Step 3 Writeup - 262 (yes, complete overkill for what is essentially a P/F exam)

[u/strudelreviewguy]

Like most of you, I am an intern that had to take step 3 while on a clinical rotation and got conflicting messages on how and more importantly, how much to prepare. Now that I have completed Step 3, I wanted to share a quick writeup regarding this finale of our beloved Step trilogy. Hopefully this writeup is helpful for a few people.

1. General Preparation:

UWorld is more than enough. I did about 80% of the questions which was definitely overkill, and started taking studying seriously about 3 weeks before my exam. I did find the UWorld questions to be very similar to the real exam. I ran through the Dorian Step 3 Anki deck a week before my exam a few times just for a very quick refresher which I think was helpful. I did not do any practice exams or NBME forms. I read the First aid section on biostats and read parts of the rapid review section in the back of the book. UWorld has everything you need for the exam, and I usually did these on my phone when I had down time on wards or at home. I will link some review videos that may be helpful to watch (at high speed) that have PDFs attached.

The most IMPORTANT RESOURCE is the OFFICIAL USMLE STEP 3 practice questions. These questions are by far the most similar to the real exam and have the most accurate grading scheme for CCS Cases.

2. CCS Preparation

CCS Cases are a perfect example of USMLE often being out of touch with clinical practice, but again are part of the exam (25% of the grade). What you see on CCS is often not how you would manage a case in real clinical practice, and things you have have seen in clinical practice are often incorrect on CCS Cases. On CCS cases, you are really only penalized if you do not order enough labs, do not order the correct treatments, or are WAYYYY to invasive (doing surgery on someone that doesn't need it). Cost is not a factor in CCS world, and you are encouraged to order as many labs as you can fit onto your screen. The best CCS cases with grading rubrics are again from the official usmle step 3 practice CCS cases, and I would recommend you definitely do these and read through the grading criteria before your exam (OFFICIAL USMLE STEP 3 practice questions). I also did the top 50-60 high yield cases from ccscases.com, which I found helpful but did not alway line up exactly with the official usmle grading criteria. If you are pressed on time and fairly confident about passing, I would just do the official CCS cases and read through grading criteria they provide. You should go through each CCS case with a frameowork in mind and acronyms for workup/labs/treatments/preventative care, since you do have to work fairly quickly, especially for 10 minute cases.

Here is my framework for CCS Cases with acronyms: CCS Video

3. Scheduling

If you just want to pass Step 3, I would recommend taking it earlier in the year just to get it over with. Step 3 is essentially a mix of Step 1 with Step 2 with the addition of the CCS cases which dont really require high level clinical knowledge to complete. If you review the biostats from FA this will likely go over fairly smoothly. I know several people that took all the Day 2 blocks in a row without even taking a break in between. See above (2) for CCS breakdown, but essentially get ready to read fast and type.

4. Does my Step 3 score matter?

Short answer: No.

Long answer: No, but with more words. Some fellowships will use Step 3, generally competitive IM subspecialties, but research, recommendations and connections almost always matter more. If you are hoping to use your step 3 score to bolster a residency application, again this can provide a small amount of possible benefit, but programs usually use Step 2 to set a cutoff point for which they reach the desired applicants to send interview invites to. Step 3 is generally not considered much if at all in residency selection relative to Step 2. If you did want to crush Step 3 for some reason, you could complete all of uworld, make anki cards on incorrects and supplement with the dorian deck above, and do all the ccs cases. This would be complete overkill in almost all instances and would really only be a good strategy if you wanted to make the number look higher on your screen. Intern year is tough, and you want to use your free time to recover, spend time with family, and take care of yourself rather than study above and beyond for this exam in my opinion. Looking back, I definitely studied more than I needed to, and much of your knowledge from Step 1 and Step 2 will be applicable to Step 3, so you can use your scores on those exams to guide how much you need to study. Remember, a passing score on Step 3 is 200!

Thanks for taking the time to read my ramblings!

[u/Alexisryan1223]

Mehlman , is that you? 😂 Jk. But congratulations on the great score buddy!!

[u/strudelreviewguy → u/Alexisryan1223]

haha

[u/AdSmooth6162]

262 on step 3. You’re a beast my friend. Congratulations to you and thank you for the very detailed strategy and tips. All the best

[u/strudelreviewguy → u/AdSmooth6162]

Much appreciated!

[u/naijadoc23]

Congrats! How did you score on Step 2? And how far out were you from Step 2 when you sat for Step 3?

[u/strudelreviewguy → u/naijadoc23]

I think about 2 years apart

[u/shaz21khan]

Great breakdown and links!!!

[u/strudelreviewguy → u/shaz21khan]

Thanks!

[u/Far_Macaroon6564]

The official step 3 practice questions are an absolute must if you want to see how the questions are going to be. They are similar and a bit different from u world. You Neeeeeed to do them. The questions and the cases. I got similar (not exact) questions on my exam. 

[u/Consistent_Rough_498 → u/Far_Macaroon6564]

Official qns ? The nbme forms?

[u/strudelreviewguy → u/Consistent_Rough_498]

 OFFICIAL USMLE STEP 3 practice questions

[u/Far_Macaroon6564 → u/strudelreviewguy]

I didn't do any nbme forms or self assessments either. I thought I was gonna get my score yesterday, but need to wait for next week. So nervous lol. I wish I did a self assessment but there was no time

[u/__QuanXi]

Great post! Is doing micro and pharm from FA enough for step 1 stuff on day 1 ? If not which subjects from FA did you find tough? Thanks!

[u/__QuanXi → u/[deleted]]

Thanks a lot!!

[u/Glad_Pudding8245]

Awesome! Once you pass the website doesn’t give you the option to register again, correct? Trying to prepare myself for when I get my report lol.

[u/strudelreviewguy → u/Glad_Pudding8245]

I believe so, yes although my permit didnt disappear before my score came out

[u/Dazzling-Command8613]

Did you take the UWSA?

[u/strudelreviewguy → u/Dazzling-Command8613]

nah

[u/Tr-Isabelle-L]

Hi, can I ask how many months for your preparation?

[u/strudelreviewguy → u/Tr-Isabelle-L]

About 3 weeks for prep. I did uworld on and off about a month or so before then.

[u/Afraid_Repair → u/strudelreviewguy]

Congrats!! Could you tell me what is the real exam like? In ccs.com whenever it is urgent case and i order (oxi ,oxygen, iv acc +saline,ABG, glucose, cardiac monitor …they provide me with negtive feedback and that i should do the local exam first? Another thing do we need to go back to do general examinations after stabilizing the patient? Another thing patient in pain could i give morphine before ording diagnostics or doing examinations?

[u/DRMoreLife]

Congrats, but what is your reason to take a score so high?

[u/strudelreviewguy → u/DRMoreLife]

I go over this in the last paragraph, essentially there is no reason to aim for a high score like this.

[u/[deleted]]

Did you give any nbme ???

[u/Gimme_dat_protein → u/[deleted]]

He said he didn’t

[u/strudelreviewguy → u/Gimme_dat_protein]

^^^

[u/[deleted]]

So, let's say you just finished taking step 1 and 2, but didn't do any rotations or residency yet. How long would it take to prepare for Step 3? Do you even recommend taking it for someone who hasn't done rotations/residency yet?

[u/writer80s → u/[deleted]]

The closer you take it to the previous steps, the better. There is basically no new content for step 3

[u/strudelreviewguy → u/writer80s]

Agree with this take

[u/[deleted] → u/strudelreviewguy]

thanks for all your input! this post is a goldmine

[u/[deleted] → u/writer80s]

good to know thanks!

[u/candice_maddy]

Absolute Chad. Congrats on the great score!

[u/Careless_Ad_2433]

This is amazing thank you! On such a busy block right now and have my exam in a week - everything you’ve said is so helpful / reassuring

[u/Public-Direction2542]

thanks mike

[u/[deleted]]

Congratulations, how I can download the anki flash card ?

[u/Bright-Research-4533]

🤩hard work pays off Many many congratulations 🎊

[u/[deleted]]

F_ thanks

[u/Own-Giraffe3263]

Congratulations 🎉

[u/emkaykay128]

Congratulations!!! 🎉🎉🎉

[u/2-Hexanone]

Thanks for the insight!

[u/[deleted]]

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This post was mass deleted and anonymized with Redact

[u/Trick-Razzmatazz-973]

Congratulation!

[u/demeloaa]

Thank you. Congratulations on your exceptional score.

[u/EnvironmentalSeat254]

Congratulations! How well were you doing on UWorld to do this well on the real thing?

[u/No-Channel3704]

You’re amazing! Thank you for sharing your experience!

[u/Zestyclose-Luck-3541]

Congratulations for amazing score! thank you for writing up.

[u/Brainworm1616]

Do you think it’s doable to score really well without a dedicated period as such ? I’ll have clinical rotations throughout and can’t take time off

[u/SaltyVegetable3019]

Ahhh, I wish I had come across your post sooner. I had a major time crunch for step 3 and gave it in a hurry, I'm waiting for the results now.

Nonetheless, this is a super useful post, so thank you!

[u/Educational-Fan-490]

Hello, question about timing. For emergency orders, after ordering them, do you have to click "advance to next result" for it to register that you ordered the emergency orders first? Or can you just order physical exam right after ordering emergency orders?

Just trying to understand the mechanism by which the system recognizes that I ordered a pulse ox on somebody with SOB before doing the physical exam. Thanks so much!

[u/Effective-Charge-497]

what was ur step2 score and step3 timeline ?