The old adage has been two months for Step 1, two weeks for Step 2, #2 pencil for

Step 3. In reality, its probably more like two months for Step 1, 1 month for Step 2,
and two weeks for Step 3. But if you are worried about getting that competitive
cardiology fellowship, its hard to nurse the popular opinion that Step 3 is $815 pass/
fail two-day pain-fest that you can simply walk in and take. That said, if you
comfortably passed Step 1 and Step 2 and it hasnt been years and years, you will
pass Step 3 with nominal preparation outside of familiarizing yourself with the CCS
software and the official sample cases. Step 3 is a normalized test, and because all
residents put less effort into studying, you simply need to do less work to achieve the
same score. Id recommend taking it during your intern year,because the relatively
fresh Step skills and knowledge from Step 2 CKare more important than the clinical
acumen you will gain during residency.
Last updated: 12/31/2015
Your resources
A busy intern doesnt have much time (or desire) to comb through any review book.
If you only plan to dedicate 2-4 weeks part-time studying (which is typical), then all
you really have time for is USMLEWorld. The question bank itself is around
1567questions with 51CCS cases. Forgo the books. Do the UW qbank and
definitely do the CCS cases, and you might have time to go through the questions
youve marked/gotten wrong a second time. Besides, UW now has an iOS app so
you can do questions while your attending prattles on rounds. The questions are still
hard and the test itself still feels awful, but because everyone studies less for Step 3,
youre likely to perform similarly to Step 1/2CK with only a fraction of the work. (The
caveat is that if you struggled to pass Step 1/2CK, then you need to take this test
seriously [of course].)
Dont forget to download the official USMLE Step 3 practice materials here, which
contain the official software, some sample questions, and six CCS cases (which are
a must do). If you dont bother going through lots of example cases, at least do the
six free cases to become intimate with the software.
If you have the time and desire to do a slow-burn and read actual books, you can
(but probably shouldnt/wont). However, know that none of entries from the classic
series are really as good as their previous Step counterparts.
Crush Step 3is the fastest, but its skeletal and fulls of holes as always. Its definitely
the only book thats fast enough to blaze through. First Aidwas recently updated and
likely less out of date; its still that densely-packedoutline format, which is less high
yield and more difficult to get through than it used to be. Master the Boards USMLE
Step 3 is probably the best complete book on a time and mental energy budget,
but theres still no way most interns will bother getting through it. USMLE Step 3
Triage is more targeted/high yieldthan First Aid, very readable and well-organized,
with a nice conversational tone anda nice free companion website with practice
questions[link dead for now] that anyone can use; unfortunately, it was last updated
in 2008. You can also find some free questions on the Archer USMLE site.
As always, questions are most important, and UW is indispensable. Never use a
book in place of questions. If youve spent a few days on a medicine service, an ER,
done any general surgery, played with kids, or avoided poisoning a developing fetus,
then your clinical experience will serve you well. But you dont really need itas
always, this is a test. It tests your ability to take a test, not to be a physician.
A few words about the CCS (Computer-based Case Simulations)
Typically getting the diagnosis and the primary treatment are pretty straightforward.
The finesse comes from two skills:

Get the diagnosis and management done quickly and efficiently. Do only the
focused physical in an emergency. Dont order and wait for tests that delay
proper management. The amount of virtual time that passes prior to certain
diagnostic tests or interventions does matter. Dont just be thorough when
time doesnt allow for it.
2
Know the related but fundamental orders. Using CCS is awkward. You have
to order patient counseling and other things that you would simply do in real
life. You also need to remember to follow up labs and the like. If you start
methotrexate, you need to order a follow-up CBC and hepatic function panel.
If you diagnose someone with lupus, they need a renal biopsy. If you give
someone a stent, they need clopidogrel. If someone is going to surgery, they
should beconsented.Statins and LFTs.Pregnancy testbefore giving
teratogens to women. Etc. Keep these sorts of things in mind, and youll feel
much better as you go through the cases.
3
That said, the little things matter much less than the key management (i.e.
appendicitis requires surgery). Like Step 2 CS, you can forget to do a lot of
things.
Before you start, it might help you to write out on the test-center sheet the common
orders that you would otherwise forget to do so that you can be methodical in your
approach (the kinds of things that just happenin the hospital), like starting an IV.
When ordering consults or inputting the primary diagnosis on the final screen, you
may ask yourself, I wonder how this is graded? Do they have human beings read
through more than 25,000 tests to determine if the words deserve credit? Is there an
algorithm that checks the text for the presence of the correct words? The answer is
neither. This text is not saved as part of the examination, is lost forever in the sands
of time, and is in no way used for scoring. Interesting isnt it? So it makes more
sense to use the last two minutes on the final screen of each case to make sure your
final orders are as complete as possible rather than making sure you have time to
type up the diagnosis.
Recent changes in 2014-15
1
Being able to take the test on two nonconsecutive days is a good thing, both
for scheduling flexibility and for test fatigue.
2
I see no reason to be overly concernedabout the much-maligned return of
basic sciences. Content changes for the Step exams have remained minimal
for quite some time. Its not as though the addition of drug ad style questions
has meaningfully changed the prior Step exams or required a significant shift
in study patterns. The basic sciences that will be invoked on this test are
unlikelyto be of sufficient quantity to matter to most takers and are also likely
to be the most relevant or highest-yield bits from the old daysthe stuff you
are most likely to remember anyway. I personally wouldnt worry too much.