USMLE Step 3 Preparation Before Residency

USMLE Step 3 is the last board exam a physician must pass to practice medicine in the United States. It can only be taken after graduating from medical school; most residents take it in their intern year before getting into the bulk of their residency training. However, there are a handful of states (Texas included) which permit students to take the exam without completing any of their residency. In other words, one can register after graduating from medical school but before starting residency (ie, May or June). This is my tentative plan (as long as the registrar can quickly submit my graduation stuff so I’m eligible to register).


An excerpt from

Step 3 is a two-day examination. You must complete each day of testing within 8 hours. The first day of testing includes 336 multiple-choice items divided into 7 blocks of 48 items; 60 minutes are allotted for completion of each block of test items. There is a maximum of 7 hours of testing on the first day. There is also a minimum of 45 minutes of break time and a 15-minute optional tutorial

The second day of testing includes 144 multiple choice items, divided into 4 blocks of 36 items; 45 minutes are allotted for completion of each block of test items. Approximately 3 hours are allotted for these multiple-choice item blocks. The second day also includes a 10-minute CCS tutorial. This is followed by 12 case simulations, for which approximately 4 hours are allotted. A minimum of 45 minutes is available for break time.

So in other words, the medical licensing board is trying to finish us off. 😉


At first, it doesn’t make sense to take the exam before intern year. Won’t a lot of the tasks I do as an intern indirectly prepare me for this heavily clinical exam? Compared to an internal medicine resident who will be inundated with a variety of cases throughout months of general medicine wards, my anesthesia intern year has a much narrower scope with only two months of adult wards. In addition, while studying for USMLE Step 2 CK, I noticed that clinical medicine (what goes on in the hospitals) varies quite a bit from textbook medicine (things we’re tested on). I’d much rather avoid having to study two different workups or treatment modalities for the same thing.

And the most important reason… I just want to be done with the USMLE exams!! 🙂


Akin to my Step 2 CK preparation, I’ll use only a handful of resources for Step 3.

  • Master the Boards USMLE Step 3 (2nd Edition)
  • Crush Step 3 (info which I’ll annotate in Master the Boards)
  • USMLE World Step 3 question bank and clinical case simulations (CCS)

I’m relatively comfortable preparing for the multiple choice section from my experience preparing for Step 2 CK. The difference is the clinical case simulation (CCS) portion of Step 3. I have little experience with such a format (ordering exams, allowing time to pass, adjusting the workup, etc.) while being docked points for unnecessary exams. In reality, this may be a major drawback to taking the exam prior to actually doing these things in residency.

So that’s where I am. I’ve gone through Master the Boards once and am ready to start Kaplan Videos. 🙂

Any thoughts for or against taking USMLE Step 3 before residency?

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  1. Hi Rishi,
    I know this post is from ages ago, but I was wondering if you were actually able to end up taking Step 3 before you started intern year? If so, do you recall at all how long it took to get verified by NBME, get the scheduling permit, etc.?

    Additionally, how did you go about scheduling your vacation before starting intern year if you were studying leading up to it?

    Thank you

    • Hey Ian! I actually tried to register, but by the time I became eligible, the only dates available were well into my intern year which defeated the purpose of taking the exam beforehand. I ended up waiting till I had an easier rotation later in my intern year to take it.

      In hindsight, it was a really dumb move to waste that time between MS4 and intern year studying for an exam I wouldn’t take for many months later. I strongly recommend dedicating that time to travel, hobbies, family time, etc.

  2. Hi Rishi,

    Hope you’re doing well! Regarding step 3 prep – do you recommend just uworld or uworld + other resources?

    I’m graduating in December (took medical leave in between) and have some time before July 1 for residency (hopefully I’ll match?!?!) . I recently took CK and figured I can probably rely on some of that knowledge for this exam.

    So far I’m considering using the strategy I used for CK: Kaplan tapes, uworld + FA annotations. I’d really like to finish this exam before July 1, because I’m terrible at exam taking and definitely need dedicated study time to pass this thing.

    Last – is this exam more important to get a high score on or just to pass? I’m going into Family Med but am considering doing a fellowship afterward. Like I mentioned before, I’m terrible at all exams (including all of the previous steps).


    • I used Master the Boards and UWorld. It was plenty. Spent some time learning how the CCS section is formatted too. Your study plan sounds reasonable too! I think it’s fair to say that the overwhelming majority of people do worse on Step 3 than Steps 1 or 2, so just make sure you pass! 😉

  3. IMGs take Step 3 before residency as a rule… I don’t see why you cannot.
    But I think there is another reason why you might want to take it. They are probably going to change the exam pattern starting 2014 or was it 2013?

    PS: I am referring to IMGs who are fresh out of med schools, have not done residency in their home country and who do not have GC/PR.

  4. While I’m very premature in my medical school training to say something for or against your decisions, it seems like a very smart decision to take your exam early. As you get into training, you will never has as much time as you do currently to study for yet another exam.
    I’m very curious to read other’s opinion on this decision.

    • Totally agree. As I get further, I’ll need to focus on my in-training exams (ITEs) for anesthesiology – won’t have time (or motivation) to study for Step 3.


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