DIP Episode 115 - How To Study For The USMLE Step 3 Exam

Okay, welcome. My name is Devine. I am a PGY1 Transitioner year resident that's ultimately going to be going into our radiology. And this is the 115th episode of the Divine Intervention Podcasts. This will be a relatively short and sweet podcast, but it's one I've kind of got in a lot of requests on. So I'm just gonna talk about how to prepare for the USML step three exam and how to study for it. Something I've got a lot of requests from people over the last like three weeks really for some reason. So I might as well just go ahead and cover it. So the thing is the step three exam right is basically the last USML obstacle you essentially have to face before you kind of hit your goals as being a physician right. So there's step one, there's step two CK, there's step two CS and there's step three. And the thing is the USML step three exam is something that you can only take after you've graduated from med school right. So for American medical graduates there's no you can take step three or fourth year right. You can only take it after you graduate. So basically in fact I'll say this pretty much. You can start the application only after you've essentially walked at graduation okay. So that's kind of like a big thing you want to keep out the back of your mind. Now one question I get from a lot of people is when should you take step three. Again everyone's opinion is different right.

This is just my opinion but I am on the side of taking it as soon as you can in in turn here right. Because the thing is when you start out in turn here you tend to have like less responsibility because you pretty much know nothing right. So you tend to have less responsibility. So you tend to have kind of like even if you it may look like you have a lot of working on your plate. If you compare like the beginning of the end of the end of the end of the year you do actually have a lot more time in the beginning right. So that's one that's one reason. Second reason is the more you depart from the end of med school the more you forget stuff right. And the more you forget stuff it just makes your study period for step three that much harder right. So it just makes sense to just get it out of the way and then you never have to worry about it again. Although in general right to me your step three score it matters more so for some special tease matters less so for certain specialties but the thing I will tell you right of the bat for sure right. I'm not gonna call out any speciality here and say oh it doesn't matter for this specialty you can find that answer online pretty easily but I'll just tell you this if you're going for a competitive medicine subspecialty like cardiology or pulmonology like pulm critical care or he monk right or GI so gastroenterology those specialties generally you want to be able to have a solid step three score.

I'll just encourage you to maybe take the exam a little more seriously than other specialties do. So that's the first thing. And then the other question is what time do you take you exam right. You should try to take you exam when you're like on an easy elective or something where you don't have like tons and tons of hours that you need to dedicate. Now in terms of how much time you should dedicate to the exam I will say that usually you try to at least have like an aggregated like two to four good weeks. So if for example you remember a ton of stuff from Metzple right you're like yeah I can just use a few days sort of brush up on my knowledge let's say you still recall a lot of the stuff from step two then I think it's absolutely fine to take like two weeks but if you're sort of like in the situation where you're like hmm I forgot in everything can really remember a lot of stuff then I will say to be on the safe side you'll be privileged to go ahead and take four weeks to prep for the exam and that four weeks does not have to be like a step two dedicated period where you spend like 12 13 hours every day studying for four weeks no that's not what I mean right I mean something more along the lines of you go to work you're an elective you get of it like noon or like 2 p.m. and then you study for like five six hours a day okay that's kind of what I mean with those time frames.

Now in terms of studying for the exam right what kinds of resources should you use the first resource right you should definitely try to make sure you use is your world so your world for step three is about 1500 questions it's basically my thoughts on your world of that your world is again trying to protect myself since this is a podcast again I don't want to mention anything bad about anyone but I'll just say that I got a lot more use from your world for step one than I did for step three okay but your world is certainly one of those resources you should absolutely use for step three and the thing is when you're using your world for step three you kind of want to use the resources that you will provide right so one you obviously want to do the Q bank that's an important that's a given right second thing you want to use at the your world CCS cases and I'll talk about that in a bit and then the third thing you want to use especially if you feel weak with bio statistics is the your world bio stats thin that is sell alongside I think it feels for like 20 or 30 or something like that it has very good explanations for things so but before I guess talk about those resources I realize I'm kind of getting ahead of myself here let me just talk about step three right so step three is a two-day exam right it's not a one-day exam like the other USM is it's a two-day exam the first day is like seven hours and the second is like nine hours so the first day basically you have 45 minutes of break time and then you have six blocks of like 40 questions each usually it doesn't even know being exactly 40 questions you can be like thirty-three nine questions like some weirdness but basically the first day is like just to simplify things for you think of it as six blocks of 40 questions about 240 questions on the one now you have 45 minutes of break time where you can basically increase t

hat time to an hour if you do not watch the tutorial at the beginning right and you definitely should not watch the tutorial at the beginning because you ideally should have watched it on your computer from home so you know exactly what you're jumping into right so that you can get that extra 15 minutes of break time and really the first day of step three is pretty much it's kind of like step two it has a lot of like stuff on like internal medicine has some basic science stuff thrown in for whatever is in the tend to love from ecology quite a bit on step three right so you see like these are kind of like from ecology questions here and there in fact that was one of the reasons why I made the cloture from ecology podcasts so first day you find like you know a lot of internal medicine stuff but one thing that is particularly important on the one is you find a lot of ethics questions right a lot of ethics and a lot of bio stats I feel like definitely at least about 10 to 15% of the questions on the one revolve around bio stats and ethics so it's just one of those things you definitely do not want to you don't want to move you around with those things can significantly impact your score so you better know your bio stats and ethics and I'll talk about how you can tackle that in a bit so that's the one right now the two the two has less in the world bio stats but it still has a decent amount of ethics but on D2 you then have like internal medicine again more internal medicine questions but they tend to go like little want to like management right so like going a little above what you learned studying for step two CK they begin to kind of expect you to know those things right so you get like internal medicine questions and then you get questions in all those specialties like obstetrics and gynecology, pediatric surgery stuff like that so you get questions in pretty much ever

y domain right but the main subject that is represented on step two I mean on step three is internal medicine okay but do not downplay those other areas like your peets, obi guys, psych, neuro and stuff like that you'll find some of those questions on D1 where you'll find a lot more of those questions on D2 and the thing is D2 is a nine hour day pretty much right so you have like again six blocks of questions but these the questions this time tend to be like 30 questions per block so it's like 180 questions and then you have like two hours worth of things known as CCS cases basically CCS is something where it's like software and it's a part of the exam and you basically get a patient presentation you get the HPI and then you're expected to order like physical exams and other labs and performing interventions and give medications and stuff like that and again I'll sort of talk about that as we as we go along and then again you also have like your classic one-hour break and the CCS cases you tend to get like 13 cases be either 10 minutes long or 20 minutes long the 10-minute cases tend to be cases where it's something you can just like your suppose like recognize quick and manage like like attention you will throw out sort of deal versus the 20 minute cases where sometimes the patient may have to go home come back you may have to move the patient to the ICU or something like that in their management okay and I know as I'm saying it now it sounds really hard and it is hard but it's it's not terrible trust me it's not as bad as it sounds on initial inspection so again you have 45 minutes of break time on D2 right but again you can bomb that up to an hour pretty much by not watching the tutorial now one thing that is a little on nerve in for many people on step three is that they notice a lot of like drug-at-questions right so on step two CK right probably see like like th

ree or four drug-at-questions like this is so much now on step three there's a lot more drug-at-questions than a step two CK right the thing you want to keep out the back of your mind is and this is pretty much what I do I always leave those questions for the end right I don't once I see a drug-at-question I don't even waste my brain cells on it initially I run through the rest of the exam and then in the period I have left I come back and then work on those questions because again every question is worth the same number of points right those drug-at-questions certainly take a long time to go through right so again you kind of want to be careful don't don't burn your don't go through a drug-at-question and try to answer it on the first pass that is just generally not a smart idea for the great majority of people so that's one thing I'll say for sure you want to keep at the back of your mind and those drug-at-questions right again if you can get to them at the end I know it sucks right but think about it right you're probably getting you probably got in most of the easy questions in the block correct right and you're just maybe like living like three or four questions on the table okay so again just sort of keep that in perspective but I would I feel like for most people that have cheated I essentially tell them that they should leave that for the end of a block and usually those blocks that have drug-at-questions tend to have fewer right so let's say for example on D1 you say a drug-at-question a block that block usually does not have like 40 questions in it it usually has like less than 40 questions so it's kind of like the NV Me's we have saying you know what okay we know we're kind of stoning you guys with with this a drug-at-question so let's kind of make your life a little easier by deducting like two three four questions from a block instead of giving you 40 ques

tions here so that's that's that now again don't forget your bio stats is super super important like bio stats is tested very extensively on step three right so the best in our recommend in terms of bio statistics is the is the public health sciences chapter of the first textbook for the US Emily step one that is probably the best thing you can do to prep yourself there and then the second thing you should also consider so the thing I tell people is right for person like myself for example I was more than fine just going through the public health sciences chapter of first day for the US Emily step one but and I noticed I was doing okay on my practice test with just that knowledge right so I didn't feel the need to use the you world bio stats too but if bio stats is an area where you're like I don't feel great then I strongly recommend doing the you world bio stats questions at least I have seen some of them and I have toured a lot of people that I've used them and those people in general have had very good experiences with those now in terms of resources right so I already said right you should do the you world you should do the public health sciences section of first date for the US Emily step one other things you should also do right so you should obviously do the practice exams available right so there's your self assessment one and two you want to make sure you get through those the mbme has like two practice tests available those practice test they don't exactly give you a score what they tend to give you like a three-digit number so I know you may be like oh divine but three-digit number sounds like a score it's kind of like a score but it's not a skilled score so it's not like a 270 or whatever right it will usually be a number that's like 400 or 500 or 600 or 610 or whatever and the thing I will say is again I can I'm not gonna say that oh this applies to ever

y single person but in general if you're scoring above like a 450 on those mbme practice exams so again I'm just seeing this based on my experience tutoring a ton of people and advice in a ton of people that are taking this test in general if you're getting like a 450 or higher on those tests you have that has a very positive predictive very strong positive predictive value for passing the exam okay so that is something you kind of want to keep at the back of your mind so if you're scoring like a 350 maybe you should put in a little extra time so that you don't feel the exam right I mean it just generally doesn't look good for a person to fill the USM list at three exam because the passing score I mean it's it's pretty low right so you certainly do not want to fill the step three exam although it's not the end of the world you can always retake it but let's just say doesn't look good on your application and on your resume so just try to pass it the first time so that's kind of like a score gauge you want to keep at the back of your mind it's a little stringent but I've also found out to be like almost like a hundred percent positive predictive value in pretty much everyone I have to do it for for the exam so and also don't forget the free 120 right so there's a free 120 you should certainly do those and then another thing you should also use right so you were right so I just talked about the CCS cases that you see on the exam you were also has a bunch of CCS cases I would strongly strongly recommend doing every single your world CCS case if you feel comfortable with doing those your CCS cases chances are you feel very comfortable doing the CCS cases on your exam right I mean like I feel like that those your world CCS cases prepared me super super well for that section of the test I mean like many of my 10 minute cases I finished on them in like two three minutes many

of my 20 minute cases I finished most of them in like seven minutes right so that CCS portion probably ended up taking me about like 45 minutes total instead of 12 hours so the your CCS tool is phenomenal right to you like you just meet very few unfamiliar situations if you go through those cases and feel comfortable using them because the thing is CCS right like most of the cases you will get a classic common presentations of things they don't give you anything exotic or anything like completely out of the blue it's like something where you're like you're reading the case you're like oh I think I have a pretty good idea as to what may be going on right but they are certain things that then become important right like what kinds of exams do you other first what kinds of diagnostic studies do you order first what kinds of procedures or medications do you other first how are you monitoring the patients condition are you monitoring for worsening of their symptoms are you monitoring for resolution of their symptoms is the patient in the right place they need to be should they still remain in the emergency department can this be an office visit can you transfer the patient home should you move the patient to an intensive care unit should you move them to a regular floor those are all kind of decisions that the MBA me sort of want you to take as you are going along with with the CCS cases so one thing that is super super important in the CCS cases is knowing the order in which you do certain things and one thing you need to remember is that the order in which you do do things is the way the MBA me says you should do things right so the order in which you do things in the real world in the hospital does not always correlate with the order in which you should do things on the US Emily step three CCS portion of the exam so that's again why you also don't comes into play here a

nd also another good thing is the MBA me actually has like six practice cases and they have like the software that you can download and run on your computer and run those six simulations I personally feel that running through the software and running through those six case simulations will help you tremendously as you prepare for the exam again you do sure see the CCS portion of the exam is not one of those things that you want to show up for and feel uncomfortable with the software that's a recipe for disaster right so you don't want that so to prevent that from happening I was strongly encouraged to just play around with software it probably took me like two three hours I just run through all six cases sort of saw like the different parts of the software how to order things and stuff like that is how pretty pretty easy to figure out you don't need to be like a tech genius to be able to do any of those things just play around with it for like an hour or two and you should be golden for the most part so those are the things I would do in terms of like testing right so to prepare yourself for the test I will do your world I will go through the MBA me practice exams I will do the free 120 I will do the U World self-assess meant right and then I will do the the UL CCS cases the UL bio stats tool if you don't feel great enough with bio statistics from just reading the public health and sciences section of first aid for the USML step one and then you also you also we will serve to do those are practice as CCS cases that the MBA me has they have about six of them and they have like the software the actual software that you literally use on your exam so just sort of practice along with those now in terms of content review right so in terms of content review the thing I would strongly recommend doing for your test is kind of making sure that you do not neglect the other speci

alties outside of internal medicine because the thing is you were first set three covers internal medicine really well right but I will encourage you to strongly consider like other resources for like OBGYN, psych, PEEDS, Neuro, surgery and stuff like that because you're gonna get a bunch of questions here and there on those topics and I know again at the risk risk of some self promotion but I do strongly believe that the podcasts and videos that I have for those different shelf exams should be more than adequate to tackle the questions from those other sub disciplines on your step three exam so I have like videos for internal medicine that are very comprehensive I have videos for psychiatry I have audio podcasts for neurology I have videos for pediatrics I have videos for psychiatry those are things that I feel like if you sort of run through those that was sort of dust off the cobwebs that you have in your brain relating to those are sub disciplines that are tested on step three now in terms of internal medicine content right because again the thing is to be perfectly honest the kinds of questions you'll get on step three mirror in many ways the kinds of internal medicine questions you get on step two CK but there is actually a decent number of questions that test information that is kind of beyond the level of a third-year medical student because the people that are taking step three right that people that are generally residents in programs so they expect you to have like a little more advanced knowledge of some of these like things like endocrinology or bio statistics or he-mongue or stuff like that right so kind of knowing like a little more detail in terms of like management of like DKA for example or endocrine disorders like oh okay maybe for step two CK all you have to know was oh if a person has this condition you give this treatment right but now you may wa

nt to know like okay what is the is there a particular lab metric or a lab marker or lab measure that would make me go more with this treatment option versus the other right so it's a step above step two CK right but it is I will say especially for the internal medicine section of the exam you're gonna see questions on stuff where you're like hmm I know this thing from step two CK both you're demanding a little more detail or at more advanced knowledge than you're used to so one thing you can use to counter that is I do have some podcasts that again again they are targeted towards a step three in fact so far as of this city and I'm pretty sharp made like eight of those again I plan to make a bunch in the near future and hopefully at some point get to a stage where it is pretty comprehensive for the USM at step three exam and yes the podcast is kind of targeted also towards like the medicine in training exam and internal medicine board exam but again a lot of the content certainly shows up on the USM at step three exam even in not in as much detail but it certainly does show up so I'll encourage you I do have podcasts on the USM at step three like podcasts that are targeted towards step three I probably have like six seven hours worth of content at this point I think it's a pretty helpful to review those podcasts and any ones I kind of make as time goes along now other things you can use for review so online method they have like this section of the website that's titled the intern content the intern content I have found it to be one helpful right in just management of problems on the words but it also kind of helps you like with again some of these like weird things where you kind of need to know a little step above what is expected for step two CK okay so that's one of the thing that can help there are other texts out there that are commonly recommended and I have be

en through a lot of those texts and in general I have not found those to be very helpful okay so again I'm not gonna mention any specifics here but just think of the things I've mentioned in terms of being the most helpful and maybe kind of stick with those I think those are probably those will probably give you the best bank for your book in preparing for the USMLE step three exam now many people freak out on step three about basic science basic science basic science basic science you're like oh divine how do I prefer prepare for the basic science portion of the exam right so the thing is step three unfortunately right has a certain percent that goes into questions that you're like man this is street recall from step one right like you may see questions about like genetic mutations or you may see questions about mechanisms of inheritance of a disease or you may see questions about basic pharmacology like oh this drug what is the mechanism of action so the thing is they're usually like pretty simple basic science questions the only problem is you just have to actually like remember them in the first place so if you may not if you notice on my website you see that I have like podcasts that are called like clutch micro for example or clutch pharmacology for example or like even my internal medicine like shelf videos right you may notice that again I kind of like emphasize like some basic science in those videos there is I mean in those podcasts and I guess videos the reason I do that is again the USMLE exams is not just about having clinical knowledge they kind of want to expect you to also remember certain basic science pieces of information and the thing I will say is if you're like divine okay just tell me one ear that I should focus on I'm not saying that your exam is going to overt overtly represent this what I will say that like basic pharmacology is kind of like

a good thing to know going into your USMLE step three exam again if you get all the pharmacology questions wrong are you going to fail the test probably not because there are many ways you can redeem yourself right there is like the CCS cases the CCS cases no one knows exactly what percent of the total score it determines but general consensus is that about 20 to 25 percent of your grade is based on those CCS cases and the thing is the CCS cases are are is an area where I feel like if you prepare really well you can actually do really well on that section and it can prop up an otherwise bad knowledge base and it's something that you can get really good at if you're just putting the adequate like adequate amounts of time to prepare so I will again strongly recommend do not like mostly through the CCS portion is something that can certainly help you and kind of see your bacon on the exam so and again you may see divine you're recommending so many of your podcasts and this and that and this again maybe there's a self promotion aspect to this but the truth is on like step one and step two seeking there is not much in the way of good resources available out there for the USMLE step three exam in fact that is probably one of the biggest reasons why I'm making podcasts that are specifically targeted towards the exam because really again trust me as a person that has treated and thought thousands of people there's really not much out there in the way of good material that really does like specifically say okay this is going to be something comprehensive that will prepare you for the USMLE step three exam so again apologize if it does sound like I'm promoting my materials but in my experience those things have proven to be very successful for people that have used them even I myself that is giving this podcast when I studied for step three I actually went back and re watched m

any of the shelf specific like review videos and podcasts that I had made for like literally for my website and literally went back and reviewed those things and he helped me tremendously now one of the things that you should also keep at the back of your mind in preparing for step three is knowing like risk factors for things right so like biggest risk factor for this most common cause of death in this big biggest prognostic factor for social and so disease those things I talk about them pretty well in episode 37 and 97 on my website so it's like the risk factors podcast like screening guidelines and stuff like that those things are richly represented on the USMLE step three exam and one other thing in terms of step three is it's a two day exam many people ask do you have to take it back to back to be perfectly honest I mean I did take the exam on consecutive days but in retrospect I really do not think that that was the best idea in the world because I felt super burnt out by the end of the second year and I literally had to return to the words the next day right so I felt like super burnt out so I will see maybe spacing it by a couple of days probably makes a lot of sense right so you can take up to I think like a week between both days so I think I would err more on the side of sort of spacing you exam than doing it uh than doing it back to back than doing it back to back I think that is probably a smart way to go about things so uh let's see again this is kind of like a freestyle podcast so let me just see is there any other thing I think I want to talk about here um um again don't ignore step don't ignore CCS that is a section that can help you quite a bit on the exam um so I guess to just kind of summarize so in terms of stuff to use right um you world you world um CCS cases you were bio stats tool first date for the USML is step one public health sciences chap

ter um the risk factors podcast that I have on my website so like episodes 37 and 97 the clutch from ecology podcast to prepare for like the basic pharmacology questions you see on the exam the practice MBA is there's about two of those the you world self assessments right there's one and two um the free one 20 right there's the free one 20 again you may not necessarily need to take all these practice exams but for me I err more on the side of doing all practice exams available for a given USML exam um let's see what I was in I mentioned um the practice software on the mbme website where like the six practice cases with like the software that you will actually use on your test those are things you all kind of want to go through and again the shelf specific like videos slash podcasts that I have for the different specialties and also the the step three focus podcast that I have on the website they're not super comprehensive but they touch on many of the subjects that are tested on the exam and again it's a two day exam first day is seven hours long six hours basically six blocks of like 40 questions and then an hour of break time if you don't watch the tutorial and then the second is nine hours six blocks of about 30 questions each and then tours of like 13 CCS cases so my 10 minutes long so my 20 minutes lock and then you have like an hour of break time again if you do not watch the tutorial at the beginning which you should but watch because you ideally should have watched that at home um and I think that's pretty much it if you have any pressing questions feel free to reach out to me and as I always do at the end of a report cast I do offer one on one tutoring for the USM list step one step two CK step two CS and step three exams uh also offer tutoring for the medicine like internal medicine in training exam and internal medicine board exams so the ebiim exam and th

en the preclinical exams in med school and then the 30-ish off exams I do offer tutoring for those and then if you have a college buddy that is taking physics general chemistry organic chemistry biochemistry physiology histology I do offer tutoring for all those and then if you're a college student applying to med school so like an Amca application or a medical student applying to residency so an era's application I go for like one on one I guess kind of like consulting for that I've been on the admissions committee of a top two med school for like a year and I've shifted through thousands of high quality applications and again this past cycle pretty much everyone I worked with matched into their matched into residency and like 98% of them matched into their first choice so take that for what you will so if you need help in any of those things just reach out to me I do want to want to uh consulting for those so have a wonderful rest of your evening uh god bless you and I'll see you in the next podcast thank you

You must have graduated from medical school.

As soon as possible in early residency, when responsibilities are lower and knowledge decay is minimal.

Approximately 20-25% of the total grade.

Day 1 has a high emphasis on Internal Medicine, Biostatistics, and Ethics; Day 2 broadens the scope to include management from multiple specialties (OBGYN, Peds, etc.).

The order in which you perform physical exams, order labs, or administer interventions matters greatly.

Do not spend time on them initially; save them for the end of the block when you have more time remaining.

At least two to four good weeks (studying 5-6 hours/day on elective days).

The Public Health Sciences chapter of First Aid USMLE Step 1, and U World's dedicated Biostats tool.

Space the two days out (e.g., by a week) rather than taking them back-to-back to prevent burnout.

OBGYN, Pediatrics, Psychiatry, Neurology, and Surgery.

To master the correct sequence of diagnostic steps (HPI $\rightarrow$ PE $\rightarrow$ Labs $\rightarrow$ Interventions/Meds).

A score of 450 or higher.

At least two to four good weeks (studying 5-6 hours/day on elective days).

The Public Health Sciences chapter of First Aid USMLE Step 1, and U World's dedicated Biostats tool.

Space the two days out (e.g., by a week) rather than taking them back-to-back to prevent burnout.

OBGYN, Pediatrics, Psychiatry, Neurology, and Surgery.

To master the correct sequence of diagnostic steps (HPI $\rightarrow$ PE $\rightarrow$ Labs $\rightarrow$ Interventions/Meds).

A score of 450 or higher.