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Congratulations! If you are reading this, you are likely preparing to take the third and final (yes, the END is finally in sight!) United States Medical Licensing Exam! 

The two examination days are divided by content, with Day 1 focusing on basic science and Day 2 focusing on clinical science. Although both are part of the same exam, each day requires different sets of skills and preparation to successfully navigate it.

Below are the top tips and tricks pertaining to this final USMLE Step exam.

1. Understand the differences between Step 3 and the other Step exams.

The USMLE Step 3 exam is unlike the other Step exams in several ways. First of all, this examination spans over two full days, unlike the other Step 1 and 2 exams which lasted just one day each. The first day of Step 3 consists of 6 blocks of questions, each consisting of 38-39 questions. You have one hour to complete each block, and will have 45 minutes of break time on test day. There are approximately 7 hours of testing on day one. 

The first day of Step 3 focuses on basic medical and science knowledge, such as ethics, fundamental principles, biostatistics, and medical literature. This first test day is exclusively multiple choice and is most similar in content and material to the USMLE Step 2 exam. There is, however, a unique and sometimes dreaded feature to this part of the test: the scientific abstracts and pharmaceutical advertisements.

Day 2 is a 9-hour test day. It has 6 blocks of 30 questions each, followed by 13 cases. You will encounter a combination of multiple-choice questions and computer-based case scenarios. This particular test day tends to emphasize diagnosis, management, and medical decision making. You will have 45 minutes to complete each block and 10-20 minutes for each case simulation. You will also have a minimum of 45 minutes for break time.

As you prepare to sit for Step 3, I would strongly advise you to do many timed practice sessions to ensure your ability to complete all questions in an allotted time is well-honed. 

Hindsight 20/20: Leave the drug-related questions till the very end of the block.

2. Statistics/Statistics/Statistics

One must focus on statistics to do well on this exam. Each block on Day 1 consists of 7-10 statistically-related questions. One should be confident with the interpretation and calculation of topics like positive and negative predictive value, sensitivity, specificity, likelihood ratio, odds ratio, etc. 

One should also familiarize him or herself with different study tactics for their strengths, weaknesses and associated biases. 

Hindsight 20/20: Review USMLE Step 1 material related to Statistics and do as many practice questions as possible.

3. Select the Step 3 study resources that will work best for you.

There are a variety of practice materials available to prepare for the USMLE Step 3 exam. The bottom line is to select a few key resources that work best for you and be consistent with using them. Similar to the other Step exams, UWorld tends to be a highly favored resource for helping to prepare for the breadth of content that one could possibly encounter on Step 3. Also like the other step exams, question strategy and pacing are important skills to hone  for the multiple-choice sections. UWorld does offer an option to purchase further practice cases to prepare for the case scenarios. The USMLE website provides an abundance of information and sample items to be ready for the exam.

Topics tested in UWorld are more detailed and challenging than the actual examination, so do not get discouraged by your score. Going through the questions at least twice is optimal for preparing with UWorld. Additionally, taking assessments (e.g. NBMEs) will help you more accurately predict your Step 3 score. 

Hindsight 20/20: There is no substitute for doing questions. Do as many questions as possible and do all the cases present in UWorld.

4.Thoroughly work through case scenarios.

As mentioned above, the second test date includes 13 clinical case scenarios (CCS), each lasting 10 to 20 minutes. These require a different thought process to master them. With multiple choice questions, the end goal is to find the right answer. However, with these cases, grading includes the method of arrival for the right answer as well as subtleties of patient care. 

Use your common sense when doing cases and always await the result of the initial tests before ordering subsequent studies. Do not be afraid to send the patient home and have them follow up in office for further care. 

Depending on one’s background, stage of training, and medical specialty, these cases may be one of the more difficult aspects of the exam. It is extremely important to work through several practice cases, and familiarize oneself with the case testing software, well before examination day. The USMLE provides a free downloadable version of the CCS software as well as a few sample cases.

Hindsight 20/20: Use the real world clinical skills acquired for this part of the test. Treat the patient as a real patient and not an examination prompt.

5. Emphasize the importance of time management.

Time management is a critical skill to have as a physician, regardless of the stage of training. This skill is especially important when preparing for Step 3. The majority of students take step 3 when they are already in residency. This means most people will have to study for Step 3 in addition to a full work schedule. While students may have had the luxury of taking weeks off solely to study for the Step 1 and 2 exams, this is highly unlikely to be the case for Step 3. Most residents will work full days, nights, and weekends and still be expected to study for Step 3 on top of an already heavy workload. For that reason, time management and planning are crucial. It is essential to plan when to take Step 3 well in advance, to make sure there is ample time to study. Some residents try to plan to take the exam during a lighter month of residency (such as during an elective/consult month or during a time when one might have no or little call) to possibly allow more nights, weekends, and days off to study. Regardless of one’s schedule, it is important to find the time to set aside regular studying for Step 3 and hold oneself accountable to a schedule in order to be best prepared on test day.

6. Use Your Breaks

Do not be in a rush to finish the exam early. Each block is gruesome and requires a lot of mental endurance to be focused throughout. Plenty of break time is allotted throughout the exam, so take a few minutes between each block to refresh your mind. Plan one longer break for food and other necessities. 

Always keep time in perspective and know that one block is just one block and does not make or break the exam. This exam is definitely a marathon and not a sprint. 

Hindsight 20/20: Take a mini break between each session even if it's just 2 minutes to clear your head. Plan your breaks prior to test day, but be flexible enough to change it up based on the feel of the exam. 

Why is Step 3 important anyway?

Since most people take Step 3 while already in residency, this may alleviate some pressure (since then the score clearly can’t be used in admittance to residency). However, Step 3 is still a highly important exam. Most institutions require students/residents to pass it before being able to advance to a certain year of residency. Successful passing of Step 3 is also a requirement of most medical boards, and the score could be used in determining admission into competitive fellowship programs.

For complete information on the USMLE Step 3 examination, as well as sample questions and content, be sure to review the USMLE website.


Many thanks to Dr. Anand Patel and Dr. Justine Falcone for their contributions to this article.

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