This is it the final examination in the three-step series separating med school

grads from licensed doctors who can practice medicine without supervision.
If youd like an overview of eligibility, registration, scheduling, structure, content, and
scoring, see my overview of the U.S. Medical Licensing Exam (USMLE) Step 3. As I
mention there, this exam tests whether the examinee can apply medical knowledge
deemed essential to the unsupervised practice of medicine. It is administered over
two days, is entirely computer-based, and features a mixture of multiple-choice
questions and clinical simulations.
As the Step 3 overview explains, youre only eligible to take this part of the exam
after passing Step 1, Step 2 CS, Step 2 CK, and graduating from medical school.
Youll probably end up taking the test at a point in your residency during which youve
got some study time (often during research or vacation).
Though theres a common tongue-in-cheek saying in the medical community two
months, two weeks, two pencils to refer to the prep time required for Steps 1, 2,
and 3, respectively, Step 3s recent expansion to a more rigorous two-day format
requires at least a few weeks of study time for most examinees. Plus, competitive
fellowships do care about scores on Step 3. So if you want to get into that
subspecialty fellowship youve got your eye on, youll need to do more than just pass.
Heres how to prepare so you can ace this ultimate exam.
Preparation Resources
Step 3 study resources fall into three main categories:
1. USMLE Free Practice Questions
Each year, USMLE.org offers free practice test items for Step 3, including a tutorial,
an overview, and question blocks. The blocks can be timed to simulate the highpressure exam experience. Use this resource as your starting point for studying so
you can quickly learn how to navigate the computer system and get comfortable with
the style of questions. Also, be sure to review the Primum Tutorial to understand how
the computer-based care simulations (CCS) work. It should take about one to two
hours to gain comfort entering orders, viewing results, and advancing the clock in the
CCS cases. Unfortunately, the program can only be used on a PC.
2. Courses
Live courses offer structured classroom lectures and preparation materials. Most are
run by private companies, similar to other USMLE and MCAT prep courses. The
traditional test prep companies, Kaplan and Princeton Review, offer USMLE Step 3
courses in addition to question banks and books. There are many other options for
live courses, too, some of which test-takers find more effective, including Dr. Reds
Step III Reviews and CCS Workshop and Premier Review.
Please note that you do not need to take a live course to excel on the USMLE Step
3. Courses are best for students who perform well given structure, a defined
program, and a set schedule. When choosing a course, take note of the timeline,

study materials, teachers backgrounds, class sizes, and success rates.

3. Question Banks (and Books)
Question banks are essential for USMLE Step 3 preparation. Most Step 3 examinees
even believe theyre more important than books. They provide hundreds of questions
and lots of flexibility: Test-takers can with or without an active timer simulate full
tests, practice blocks within the exam, isolate questions by category, and get
explanations for every answer. Many examinees are tripped up by the CCS
questions, as these differ in format significantly from typical multiple-choice
questions. Gaining familiarity with the Primum software and understanding how to
complete the CCS are keys to success in the USMLE Step 3.
Also worth noting: There are many proprietary companies offering question banks,
too, with the most popular being UWorld, Kaplan Qbank, USMLE Consult, and
USMLE-Rx.
Though question banks trump book preparation for most Step 3 examinees, there
may still be a place for reviewing Step 3 boards in print. Here are the most popular
options:
Kaplan Medical USMLE Master the Boards Step 3
First Aid for the USMLE Step 3
Brochert's Crush Step 3: The Ultimate USMLE Step 3 Review
Step Up to USMLE Step 3
Preparation Strategies
Gearing up for the test, you should think as much as you can about balancing
efficiency and thoroughness. This is important throughout the test, but nowhere is it
as crucial as on the computer-based care simulations. As I noted in my overview of
Step 3, test-takers are allotted either 10 or 20 minutes of time for each simulation,
but the cases themselves can cover weeks or months of simulated time as you
manipulate the clock, moving with patients from the emergency department to the
inpatient ward to their homes. You are responsible for ordering everything for each
patient lab tests, radiology, medications, IV fluids, and procedures in addition to
providing patient education and prevention counseling.
Though the USMLE has kept quiet about exactly how Step 3 CCS cases are graded,
it is clear that shrewd management is key. Failure to order specific tests or
treatments, a lack of efficiency in patient care, and the decision to order
inappropriate or dangerous tests or treatments can all result in a lower grade. Timing
and sequence of care matter. Youll need to find the sweet spot between working
quickly and working carefully on this whole exam.
Once youve absorbed this large-scale advice (and decided whether or not to take a
course and which materials youll use to study), you should employ the following
preparation strategies:
Determine the best time to take the test (bear in mind your busy residency

schedule).
Make a schedule for the weeks leading up to the exam including breaks, times
to eat, and days for taking a full-length test. If at any point your schedule is not
working, then change it.
Take a practice test early to see where you stand. You need to get used to the
pace of the exams question blocks and get your body ready for the long and
grueling two-day testing process.
Go through as many questions and question banks as you can. Then go through
them again.
Focus your CCS preparation on gaining familiarity with the software and on
balancing efficiency with thoroughness in the virtual care of patients. Work on
completing the diagnosis and management aspects quickly; perform only a
focused physical exam in an emergency; and avoid ordering tests that delay
urgent treatment. Master the most common types of orders in real medical
care putting in an IV, getting patient consent for surgery, and providing
counseling. Finally, remember to order follow-up labs and procedures, such as
clopidogrel for patients who have received a stent, or liver function tests for
patients youve started on statins.
Identify areas in which your knowledge is weakest and review, review, review.
Study what you dont know. Its easy to fall into the trap of reviewing what you
already know to boost your confidence. If you have mastered a subject, then
spend time studying areas in which you are struggling.
On a related note, if you are taking the test for the second or third time, focus your
preparation on the areas in which you did not excel. Fortunately, the score
report from your previous test(s) will have provided graphical performance
profiles for each testing category so you can see where you need the most
work.
Take breaks, especially on days when youre deep in question blocks and books.
Go outside. Exercise.
Test-Taking Strategies
As the test day arrives, here are some tips to help you ace USMLE Step 3:
Learn how to get to the test site, and do a practice run. There are few things worse
than feeling rushed on the morning of the test.
Arrive at the test site at least 30 minutes early, and be sure to have a valid picture
ID with your signature and a printed copy of your scheduling permit.
Bring a lunch, a snack, and earplugs.
Answer every question. Wrong answers do not count against you, so guess away
when youre not sure.
Be sure you have checked all the questions in a block before you move on to the
next one. Once a block has ended, you cannot re-enter it to review questions.

 Gain extra break time by skipping the optional tutorial. You should be so familiar
with the format of the test that you dont need it anyway.
Decide what youre going to do during breaks ahead of time. Consider using this
time to review your overall strategy.
Get a great nights sleep the night before the night before the test. Studies have
shown this night of sleep is important for enhancing test performance.
Though youll have to wait up to eight weeks for score reports to come in, youll
probably find out in fewer than four. And as I mentioned in my last article, the pass
rate in 2015 for graduates of U.S. and Canadian medical schools was 96 percent, so
be confident in your abilities.
Follow these links for more guidance in preparing for the USMLE and launching your
medical career.