USMLE Step 3 Experience and Tips

I’m finally done with the series of United States Medical Licensing Exams (USMLE) – Step 1 ($530), Step 2 CK ($530), Step 2 CS ($1230), and as of 12:30pm yesterday, Step 3 ($800)! Assuming I passed, I’ll be able to apply for my US medical licensure in a few weeks. 🙂

The first day was as long as Step 1. After completing 7 sections (46-47 questions each), I was mentally exhausted and definitely burned up the Greek yogurt and green tea I ate for breakfast. I finished each section with just over 10 minutes left, but ended up having to take a 5-10 break in between every section to stretch out some inopportune lower back spasms. This was in stark contrast to my previous standardized tests where I kept breaks to a minimum; however, it was refreshing having time in between to clear my head and soak in the sun.

The exam was definitely made worse by some painfully slow question transitions. At least 10-15 minutes were wasted waiting for some questions to transition to the next one. I mentioned this during my post-exam survey (apparently, other test-takers had similar complaints). *Shrug*

Fortunately, day 2 was much better. Although the question stems seemed shorter, I found myself finishing with only five minutes left. With my back feeling better, I slammed through the four remaining sections of multiple choice questions (36 questions x 4 sections with 45 minutes allotted for each section) without taking any breaks.

The 12 clinical case simulations (CCS) were very straight forward as well, and I finished most of them with over 10 minutes to spare in each case. Also, the aforementioned computer glitchiness was substantially better. I left Prometric with such a heavy burden off my shoulders (again, assuming I passed).

So now for some tips:

  • During your break time, go outside and spend some time in the sun – it’s amazing how refreshing and “awake” it makes you feel.
  • For multiple choice questions, read the last sentence of the question stem first. This will clue you in whether they’re asking for “the most likely diagnosis”, the “most appropriate next step”, the “best diagnostic test”, etc. Also read through the answer choices so you have an idea what the question stem entails. Often times the vignette is extremely long, so you want to know what you should focus on.
  • Skip questions which involve reading a pharmaceutical flier or case abstract until you’ve finished everything else in the block. This will help with time management.
  • Don’t blow off biostatistics. Easy points!
  • Start CCS cases by looking at the vitals (febrile, hypertensive, tachycardic, tachypnic, irregular rate?) as these should all be addressed with your plan (Tylenol, fluid boluses, rate control with IV metoprolol/diltiazem, etc.)
  • As you’re reading the CCS vignettes, start writing down orders. If the patient is a young female, you need a pregnancy test. If they smoke, consider smoking cessation. Based on their gender/age, always keep screening tests in mind (DEXA, mammogram, colonoscopy, vaccinations, etc.)
  • Don’t worry if your CCS case ends early!

Leave a comment below if you have questions or tips to offer! 🙂


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