A lot of the “answers” are things you’d do without thinking (i.e., “order type and screen,” “urine pregnancy test”). You need a lot of practice to get these small rote orders drilled into memory.

Preparing for Step 3 needn’t be miserable. It’s just another part of your medical journey. Here’s a quick recipe for obtaining your passing score. Dedicate the necessary time to studying. Prepare and meticulously utilize a combination of high-yield resources. Add a pinch of multitasking and a full night of sleep before your test. Enjoy your success!