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Dr. David Sola-Del Valle and Dr. Taylor Purvis contributed to this post.

After surviving medical school, Step 1, Step 2 CK, Step 2 CS and possibly even internship and parts of residency, you have just failed the last test standing in your way of obtaining a permanent medical license: Step 3.

After so many years of studying and so many exams passed, you cannot fathom how on earth you failed Step 3. Let me assure you that you are not alone.

Many people fail Step 3 every year, especially after new changes were made to the exam format and content in recent years. There is now more emphasis on statistics and the inclusion of Step 1-esque material. If you recently failed, take a deep breath and assess the situation by asking yourself the following five questions:

1. Did you underestimate Step 3?

Probably the biggest mistake people make is to underestimate Step 3. The old adage “2 months for Step 1, 2 weeks for Step 2, and a Number 2 pencil for Step 3” definitely does not apply, at least not anymore.

(I don’t know about you, but I also definitely took more than 2 weeks to study for Step 2! Not to mention that we no longer use Scantrons.)

In order to ensure a passing score, Step 3 deserves your full attention and respect. The score may also be more important if you are considering a medical fellowship after residency.

Remember, just because you passed Steps 1 and 2, it doesn’t mean you don’t have to study to pass Step 3. Step 3 has its own set of challenges, especially the newest version of the exam. If you answered "Yes" to this question, the good news is that this may have a relatively easy fix (see my Tips to Crush USMLE Step 3).

2. Did the CCS cases do you in?

You've taken USMLE Step exams before and passed them, BUT none of them had CCS cases. Approximately 25% of your Step 3 score depends on how you performed on the 12 CCS cases that are part of the exam.

Typically 10 of the cases will be straightforward, BUT even if you know the management of the diseases presented, you may not score well, simply because you’re not familiar with the CCS computer program.

Examine your score report and if CCS wasn't a high score, then prepare to address this deficiency head on.

Check out our blog post on how to crack the CCS cases.

Many students may ask, “is it possible to fail CCS and still pass Step 3?” The jury is still out, and official USMLE sources do not provide firm guidance on the issue.

I like to encourage examinees to instead focus on the opportunity that the CCS section presents for boosting your overall score! (This means you can worry less about the minutiae on the multiple choice question portion of the exam).

Like for Step 2 CS, there is a fairly limited set of patient presentations that pop up again and again on the CCS portion of Step 3. Committing to a good review material (such as ccscases.com or the UWorld CCS section) and going through each case in great detail ensures a fantastic score on this part of the exam. It can really make a difference!

3. Did you time your Step 3 test date appropriately?

One of the biggest problems about Step 3 is that most people are forced to take it during busy internships or residencies. When you’re doing night float or are trying to survive on one golden weekend per month, it can be extremely hard to find time or energy to study for Step 3 the way it deserves.

Almost every internship/residency will have 1-2 months of clinic or research or ER, when it may be significantly easier to plan a solid detailed study schedule. Plan in advance and pick your new test date with your schedule in mind. Choose the least time-consuming rotations you can before you plan to retake Step 3. That way, you will be able to study effectively.

Also give some thought as to when you’d like the two test days to occur. Back-to-back days might be easier from a rotation standpoint and certainly gets the test over and done with quickly. However, it can be incredibly draining to sit in a testing center for two days straight. If you’re like me, you may find yourself in a pretty sour mood on day 2 when you left in the afternoon the day before!

4. What are your biggest weaknesses?

Again, examine your Step 3 score report in detail and pay additional attention to the areas in which you scored the lowest. Ultimately, you will have to review everything again, but if you scored extremely poorly in OB/Gyn or behavioral sciences/statistics, then you should dedicate more time to those areas when you’re preparing your study schedule.

Don’t neglect prior shelf exams if you run out of UWorld questions for these specific areas. That material is still fair game for Step 3 and can be a great way to freshen up on the material.

5. Do you need help with your test-taking skills?

Were you overly anxious? Did you have difficulty with timing? Did you have difficulty with questions that asked for a diagnosis or with management questions? Did you have difficulty approaching the statistics questions with those long stems? If you answered "Yes" to several of these questions, completing the Qbank questions several times over (ideally three) in a timed fashion will help. If you’re still having difficulty, finding a tutor to give you advice and discuss questions with you may be the way to go.

You can do this.

You are not alone. You have come this far, and you are not about to give up after passing Step 1, Step 2, and finishing 8+ years of schooling/training. Buckle down and prepare adequately to retake Step 3 using all of these tips. 


Step 3: 6 Tips to Help You Ace Exam Day

How to Study for Step 3: What Resources Should I Use?

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

Your Step 3 Study Plan

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