Best Step 3 prep strategies, from those who've been there

(Note: This article is part of a series for residents on the United States Medical Licensing Examination (USMLE), a three-step examination for medical licensure in the US. The USMLE assesses a physician's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills.)

Step 3 of the USMLE can mean at least two different things to different residents. For those who’ve already matched in a categorical residency program, it’s a box that needs to be checked, and simply passing is sufficient. But for those who’ve yet to match, obtaining a competitive score is an anxiety-provoking must.

MDLinx interviewed two physicians who‘ve cleared Step 3 to identify effective study and test-taking strategies. Both said that if you’ve passed Steps 1 and 2, you can tame this (slightly) milder beast with some deliberate practice. The Step 3 exam mostly covers diagnosis and treatment, which your residency training supports. However, studying will help you understand the nature of the test and how questions are worded.

Know your learning style

Courtney Connelly, MD, a pathology resident at NewYork-Presbyterian Columbia University Medical Center, described Step 3 as “horrendously difficult—like, ‘did-not-know-a-single-question’-type difficult.” 

But like so many other residents, all she had to do was pass, and pass she did.

Kristen Fuller, MD, a family physician, was in a similar situation. She said that if you’re already in a residency program, relax. 

“Don’t sweat Step 3,” said Fuller, author of MDLinx‘s Real Talk. “Your goal is to pass, which takes a lot of pressure off. Do not jeopardize your patient care or performance in residency for studying for Step 3.”

That said, both doctors noted that some preparation is required. According to Fuller, it starts with knowing your learning style. 

“By this point in your medical school training, you should already have your study and learning style down to the last detail,” she said. “Whether it is practice questions, review books, videos, audiotapes, or notecards, you have a solid learning and study structure down, since you have already taken Steps 1 and 2.”

For Fuller, that meant no group study (although that may work for you), but reliance on practice tests and questions.

The important thing, both said, is to know what works for you and to log your study time.

Set aside study time

According to Fuller, if you haven’t matched into a residency program, you probably should devote more time to studying. But for residents who’ve matched, studying may just be a matter of identifying and addressing your weak points.

Fuller spent 1 to 2 hours nightly studying after work for about 6 weeks.

“The good thing about Step 3 is it’s mainly diagnosis and treatment, which you see all day long during residency, so the studying was mainly for understanding how they are wording the questions,” she said. 

Connelly studied in 15-minute chunks whenever the opportunity arose at work. She said you can also be strategic about when you schedule the exam. Connelly chose an easier month of her rotation so she had more time to study by day. But she emphasized that she didn’t study outside of work.

It helps to split study sessions up with breaks, Fuller said.

“Take as many breaks as possible, and do something to move your body and turn your brain off, such as running, going for a walk, or taking a bike ride,” she said, adding that a good diet and sleep also help.

With your study strategy in place, and time devoted to executing it, you’re ready to start preparing.

Practice with intention

Both doctors said you should study with the intention of identifying weaknesses—and then eliminate them. According to Connelly, residents in specialties such as IM or any of the surgical fields can probably rely heavily on their residency experience. But as a pathologist, she had extra studying to do.

She relied heavily on the UWorld question bank, which got her through Steps 1 and 2. She also used the NBME’s free examples of clinical vignettes you’ll encounter on the test’s second day.

Fuller also used UWorld, as well as Kaplan. She selected random sections of the UWorld test, and then revisited areas she was consistently flubbing.

“Turn off distractions, wear ear plugs, sit at a table, etc. Do all the things you would on test day,” she added.

Connelly agreed that on test day, timed practice pays off. If you’ve matched to a specialty, then practice, pass, and don’t think too much about the results.

“No one that I know stressed out about Step 3 because we all knew that you just have to pass,” Connelly said. “If you’ve passed the last two and you put some effort into UWorld, then it’s fine. Not many people fail. It’s kind of a low-risk situation.”