How to Painlessly Prepare for USMLE Step 3 & COMLEX Level 3

Preparing for USMLE Step 3 and COMLEX Level 3 Simultaneously

So, you’ve matched, graduated from medical school and planned out your new life in perhaps a new city or location away from home. You’re ready to start off intern year on the right foot and feel like you’re done with those arduous days of preparing for USMLE exams. But wait, there’s still USMLE Step 3/COMLEX Level 3 around the corner. Therefore, in this post we’ll cover:

• What is Step 3/COMLEX 3
• When do you take these exams
• How should you study for these exams

There is that old saying that students usually take “2 months” for USMLE Step 1/COMLEX Level 1, “2 weeks” for USMLE Step 2/COMLEX Level 2 and just need a “#2 pencil” for Step 3/COMLEX Level 3. But not so fast! USMLE Step 3/COMLEX Level 3 is the final examination in a three-part series for medical licensing in the United States. It is unfortunately treated by many residents as an afterthought; after all, you’ve made it through grueling study days for USMLE Step 1/COMLEX Level 1 and Step 2 CK/COMLEX Level 2, and Step 3/COMLEX Level 3 seems to be just a small blip on the radar in the long journey called residency and fellowship training.

The biggest mistake students make when it comes to USMLE Step 3/COMLEX Level 3 is not taking it seriously enough. Intern year and residency are hard enough and it can reasonably be difficult to find time studying for yet another standardized exam. The goal of this blog post is to equip you with the tools to be organized in your approach towards a painless study period for USMLE Step 3/COMLEX Level 3.

So, what’s different about this test? 

USMLE Step 3 encompasses two major components:

1. A multiple-choice component, very similar to that Step1/2
2. A clinical case component, where you will in real-time manage, treat and diagnose patients using a computer simulation tool. These are simulation cases

The test runs two days. The first day entails a total of 232 multiple-choice questions, divided into 6 blocks. The second day entails a total of 180 multiple-choice questions, divided into 6 blocks, in addition to 13 case simulations, which each run up to 10-20 minutes of real time. 

COMLEX Level 3 is also a two-day examination that in total contains 420 multiple choice questions and 26 clinical decision-making (CDM) cases that each contain two to four question each.

How does one prepare for this examination during the busy time of internship/residency?

There are two sets of students taking USMLE Step 3/COMLEX Level 3 and depending on which category of student you fall into, your timeline for this examination might be different. The first set is the residents who are doing a separate internship year as part of an advanced residency program (this includes radiology, radiation oncology, dermatology, ophthalmology and in some cases, neurology and PM&R). The second set of residents is those who are in a categorical program (meaning their training from internship to residency is at the same institution and linked). The reason this distinction matters is because for those students who fall into the first bucket (separate intern year, then beginning and advanced residency program), they are required to take USMLE Step 3/COMLEX Level 3 prior to starting their advanced program (PGY-2), and therefore, must take it by the end of intern year (often with a few months to spare). Those residents in the categorical programs can usually take in on a more flexible basis during their PGY-2 (or sometimes, later) years, per their individual residency program guidelines.

However, Step 3 is required to obtain a state medical license and DEA license. Thus some programs have specific deadlines for the exam. In surgical specialties it is more common that individuals are expected to take it during internship and must have completed the exam prior to PGY2. In surgical specialities it is often requested that students take the exam while “off-service” meaning rotating on a speciality that is not their own, in order to not lose valuable educational time on their home service. 

What are the best resources for this examination?

At Elite Medical Prep, we recommend the tried and true resources of a gold-standard question bank, a content review resource and simulated practice exams. UWorld continues to be an exceptional question bank for USMLE Step 3/COMLEX Level 3, and also includes approximately 50 interactive cases (with additional non-interactive review cases and a separate section devoted to biostatistics), as part of their package.  In terms of a content review resource, Master the Boards for USMLE Step 3 is often a favorite of students, providing concise high-yield information in a palatable format. And finally, practice tests, including UWorld self-assessments and NBME practice USMLE Step 3 forms are again king. USMLE also provides a limited number of practice cases on their website which are very helpful to see real exam formatting (https://www.usmle.org/practice-materials/index.html#tab_step3_ccs)

When should this exam be taken and what is the best way to devise a study schedule? 

Regardless of when one is taking this examination, it is important to determine a general ballpark (based on your rotation schedule) of when you might want to take the examination. Some suggested times are during a lighter month (such as an elective, ambulatory rotation or ED rotation) or immediately following a short 1 to 2-week vacation. Invariably residencies across the country allow students, with advanced permission, to miss workdays in order to take the exam. Therefore, it is not imperative to schedule during a vacation block, though often students appreciate having some amount of dedicated study time during a few days of vacation. 

Start early: 

• Preparation should begin much earlier, usually 2-3 months into intern year, after you have had some time to settle into your clinical duties and have learned the ins and outs of the hospital system and EMR.
• You will have to apply for a testing time frame, which involves having form audited by your resideny. This process can take longer than expected to start early in order to ensure you are able to take the exam when you desire
• Make a habit of doing somewhere between 10-20 multiple choice UWorld questions/day and then on the weekends (or other days off) supplement with additional questions and even doing a few cases. This is ideal because it won’t feel overwhelming to do this during your days but at the same time you are making significant inroads towards mastering the clinical material for your examination. Then, once one gets to the easier elective rotation or short vacation (as discussed above), this can be considered the “dedicated” study period where you can reset the question bank and cases and go through them each one more time, with this second review much easier than the first time through since you will have gained the knowledge required to answers these question during your first run during the year. Additionally, this is the time to incorporate simulated practice tests as well.

I’m not going into internal medicine; how will I remember any of it?

While there are surgical fields represented on the exam, it is heavily weighted toward internal medicine. Often students going into surgical specialties will try to take the exam earlier in intern year, before they “forget” everything from MS4. This is not imperative, as you’ll be surprised how quickly information comes back to you with studying, but another reason to start studying early and do UWORLD/qbank questions often. 

USMLE Step 3/COMLEX Level 3 are important examinations that require your focus and attention during the difficult years of residency. It is our hope that with proper planning and effective, efficient studying, this approach will not only make your studying as painless as possible but also give you the best chance at scoring the highest you can!

As always, if we at Elite Medical Prep can be of any assistance to you with 1-on-1 tutoring, please don’t hesitate to reach out.