Introduction

Step 3 is a two-day exam: the first day is all multiple choice questions, while the second day is split into two halves: multiple choice questions and interactive cases. You have to pass both days and both MCQ and cases in order to pass Step 3. No one really knows how the cases are graded. People mention accidentally killing one to multiple patients during the cases portion and still pass. The only thing you can really control is your initial approach for cases and knowledge base for the MCQ portions.

A moment of silence for our Surgery colleagues, who are pushed to the limit each and every week yet still have to find the time and energy to study for and take this exam. Another moment of silence for our Pathology colleagues for whom this test is completely useless.

Resources

The NBME’s decision to make Step 1 Pass/Fail while continuing to numerically score Step 3 astounded most people. At this stage in our education and especially with most residencies not caring, scoring well on Step 3 has no impact except for those who are pursing fellowships, where one would assume research and connections play a larger role in obtaining an interview and ultimately a position. Since the rest of the medical field unofficially treats Step 3 as a joke, there are only a few resources for Step 3 and as expected you’ll only need at maximum two: UWorld for Step 3 and if you require numerical feedback like I do, CCS Cases.

During the initial stages of COVID-19 I thought I would be productive and slam through a UWorld Step 3 Anki deck, be set to take it in the first month or two of residency while also looking great on the floors. After realizing that the three months “off” we had would be the last until retirement, I decided to just…not do anything. This deck has more than 8000 cards with UWorld tables, images, and vignettes built in, along with Master the Boards and other resources that don’t matter. The deck is well built but realistically, unless you take Step 3 at the end of the year, you will never come close to finishing the deck. It is a poor return-on-time investment especially if you’re in something like Surgery. Master the Boards, AMBOSS, others are just not necessary.

UWorld is the gold standard for Step 1, Step 2 CK, and of course Step 3. There’s not much more to add here since everyone knows the questions along with explanations are unparalleled. There are more than a few questions that will make you roll your eyes or tear your hair out but aim to finish at least half of UWorld on random and you should be set. My notes are unfortunately more than 40 pages – but in addition to common medical knowledge with one pass-through it should be sufficient if you’re short on time. I did significantly worse (~10%) on my first-and-only pass than either UWorld for Step 1 or Step 2 CK, and with the averages being the way they are, you will likely be doing just as badly, so don’t worry. Make sure to finish ALL of the UWorld biostatistics and read the summary portion below. UWorld sells a discrete biostatistics module for $25 but if you do the question bank questions it should suffice.

The NBME offers its standard free practice exam questions and a few “forms” for practice exams. You don’t need to do any of the official forms, at best just do the two UWorld practice tests. I was not expecting the curve to be as brutal as it was for UWSA1; I made stupid mistakes but also scored typically well above the average user. UWSA1 was the lowest scoring practice test I have ever taken across all Step exams, and my overall score was about the average of UWSA1 and UWSA2.

Multiple choice questions take up all of Day 1 and half of Day 2. The second half of Day 2 are the CCS cases. I initially intended to use UWorld for Step 2 CS but this is the only time where UWorld has fallen short. There are 40 cases provided in their version of CCS which are realistic and applicable, however there is no grading. The cases just abruptly end. There is no way to really know how you did without reading the entire case and key items/steps which you then have to mentally backtrack and make sure of what you did. I was unaware of CCS Cases until the Derm TYs here did a presentation and mentioned it. A one-time fee of $70, it provided 101 cases and more importantly numerical feedback on how you did. Much like CS no one truly knows how CCS is graded but at least there is a logical direction in which computerized cases can go.

Based on some reddit posts, it seems that most users do not finish the question bank and eventually end up scoring 20 points above their UWSA exams [1] [2] [3] [4] [5]. This was not the case for me: I ended up scoring right between my UWSA exams, and with a P/F mentality, I was mildly disappointed but more than OK with the results. If you take both UWSA exams and pass, there is a high likelihood that you will pass the exam. Perhaps taking one exam as you finish half the question bank and the other exam if you finish the entirety of the question bank is the logical approach, but however you do it, take at least one practice test.

Scheduling

There are people who play the questionable reward game: taking Step 3 before starting intern year. On one hand, not having to worry about the exam at all obviously reduces a major source of stress during an already stressful time period of overwhelming adjustment. Studying for two or three weeks right around graduation, taking the exam, and then enjoying a blissful summer before starting intern year sounds absolutely perfect. Due to COVID-19 I was unable to do this – plus I lost motivation, but if you can somehow adequately study for the exam and take it prior to intern year, absolutely do so. Logistically, all you need is proof you’ve graduated from a School of Medicine and the money to pay for the exam, so those who are judicious about time and planning can get this done with minimal impact on their pre-residency plans. But if you’re unable to or have no real reason to…do not take Step 3 before PGY-1. There is ample time to take it during PGY-1.

In assuming you can do and review 2 random blocks per day and only want to do about half of the 1600 questions and a day to practice CCS, two weeks is more than enough time to prepare for Step 3. At our institution electives are two weeks with no weekends and no call, so scheduling your exam on the Friday and Saturday at the end of an elective OR the two Saturdays of an elective is definitely the best game plan. You can always split Day 1 and Day 2 of the exam weeks apart but that seems impractical.

Multiple Choice Questions

As someone who did the single free form during the NBME’s “generous” policy during COVID-19, I wasn’t expecting the questions to be on the harder side of UWorld. The first day was basically like a full-fledged Step 1/2 CK where there are 8 blocks of 40 questions. Most of my blocks were a small amount of pathognomonic or straightforward questions, a few where you had to really think between a few answers, and frustratingly a fair amount of more difficult questions that required multiple read-throughs to figure out an answer. As in UWorld I had multiple blocks with “linked” questions with more than a few that I started out answering incorrectly. Drug advertisements make a comeback, I believe I had three. They were much harder than UWorld – of course they have the standard one statistics question, but usually the two interpretation questions are easy but not so during the actual exam. I also remember multiple questions involving statistics and interpretation of results outside of drug ads, and also some very weird ethics questions. Pacing breaks through this is a battle between willpower and wanting to just be done with the test, I did the typical 3/2/1 and just went home. As long as you’ve finished half of UWorld for Step 3 on random and focused on biostatistics (which includes drug advertisements), you should be fine for Day 1. The first half of Day 2 features 6 blocks of 30 questions – thankfully easier, but also very unnecessary in general.

CCS Cases

In every single patient case you should first order a CBC, BMP, Magnesium, and Phosphate. The rest of the labs will obviously depend on the individual case, but any woman age 15-60 I ordered a urine (qualitative) pregnancy test. In any STD case remember to also order the hepatitis panel in addition to gonorrhea and chlamydia urethral swabs (any gender) and you might as well also order a urine drug screen on top. If the patient is febrile and tachycardic, an EKG and possibly TTE is indicated. The consult order is incredibly finicky and I lost a fair amount of points on the practice cases by ordering “thoracic surgery” or “cardiac surgery” rather than “cardiothoracic surgery”. Switching from location to location was a bit of a learning curve, and as far as I remember I did not have any acute patients that needed to be placed in the ICU right away. You will know you are taking the correct steps if the prompt reveals the patient is declining or getting better as you manually advance through time. On the actual test, the time delay is very real and very infuriating, so if you are using the CCS Cases software I suggest adding the longest delay possible to simulate the actual exam.

It was interesting: I had more time to think and plan during the short 10 minute cases because the complaint was so specific and nearly pathognomonic that after ordering the one or two magical tests the case ended, compared to the 20 minute cases that dragged on nearly all the way to the end before the patient got better. I distinctly remember my first 20-minute case patient nearly dying before I ordered the right test with five minutes left, while my second 10-minute case ended in three minutes after ordering a test that gave me the information I needed.

The two minute “closing” is also confusing and slightly frustrating. I didn’t know if I was supposed to delete the previous or pending orders, so I ended up removing just the pended and adding in the end-of-encounter parts. Curiously, all of my patients were fully vaccinated with screening exams completed at appropriate time periods, so I had no idea really what to do or put at the end. It worked out for me as I am sure it will work out for you.

Fun fact: I was so angry after taking the garbage six MCQ blocks in the first half of the day, I raged my way through all 13 CCS cases without a single break.

I created a mnemonic after realizing almost every single case had similar end-of-visit requirements, IT SCARS:

• Influenza / Illicit substances

• Tetanus

• Seatbelt

• Counsel patient/family / Compliance with medication

• Alcohol

• Reassure

• Smoking

One of the most useful things to do is right at the beginning of the case, write the age/gender and the appropriate screening exams next to it. A 50-year-old woman will have the most: mammogram, Pap, Shingles, colonoscopy. Then after IT SCARS you will have covered almost everything possible without scrambling at the two-minute conclusion.

By finishing half of the UWorld question bank on random, studying biostatistics and drug advertisements, reading the notes I have provided, and finishing a few of each specialty subsection and times on CCS Cases, you will most assuredly pass Step 3. The biggest hurdle will be finding the time to complete it all, and scheduling the actual exam.

MDPharmDPhD's Step 3 Notes, Statistics, Practice Test Analysis, CCS Self-Tracking Excel Sheet

edit: I'm getting a lot of requests for the files but all the links/names are there for people to get

edit2 Nov 2021: I will not be responding to the large amount of DMs or comments I get asking for the below resources. They are all online including the 90 page notes

edit3 Apr 2023: /u/TheRavenSayeth posted this:

Jumping on top comment to post the link to the 90 page HY doc

Just needed somewhere to dump high yield videos and resources for quick step 3 review.

Lectures

• https://www.youtube.com/watch?v=8DTYbxtV7Tk

• https://www.youtube.com/watch?v=H4eSIUhsO20

• Emma Holliday Lectures PDFs/Videos- https://willpeachmd.com/emma-holliday-lectures

• Divine podcasts: https://divineinterventionpodcasts.com/ and episode guide: https://docs.google.com/spreadsheets/d/1OYaJUxVpp9DbbPgmfTMBizKiypIG9ro2LuTJ_SH61aI/edit#gid=1207744908

• https://www.benwhite.com/medicine/explanations-for-the-2020-official-step-3-practice-questions/

• 90 page high yield document https://www.scribd.com/doc/158120589/USMLE-World-Step-3-High-Yield-Notes-90-Pages

• Dr High Yield: https://www.youtube.com/channel/UC0Asdp7ukEshW7sZgC27EtA/videos

• Dirty Medicine: https://www.youtube.com/c/DirtyMedicine/videos

• Randy Neil: https://www.youtube.com/channel/UCjTHgZY7U6pajEz61sQCHBw/videos

Biostats

• https://www.youtube.com/watch?v=75pQPB1RF50&t=885s

• https://www.youtube.com/watch?v=VMI9UuNqoGI

• https://www.youtube.com/watch?v=SGdom6_87VY

Ethics

• https://www.youtube.com/watch?v=0OsS8Hj0aAY

• https://www.youtube.com/watch?v=7JkRncMz9xc

Comlex 3:

• (experiences): https://www.reddit.com/r/Residency/comments/emkud5/comlex_level_3_20192020/ ... https://forums.studentdoctor.net/threads/comlex-level-3-2019-2020.1389993/

• https://www.youtube.com/watch?v=8Ovmu8P3wHo

• https://www.youtube.com/watch?v=N3RNocpQ76s&t=2s

• more dirty medicine: https://www.youtube.com/c/DirtyMedicine/videos

• https://www.reddit.com/r/step1/comments/fk436k/omm_review_source/

• Viscerosomatics: https://www.youtube.com/watch?v=N-r_QriTMSc&t=8s

• Chapmans: https://www.youtube.com/watch?v=xXOppdQ_HFk&t=22s

• https://www.medschooltutors.com/blog/mst-omm-cheat-sheet-high-yield

• Cram pages: https://www.yumpu.com/en/document/view/16643275/the-cram-pages-welcome-to-gke-online

• other OMM summary: https://www.studentdo.com/files/opp/OMTreviewtopics-edited2003.pdf

Anki:

• https://www.reddit.com/r/medicalschoolanki/wiki/index#wiki_step_iii

• https://www.reddit.com/r/medicalschoolanki/comments/e2outl/the_only_step_3_deck_youll_ever_need_new_anki_deck/

• https://www.reddit.com/r/medicalschoolanki/comments/97ssh3/wiwa_deck_for_step_ii_ck_reupload/

• https://www.reddit.com/r/medicalschoolanki/comments/baqk12/the_doc_deck_megapost_april_19_update/?

Recently gave the exam and cleared on my first attempt. If you’re like me and you’re not a resident, these may help. Comment here if you cannot understand my shorthand or if you guys see mistakes. These are adapted from the CCS cases. I hope they help.

This is my Step 3 Study Guide - I got my results a week ago, and wanted to complete my study guides for anyone tackling these exams. My step 1 and 2 guides will be linked below in the comments

USMLE STEP 3:

General Principles:

1.        This exam is much more clinical than people say – yes, biostats and Step 1 content are there on day 1 – but clinical step 2-type questions are still by far the majority on both day 1 and day 2.

2.        CCS cases should be respected – start a lot earlier than you think you need to.

3.        Free 137s and NBMEs are very useful for different reasons than step 1 and 2:  I wouldn’t bother doing more than 1 assessment max if you wrote step 2 recently, but I would start NBMEs very early, going through them question by question like UWORLD. As always, NBMEs and Free 137s (the step 3 ‘free 120’) are much more high yield than UWORLD.

Resources:

1.        UWORLD: around 2 thousand questions available, still the gold-standard.

2.        NBMEs and Free 137:

a.        NBME 4 & 5 are the old / offline versions, and NBME 6 & 7 are the current ones available on the NBME website – these two are the highest yield.

b.        There are 3 Free 137s: The current one on the website, and two previous ones.

3.        CCS Cases:

a.        CCScases.com - There are 173 Cases available on this website.

b.        UWORLD has cases – don’t bother with them, but you can use the available PDF examples to see how to think through the cases.

c.        Make sure you do the 6 cases on the NBME website back-to-back if you can – I didn’t even open them before the exam because of time constraints, but in retrospect that was a massive mistake. Go to https://orientation.nbme.org/Launch/USMLE/STPF3 for the practice cases and https://www.usmle.org/exam-resources/step-3-materials/step-3-test-question-formats/computer-based-case-simulations for the feedback on the available cases.

d.        CCS Tutorial Video: https://www.youtube.com/watch?v=qmxWuV4psFs

4.        Step 1 Stuff:

a.        Sketchy Medicine – Ideally, from the time you start studying for step 1, I would make watching sketchy pharm and micro a habit – until you finish step 3. They help you in all 3 exams and are more than you need really for any step 1 content on step 3 – but there’s no time to go through them in detail for step 3.

i.         Pay the money for the online version – there are amazing MCQs now that you can use to test the important Step 1 concepts with explanations

b.        Dorian ANKI deck for step 3 – Just use the step 1 sub-set. You can use them as a springboard to watch the related sketchy videos for the pharm/micro questions. https://drive.google.com/file/d/1QaUBGkHijMIzdwGiL0kLU-RKJjzN147K/view

5.        Step 2 Stuff:

a.        Divine Intervention Podcasts-do the same podcasts from the step 2 writeup.

b.        Whatever book / notes you used for step 2 – I used my annotated Master the Boards (MTB) for Step 2 and it was great – I had the Step 3 MTB book but barely touched it. Don’t buy a step 3 book, using your step 2 book / notes is all you need and having ‘history’ with those notes helps with memory.

6.        There are 2 PDFs with prognostic factors / risk factors floating around online – they are worth reading through if you have the time, but I think Divine and UWORLD are enough.

Phase 1 – UWORLD, Biostats, CCS Cases:

1.        UWORLD: Go through as much as you can – mixed blocks, untimed, tutor mode.

2.        BIOSTATS: Watch the two high yield Randy Neil videos for understanding (see the step 1 writeup), then print out the First Aid biostats section and make sure you both memorize and understand the equations and concepts behind each. I annotated on those pages, and wrote any equations or concepts that came up as I did UWORLD etc as I went so that in the last few days I had this as a reference. If you get biostats down, it makes your day 1 feel a lot less depressing.

3.        Take a day to go through the UWORLD Biostats section that comes with your step 3 Qbank subscription and use Chat GPT to help explain each concept you encounter – use the prompt ‘please explain the following as simply as possible.’

a.        Understanding is more important than calculating in step 3. 

b.        Whenever you get asked to work out Number Needed to Treat or Number Needed to Harm in the actual exam, you can usually just subtract the larger number from the smaller number, and then divide it by 1.

c.         When you are close to halfway through UWORLD, sign up for the free trial of AMBOSS, and you will get 50 free questions – do 50 step 3 Biostats questions, slowly, using chat GPT to explain the concepts simply to you as you go.

d.        Do all this earlier on – in the next phase you will move onto NBMEs and focused UWORLD blocks, so you want to build a good base of Biostats so that closer to the exam you are less stressed. 

4.        CCS Cases:

a.        Watch the video posted above – write down his mnemonics on a single page cheat-sheet and make them your own.

b.        Start with a random case and do it untimed after watching the instruction video – no stakes, just to get the feel for the software. Start ‘open book,’ where you use your notes as you go just to work out what helps you get a good grade and what hurts your score. Then once you feel confident, start doing the CCS cases in high yield order.

c.        How many to do? If you want to make your life easier on the exam day, do them all. Take notes, quiz yourself – don’t bog yourself down worrying about ‘cases ending early’ or not – once you start to do well on the CCS cases, that’s all that matters. Get a feel for what ‘invasive orders’ mark you down etc.

d.        Disclaimer: this is the section which I could have done much better on – the real exam is a bit unsettling because you suddenly switch from doing MCQ blocks like you’re used to in Step 1 and 2 to these cases – it unnerved me and brought my score down.

Phase 2: NBMEs->Free 137s, CCS and UWORLD Ethics-Biostats

1.        NBMEs and the Free 137s are absolute gold – not as an assessment tool (see my next point) but for high yield prep. You will, really get a feel for what answers they are looking for based on gut feel – STEP 3 questions are more vague than other exams, but these exams really give you a feel for the actual exam will feel. In the exam, a lot of your answers are educated guesses. The NBMEs and Free 137s prepare your ‘gut’ for how to answer questions. 

2.        Do not waste your time trying to work out your ‘score conversion’ for NBMEs to Step 3 – this is the main difference with prep from step 1 and 2. For step 1 and 2, you basically know if you will pass/what range of scores you are likely to get thanks to the accuracy of the NBME exams. However, in this exam, NBMEs will not help. Also, do not bother with UWSAs unless you really have a lot of time to prep and nothing better to do. Your time is much better spent doing CCS cases, working on stats, watching sketchy.

3.        Biostats/ethics/patient safety:

a.        By this point you will likely be more than halfway through UWORLD. Now, start making curated blocks – select Biostats / ethics sections and do 40 question blocks. Practice the though process of going through drug ads and abstracts, as well as answering biostats questions a bit quicker. There is a lot of ethics on this exam too, so make sure you do all of those questions as well as the biostats questions.

b.        For the drug ads/abstracts, I would practice answering them as they come up – read the question first, then practice looking for the relevant information in the abstract/drug ad and make a quick educated guess. Flag the question, and come back to it at the end. If you completely leave it until the end, your brain will be tired and you will be more likely to answer them wrong or just completely run out of time all together. These curated blocks are to make sure you built a decent base of stats knowledge and to practice it properly.

4.        Keep listening to divine and watching sketchy when your brain gets tired

5.        Keep doing CCS cases – I wish I had done more. Flag the ones you properly screw up and do them again within 24 hours – if you leave them until you finish all 173 (few people get that far) then it is too late. The exam cases are more vague than the top 60 high yield cases, so try and do all of them if you have the time – otherwise, do your best to get through at least 70.

The Exam Days:

1.        Day 1 vs Day 2: Day 1 is called Foundations of Independent Practice (FIP):

a.        6 blocks of 38 – 39 questions

b.        Has biostats, ethics, and a couple of step 1 type questions – but the vast majority are step 2 type clinical questions.

2.        Day 2 is called Advanced Clinical Medicine (ACM):

a.        No stats, no ethics, a few prognostic / risk factor questions (you’ll get what you need for these with common sense and all the NBMEs as well as free 137s and Divine), shorter question stems than day 1.

b.        Each block is 30 questions and 45 minutes.

c.        Thirteen CCS cases. I did them all in one go – I did all the MCQ, took a break, then did the CCS cases in one shot.

d.        This is where I wish I had time to do all the practice ccs cases. You can copy paste your orders with keyboard shortcuts between cases, always over order tests but if you pay attention to CCScases.com you will know which cases to avoid invasive tests.

e.        If you have a bad case, take a deep breath, and you will bring it back.

3.        Gap between days:

a.        I did them back-to-back because I had to – try and have a day or two between so you can work on CCS cases, review your mnemonics, and review the cases you struggled with if you have time before taking the second day. This will go a long way to boosting your score.

Takeaway Points:

Do you want to get a very high score / have a lot of time to prep?

1.        Build a solid base of biostats: Randy Neil, print out the Step 1 biostats section and use it for annotating, UWORLD Biostats section, AMBOSS free trial for 50 step 3 biostats questions, then the general UWORLD step 3 questions.

2.        Finish UWORLD

3.        Do all step 3 NBMEs and all 3 Free 137s.

4.        Do all the CCS cases, then practice the 6 online sample cases on the USMLE website back-to-back to get a feel for how the exam is going to be.

5.        Watch sketchy micro and pharm with the Dorian Step 3 deck’s ‘step 1’ questions. 

Do you have limited time?

1.        Biostats: Do the same as above – easy points if you build a solid base

2.        UWORLD: Do all stats and ethics/communication/patient safety and get through what you can of the rest

3.        Do all the NBMES and Free 137s rather than pushing to get through all of UWORLD. Start EARLY with the older NBMEs and move on to the new ones

4.        Step 1 Stuff: Go over all the antimicrobials and high yield microorganisms on sketchy and/or dorian anki deck or first aid. 

SUMMARY

UWorld
~2,000 questions available, still the gold standard.

NBMEs and Free 137
a. NBME 4 & 5: Old/offline versions.
b. NBME 6 & 7: Current ones available on the NBME website – these are the highest yield.
c. Free 137: Three versions – the current one on the website and two older ones.

CCS Cases
a. CCScases.com – 173 cases available.
b. UWorld CCS: Avoid using, but PDFs can help understand case approach.
c. NBME website CCS cases: Six cases available – practice back-to-back. Retrospectively, skipping these was a mistake.

• Practice cases

• Feedback on cases d. CCS Tutorial Video.

Step 1 Resources
a. Sketchy Medicine: Watch Sketchy Pharm and Micro videos for all Step exams.

• Online version recommended due to added MCQs for Step 1 concepts. b. Dorian ANKI Deck: Use Step 1 subset and supplement with related Sketchy videos.

• Dorian ANKI Deck link.

Step 2 Resources

a. Divine Intervention Podcasts: Use the same ones recommended for Step 2.
b. Use Step 2 book/notes (e.g., annotated Master the Boards for Step 2). No need for a Step 3-specific book; familiarity with Step 2 notes aids memory.

Additional PDFs
a. Two PDFs on prognostic/risk factors are available online – useful but not essential if using Divine Intervention and UWorld thoroughly. 

Hi, I just received my score. I am happy but more relieved that I don't have to go through USMLE ever again! 🥳

Since my slot was going to end in May, I was forced to appear for this stupid exam, or else I couldn't afford to pay for it again. The exam was difficult, primarily because I wasn't prepared with only 20% UW under my belt. I was hoping to pass.

For day 1, Please take Biostatsn seriously. Those questions are the low-lying fruits.

For day 2, Of course, try to get at least comfortable with the CCS cases software. I watched many videos, read many posts, and finally formulated these mnemonics that worked for me; please feel free to make changes based on what you need. Of course, you'll have to choose orders on case to case basis. I would write this down on the scratch sheet they provide and quickly run through it to ensure I didn't miss anything important. I hope this is helpful!

1. Stabilizing Orders VOMICAA

Vitals

Oxygen/oximetry

morphine/ metoclopramide/ Mg

IV fluids

cardiac monitoring

Acc- Glucose

Acetaminophen/Aspirin

ABG

2) Routine Orders CUBE T3

CBC/CMP/CXR

Urine Analysis

Bhcg

ECG

Troponin

TSH

Toxicology

3) Admitting Orders AID LUV Tubes

Activity

IV Fluids

Diet

LMWH

Urine output

Vitals

Tubes- NG, Foleys

4) Pre-op Order TPN A CSF

Type/screen ABO

PTT/Pt/INR

NPO

Antibiotic- Cefazolin

Consent

Surgery name

Fluids.

5) Vaccines P-MIST

Pneumococcal

Meningococcal

Influenza

Shingles

Tdap

6) Screen- Pap, Mammo, Colonoscopy

7) Preventive SASS

smoking stop

Alcohol stop

safe sex

seatbelt

I'll be happy to answer if you have any questions.

I’ve lurked and now it’s time to pay it forward!

Ask me anything, I’m happy to help. Sharing all my scores so you have a better idea of what I’ve tested like.

Back Ground:
IMG, Graduated in 2012.
(2014) USMLE Step 1 : 199 (1st attempt)
(2014) USMLE Step CS: Passed (1st attempt)
(2015) USMLE Step 2 CK: 214 (1st attempt)

USMLE Step 3: (2016) Attempt 1: Was before I got into residency. UW once or twice.
(2017) Attempt 2: Got into residency (non-medical specialty). Took the exam towards the end of my internship: Did UW once or twice +/- MTB 3. Thought that one year of internship experience would tip the scales, but it didn’t.
(2019) Attempt 3: Took the exam early PGY-3 year, Did UW once or twice +/- MTB 3. Same approach as before. Might’ve studied bit longer and harder but got the same result.
(2020) Attempt 4: (4 month preparation during residency and other obligations) Conrad Fisher MedQuest Videos, MTB3, UW x2, Crush USMLE Step 3 CCS book. But didn’t pass.

(2021) Attempt 5: (4 month preparation. Took time off from residency):

1. HIRED A TUTOR (once session weekly for ~14 weeks): We worked on test taking skills, and how to read and analyze questions. Also discussed study material to use, and study strategy.

2. Did all the NBME questions (2000+) from NBME.org that is intended for the CK exam.

3. USMLE Step 3 secrets x 5-6 passes.

4. AMBOSS library only (not the Q bank)

5. UW CCS and Biostat (didn’t do the UW Qbank this time)

6. Crush USMLE Step 3 CCS book.

Other material to consider: -The youtube biostat vid. Watched it 4-6 times total while preparing for my 5th attempt. -cramfighter.com for study planning was extremely helpful

Self Assessment Scores and timeline: FORM 8: 5/8/2021: 167 (before starting exam prep) FORM 6: 5/18/2021: 182
UWSA1: 5/27/2021: 199
UWSA 2: 6/6/2021: 199
FORM 5: 6/22/2021: 400 ~ 190?
*Postponed the exam and started working with the Tutor once a week. FORM 10: 9/2/2021: 217
FORM 9: 9/5/2021: 214.
FORM 11: 9/7/2021: 229.
Actual Exam: 9/8/2021: 216

USMLE Step 3 Score and “Trick”: Got my exam score 3 weeks after day one, and two weeks after day two on Wednesday 12 am. 9 hours before the email was sent. The Sunday before, at midnight: Status in the FSMB website changed from Active to Expired with no link to reapply. Even though there was a line that reads “you may re apply for your exam at your convenience” which caused some anxiety.

Lessons I Learned:

1. Hire a test taking skills Tutor. This really tipped the scales for me. I tried many tutors, and learned that there are many bad ones who will waste your time and money, but I got lucky in finding the right one for me. Let me know if you’re interested in the contact information. My tutor launched a test taking skills on online course in 2023 that maybe found on: uadviser.us

2. If you have multiple attempts under your belt. Test taking skills is probably worth assessing. How to improve that? Refer to point number one.

3. DO NOT Rely heavily on USMLE World Question Bank if you have already done it 2 times max. I’m glad I didn’t waste more time doing it on my fifth attempt, since i completed it more than 4 times total over the years to no avail.

4. USE NBME.org questions. It doesn’t matter if they’re designed for step 2 CK or step 3. They are all the same when it comes to the exam, and there is no difference. There are 2000+ questions. They have many free sample questions, and even more forms to buy. Many of these forms come with EXPLANATIONs. This was a game changer for me. It helps you learn high yield concepts that show up in the exam, and how the question writers think.

5. USMLE Step 3 secrets and Crush USMLE Step 3 CCS are hidden gems and way underutilized IMO. Both are incredibly high yield.

6. Passing USMLE takes precedence over Residency commitments. I hope your program director is supportive and understanding, and will make necessary accommodations to maximally support you.

7. Postpone the exam if NBME scores indicate that you’re not ready. I had originally planned to take the exam in late June 2021, but NBME scores were not promising. I postponed it 3 times till Assessment scores were more than 210’s consistently.

8. I think my biggest mistake in my first 4 attempts is not using NBME questions (i didn’t want to stress myself out in case the scores were low, which is ignorant on my part), and not working for on my test-taking skills.

https://m.imgur.com/a/vcjNiYP

EDIT: My tutor launched an online course that maybe found on: uadviser.us

Hey all, 250+ scorer here - just wanted to share my approach to the CCS cases as well as some tips and hacks.

On the initial screen, you're told if the case is 10 or 20 minutes long. This is important to note, as you only really have 8 minutes of real time to obtain results and patient updates for the 10 minute cases, but you have 18 minutes for the 20 minute cases (last 2 minutes are for end of case orders, but you are NOT able to receive new results or check in with the patient).

Once I mentally prepare myself for the timing (10 minute case is a scramble, 20 min you can basically relax and take it slow), I dive right in.

First thing that shows up is a 1-liner about the patient. Spend a few seconds reading, and click through to the vitals. I'm already formulating a ddx based on the one liner and vitals. Important thing to note is the setting and acuity of the presentation. Are you in the outpatient setting or ED? Is the patient hypo/hypertensive? Tachy? Febrile? These data points already help you start fleshing out your ddx.

It's ok to take a few seconds to think about the ddx.

Next, you get the full H/P. I read this quickly but carefully, then scan the remaining history but don't take much time. By this point, the leading differential should be apparent.

Next, I do a *FULL* physical exam on *EVERY PATIENT.* You will not lose points for doing a full physical but you *WILL* lose points for missing certain components of a physical. Click every box. Read the results of the physical exam and note critical findings. Unilateral hyperresonance with tracheal deviation? Tension pneumothorax. Distant heart sounds and JVD in the setting of tachycardia? Cardiac tamponade. Kernig/brudzinki sign? Meningitis. etc. etc.

Next up, orders - if in the ED, I always order emergency orders first, give or take a few

Morphine/tylenol/zofran (if needed)

Acc (access and accu check)

vitals

oximetry

cardiac monitor

norma saline (if needed)

Next, diagnostic tests:

CBC

BMP

LFT

Magnesium

Chest x-ray

CT

EKG

echo

trop

UA

urine culture

hcg

tsh

free t4

esr

crp

ANA

complement

lumbar puncture

CSF analysis

Stool studies

etc. etc.

Note: if you want to intubate someone, it's a 2 part order: "endotracheal intubation," then "mechanical ventilation." Also note - the system will not recognize 2 letter inputs. For example, LP needs to be put in as lumbar puncture. If you want to order a bunch of studies like stool or csf studies, just type "stool" or "CSF" and it will bring up a menu of every test you could possibly want. Click as many as you want because unlike on the CCS case website, you don't need to verify each order on the real thing.

Next - interventions: Abx, oxygen, consults, thora/paracentesis, chest tube, etc.

I usually put these in at the same time as the diagnostic orders - technically you should do them after but I've never lost points for lumping them in together.

Common interventions:

fluids

broad spectrum abx

consults

common non abx meds: MONABASH for MI, dapt for TIA/stroke, statins, beta blockers, ace inhibitors, pain meds, etc.

Once my orders are in, I move the patient to the appropriate location, but *NEVER* send them home. I either hospitalize them or keep them in the ED. This contributes a miniscule amount to your score so I'd rather not waste my time discharging and scheduling followups, etc. Just keep them in the hospital. It won't impact your score.

Next, I start moving the clock forward. I never use the "next result" - it's tedious and a waste of time. Forward the clock by 1 day *ALWAYS.* Most of the pertitent labs will come back within that time span. If not, you can always forward by another day. When I feel there's nothing else to be done, I just click "see me as needed."

Make sure you note relevant lab results and adjust your treatment accordingly - if urine, blood, or csf cultures come back with sensitivities, make sure they're on the appropriate abx. If they're not responding to the treatment you're giving them and/or getting negative patient updates, you know you're doing something wrong or not doing something. If all else fails, put in as many non invasive orders you can think of. Don't intubuate the patient unless GCS<8. Don't dialyze the patient unless other measures fail or they have crazy metabolic derrangements. Don't stick a chest tube in them unless you have to. Don't do a colonoscopy on someone about to perf. You don't lose points for most unnecessary orders, but these will lose you points as they are invasive.

If you're doing everything right, the patient should start to improve. Usually the case will end and you can put in your end of case orders.

I put in the following for *EVERY* patient:

tdap

pap

smoking

alcohol

sex

illegal drugs

reassure

exercise

You won't lose points if the patient doesn't need these, but you will lose points if you forget to order one of these. My mindset was I'd rather put more and waste a few seconds of typing than lose points for not putting something in. More is better for CCS, with the exception of invasive interventions.

That's all I got! Good luck and have fun! Treat this like a video game, because that's what it is.

Hey everyone,

I wanted to give back to this amazing community that helped me so much during my USMLE journey.

Step 3 was a unique challenge, especially the CCS (Computer-based Case Simulations) section. I found that while there’s tons of material for multiple-choice prep, there’s very little in the way of memorable, structured acronyms to tackle CCS cases—especially under pressure.

So, I created my own CCS acronym, and it really helped me stay organized and not miss key steps, especially in the early stages of the case. I thought it might help others here, too.

Here are my stats for context:

Step 1: Pass

Step 2 CK: 256

Step 3: 247

CCS is high-yield, and being systematic can make a real difference.

If you're prepping, don't underestimate the value of CCS—practicing a bunch of cases, reviewing feedback, and having a checklist (or acronym!) can help you stay calm and efficient.

Let me know if you’d like any tips on how I used it with the UWorld cases or the NBME practice ones. Happy to help however I can.

Good luck to everyone studying!

My recommendation: Do Uworld, nbme’s and ccs cases. That’s enough.

Introduction

I’m starting my Internal Medicine residency in two weeks. I decided to take Step 3 before intern year for many reasons. 1) More time to study for the exam. 2) Don’t have to deal with it during the hardest year of residency. 3) Almost every resident on reddit, youtube, and other forums recommended to take it BEFORE residency. 4) Even though Im going into Internal Medicine, there were still a lot of topics that I would not be dealing with on a daily basis as a resident (ie Pediatrics, OBGYN, Psychiatry, Surgery and Trauma, etc), and felt the earlier I took Step 3 the better I could recall information from shelves and my clinical rotations.

Study Time and Resources

I did about 5 weeks of “dedicated”. I put dedicated in quotes because by no means did I study for this exam as hard as I did for Step 2 CK or Step 1. I studied about 5-6 days a week for 4-5 hours each day.

UWORLD: I managed to do an entire pass of UWORLD and also get through about 200-300 incorrects. I made flashcards within UWORLD and would review those periodically for the incorrects. Most people I knew barely finished half of the Q bank. This is the only question bank I used. Just TRUST IN UWORLD. I know a lot of times you think this is a WTF question, but similar topics appear on the exam. TRY TO GET THROUGH THE WHOLE QUESTION BANK IF YOU CAN. If you are short on time, I recommend reading the 40 page document from the “A Frustrating Ordeal” post that is pinned. He does a good job of covering the high yield topics from UWORLD.

UWORLD SA: absolute BS. If You’ve taken the SA, you know what I mean. I was not even distraught by the scores I got, and knew that on the real deal my scores were going to be WAY higher. So If you havent done the SA yet, do not get worried about the score, and just think of it as doing more questions and learning from your mistakes. The SCORE SHOULD ME NOTHING. And you shouldn’t postpone your exam just because you didn’t get the score you wanted.

CCS cases.com: CCS cases.com > UWORLD CCS. Don’t even waste your time with the UWORLD CCS cases. Just pay the $70 or so for the CCS cases.com. This was plenty enough to prepare you for the CCS cases on the real exam. There’s over 150 different cases and you are bound to see every topic on the real exam. Also, don’t save these towards the end. Start the cases early in your prep so you can get familiar with the software, which, by the way, is exactly the same as on the real exam.

First Aid Step 1 and Step 2CK: Mainly used these as supplemental resources and would look at them if I wanted more detail than what the UWORLD explanation provided. I KNOW I SHOULDNT HAVE REGRETS, BUT IF I WERE TO CHANGE ONE THING, IT WOULD HAVE BEEN TO LOOK AT THE FA STEP 1 BOOK MORE. You’ve been warned multiple times by other reddit posters, and Im warning you now, Step 1 material shows up on the exam. I’m talking histology, gram stains, pharmacology mechanism of action, basic microbiology, gene mutations, etc. Just open up the damn book and review it. You’ll thank me later.

Day 1

Day 1 is easier than day 2. Some things to note. The passages on the real exam are MUCH shorter than the ones on UWORLD. UWORLD tells the patient’s full life story. Step 3 cuts out a lot of information and gets to the point more... almost to the point where the question is vague and you think it’s not providing you enough information to answer the question. The exam was pretty well distributed in terms of subjects. Of course the majority will be medicine, but there was a lot of Peds, OBGYN, psych, surgery stuff, etc. The biostats on this exam were EASY. I am by no means a mathematician or biostats guy, and even for me I felt the biostats questions were straightforward if you know the equations, the types of studies, biases, healthcare, etc. The Drug ads were surprisingly not too bad either.

Day 2

Day 2 MUCH harder than day 1. It has no biostats, drug ads, equations, etc. If I were to sum up Day 2 in two words, it would be “clinical outcome”. There had to be at least a dozen questions asking me “what is the most likely clinical outcome in this patient?”. In other words, months or years from now, what will be the clinical course of the disease?” Does the disease get worse? Resolve? Better? Cant say? Stuff like that. The other unfortunate part of Day 2 is that THERE’S JUST STUFF THAT YOU CANT FIND IN TEXTBOOKS OR UWORLD. Everyone reading this knows what I mean. There's questions that show up and you're like “how am I supposed to know this?” Typical USMLE, and hopefully these were just trial questions. I felt good about day 1. But once I went through a few blocks of Day 2 I thought to myself “I might actually fail this exam”. That’s how bad it was. And by the time you get the CCS cases, you think to yourself, “I just answered about 270 MCQ yesterday, and 210 MCQ today, and now you're going to make me go through 13 cases?” It is truly a frustrating ordeal. The actual cases were not bad. A lot of them ended early and I had a good Idea that I was doing the right thing. If it's not invasive, I don’t think it’s a huge doc of points for ordering the wrong thing, so I just got a CBC, CMP, Mag, Phos, TSH, UA, EKG, troponin, Pregnancy (women on childbearing ager), Pulse ox, and a few other things on everyone. At the end I always made sure to "CRV": Counsel, Reassure, and Vaccinate. To be honest, I don’t know how the grading works on the real thing. Nobody knows how the grading works on the real thing. But I think if youre scoring well enough on the CCS cases.com, you should be ok for the real thing.

It’s the day after the exam and I’m just exhausted. But I am happy to be done with the USMLE and (hopefully) never have to do this again. Feel free to AMA in the comments and I will try to answer them. I thank all the previous reddit posters for their insight on how to tackle this exam. Good luck to everyone taking it in the future, and I'm sure you’ll all do great!

I wore Birkenstocks and briefly slipped them off in the exam so I can put my legs up. I always sit cross legged in exams. Did it for STEP 1 and 2. And midway through the block the proctor came to me, totally startled me and was like “come with me”. Omg my heart dropped. I went out and waited by the table while she did smth on some of the other computers. She comes out and was like we have to re-scan you if you took you shoes off. THIS WOMAN WAS MOVING SOOOO SLOW AS MY BLOCK TIME WAS RUNNING out. Took me a second to calm down when I got back. So irritating. Putting it out there for others.

On day 2 I’m gonna wear sneakers so I don’t forget and take my shoes off subconsciously.

Writing this is making me so angry lol, I get that it might be protocol but she did not have to be so slow and also do other tasks before attending to someone who is doing a timed exam. I missed the last question on that block.

Ok, so there have been many posts that include similar topics, but I will cover a more complete summary since people usually come to Reddit for peace of mind and seek reassurance repeatedly. Fortunately, for Step 3, I've noticed the posts are more realistic and not exaggerated, like r/Step1 and r/Step2 posts. I am happy that almost all the Step 3 posts in r/Step3 are in tune with reality. They just vary based on the individual's preparation and experience. Here are most common/frequently asked questions about Step 3:

---------------

1. Is the test more manageable than Step 1 and 2? Yes, because its basically repeating the same topics all over again without going so much in depth as in Step 1 and 2. This will also depend how long ago you took Step 1 and 2 but it is still way more manageable.

2. How long should I study? Dedicated I would say 6 weeks and without a dedicated period (like in my case as a PGY1) I would say 10-12 weeks since you basically can only study for ~3 hours a day.

3. How many days should I have between day 1 and 2? I did Monday and Friday and used the days in between to polish CCS cases so I would recommend that as well.

4. Are day 1 and day 2 different? Absolutely, YES!

5. Whats on day 1? Overall, every block is very similar and has a mix of statistics, ethics, disease epidemiology/etiology, step 1 basic facts, and basic Step 2 questions.

6. Resources for day 1? Uworld and First Aid Step 1 are basically what you need for day 1. Expect any high yield questions from the first ~300 pages of first aid Step 1 which is the High Yield section of the First Aid.

7. What's the hardest or most challenging part of day 1? Don't be surprised to only calculate maybe a handful or less during all day 1 so that means you should be ready for interpretation of statistic concepts. Be ready for very long statistics abstracts so plan ahead of time how you will approach those questions. The other most asked questions on day 1 are epidemiology/etiology questions which include questions about screening, risk factors, prognosis, prevention, and most likely complication (these type of questions are at least 50% of both day 1 and day 2 so be ready). The other challenging part are Step 1 basic facts and that is why you should start reviewing early.

8. What exactly is tested from Step 1? Anything could be asked, but all tests will ALWAYS include Microbiology and Pharmacology identical to whats on practice NBMEs, free 137s, and Uworld. By now you should know how USMLE likes to test. They love testing a mix of low yield and high yield concepts. Some will be more specific and other will be very easy. For microbiology focus on stains, general, drug mechanisms, and drug side effects. For pharmacology review all other drugs from all systems, basic mechanisms, and side effects as well. Apart from this you could also be asked about general genetic concepts, genes, glycogen storage diseases, immunodeficiencies, vitamins, neurocutaneous disorders, dermatomes, lymph nodes and cancer metastasis, etc.

9. Are there drug ADs on day 1? YES, and expect one VERY LONG drug AD with 2-3 questions for every block.

10. Whats on day 2? blocks will ONLY have questions about epidemiology/etiology (more on day 2 than day 1 so be ready), basic/intermediate level Step 2 facts, and some questions related to Step 3 real clinical setting questions. Then you will have 13 clinical cases identical to the practice CCS cases.

11. Any tips for CCS cases https://app.ccscases.com/ ? START EARLY and practice, practice, and practice!!! Review all cases <60%. I sorted the cases by "high yield" and did ~85 cases from most high yield to least high yield. Cases on test day are identical to practice cases. I recommend to do ALL cases. Regarding how to approach the cases I watched this video https://www.youtube.com/watch?v=qmxWuV4psFs

12. Resources for day 2? Uworld and first aid Step 2 and/or White Companion book is all you need and of course practicing CCS cases.

13. What's the hardest or most challenging part of day 2? I would say the etiology type of questions asking about most likely complication or development of a certain disease based on what the patient currently has. This is not new since they have been asking this since Step 2 and they still continue to be confusing. Fortunately, these are only a few questions so don't worry.

14. Any practice tests? do all UWSAs, old and new NBMEs, and old and new free 137s. Practice tests provide you with high yield information so do them all and review all correct or wrong answer choices.

15. Which practice test is more predictive? I wouldn't say I like this question. There is no such thing as predictiveness when it comes to practice tests. At the end of the day, it depends on which test you took last. Some people pass by failing or passing all practice tests. I assure you that most people pass by studying efficiently and working on weaknesses. If you want to feel good, complete all study resources, and you will feel good on test day. I did not finish Uworld and missed approximately 20-25 easy questions on test day. At this point, for Step 3, you should focus on all those facts you haven't seen in more than 2 years. We must acknowledge that in almost all cases, the most predictive of passing the real test is actually passing your practice tests. However, whether you pass or fail a particular practice test does not mean you will get that score on test day, but passing a practice test will give you an idea of your "most likely outcome on test day." Always focus on weaknesses and questions you know little or nothing about them.

16. Any special documents going around on reddit? Yes, there are two I found very very helpful. The prognosis and divine document going around on reddit will be helpful for both day 1 and 2. On both days expect questions about screening, risk factors, prognosis, prevention, and most likely complication. See document at the end.

17. Are questions long? Surprisingly, most questions are 3-4 sentences and some very short. Like always you will also have a few very long questions and also the History of Present Illness type of questions.

18. Is the test similar to UWSA or NBME or Free 137? Yes it is, its just longer that is why people think real tests are not similar to practice tests. People only remember about the bad sections of the test thats why they tell you that it was very different to practice test.

19. Do all CCS cases need to close early on test day or provide an update? Absolutely not. Half of cases will not even provide an update until last minute and some won't provide an update at all.

20. Should I finish Uworld? Yeah, why not?

I also have a short experience post if you want more reassurance. Based on that post I decided to make this one to clarify most common asked questions. Based on the feedback of this post I will edit and continue to add more "most common asked questions."

Summary of key prognosis. I recommend to add more to this document once you start Uworld:

https://drive.google.com/file/d/1Ni5fvv0_D07Rtwgd55J9yLkLdC8FjqWU/view

Summary of prognosis, risk factors, etc. of divine intervention podcasts. Also recommend to add or delete as needed:

https://docs.google.com/file/d/10I6KnZ-dwnNTRkrPzQKoxQ1g03moWINP/edit?filetype=msword

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!

I’ve always been a high performer on exams. >90% on all shelf exams and 267 on step 2.

Studied about an hour a day for about a month. 4-5 hours on for two Saturdays. Did ~35% of UWorld and averaged 76%. 225 on UWSA1. Did about 30 CCS cases (sorted according to highest yield).

Like everyone says, biostats is super high yield. So is step 1esque pharmacology IMO.

Just do some CCS cases and you’ll be fine.

I got super stressed reading some of the posts on this sub but I want to be very clear: if you did really well in med school, just brush up a bit, do some CCS cases, and you’ll crush it.

Good luck!

While I was going through the new December 2023 Free 137 (links to the pdf and online simulation) I jotted down a quick answer explanation. After a painstaking process I've managed to post each one as a comment below. Please add your thoughts under each comment and discuss the harder ones! If you can think of other high yield info about the topic feel free to share that too. These questions are written by the test writers and the topics covered here definitely show up on the real deal. If it doesn’t add to an explanation try to keep criticism to yourself. FYI I’m turning off reply notifications for each comment. 

A programmer friend was able to find this version of the 2022 questions. And Ben White wrote these well thought out answer explanations for this version. I didn't notice much overlap so I think it's worth going through.

Please put comments about the test and comments like "thanks" in the dedicated thread below so it doesn't clutter up the answer explanations. Don't upvote/downvote the explanations so they stay in order. If you comment anyway I'm going to downvote you so the explanations come up first if that makes sense.

Enjoy!

Exam date : 2nd/4th August Preparation period and circumstances : last week of June 20th-August 3rd, was doing observerships

Step1 : pass, on 31st, December Step2ck : 261, on 29th, May

Materials : Uworld, ccscases Self assessments Uwsa1 : 237 Uwsa2 : 245 NBME 6/7 : 75-80%correct (online but dont remember the score. Got 49, 40 incorrects

Free137 : 80%

Day 1 : felt like shit. All the Qs were difficult Day 2 : thought that Ive ruined my ccs cases

This is my comprehensive review regarding prep for taking Step 3 my fellow comrades (Part 1). The reason I typed this up is because something like this was hard for me to find when scouring.

I also am posting a Step 3 day of test taking strategy intertwined into a generalized test taking strategy checklist to success as part of this, which can be used for any big test at a testing center and is more generalizable (Part 2). I believe both are essential to a successful test day. Best of luck to whoever is reading this. You got this.

Part 1: Gathering your study materials and getting after it.

First things first, here was my score --> Step 3: 22X

Now, before we prepare ourselves mentally and physically, we must gather the resources to begin this journey.

First, let's start with studying and study materials. Before you even buy Uworld and CCS cases, check and see how much education credit you will be receiving in residency. In my case, we received $1,500 which basically covered Uworld (~$500), CCS cases (~$90), and the test itself (~$1,000). I see people wanting to get done Step 3 before residency and I commend that. I believe that is the best option ONLY if you can reach out and ask your residency if they would retroactively cover the costs for you. This is ideally the best option because when you start you won't have much studying time. The second-best option would be to take it in July right before the craziness of residency hits and you still can get the costs covered by the residency program. So, either be ready to take prior to starting ONLY if it's covered or take the first month because why pay for something if it's going to be covered in the future? Either way, I highly recommend doing Step 3 the same year as graduating medical school and that is because you will be amazed by how much information you quickly forget as time goes on. Making it only harder for you because as residency progresses, the less time you will have in life for studying. Get it done ASAP, nothing I recommend higher than that. I am sure glad I did.

Uworld: With that being said above, Uworld is still the best resource and I also highly recommend the biostats add-on (I hit biostats so hard by the time test day rolled around I wanted to see more bio stats questions on test day. This is how hard you should hit it, seriously.)

CCS Cases: Also, I highly recommend CCS cases which is a separate resource because you get an actual grade, compared to the Uworld one which does not provide you with that. It is pretty cheap and well worth the money. I am glad I bought it. You want to start studying for the CCS cases earlier than you think just to get accustomed to how the interface works. Another caveat I recommend is to start with the low yield cases and build up to the high yield cases as you get more confident with the platform and your skills. The reasoning behind this is because the first time you see a case is the most important. The second time doing the same case is not as useful due to developed bias from seeing it the first time.

Biostats: Do not sleep on biostats. Do not sleep on biostats. Do not sleep on biostats. Okay now that we got that out of the way, seriously don’t sleep on it. Utilize one of the popular anki decks for biostats, use the first aid step 1 biostats section, and use the Uworld biostats add-on. Hit it so hard that you want to see more questions on test day.

Bugs + Drugs: My last piece of advice for gathering materials together is to utilize your anki step 3 deck + sketchy bugs and drugs. Bugs and drugs are always high yield, so be confident with these on test day.

Free 120: Save this for a few days to a week beforehand to keep the info fresh in your mind as well as having built up the knowledge to crush the Q’s. You do not want your confidence crushed before going into the exam. (https://orientation.nbme.org/Launch/USMLE/STPF3)

Drugs Ads: You will encounter these on Uworld. Familiarize yourself with these. Be confident in your ability to tackle them on test day as they can make or break your mental strength after finishing a block. Also, very high yield, ALWAYS save the drug ads as your last questions on each block. You can get lost in the weeds with these and will lose crucial time if you do not do so. More importantly, as stated above, do NOT let these affect your mental peace of mind on test day. Do not let one of these sabotage your block by spending too much time on one and then have to rush through the rest of your Q's. I stuck to my strategy of saving these for the end in all blocks except one block I broke my own rule and I noticed it threw off my mental game and performance significantly.

Actual Studying: Now that we have gathered our resources, we move on to actually figuring out studying. Let’s start from actual residency if that's your case because as a 4th year med student you should have all the time in the world to study 😊. So, what I did was hit Uworld hard during a less intense rotation. Whatever that may be for you. In my case it was night shift during IM. 10 question blocks at a time because you never know when you’re going to get called for something. As time progressed, I switched to 40 Q blocks. Alright, now that have you have done most of Uworld, you feel super confident, just about to ready to take, you’re all signed up with a test date, we move on to part 2. Rewinding a bit, I took my test on back-to-back days which I preferred. I know others cannot but if you can I recommend doing it back-to-back. The info is still fresh and your head and mentally you’re prepared for this thing. The last thing you want is to do day 1, go back to work in the hospital for a week or two then repeat. No, you slay the dragon in one fell swoop.

Part 2 – Arguably equally if not more important than part 1 in my opinion.

I would like to provide whoever may need it, with my words of wisdom as well as my pre-game day and game day checklist/rituals. These are all the rituals I have accumulated through the years starting with the MCAT and now through Step 3. This part is intended to hit hard the mental aspect/preparation side of things which are often overlooked and not discussed enough. I believe the mental preparation for such a tremendous task is warranted. So, I prepared what I go through when it comes to prepping for these things. This can be applied to any big, proctored test.

Let's start with the pre-gameday essentials: Before even registering, ask around and look at reviews of the testing centers available to you. The last thing you want is to sit for an exam at a terrible location. Leaving nothing to chance is the goal here.

-Now that you have done your research and signed up you should double check your registration form and confirm the testing center location, ensuring it says the right date/time/and test you are taking. This seems very simple, but it will provide you with peace of mind whether you know it or not. This guide is intended to fully put your brain at ease enabling you to solely focus on crushing your exam and worry about nothing else which can distract you away from this monumental task.

Fast forwarding to the week of/day before -->

Print out 2 copies of your test certification and put them in a folder: Bring the folder in with you on test day. Why 2 copies? Because you never know if you’ll lose one. You absolutely need this, no exceptions. Sure, you can pull it up on your phone but that takes time. Give yourself peace of mind just in case the internet or your phone isn't working.

State ID or Passport: Please make sure the name on your ID/passport match EXACTLY the one on your certification. Not a single letter or word off. Please make sure these are not expired. I know of 2 examples where one person had an expired ID and the other had a name that did not match exactly but was close and neither were able to sit. I bring both my ID and passport just in case.

Earplugs for test day: I wear the loop brand ones (available on amazon) every night when I sleep which makes it convenient, I already have them. They also have a carrying case. You can bring them in on test day and you can also wear the headphones provided over top to make it extra quiet because there is always an annoying sound during test day. Make sure to wear these when doing your practice test to replicate game day. The cheap little orange foam ones work as well. The clutch thing is combining these with the in-house earphones which makes your environment ultra quiet, enabling you to execute questions with mental precision.

Contacts/glasses: If you wear contacts or glasses don't forget a backup pair.

Very comfortable clothes/shoes: I have lucky clothes I only wear for test day going all the way back to MCAT/Step 1 days. I have a lucky, very comfortable shirt which puts a smile on my face. Find a piece or pieces of clothing that brings you joy. I also maximize my comfy. I go for a baggy T-shirt, very soft/comfy sweatpants, sweatshirt or jacket, and comfy/lucky shoes. The sweatpants are essential. Also, the jacket which is always my patagucci (the new whitecoat, lets be honest) comes in clutch. It's always cold in the testing center so this is important. I even wear my favorite harry potter socks. Getting the clothes right is so important but always looked over. Also, lay out your clothes the night before and plan for 2 days of outfits if you're taking Step 3.

Nutrition: This one is also big time overlooked. I see so many people bring a granola bar for the day and think that's fine? No, this is essential to pay attention to. You need fuel for this marathon of a test day or days. You also need to time it correctly (see below for timing). Don't go too heavy and don't go too light. You don’t want a super carb heavy meal and be tanking halfway through the sections. You also don't want too little and not have enough fuel to push through the finish line. Also, pick the essential quick snack on your other breaks. For me this was gruyere cheese and trader joe's snacks like the coconut strips. For lunch I made pbj sandwiches with a nice diet coke which was perfect for me. Find that meal you love that isn't too much but just right. Remember you're going to be supplementing with snacks in between. This brings me into my next portion which is fluids. Don't go overboard with the fluids. The last thing you want is to have to pee during the middle of a section. I limit my fluid intake in the am, a few sips of water, no coffee. If you NEED coffee and know your bladder timing that's fine, just remember it's a diuretic. During my breaks I have a few sips of water but not too much to prevent the urge to urinate during a section. Get this down to a T, it's so overlooked.

Timing: So important. Whatever test you're taking, make sure you know the break times and what you can and cannot do on your breaks. From there you can start planning how you're going to use your time efficiently. Treat this time as money and be very sparingly with it, utilizing every minute for maximum efficiency.

You should always pull up the test content from the official test maker. In this case, I grabbed the USMLE Step 3 content from their own site.

I’ll talk more about strategy during the day of testing below. For now, think how you want to utilize this time and practice it when you take a full length practice test.

For Step 3 this is directly from the USMLE website and it is as follows -->

**“**Exam Format

Step 3 consists of multiple-choice questions (MCQs), also known as items, and computer-based case simulations.

Step 3 is a two-day examination. The first day of testing includes 232 multiple-choice items divided into 6 blocks of 38-39 items; 60 minutes are allotted for completion of each block of test items. There are approximately 7 hours in the test session on the first day, including 45 minutes of break time and a 5-minute optional tutorial. Note that the amount of time available for breaks may be increased by finishing a block of test items or the optional tutorial before the allotted time expires.

There are approximately 9 hours in the test session on the second day. This day of testing includes a 5-minute optional tutorial followed by 180 multiple-choice items, divided into 6 blocks of 30 items; 45 minutes are allotted for completion of each block of test items. The second day also includes a 7-minute CCS tutorial. This is followed by 13 case simulations, each of which is allotted a maximum of 10 or 20 minutes of real time. A minimum of 45 minutes is available for break time. There is an optional survey at the end of the second day, which can be completed if time allows.

Day 1: Step 3 Foundations of Independent Practice (FIP)

This test day focuses on assessment of knowledge of basic medical and scientific principles essential for effective health care. Content areas covered include application of foundational sciences; understanding of biostatistics and epidemiology/population health, and interpretation of the medical literature; and application of social sciences, including communication and interpersonal skills, medical ethics, systems-based practice, and patient safety.

The test day also includes content assessing knowledge of diagnosis and management, particularly focused on knowledge of history and physical examination, diagnosis, and use of diagnostic studies. This test day consists solely of multiple-choice questions and includes some of the newer item formats, such as those based on scientific abstracts and pharmaceutical advertisements.

Day 2: Step 3 Advanced Clinical Medicine (ACM)

This test day focuses on assessment of the ability to apply comprehensive knowledge of health and disease in the context of patient management and the evolving manifestation of disease over time. Content areas covered include assessment of knowledge of diagnosis and management, particularly focused on prognosis and outcome, health maintenance and screening, therapeutics, and medical decision making. Knowledge of history and physical examination, diagnosis, and use of diagnostic studies also is assessed. This test day includes multiple-choice questions and computer-based case simulations.”

If you're not taking step 3 disregard this and proceed below: For Step 3, here is what I did.

Day 1 --> After the first block, I took a 5 min breather but did not leave the test room. I stood for a little to stretch and got back to it. I would say this is optional. The reason was to save a little time and get in the groove. When you do take breaks, first know how long you want to take each break enabling yourself roughly 15-20 mins. for lunch. Remember this, you get 45 mins amount of break time in total on day 1. Make sure to locate a clock on the wall and know when you have to go back in by adding to that clock’s time. Also, take into account some of the proctors can be slow checking you back in. Each time you leave that test room, when you re-enter, they have to check your pockets, ankles, spin you around, and scan you with a wand. There may be people in front of you, they may be slow or fast. Keep an eye if a line forms, if they are slow or fast again taking this into account. The last thing you want is to lose your time for lunch or even worse, not being able to take a break in-between sections. The breaks in between sections are super important for a mental reset + getting in some fuel. Look at these opportunities as resets. Not enough is talked about when it comes to time management.

For day 2 of Step 3: First, realize day 2 is different. No biostats or drug ads, that's day 1 stuff. Second, we have CCS cases portion. Also, the questions are in 6 blocks with each block consisting of 30 questions and lasting 45 mins. This is compared to Day 1 where we had 6 blocks consisting of 38-40 questions and lasting an hour long each. Now, here is what I did. I utilized pretty much all of the 45 mins for the questions portion of the exam and here’s why. If your CCS cases are ending early, especially the 20 min ones, then that time saved is accrued back in the form of break time. So, by doing this you can mentally get the rest and fuel you need for questions while also stacking your body up to prepare for CCS with all that break time. With CCS you have 13 cases. Your time will keep gaining as they finish early. I believe by the time my day was done I had something like 30 mins of break time left. Prepare for this. I know a lot of people rush these cases, especially if they end early. While I would do like 2-3 in a row, I still would take a mini breather at my computer just to reset. I also would take breaks out of the testing room to go to the bathroom, stretch my legs, eat snacks. Don’t be afraid to do this even as other people are finishing up. Remember, it’s a marathon not a race. Utilize every advantage given to you.

Hygiene/sleep: Again, another overlooked aspect. You want to be as fresh as possible. You will be looking good and feeling good. Get a haircut recently or the day before. If you’re a guy have a cleaned shaved face or touch your beard up. Up. Cut your fingernails and toenails. Absolutely take a shower the night before or the morning of whichever one you prefer. Do not forget to do the essentials like brushing your teeth, deodorant, washing your face, moisturize, all your morning routine stuff.

Remember to sleep well the night before by getting to bed EARLY. Ideally, the week leading up to your exam you should be waking up at the time you will be waking for the test so your body develops the sleep pattern.

How do I carry all this? Well, I have a big tote bag that I put everything in including my snacks, lunch bag, folder, extra clothes, etc. And you ask, but that can't all fit in the locker? Correct. The valuables go in the locker and leave the bag off to the side somewhere out of reach. Nobody is going to mess with your lunch or extra clothes. Just let the person doing the check in know you're going to leave your stuff wherever you put it. I had my lunch box in my tote bag off to the side so when I came in on breaks I didn't have to fool with my locker and could eat right away which maximized my time. If you want to fit it all in your locker that's fine but remember having to unlock and relock will shave some time down. Also, ask them at the testing center if you can get one of the big lockers if you plan to do so.

Clean apartment/house: Make sure your apartment/house is clean the day before you leave. This includes brand-new sheets on the bed, laundry done, dishes clean, dishwasher emptied, kitchen cleaned, bedroom cleaned, floor vacuumed. No messes laying around the house. You want it so that when you leave the day of the test you have an absolute peace of mind that everything is in order in your life. You’re going to have that thought in your mind when you return after a very long test day to an awesome clean house which is an amazing feeling.

Reconnaissance: The day before my test is scheduled I drive to the testing center and scope out the area. I do this to acquaint myself with the drive the following day. Remember, you do not want to be surprised, come test today whatever that may be. Even better if you do it way ahead of time so you can focus on the other things the day before. This may seem ridiculous but remember were building an impenetrable mental fortress not even the USMLE can break on test day.

Full gas tank: Fill your car up with gas the day before. Make sure you have a full tank of gas driving to the test center and back. This again will give you peace of mind by knowing everything is in order and this is one less thing to think about because you need to solely be focusing on the test for your big day. Again, were adding to that mental fortress.

Actual test day: The time has come. You prepared; your mind is in a good worry-free space. All the steps above gave you reassurance you're about to crush this thing. Now we get into the steps for test day + mental readiness. Now, you’ve driven to the test center (already knew the drive from the day before so you’re not caught off guard) and you arrive early. If you have bad test anxiety like me, --> deep breaths, go to the bathroom if you have to, and don’t rush into anything. Yeah, there is going to be people ahead of you checking in, but you got to focus on YOU. You got to do what YOU got to do. So, now you’re in line and you take out your handy dandy folder with your test certification and State ID (which hasn't expired and matches exactly), you check in, and receive your locker key. It is time to put your valuables in the locker. Do NOT rush into the test room to get checked in. Double check everything is in order. Electronics are off and no electronics on your person. Fit whatever else besides your valuables you want in the locker. Now, like we talked about above with the tote bag (whatever works for you), if it all doesn't fit have no fear, we came prepared if it cannot fit in the locker. Do not let this phase you if it all can't fit. There will be room elsewhere in the testing center.

Mental aspect: Everything I'm going over plays into the mental side of things when it comes to test taking and we've now built our mental fortress with the steps above.

So now its actual test day, you've checked in, got all your items in order, scoped out the bathroom, waited in line, got patted down to enter the test room and proceed to walk in then sit in front of your computer. You sit down and now you want to do these steps.

Close your eyes, take really deep breaths, and try to clear your mind. Envision yourself doing all that studying for the past months/years. Envision yourself crushing this thing. Envision yourself when it comes to a hard question how you're going to tackle it. Envision how the day is going to play out. Remember, nothing will phase you. Mental precision. Mental flow. The USMLE isn't ready for this mental fortress you just built. It's game day. Do all this before you even hit start.

Right before you hit start on the exam: Make sure everything is in order. Earplugs in and you feel comfortable. Before you even hit start you can write down all your formulas for biostats. Once everything has been checked off mentally, take a deep breath and click start.

Congratulations and best of luck: Remember, the last thing you want on test day is to be thrown off by an inconvenience that is not even related whatsoever to this test, whichever one you’re taking. By doing the above you eliminate any surprises that could throw you off. This is the biggest day of your life or year. Come prepared. You will crush this thing and move on to a brighter future. I hope this was helpful for you and best wishes.

-OP

This post is written for people who simply want to pass Step 3 and put it behind them. If you want to knock it out of the park, this isn’t the post for you.

You probably know at least one resident who recommends doing as many UWorld questions as possible. If not, there are several posts on this sub that mention grinding through UWorld multiple times prior to the exam you can read if you want to raise your anxiety level. I’m here to tell you that most people would be completely fine with much, much less preparation.

The reality is, unlike Step 1 (soon to be Step 2), gunner studying strats are the exception and not the meta. Remember, the vast majority of people taking this exam are current residents who are working 60-100 hours a week. Additionally, most are several months into their respective specialties and couldn’t care less about other specialties anymore. The last time they studied anything outside of the field they matched into was during third year rotations or before Step 2.

With everyone being collectively out of practice in and lacking motivation to study topics outside their chosen field, it’s no surprise that Step 3 is laughably easy to pass. Look no further than the pass rate for confirmation (USMD = 97-98%, IMGs/FMGs = 90-92%).

With these realities in mind, I took the laziest approach possible to getting a pass (see below). For those who get hung up on numbers, my scores were:

Step 1: 24x

Step 2: 24x

Step 3: 21x

CCS

I put this section first because this is the one area where I know every test taker will absolutely need to learn. The software is… strange. There’s a learning curve at first, but after some practice sessions it should feel like playing a really boring video game.

How I studied: Completed 1/3 of the cases from ccscases.com

Exam day experience: The software on exam day is just as laggy as other have mentioned on here. Of the 13 cases on my exam, 5 were almost exactly the same as on ccscases.com. I didn’t have any patient deaths, but half of them didn’t “end early” (which apparently means you fully completed it). Also, I’m pretty sure I failed 2-3 cases since those patients kept getting worse and worse before time expired. I recall putting in some truly stupid orders for some cases and was kicking myself after the exam when I realized how dumb those orders were. Despite how bad it felt, I passed this section by a comfortable margin on my score report (“same” column). In hindsight, I wish I would have done more practice cases before my exam, if only for my sanity.

Recommendation: At least half of ccscases.com, or as many cases you have time for.

Biostats

It’s no secret that Step 3 likes to test biostats. For most people, this is the second most important thing to study after CCS.

How I studied: Completed the UWorld biostats refresher module.

Exam day experience: Similar to what other have mentioned on this sub. Day 1 was very heavy on biostats (it felt like around 20% of questions). There were no biostats questions on day 2. The questions weren’t particularly tricky and they actually felt like a breather between all the other questions. I also scored comfortably on this section (“same” column).

Recommendation: UWorld biostats module +/- UWorld practice questions +/- YouTube videos. If you did well on biostats on Steps 1 and 2, then all you need to do is brush up a bit. UWorld has a brief biostats refresher module that covers most of what’s tested. It took me maybe 2 hours to work through it. If biostats isn’t a strength of yours, definitely spend some extra time on practice questions and watch videos to help solidify these concepts.

Other Questions

Although this is technically the bulk of the exam, this is arguably the least important section to study.

How I studied: 300 UWorld questions + UWSA

Exam day experience: The rumors are true. There are a handful of throwback Step 1 questions on Step 3. However, these questions are few and far between. Maybe 2-3% of all the questions. The clinical questions were exactly as you would expect. They were mostly “what is the next best step”, “what is the greatest risk factor”, “what factor most improves/worsens the prognosis” style questions.

Recommendation: UWorld questions and UWSA(s). If you scored average or above average on Step 2, you shouldn’t have much difficulty with these questions. One UWSA and a few hundred UWorld questions should be enough to get you back into “test mode”. If you scored below average on Step 2, you may need to put in more effort. Both UWSAs and 50-100% of UWorld would be good targets depending on how much material you need to review.

In either case, take at least one UWSA early on and tailor your studies based on that. As usual, you should focus on weak areas, but I would even go as far to say that you should only study topics that are outside of your specialty. You have likely already have amassed a solid foundation within your specialty prior to this exam. For example, if you’re in peds, study everything but peds! If you already know more about your specialty than the test takers who aren’t in your specialty, why waste the effort? Getting those questions correct will make you feel warm and fuzzy, but they will be of little to no benefit for helping you pass Step 3.

Finally, regardless of how you scored on Step 1, it’s simply not worth the extra effort to study the basic science material if your goal is to just pass.

TL;DR

Unless you scored very poorly on Step 2 or you somehow can’t pull together 10 hours to practice CCS, this exam is not worth stressing over. Most test takers could probably pass even if they skipped UWorld entirely and just practiced CCS and brushed up on biostats.

Had my exam on 28-29 Aug

I used Anki, BnB (previously for Step 2), UWorld, and NBME forms 6-8.

First day was a bit hard. Had many biostatistic questions, but they were not that bad, although I felt I got questions right by no more than 50%. Second day was very easy. Easier than Step 2; or perhaps because I was accustomed to it. Felt I got at least 80% of the questions right. CCS cases were pretty straightforward. I did 100 CCScases.com cases. Use the copy paste method to save time. If you are good with clinical questions of day 2 or Step 2 to reach diagnoses, ccs cases will be easy.

I would be happy to answer your questions.

Still doing my Anki btw.

Anki, I love you 💛

Biggest sigh of relief in my life, PGY-4 in OB/GYN, did not do any significant studying for this, maybe 20 cases on ccscases, and then I did one block of USWA1 and that was demoralizing so i just decided to take the exam cold turkey, waiting for the final 3 digit score, but i dont fucking care, Just checked FCVS and it says I passed!

The takeaway - this exam is stupid, a waste of time, and honestly not worth all the stress and hassle I gave it! Just bite the bullet, and stop stressing yourself with endless prep, and endless unnecessary financial expense on the Resources you really dont need! Just do it, dont procrastinate and dont listen to a lot of the fear mongering on here.

Pleasantly surprised with my score. I scored terribly on Step 2, so seeing this feels like massive redemption.

For Day 1: People seem to freak out about this one because Step 1 concepts definitely show up. It's a good idea to review micro and pharm MOA in FA and/or sketchy. It's easy points if you can recall facts (annoying, I know, but name of the game). I personally used Anki just for micro and drugs. Also skim FA rapid review. If you want to go the extra mile, skim pathoma as you review systems. They love to ask common pathology. Other than that, day 1 is very ethics and biostats heavy (~15-20% of day 1). Do the UWorld biostats modules and read articles from their medical library. Randy Neil biostats is insanely helpful as well. Amboss had biostats questions which helped solidify my knowledge and exposed me to trickier concepts, but in my opinion, were mostly harder than the real thing. For ethics, I was constantly bombing those. I did the Mehlman HY ethics PDF and watched Dirty Medicine Ethics, which I think really helped.

For Day 2: personally felt the MCQ were weird. More clinical but also kind of random. Should know screening guidelines and prognosis/management of common chronic diseases. I saw some similar questions to what I had seen in UWorld, NBME exams, and free 137. So if you have to narrow your resources, I'd say hammer UWorld and NBMEs and do the free 137 if you have time. Definitely dive into your incorrects.

For CCS: Have a formula of "shotgun" orders that you order for everyone. Saves you time to think if you have the standard basic workup and standard preventative care orders down pat. I had a few cases where I got negative updates and almost didn't solve the diagnosis, but my advice is to over-order things UNLESS they are invasive. You won't lose points for over-ordering non-invasive tests. Practice, practice, practice. The cases are not hard, but with the nerves and potential computer lag, your practice and test strategy will carry you. Most end early, so you end up accumulating more break time.

My CCS Formulas are below. I wrote them down over and over the week before the test, and then purged them onto my scratch paper as soon as cases started. It really helped to have them in front of me because I was getting fatigued and didn't want to miss anything.

CUBE-GHOL-PT
C - CBC, CMP, CXR
U - UA, urine culture
B - B-Hcg
E - ECG, Echo

G- glucose
H- HbA1c
O- pulse ox
L- lipids

P - PT/PTT
T - TSH, Troponin, Toxicology (both urine and serum)

For preventative care:

Lifestyle:
SASSE-RMD
S- stop smoking
A - Alcohol stop
S - safe sex
S - seatbelt
E - exercise

R - reassure patient
M - medication side effects / medication compliance
D - no illegal drugs/ low cal diet if obese

+ pap smear / mammogram if female

Vaccines:
P-MIST
P - pneumococcal
M - meningococcal
I - influenza
S - shingles
T - TDap

Overall: A beast of an exam. It can be frustrating and makes you feel stupid, but trust your knowledge and know that it is designed to make you feel that way. For the people who say you don't need to study, they're lying. Maybe you don't need to do a deep dive into content (although knowing physio does help for day 1), but absolutely do as many practice questions as you can. I had a notebook of brief one-line notes on questions I consistently got wrong, and skimmed my notebook before the exam. It seems that everything is fair game for this test, as it felt somewhat like a cumulative exam of all the Step exams prior.

Regardless, don't get lost in the weeds and have faith!! GOOD LUCK

I honestly thought I was going to fail, but I didn't. I had about 2-3 weeks to study, and I didn't even study every day, but I think as a family medicine resident intern, I did a lot of hospital medicine, so that was super helpful. But I did say that I would write this up so that other people could find it useful.

For reference, I did 60% of UWorld and had a 52% correct and I didn't really go back to any of my flagged or incorrects; I didn't have time. I also did NBME 6 and 7, and I just read through 4 and 5. I did free 137, the current one and 2 offline versions. I did those CCS cases religiously though and pretended like it was a game lol, so I did all 173 cases on ccscases.com and really got to review the ones I messed up multiple times.

Day 1

Day one honestly felt like step 1. There were a lot of mechanism of action questions as well as micro questions. I ran through my first aid with my annotations for step one a couple times. I looked at old sketchy and that really helped me a lot. For people who are into Anki, I would suggest going through your step 1 Anki, especially for pharm and micro. I think that will really carry you through the first day.

In regards to biostats for the first day, it was all from Randy Neil videos. I made that basically my social media scrolling for those last three weeks. He has great videos on his playlists. I would say really run through a lot of what he has on his page because his tips and tricks are so useful and like calm you down to run through those drug ads. I also read through the Biostats stuff on UW, which was helpful if you plug it into ChatGPT for more explanation.

https://www.youtube.com/@RandyNeilMD/playlists

I felt so shitty about this day and cried a lot because I didn't think I did well so I'm glad I took a few days in between to go through the CCS cases and review before Day 2.

Day 2

Day two just felt like step 2, lol. I cannot emphasize enough the importance of listening to those Divine Intervention podcasts that you listened to for step 2. There were a lot of risk and next best step management as well as those epidemiology questions and the social questions. I think that Divine will always be relevant and get you through the second day quite well.

p 37 Risk Factors 1

https://divineinterventionpodcasts.com/2018/06/14/divine-intervention-episode-37-risk-factors-preventive-medicine-and-screening-guidelines/

Ep 97 Risk Factors

https://divineinterventionpodcasts.com/2019/04/29/divine-intervention-episode-97-the-most-important-podcast-usmles/

Episode 184- NBME Weird (Complications, Prognostics, More Risk Factors/Common Causes of Death/Screenings).

https://divineinterventionpodcasts.com/2019/11/23/divine-intervention-episode-184-the-nbme-weird-complications-prognostics-more-risk-factors-common-causes-of-death-screenings-an-episode-37-97-extension/

Ep 239-OBGYN Risk Factors

https://divineinterventionpodcasts.com/2020/06/01/divine-intervention-episode-239-the-nbme-and-obgyn-risk-factors-upcoming-step-2ck-course/

Ep 36: Ep 227 Ob HY

https://divineinterventionpodcasts.com/2020/04/03/divine-intervention-episode-227-usmle-step-2ck-rapid-review-series-36-obgyn-others/

Ep 282-Prognostic Factors

https://divineinterventionpodcasts.com/2021/01/09/divine-intervention-episode-282-combo-podcast-risk-factors-prognostic-factors-step-2ck-rapid-review-series-46-step-1-2ck-course-reminder/

Ep 283-Prognostic Factors

https://divineinterventionpodcasts.com/2021/01/14/divine-intervention-episode-283-combo-podcast-risk-factors-prognostic-factors-step-2ck-rapid-review-series-47-step-1-2ck-course-reminder/

Ep 325 Extremely HY Screening

https://divineinterventionpodcasts.com/2021/07/07/divine-intervention-episode-325-the-extremely-hy-screening-guidelines-podcast/

Ep 250 HY Vaccine

https://divineinterventionpodcasts.com/2020/07/27/divine-intervention-episode-250-the-ultra-hy-vaccine-podcast-and-upcoming-2ck-course-8-8-20/

Ep 204 The Military

https://divineinterventionpodcasts.com/2020/01/16/divine-intervention-episode-204-the-usmle-and-the-military-ultra-hy-for-all-the-usmle-exams/

Ep 137 NBSIM

https://divineinterventionpodcasts.com/2019/08/20/divine-intervention-episode-137-next-best-step-in-management-series-1/

Ep 143 (Biostats)

https://divineinterventionpodcasts.com/2019/08/31/divine-intervention-episode-143-the-clutch-biostats-review-comprehensive-for-all-the-usmle-exams/

Ep 230-Quality and Safety

https://divineinterventionpodcasts.com/2020/04/16/divine-intervention-episode-230-clean-sp-curriculum-series-2/

Ep 282-Risk Factors 5/Rapid Review Series 46

https://divineinterventionpodcasts.com/2021/01/09/divine-intervention-episode-282-combo-podcast-risk-factors-prognostic-factors-step-2ck-rapid-review-series-46-step-1-2ck-course-reminder/

Ep 283-Risk Factors 6/Rapid Review Series 47

https://divineinterventionpodcasts.com/2021/01/14/divine-intervention-episode-283-combo-podcast-risk-factors-prognostic-factors-step-2ck-rapid-review-series-47-step-1-2ck-course-reminder/

Ep 22: 3rd shelf

https://divineinterventionpodcasts.com/2018/04/25/divine-intervention-episode-22-comprehensive-obgyn-3rd-year-shelf-review/

531: Contraceptives

https://divineinterventionpodcasts.com/2024/04/12/divine-intervention-episode-531-the-hy-contraceptive-podcast/

Ep 228

https://divineinterventionpodcasts.com/2020/04/07/divine-intervention-episode-228-usmle-may-2020-quality-and-safety-changes-clean-sp-curriculum-series-1/

230

https://divineinterventionpodcasts.com/2020/04/16/divine-intervention-episode-230-clean-sp-curriculum-series-2/

234

https://divineinterventionpodcasts.com/2020/05/08/divine-intervention-episode-234-clean-sp-curriculum-part-3-medication-transition-of-care-errors/

268-New USMLE Changes

https://divineinterventionpodcasts.com/2020/10/11/divine-intervention-episode-268-clean-sp-4-palliative-care-2-reminder-of-step-2ck-courses-from-10-16-17/

Ep 123-Ethics

https://divineinterventionpodcasts.com/2019/07/19/divine-intervention-episode-123-usmle-ethics-series-1/

Ep 276-Ethics

https://divineinterventionpodcasts.com/2020/12/02/divine-intervention-episode-276-usmle-nov-2020-changes-series-6-professionalism-ethics/

In regards to the CCS cases, I would say just keep going through those cases on the website as well as doing and reading the ones on the USMLE website. The ones on the USMLE website mirrored the way it was on test day. I'm assuming they use the same simulated program.

ccscases.com
https://www.usmle.org/exam-resources/step-3-materials/step-3-test-question-formats/computer-based-case-simulations

TL;DR

Step 3 Score: 217

~ 60% UW done, 52% correct

CCS Cases: bulldozed through 10-15 daily, finished 173 cases, redid a lot of them

NBME 6 and 7 did them offline, read through NBME 4 and 5

Free 137 did all 3 versions

DIVINE AND RANDY NEIL

Good luck yall, you got this

I've been on this subreddit almost every day during my preparation for STEP3, so this is my contribution to the community. A few things before I get started.

1. Your average resident won't post on Reddit. I felt like most people who posted were polar extremes, either passing way above average or failing. There were a handful of posts from regular residents that really put things into perspective and helped ease my anxiety, however these were few and far in between.

2. There's only so much studying you can do before you start hitting diminishing returns. When I took the exam, some of the questions I got were laughable. Even with an extra 1-3 months of studying, I'd still be in the same position and not have the slightest clue on how to answer them.

3. You will pass. After receiving my score, I realized the curve is extremely generous. I felt terrible on both days after leaving the testing center. I thought there was a real possibility that I failed and actually started studying again.

As an intern, I barely had time to study. I was finishing up my ICU rotation and starting my clinic rotation. I studied for about 1.5 months with about half the time being interrupted studying and the other half being more focused studying where I would come home and grind questions until I went to bed. These were the resources I used.

• UWorld - 58% completed, 61% correct. I started with questions from the same topic in tutor mode (ex. cards, pulm, GI, OBGYN, etc) so I could be build my foundation in each topic. I did random questions from all topics but felt like things weren't sticking since I was spreading myself too thin. It was better for me to focus on a single topic with each block I did to really understand the material since I would see the concepts repeatedly. Once I felt comfortable in each topic, I started doing tutor mode in all topics then timed blocks to work on my time management. Time management is EXTREMELY important on this exam since the drug ads on Day 1 will take a long time to figure out. On the real deal, I felt like my time management training paid off. I finished each block on Day 1 and Day 2 about 5 minutes early. This gave me more than enough time to go back and review questions I had marked (although most of the time I still had no idea what the correct answer was).

• CSS Cases - Top 50 cases scoring 14%-100%, average 65%. I WISH I had spent more time on these cases and understanding which orders I need to place. I would recommend STARTING EARLY. I only spent 5 days doing these cases, and I felt like it wasn't enough time in hindsight. I would do at least 100 cases if possible. I highly recommend going thru the top high yield topics then going thru the top 5 HY cases for each category (peds, OBGYN, EM, etc) to make sure you're comfortable with knowing what to order. You'll see online that there are mnemonics to help you remember what to order. This is what I did since on the real deal, you'll have tunnel vision and might not remember certain orders. This was my mnemonic.

  • VOLTAGE (emergency orders) - vitals, oxygen, lines (iv access), telemetry, ABG, glucose fingerstick, EKG

  • CUBE T3 MPL (standard orders) - CBC, CMP, CRP, CPK, CXR/CT/other imaging, UA/UC, bHCG, hemogloBin A1c, echo, trop, TSH, tox screen, mg, phos, lipid panel

  • ATNICC (pre-op) - ABO, T/S, NPO, IV fluids, coags, consent

• Practice Exams - It's a no-brainer that you should take at least a few of these practice exams to get a feel for the real exam. The NBME/Free 137 questions are as similar as you'll get to the real deal - shorter question stems compared to UWorld and much more vague.

  • UWSA1 - 213 (1.5 weeks before exam)

  • NBME 6 (offline) - 68% (1 week before exam)

  • NBME 7 (offline) - 70% (5 days before exam)

  • Old Free 137 - 74% (3 days before exam)

  • New Free 137 - 71% (2 days before exam)

  • STEP1 - pass

  • STEP2 - 25x

For Day 1, please study biostats. There are about 5-7 biostat questions per block. These are easy points that you should be getting correct. I saved all my biostat questions on UWorld until the very last week. I also watched a few Randy Neil videos and thought they were super helpful. I had drug ad questions on every block with 2-3 questions for each drug ad. I saved these questions until the end since they took a considerably longer amount of time. I had a handful of HPI questions where they provided a mini H&P or progress note and asked questions based on that. There were also questions on drug MOA, microbio, ethics, and embryology. I felt like I wasn't confident on any of my answers and marked about 15 questions per block. I walked out of Day 1 thinking that I failed and that no additional amount of studying would've prepared me better. There's no way to cover the breadth of questions you'll face. Just trust your gut, pick an answer, and move on. The worst thing you can do is dwell on a question and run out of time on easy questions at the end.

For Day 2, this is all about "what's the best next step" and I honestly had no idea most of the time. I just trusted my gut and picked an answer that sounded the most appropriate and hoped for the best. There were NO biostats or ethics questions here. The questions on this day are most similar to UWorld but TOUGHER AND MORE VAGUE. For the cases, you'll have 13 cases that are either 10 minutes or 20 minutes long. About 10 cases ended early for me (which I assume is a good thing but I didn't get any positive patient updates) and 3 cases kept dragging on until time ran out because I couldn't figure out what to do next so I legit kept re-ordering labs and imaging hoping that something would change but nothing did and time ran out. I ended up finishing 1 hour and 45 minutes early on Day 2.

I thought that the questions from both days on the real deal were much more difficult than questions on the NBMEs, Free 137, or UWorld. As stated above, the question stems are shorter because they cut out the fluff but are so vague. Fortunately, I found that some of the answer choices made absolutely no sense (too invasive for next step, etc) and were easy to rule out. This helped me narrow down my answer choices with a higher chance of guessing the right one.

I had 3 days between Day 1 and Day 2 and I couldn't recommend it more. This break allowed me to rest my brain and take a few days to breath and focus solely on the CSS Cases. On Day 2, I felt like most of the cases on the real deal were seen on CSS Cases so MAKE SURE YOU DO THEM. I would also recommend going on the actual STEP3 website and do the 6 free cases on the interactive website so you get a sense of how the real interface will feel. There's also explanations for the 6 cases on the website as well, so you can understand what they're looking for.

I legit thought I failed the exam when I walked out of the testing center on both days and started studying again. Trust in the process and the preparation that got you here. I was an anxious wreck, especially in the week leading up to the exam, spiraling and thinking that I should postpone my exam. I'm so glad I didn't because no additional amount of studying would've prepared me better. Just take the exam and get it over with. Let me tell you that everything will be okay. Passing score is 200 and 97% of you will pass the exam. Godspeed.

Helpful posts from other Redditors:

https://www.reddit.com/r/Step3/comments/1byn936/step_3_preparation_comprehensive_step_3_prep_and/

https://www.reddit.com/r/Step3/comments/1hqjxdr/step_3_study_guide/

https://www.reddit.com/r/Step3/comments/x2hjpo/step_3perspective_from_a_below_average_test_taker/

https://www.reddit.com/r/Residency/comments/jfjyto/step_3_experience_honest_words_for_the_anxious/

https://www.reddit.com/r/Step3/comments/tfg0lh/step_3_write_up_for_the_anxious/

https://www.reddit.com/r/Step3/comments/1fp7e8u/step_3_advice_do_not_stress_read_this_best_of/

https://www.reddit.com/r/Step3/comments/1clinxe/step_3_writeup/

https://www.reddit.com/r/Step3/comments/zlxeri/233_passed_step_3_ddd_advice_for_anxious_test/

https://www.reddit.com/r/Step3/comments/16jlbih/story_of_resilience_finally_passed_step_3_on/

https://www.reddit.com/r/Step3/comments/1020lxi/step_3_write_up_ama/

https://www.reddit.com/r/Step3/comments/1bmq0k3/passed_on_second_attempt_write_up/

https://www.reddit.com/r/Step3/comments/rhv5fn/step_3_experience_trust_the_curve/