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You passed your Step 1 during med school. You’ve passed your USMLE Step 2 CK. It’s time to ace Step 3, the final exam in the United States Medical Licensing Examination (USMLE) series.
It might feel daunting at first, but you’ve got this. Allow me to replace that feeling of dread with confidence and preparedness.
I’m Joel Ramirez, MD, and I’ve helped countless residents like you pass your USMLE Step 3. Let me share some top tips with you and increase your chances of success. Below, let’s specifically get into the best study resources, study strategies, and CCS prep — everything you need.
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The Best Step 3 Study Resources
You need to study, study, study — especially the CCS cases! But what’s the best way to get this done?
What resources should I use to study for Step 3? From what I’ve seen, here are the best Step 3 high-yield practice exams:
- UWorld Question Bank (QBank)
- AMBOSS Step 3
- Master the Boards USMLE Step 3
- OnlineMedEd
- First Aid Step 3
- CCScases.com
USMLE offers self-assessment opportunities to prepare for USMLE Step 3. The USMLE series is owned and administered by two entities: the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). NBME specifically offers this $62 self-assessment.
Reminder: Step 2 CS Permanently Discontinued
Creating a Study Schedule
When should you take USMLE Step 3?
It depends on your residency program. Some programs require that you pass Step 3 anytime prior to starting PGY3 (your third year of residency), but most require that you pass it during your intern year before PGY2 (second year of residency).
Generally speaking, you should try to take Step 3 earlier rather than later. The content overlaps heavily with Step 2, and the longer you wait, the less you’ll remember. This advice is especially true for those pursuing a specialty besides Internal Medicine. Most of the Step 3 questions will be Internal Medicine-related, so those specializing in, say, radiology may have a hard time remembering the content if they wait too long.
Some students even take Step 3 before entering residency, right after med school graduation. This strategy won’t be possible for everyone though. You need a medical diploma to take Step 3, and your graduation might not be verified until after your residency start date.
How long should I study for Step 3?
How long you should spend studying for Step 3 depends on whether your residency program offers dedicated time to study. Some programs do, but many don’t.
If it is possible to use an elective block for full-time studying in the lead-up to the exam, then you may be able to reduce the total number of days you need to study. If the elective block is two weeks, then you may need to study part-time for an additional two to six weeks beforehand to maximize preparedness.
If your program doesn’t offer dedicated time to study for Step 3, then you’ll probably have to do your studying on a part-time basis over the course of weeks. How long you need depends on your history as a test-taker, when you took Step 2, and what field you’re practicing in.
In general, those who struggle with test-taking, took Step 2 a while ago, or are practicing in a highly specialized field will want to spend more weeks studying than those who are good with tests, took Step 2 recently, or are practicing in IM or a related field.
Bottom line? If you’re studying on a part-time basis, you’ll probably want to spend between eight and 12 weeks studying for Step 3.
What is the best study schedule for USMLE Step 3?
You should organize your study schedule around completing a large Step 3 question bank, UWorld being the gold standard.
How to divy up the questions so that all the content is covered before you exam will depend on whether you’ll be able to use an elective block for dedicated studying.
If you’re able to use a two-week elective block as dedicated, you should spend that time studying as much as possible, 10 hours a day being the norm. Before your dedicated time, you should spend at least two weeks studying part-time, ideally for two hours a day on average.
If you’re not able to use an elective block as dedicated, you’ll have to spread your hours over the course of many weeks to accommodate your schedule as a resident. Assuming you average two hours of studying a day on average, you’ll probably want to start studying 12 weeks before your exam.
What exactly will I need to study?
Day 1 of Step 3 usually covers these high-yield topics:
- Foundational sciences, including internal medicine, pediatrics, surgery, obstetrics/gynecology, cardiology, and preventive medicine
- Biostatistics
- Epidemiology
- Medical literature
- Medical ethics
Day 2 of Step 3 typically covers the following subjects:
- Diagnosis, prognosis, and physical examination
- Health screening
- Therapeutics
- Medical decision-making for example clinical cases
Read Next: New 2024 USMLE Requirements
Preparing for Step 3 CCS Cases
While answering multiple-choice questions may come more naturally to you, I recommend focusing on studying exactly how to answer CCS (computer-based simulations).
What are the Step 3 CCS cases? CCS cases are unique to Step 3. These interactive questions present you with the chief complaint, a medical history, and vital signs. Then the case asks you to order physical exams, diagnostic tests, imaging, treatment options, monitoring, and counseling.
What is the best strategy to tackle the computer-based case simulations (CCS) on USMLE Step 3? Here are some of my handy tips on preparing for Step 3 CCS cases:
- Figure out how to interact with Step 3 CCS cases, looking up tutorial videos, or simply doing practice tests like UWorld or CCScases.com.
- Practice one CCS case every day. This pace is not overwhelming, but it can maintain a healthy growth of understanding and expertise.
- Formulate a system for reading and understanding the CCS info that works for your brain. Use this system consistently.
- If possible, line up CCS practice cases with your current studies.
FAQs
No, Step 3 will probably not be the hardest exam you take on your medical career path. You’ve already passed so many other tests. Only 2% of first-time test takers fail the USMLE.
Although it’s not hard to pass, I would aim a little higher. Getting into the 50th percentile (about 228-230 score) is usually good enough for any fellowship.
Above 230 is considered a good Step 3 score. The typical USMLE Step 3 passing score is 198. The average score of Step 3 is about 228. The highest possible score is 300.
I don’t think getting a super high score is really necessary for your fellowship applications – fellowships care more about Step 2 scores, letters of recommendation, and research output. Just aim for above average, and you’re golden!
Unlike Steps 1 and 2 CK, USMLE Step 3 is a two-day test that runs a total of 16 hours. You may take breaks whenever, but “authorized breaks” are allowed to occur between blocks.
Here’s a handy time breakdown:
- On the first day, 6 multiple-choice question blocks each take 60 minutes.
- On the second day, 6 multiple-choice question blocks each take 45 minutes.
- Also on the second day, 13 computer-based case simulations each take 10 or 20 minutes.
If you end a block early, that saved time is added to your break time.
Step 3 is taken either during residency or a few weeks before entering residency (if you’re ambitious and want to get it out of the way). In any case, you’ll take Step 3 after you match into residency, so you don’t have to worry about it affecting your chances.
The only exception to this rule is for IMGs. Foreign medical graduates looking to apply to U.S. residency positions have the option to take Step 3 prior to submitting ERAS applications. A strong Step 3 score can help verify to residencies that you have the skills necessary to practice medicine unsupervised in the U.S.
Your Step 3 score doesn’t have a huge impact on fellowship applications, though all your Step scores will be available to program directors. In general, all you need to do is pass Step 3 to be eligible for fellowships. Getting an above-average score (228+) is seen as a plus, but isn’t crucial.
End the USMLE Series with a Win
I want to prepare you for a good Step 3. Here are my top tips for USMLE prep:
- Do what works. UWorld, AMBOSS, and First Aid are considered the gold-standard Step 3 resources, and for good reason. Save time and energy by prioritizing these over un-tested resources.
- Rest the day before, maybe exercise or spend time with family or friends. Don’t get stressed out.
- GPS before test day. Make sure you know exactly where your exam is happening. Check how far away it is — you don’t want to be late on the day of.
- Protect your testing permit, and don’t forget to bring it to exam day.
- Bring snacks, including water — coffee, too, if you’re a coffee drinker. Without snacks, it may be a very exhausting day. But with snacks, you can keep your energy up throughout.
- Don’t trust their noise-canceling earmuffs. They’re typically old and ineffective. Bring your own earplugs if you’re sensitive to noise.
- You can take breaks whenever you want. In between blocks, you can take an “authorized break.” But if you need a break at other points in the exam, it’s called an “unauthorized break.” Although unauthorized breaks may be reported as irregularities, it shouldn’t be a big problem as long as you didn’t access your phone or anything. If you end a block early, that saved time is added to your “authorized” break time.
Top percentile USMLE coaches are at the ready to help medical students and residents like you boost their chances of success. You’ve made it this far, and we’re rooting for you. Good luck!
