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When to Take Step 3? A Timeline for Residents in Primary Care

The old adage “two months for Step 1, two weeks for Step 2, and two #2 pencils for Step 3” doesn’t make sense anymore. Step 1 will be pass/fail soon and Step 2 CK remains a nuisance, so when should you take Step 3 during residency?

A few things to consider when planning your Step 3 test date are how soon you want a medical license (which you need to moonlight), how confident of a test taker you are, and your rotation schedule each year of residency.

The Benefits of Taking Step 3 in Intern Year

Taking Step 3 in intern year has its benefits: you are fresh out of school and accustomed to multiple choice exams in a timed setting. Step 3 covers a wide breadth of topics in medicine and as a recent graduate, you’re well-versed in all areas of medicine.

Trust me, you lose some of this knowledge in residency. Residents starting out will practice with their resident’s license; however, taking Step 3 early allows you to apply for your actual medical license, which in turn allows you to moonlight to make some decent money and gain valuable experience.

Moreover, taking Step 3 intern year is liberating. Imagine walking out of the testing center and NEVER having to take another Step exam again!

The Downsides of Taking Step 3 in Intern Year

Testing early has its downsides, too. Intern year is stressful. Interns have medical knowledge but spend the majority of their time learning clinical knowledge, how to function as part of a treatment team, and writing notes … ugh, so many notes.

Most residencies in primary care heavily front-load inpatient rotations in PGY1 year. You have six-day work weeks with hectic hours, leaving little time for test prep. Unless you’re a specialist not in primary care, a very confident test taker, or know that you need to moonlight early, I’d recommend holding off on taking Step 3.

PGY2: The Best Time to Take Step 3

Frankly speaking, PGY2 is the best year to take the exam. Your schedule should be much more relaxed and flexible. Fewer in-patient rotations translates to more golden weekends, more predictable 8-to-5 work days, and more time to study.

You’ve gained the clinical experience from PGY1 and still retain the majority of your medical knowledge from school. Completing the exam this year gives you ample time to apply for your license, which means you have at least a full year to moonlight. Furthermore, you’ll have the entirety of your next year to focus on the board exam. Most of my colleagues in primary care took Step 3 in their second year; it’s the balanced approach that I’d recommend.

Taking Step 3 in PGY3: Too Many Exams to Manage

Taking Step 3 the same year as your boards can be tricky. Though there is overlap in material, the stress of having two major exams the same year is not recommended.

You’re a PGY3, the big dog on campus; you should be bossing interns and students around as well as applying for jobs, not studying for Step 3.

Some residency programs require Step 3 completed prior to starting your third year, and for good reason. If you fail, you can retake it before you graduate. Waiting until your last year for Step 3 makes that harder. Step 3 in third year isn’t recommended unless there was an unforeseen circumstance that prevented you from taking it earlier or you absolutely need more time to study. Selecting the right study materials will have you well on your way to a successful Step 3 study period.


Bonus: If you’re reading this as an MS4, consider biting the bullet and taking Step 3 now. Taking the exam post-match is great, as you have ample time to study and all the Step 1 and 2 knowledge is fresh. You need to fork over a hefty amount of cash for the exam but not having to worry about it in residency would be amazing. Not me though, I spent my time and money on a trip to Iceland post-match, which is also recommended.