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How Much Time Should You Actually Spend Studying For Step 3?

A doctor holding a small graduation cap after having completed the USMLE Step 3.


When entering medical school, the thought of impending USMLE exams looms over the preclinical and clinical years. Once Step 1 and Step 2 are traversed, residency is on the horizon and the idea of further examination preparation can be unsavory. However, Step 3 is not an exam to be taken lightly. As a 2-day exam with 232 multiple choice questions on day 1, 180 multiple choice questions on day 2, and 13 clinical case simulations, it builds heavily off the knowledge you gained on prior exams with a lean towards clinical practice. When deciding how much time your should set aside to prepare for the USMLE Step 3, it is important to consider the numerous contributing factors which will influence your performance come test day.


By When Must You Take the Exam?


Remember that Step 3 is an examination that can be taken at the end of medical school throughout the first few years of residency, and as a result, the time available to prepare varies wildly. Per the USMLE, it must be passed within 5 years of Step or Level 2 or before the end of residency training, though many residencies require it be taken earlier in training. Overall, given the substantial overlap between Step 2 and Step 3, it is recommended to take the exams as close together if possible. If you must take the exam by the end of your intern year, as many medical residents are advised, it is unlikely you will have substantial dedicated time to study for the exam. In that case, most students spend between 4-8 weeks preparing, with the goal to complete the UWorld question bank and familiarize themselves with the clinical cases. If possible, using an elective block to study the two weeks leading into the exam is recommended. Remember that the Uworld Step 3 question bank contains over 1000 questions and over 40 clinical cases, thus you will need to distribute these over time to ensure all the material is reviewed. Finally, it is important to complete the Step 3 practice cases provided by the USMLE, which allows you to complete cases in the virtual testing environment that you will encounter on test day. 


What Subspecialty Are You Going Into?


Remember that the USMLE Step 3 exam is a general licensing examination, meaning it will be covering content from every one of your clerkships. Thus, if you enter into a highly subspecialized field, it is likely this knowledge will quickly be replaced throughout residency with content more relevant to your field of choice. As a result, you will likely require more time to prepare for the exam the further into residency you progress. For these specialties, you may want to spend closer to 2 months reviewing questions to ensure you refresh your memory on the content. Alternatively, if you are going into a subspecialty with a more general focus, such as internal medicine or emergency medicine, your daily practice will contribute to your knowledge base for the exam, and you may only require several weeks to familiarize yourself with the material and the cases.


How Did You Perform on Prior Exams?


Ultimately, the best predictors of future performance are prior performance. This includes percentages on UWorld question banks, NMBE practice tests, and the prior USMLE exams for which you sat. If you passed Step 1, and passed Step 2 by a comfortable margin (Step 2 passing score is 214) then you likely have a strong knowledge base that will give you an advantage going into your Step 3 preparation. Alternatively, if both exams were more challenging or not passed on the first attempt, you will likely want to spend at least two months time preparing for the Step 3 exam, as the content overlaps substantially with Step 2. 


Are You Comfortable With Biostatistics?


Biostatistics, epidemiology, and population health make up 11-13% of the tested multiple-choice questions on Step 3. Indeed, the exam is notorious for its emphasis on these concepts, which are tested through varying formats including evaluation of excerpts from the primary literature, mock drug advertisements, and clinical vignettes. For those with more of a research background, evaluating these texts may come second nature, and test preparation for this subject area may just require memorizing some key formulas. For those without exposure to substantial primary literature and interpretation of the data, it is important to spend dedicated time on biostatistics, which can be done by either ensuring all biostatistics questions of the UWorld Step 3 question bank are completed or referring to dedicated biostatistics preparation materials, such as the UWorld Biostatistics Modules.


In the end, this exam is the most clinically based of all the USMLE exams, making it the most interesting and applicable of the series. With consistent preparation either over several weeks to several months, and careful review of the questions, clinical case simulations, and biostatistics, it is an exam where you can excel.


For more help preparing got USMLE Step 3, creating a custom study schedule, adopting effective study habits and more, consider enlisting the help of a 1-on-1 tutor! For more information schedule a complimentary consultation today!

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