Exam Prep
Step 3 Guide
Apr 9, 20265 min read
By Mike
By MikeUWorld 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 likely have the most accurate grading scheme for CCS Cases.
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 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 too 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 always 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 the grading criteria they provide. You should go through each CCS case with a framework 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
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 don't really require high level clinical knowledge to complete. There are 2 days of Step 3, the first day being all multiple choice questions (6 1 hr blocks of about 40 qs each), many of which test Step 1 factoids and biostats. This is often considered the more difficult day as there are a lot of questions regarding facts you probably have not thought about in a while unless you have been taking Step 1 every year or doing Step 1 Anki cards for some reason. If you review the biostats from FA and rapid review Video Playlist this will likely go over fairly smoothly. There are also some ethics, risk factor questions along with diagnosis and treatment questions. It will be hard and I did not feel great after the first day but it will be manageable. Day 2 has 6 blocks of 30 questions (45 minutes each block). These questions are more about treatment and diagnosis of medical conditions, which I found to be much more straightforward. I know several people that took all the Day 2 blocks in a row without even taking a break in between. You will also have the CCS Cases, these will be either 10 or 20 minutes in length. See above for CCS breakdown, but essentially get ready to read fast and type.
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!
— Mike