Prepping for the boards: How to study for Step 3

By Naveed Saleh, MD, MS | Fact-checked by Barbara Bekiesz
Published April 7, 2022

Key Takeaways

  • USMLE Step 3 emphasizes outpatient management, and it is created by committees of experts in their respective fields.

  • Building an effective study schedule is crucial. Cramming everything in at the last minute will not do you any favors.

  • By leveraging your professional relationships and the various study resources available, you can carve out enough time to adequately prepare yourself for the exam.

After years of study and training you have finally come to the USMLE Step 3, your final destination before state licensure—so naturally, it’s vital that you ace it.[] This 2-day test emphasizes outpatient management, and is formulated by committees of experts in their fields—including academic and non-academic physicians.

Overall, Step 3 represents the general medical knowledge needed in specialist fields. Step 1 and Step 2 CK are different from Step 3, which includes Computer-based Case Simulations (CCS) in addition to multiple-choice questions. Keys to acing Step 3 include focusing on the right resources and devoting time to study.

Create a weekly schedule

An effective study schedule is necessary for USMLE Step 3. Cramming everything in during the last weekend before the exam is probably a bad idea.

When preparing your study schedule: 

  • Mark the USMLE date on a calendar

  • Count down the days

  • Schedule each day’s goals

  • Block off a few days for rest, and 

  • Schedule a self-assessment with the National Board of Medical Examiners. 

Keep in mind that your schedule may require some flexibility.[]

A good way to set up a weekly schedule is to study two to three topics each week for 6 weeks.

For example, in one week you study pulmonology and cardiology, while in another you cover nephrology, psychiatry, and neurology.

Here’s a 4-week approach that may help, based on advice from the Med Elite Academy:

  • Week 4: Concentrate on practice CCS cases in addition to multiple-choice questions

  • Week 3: Same

  • Week 2: Do practice CCS cases and self-assessments to get used to timing and pace. Self-assessments can consist of four blocks of UWorld qbank questions.

  • Week 1: Do fewer practice CCS cases; concentrate on biostatistics questions.[]

How to stick to it

Creating and sticking to a study schedule is important. When completing the tasks on your schedule, here are some pointers to keep in mind.

Work-up your consults. Since real-life cases directly relate to practice questions, pay plenty of attention to high-yield rotations, according to the AMA. Carefully study cases involving common conditions such as diabetes, hypertension, or COPD while seeing patients with these conditions.[] Sometimes the way the test creators want you to answer differs from the real-world decision making.

Do plenty of practice questions. Nothing beats them. Although the AMA has selected Kaplan for practice questions and test materials, in-the-know students often choose UWorld, whose practice questions and cases help with pacing, strategy, and skill development.[] The USMLE website also offers sample materials.[]

According to the experts, the UWorld question bank (qbank) questions typically are much more difficult than those on the USMLE exam. If you’re gearing to just “pass” the exam, a score at the 30th percentile or more should suffice. But if you want to land a big score for fellowship, gun for the 67th percentile or more. A good rule of thumb: complete the qbank questions twice to get the most out of them. NBME self-exam questions can also be good preparation for the USMLE.

Work within your comfort zone. To prepare, rely on what has proven useful and successful for you in the past. If you like doing questions every day and find this approach works for you, then do that.

Step 3 is probably not the best exam in which to debut new study strategies.

On a related note, choose a textbook to focus on when studying for Step 3. There is no “one great” book for Step 3. Review your problem areas with the book while skipping over concepts you understand well, to save time. 

Make good use of any spare time to study. It’s difficult to find free time for study during rotations. Even a few minutes of downtime at the hospital can be useful. Schedule a set number of questions to practice each day and try to do them during your downtime. This will reduce the need to cram later; these pockets of time can add up!

Don’t underestimate statistics. Statistics makes up about 7 to 10 questions of every Step 3 block. So it’s a good idea to nail down your understanding of sensitivity, specificity, positive predictive value, negative predictive value, odds ratio, and so forth. USMLE Step 1 statistics material can help you prepare. 

What this means for you

USMLE Step 3 prep can be challenging due to time constraints. Set up a weekly schedule and make the most of your downtime. Do plenty of practice questions.

Try not to cram for the test; instead, endeavor for an organic approach, with an eye toward the exam while seeing patients during rotations. The last 4 weeks of preparation could focus on CCS questions, with the final 2 weeks involving self-assessment and biostatistics studies.

Related: 5 tools to prepare for the USMLE Step 3 board exam

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