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Choosing the right STEP 3 study materials can be challenging! In this post, I will discuss how to study for STEP 3 based on my experience on the USMLE STEP 3 exam.
What is the STEP 3 examination?
The USMLE STEP 3 is the final examination of the USMLE series. It tests your understanding of both basic biomedical and clinical sciences.
What are the USMLE Step 3 requirements?
The requirements for the USMLE STEP 3 are to be a medical graduate and have completed both STEP 1 and STEP 2CK. For international medical graduates, they should also be ECFMG certified.
What is the pass rate for USMLE STEP 3?
The current USMLE STEP 3 passing score is .
What is the average score for USMLE STEP 3?
The average (mean) score of STEP 3 is with a standard deviation of 15. Your USMLE STEP 3 score report will have your performance by systems, by Physician task, and by CCS cases.
What are the STEP 3 CCS cases?
CCS stands for and they are interactive cases in which you get presented with a history and vital signs, then you start ordering physical examinations, diagnostic testing, imaging, treatment options, monitoring, and counseling. I have made a detailed video on the CCS cases that you can check
What are the STEP 3 Study Materials?
There are books and question banks available to prepare for the STEP 3 exam.
Available books include Master the boards Step3, First Aid STEP 3, Kaplan books STEP 3, and others. You can also review the materials you studied for STEP 1 and STEP 2CK.
Master the Boards USMLE Step 3: by Conrad Fischer
This book is pages and is sold by Kaplan Education Publishing. It is structured in a system wise manner going over the main concepts tested in the exam. It has a rating of /5 on amazon.
An Amazon link for the latest () 6th edition of Master the Boards USMLE Step 3: https://amzn.to/3nHy
First Aid STEP 3
This book is part of the First Aid series, and similar to other First Aid books, it is a review book going over the high yield concepts tested in the exam. The book
is pages and has a rating of /5 on amazon.
An Amazon link for the latest () 5th edition of First Aid STEP 3 : https://amzn.to/32xsIz1
The Kaplan books (USMLE Step 3 Lecture Notes)
More detailed study material from the Kaplan company divided into two books ( pages). It has a rating of /5 on amazon.
An Amazon link for the latest () 3rd edition: https://amzn.to/3n5w5Xm
U World STEP 3 and Amboss STEP 3 are among the common question banks.
USMLE STEP 3 U World
U World STEP3 has around questions similar to the exam style divided into Foundations of Independent Practice (FIP) and Advanced Clinical Medicine (ACM) and is also divided into different systems. However, you can choose the way you would like to solve the questions in, randomly or by systems.
The U World STEP 3 subscriptions is currently $ for 90 days, $ for days, $ for days. This subscription also includes 2 self-assessments and the CCS cases which I will cover in the next paragraph.
AMBOSS STEP 3
AMBOSS STEP 3 has around questions similar to the exam style. To have access to AMBOSS STEP 3, you need to pay the membership ($89/year) in addition
to the subscription for the question bank which is 79$ for 30 days, $ for 90 days, $ for days, $ for days. This however, will give you access to all they USMLE question banks (including STEP 1 and STEP 2CK).
So to compare the price with U World STEP 3 for the 3 months’ subscription, it would be $ for U World STEP 3 and for $ AMBOSS STEP 3. So AMBOSS STEP 3 is cheaper but has only half of the questions available in U World STEP 3.
|U World STEP 3||AMBOSS STEP 3|
|Number of questions||≈||≈|
|Full year subscription||$||$|
What study materials and resources are available for the STEP 3 CCS cases?
For the CCS cases, you can use the CCS cases included in the U World STEP 3 question bank subscription or CCScases.com. You can also use the STEP3 CCS course that I created
U World STEP 3 CCS
U World STEP 3 CCS bank has 41 practice cases and 51 interactive cases. The practice cases give you information about a case and what type of orders you should put in. However, they are not interactive (not similar to how you get tested on the exam). The 51 interactive cases are similar to the exam and you solve them using a platform similar to the exam platform. No scoring is available when solving the interactive cases but the right management is provided in addition to information about the presented disease. They also don’t show you how the cases are solved in real life.
CCScases.com has cases (2 are free). Although they provide you with a score, the score validity (if it correlates with the actual exam) is not confirmed and you should not base your assessment on that score. They also don’t show you how the cases are solved in real life (just written feedback is provided).
STEP 3 CCS course
This is a course I created since just READING how to solve different interactive cases might not be enough. In this course, I show you how you approach each case using the exam platform explaining each step of the process and available options in the software. The course goes over the details of 6 cases in addition to a final lesson discussing different high-yield concepts. The course price is $ for 90 days’ subscription with % refund if you are not satisfied within 24 hours of order.
This is the link to register for the course:
Step 3 Course – The Match Guy
There is also a YouTube video I made on how to approach the CCS cases of STEP 3 in addition to a demonstration of a practice case using the exam platform.
|CCS Cases||U World STEP 3||CCScases.com||STEP 3 CCS course|
|Number of CCS cases||51 interactive cases and 41 practice cases||6|
|Shows you how the CCS cases are done||No||No||Yes|
|3-months subscription||Included in the UW question bank subscription ($)||75$||$|
|6-months subscription||Included in the UW question bank subscription ($)||85$||Not available|
What study materials and resources did I use to study for STEP3?
The main STEP3 study material I used to prepare for STEP 3 was the U World STEP 3 question bank. I feel U World STEP 3 was more than enough given the limited time we have to prepare for STEP 3 as long as you carefully review all explanations. So to answer the question of whether UWorld is enough for Step 3? U World STEP 3 is more than enough to get a great score. If you are having difficulty with the CCS cases or you would like to make the preparation easier and more interactive, check out my STEP3 CCS course as well which is only 3 hours.
What assessment tools did I use?
The main assessment tools I used were the U World STEP 3 self-assessment 1 and 2 which were close to my final score. Each of these self-assessments is four blocks.
These self-assessments are only for the MCQs part of the exam. For the CCS cases, there is currently no self-assessment tool. There are six CCS cases available for practice on the USMLE website with some written feedback on the case but they do not have assessment of your performance or show you how they are solved.
How long does it take to prepare for STEP 3 USMLE?
Generally, students take between 2 to 8 weeks to prepare for Step 3. However, the time to prepare for USMLE STEP 3 varies based on your prior knowledge but. For me, I had a good foundation from my STEP 1 and STEP 2CK; therefore, it took me around four weeks to prepare for this exam.
Do I need STEP 3 for residency?
STEP 3 is not required to apply and start residency in the US. However, some applicants choose to take STEP 3 if they did not get a high score on STEP 1 and STEP 2 CK to show program directors that they got a better score on STEP 3.
Does USMLE STEP 3 score matter? How important is the score of STEP 3?
I don’t feel that the STEP 3 score matters too much for fellowship applications as long as you are around the average. Therefore, dont spend too much time trying to get a very high score. However, for those who scored low on STEP 1 and/or STEP 2CK, they might consider taking STEP 3 before applying to the match to compensate for the low scores on STEP 1 and/or STEP 2CK. This might increase their chances of matching. But generally speaking, STEP 3 scores are not that important. Make sure to pass STEP 3 from the first time.
Is USMLE STEP 3 hard?
USMLE STEP 3 is not as hard as USMLE STEP 1 and STEP 2 CK. However, you still have to prepare for it and familiarize yourself with the CCS cases which are unique to this exam.
My final advice for students studying for STEP 3
Use U World as your main studying material. Practice CCS cases as much as possible as they are the unique aspect of this exam. You can also watch videos about the CCS and attend my CCS course. For IMGs, try to take the exam before residency to save yourselves time during residency.
What does STEP 3 consist of? How is the exam structured?
The STEP 3 exam is a two-day exam:
- The first day tests Foundations of Independent Practice (FIP) and comprises multiple-choice questions (MCQs) divided in six blocks. You will encounter a good portion of biostatistics questions. Each block is for one hour and has 38 to 39 questions. So, the first day in total is six hours plus additional 45 minutes break. There is an additional five minutes that can be added to the break if you skip the tutorial.
- The second day focuses on assessment of Advanced Clinical Medicine (ACM) and has questions both in MCQs and Computer-based Case Simulations (CCS) style. The first portion of the second day is divided into six blocks. Each block is 45 minutes and includes 30 MCQs. After you finish the six blocks, you will have 13 CCSs, each is 10 or 20 minutes of real time. There is a minimum of 45 minutes of break time for the second day (plus 10 minutes if you skip the tutorial). In most cases, the CCS cases end before the allocated time which increases your break time. So generally, the second day my run between 8 to 9 hours.
You can schedule the second day of STEP 3 within 14 days of the first day. I had my second exam day week a week after the first day because this was the closest available date. I recommend having at least a one-day break between the two exam days if possible.
What is the USMLE STEP 3 cost?
The Step 3 fee is $
USMLE STEP 3 registration and scheduling
USMLE STEP 3 registration is detailed in our other post about this topic:
USMLE STEP 3 registration and scheduling
Good Luck Everyone!
Step 3 assesses whether you can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. It is the final examination in the USMLE sequence leading to a license to practice medicine without supervision.
The examination material is prepared by examination committees broadly representing the medical profession. The committees comprise recognized experts in their fields, including both academic and non-academic practitioners, as well as members of state medical licensing boards. Step 3 content reflects a data-based model of generalist medical practice in the United States. The test items and cases reflect the clinical situations that a general, as-yet undifferentiated, physician might encounter within the context of a specific setting.
Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care.
Resuming United States Medical Licensing Examination (USMLE®) testing remains the USMLE program’s top priority. Below, please read several key updates.
Status of Prometric Testing
Testing resumed at select Prometric centers on Friday, May 1 in accordance with state and local social distancing guidelines. Although hundreds of examinees successfully tested, the overall examinee experience is not meeting expectations. The USMLE program continues to exert pressure on Prometric to rectify all issues in a timely manner. The USMLE program is working daily with Prometric and they have dedicated resources to both resume USMLE testing and address the quality of the examinee experience.
The USMLE program understands that when Prometric test centers reopened, some examinees with confirmed slots traveled to test centers only to find them closed, leading to increased confusion during an already difficult situation. The USMLE program has been disappointed with Prometric’s failure to fulfill its obligations to examinees and to the USMLE program. The USMLE program has emphasized to Prometric the importance of their obligations to examinees and the harm that their failures have caused.
Examinees who have suffered direct out-of-pocket monetary losses due to Prometric’s lack of communication or miscommunication regarding test center closures should submit a written claim directly to Prometric at prometric.com/contact-us.
In March , in response to the suspension in testing, the USMLE program extended eligibility periods to December for all examinees who had a Step 1, Step 2 Clinical Knowledge (CK), or Step 3 scheduling permit with an unexpired eligibility period with an end date in To help alleviate some of the pressure examinees may be feeling, USMLE will further extend eligibility periods through June .
- Note: Eligibility period extensions will be processed approximately over the next eight to twelve weeks.
Alternate Delivery of USMLE Step 1, Step 2 CK, and Step 3
To resume testing, the USMLE program has already identified several options for proctored testing outside of Prometric centers. The USMLE program is expecting to begin testing at some medical school campuses this month. USMLE is committed to offering a broader distribution of testing at medical schools; it is working through technological challenges in order to do so. While this solution will not completely address the testing backlog, it will provide additional USMLE-specified slots within Prometric’s overall capacity, which is increasing. Schools are being considered based on geographic location and a willingness to serve as a regional testing site. Because the USMLE program is not able to scale this solution to all schools, it plans to deliver other solutions as well. The USMLE program will ramp-up testing as we institute new systems and processes.
The USMLE program continues to aggressively explore remote proctoring and expects to have progress to report on the timeline for that project in the next week.
Validity, Reliability, and Fairness
The USMLE program recognizes the burden that reduced testing capacity places on schools and examinees. As the USMLE program moves forward with solutions to alleviate this burden, it must also evaluate the fairness of any test administration method. The USMLE program needs to ensure that its test administration models allow all test takers to reliably and validly demonstrate their skills and maximize, to the extent possible, fairness, access, security, and reliability. Increasing capacity by deploying exam administrations to schools may create differential geographic access. Similarly, with respect to remote proctoring, the USMLE program recognizes that not all schools or individuals have equal access to high-speed internet, a computer that meets the technology requirements for remote proctoring, or dedicated space in which to take the test.
Given these issues of fairness and bias, the USMLE program will continue to work with organizations in the medical education and the medical regulatory community to identify temporary changes to policy and requirements such as relaxing requirements for promotion, graduation, or licensing decisions. The USMLE program is committed to continuing its focus on delivering safe testing and fair test results for examinees.
Step 2 CS
As announced previously, Step 2 Clinical Skills (CS) testing has been suspended due to the COVID (coronavirus) pandemic, and the USMLE program is pursuing testing solutions to ensure the health and safety of examinees and test center staff. After careful consideration, the USMLE program has determined that it cannot resume the exam in its current format without unacceptable risk to examinees and staff.
Prior to COVID, the USMLE program was in the very early stages of exploring alternate formats and methods for delivery of the Step 2 CS exam, as part of overall efforts to enhance the USMLE. As a result of COVID, these plans have been accelerated and are focused on a testing solution that employs a telehealth model, where examinees and standardized patients would interact on-line, via a web browser. The USMLE program is aggressively assessing this solution, which will require significant redesign of the exams content and delivery. Expediting such changes to the exam format and delivery will help result in a safe and effective assessment for all involved.
At this time, Step 2 CS testing is expected to resume after July.
Please know that the USMLE program is doing everything it can to address the challenges of this new environment quickly, and that it will continue to provide you with updates on its progress.
Experience 2021 3 step
by Bisi Akindele
Ø Preparation time: months
Ø Main Resources: Step 3 UW + UW CCS Cases + CCScases.com
Ø Supplemental Resources: Step 1 First Aid + Crush CCS pdf + USMLE Primum software + Random overview of few Step 2 CK notes
Ø NBME 5: (4 weeks before day 1)
Ø UWSA 1: (2 weeks before day 1)
Ø UWSA 2: (1 week before day 1)
Ø FRED FIP: 81%, 79%
Ø FRED ACM: 77%, 77%
Ø UW 1st pass: 78%
1. Started with Step 3 UW:
questions in all.
I studied it system-wise, in timed mode.
Advisable to do in the timed mode as sometimes in the real deal, the questions can be long.
System wise because UW is a learning tool, and consolidating every system together helped me a lot.
2. While solving UW questions, I kept referring to Step 2 CK notes.
Initially, I used to solve 40 questions a day, then went to 60/day
3. CCS Cases (after UW 1st pass)
🔴Go to usmle.org
Watch the video
Watch the animation
🔴Download the premium software
Practice the 6 cases
🔴Read crush ccs step 3 pdf about how to actually handle the 6 cases and the 6 subcategories in which we are scored.
🔴Read 5 practice cases from UW, so that you understand how things are to be done
🔴Practice 5 interactive cases from UW to get an idea
All this can be done in days!
🔴Then, once you feel a tad bit confident, practice cases on ccscases.com
They give you feedback with % (which is missing from UW). (Aim for >80%)
So, you know what you're doing wrong.
You can practice the same case multiple times to get a hang of it.
🔴After doing 50/ cases from ccscases.com, do 20 interactive cases from UW.
The way UW distributes scores is slightly different and it is good to know both software.
Aim for cases a day.
So in one week, you'll be super confident.
🔴And then I'm hoping you can
1. Practice remaining cases from UW and ccs cases for more exposure,
2. Redo cases from ccs cases
3. Read UW practice cases
4. Read crush ccs pdf
Between day 1 and day 2 for more confidence.
4. weeks before the exam
Do the marked questions from UW as your 2nd pass
Solve random questions from Amboss for more practice. Choose to include step 1 and Step 2 CK style questions as well, especially for immunology, microbiology, a few topics from pharmacology, and few topics from biochemistry.
Read Step 1 First Aid (Just the basic topics, not in detail)
Do UW biostatistics review (Its fun. Shouldnt take more than a few hours)
5. CCS Sheet for orders
I did not use this in the test, as I liked to go with my intuition as to which tests to order. However, during practice, I had made a list of tests that I kept in mind later on!
-Type oxygen and select both pulse oximetry and oxygen therapy
-Type iva and NSS (for IV access and NS)
-cervical collar if trauma
Other important orders
-x-ray/ CXR/ x-ray abdomen for acute condition
-Pericardiocentesis or needle thoracostomy etc (all emergency treatments)
-FAST if trauma
-LFT (CMP = BMP + LFT)
-Accucheck (for glucose)
Cultures: blood/ urine/ wound/ tampon/ csf/ sputum etc
If you do synovial fluid aspiration, also place separate orders for synovial fluid gram stain, culture, gonococcal antigen, crystals, cell count, etc
If you suspect STD, dont forget to rule out other STDs (HIV, Hepatitis panel, VDRL, Chlamydia, Gonorrhea)
In a woman of reproductive age, dont forget: Beta HCG
In a pregnant woman, dont forget: NST and fetal cardiac doppler
-type and cross match
When you transfer a patient to the ward
B: Bed rest
C: Stress ulcer prophylaxis (PPI)
D: Diet (diabetic, low salt, NPO)
D: DVT prophylaxis (LMWH, compression stockings)
E: Elevate head end of the bed
F: Foley and urine output
G: Gastric tube if needed
Written by Amrin Kharawala
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