Path residents who have taken step III?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

yaah

Boring
Moderator Emeritus
20+ Year Member
Joined
Aug 15, 2003
Messages
28,059
Reaction score
438
So who has taken step III? Because of the state I am in I can't register for the test until I have completed 6 months of residency training. Is step III easy? Deceptively hard? I am not really worried too much about passing the thing but what I am worried is that I will start obsessing about studying for it and ignore my residency training for a couple of months.

I hate step 3. A complete waste of time. We should get an exemption.

Here is the "purpose" of step III:
The purpose of Step 3 is to determine if a physician possesses and can apply the medical knowledge and understanding of clinical science considered essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory care settings. The inclusion of Step 3 in the USMLE sequence of licensing examinations ensures that attention is devoted to the importance of assessing the knowledge and skills of physicians who are assuming independent responsibility for providing general medical care to patients.


Now, as a pathology resident, no one is EVER going to allow me to practice patient care and management in an outpatient setting, as far as I know. I would be practicing it as it relates to pathology, but somehow I don't think this is what the above "purpose" is referring to.

As as far as "assuming independent responsibility", isn't that more of a specialty-based issue? As in, I wouldn't assume an OB/GYN resident who passed step III could be a path attending. We have to take board exams within our specialty, and it is these exams that allow us to be accepted into the field and assume responsibility. Step III is crap. If you don't pass the pathology boards no one is going to give you a job, right? So what's the point of step III other than making money and providing lawyers with some massage therapy for their egos? It's not as bad as the Step II CS, but it's bad.

Members don't see this ad.
 
A guy in my lab is a basic science research track Pathology fellow. He took Step3 up until the last moment possible and regretted it. He passed, but he said it was hard. His opinion is that pathologists should take Step3 as soon as they can while things like case management are still dwelling in the neurons. Sure I suppose you'll ignore some training, but it's probably better to take it at a time where you will lose as little training time as possible. As opposed to the above guy where he was missing lab time and clinical training.

Either way, I don't think it's a big deal. All you have to do is pass. Do well on the pathology boards though!

-X


yaah said:
So who has taken step III? Because of the state I am in I can't register for the test until I have completed 6 months of residency training. Is step III easy? Deceptively hard? I am not really worried too much about passing the thing but what I am worried is that I will start obsessing about studying for it and ignore my residency training for a couple of months.

I hate step 3. A complete waste of time. We should get an exemption.

Here is the "purpose" of step III:
The purpose of Step 3 is to determine if a physician possesses and can apply the medical knowledge and understanding of clinical science considered essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory care settings. The inclusion of Step 3 in the USMLE sequence of licensing examinations ensures that attention is devoted to the importance of assessing the knowledge and skills of physicians who are assuming independent responsibility for providing general medical care to patients.


Now, as a pathology resident, no one is EVER going to allow me to practice patient care and management in an outpatient setting, as far as I know. I would be practicing it as it relates to pathology, but somehow I don't think this is what the above "purpose" is referring to.

As as far as "assuming independent responsibility", isn't that more of a specialty-based issue? As in, I wouldn't assume an OB/GYN resident who passed step III could be a path attending. We have to take board exams within our specialty, and it is these exams that allow us to be accepted into the field and assume responsibility. Step III is crap. If you don't pass the pathology boards no one is going to give you a job, right? So what's the point of step III other than making money and providing lawyers with some massage therapy for their egos? It's not as bad as the Step II CS, but it's bad.
 
Yeah - one of the attendings here is already on our case about taking step III. We keep telling him that we cannot even register for it until January. He is thinking of trying to make it a requirement that we take it during our first year, because there are a couple of senior residents who haven't taken it yet.

Definitely, I want to take it sooner than later while it is still fresh in my mind, and especially here where first year is less intense than other places. One of the other residents brought up to him that if the department really wants us to take the test first year they should offer to pay for it! Great idea to me! Doubt it will happen though.

Does step III result impact one's fellowship and future job placement? ;) (I am being facetious here)
 
Members don't see this ad :)
Yaah,

You can register for step 3 in any state you want. You do not have to live there, take the test there, or have any connection to the state whatsoever. On the FSMB website, there is a chart of each state's requirements for step 3 eligibility. Pick one that does not require anything besides graduation from med school, and you can take it whenever you want. Nebraska is one example of a state that does not require you to have completed any amount of time in residency prior to taking step 3.

If you're anxious to just get the test over with, that is how to go about it.

Is it hard? It's not horrible, but in my opinion it would have been a lot easier for someone who has kept up their clinical skills, like an internal medicine resident. You just don't get that kind of real life practice as a pathology resident (Umm, how do you manage an acute exacerbation of COPD again?) But if you put in even a minimal amount of effort studying and retained something from third and fourth year of medical school, you should be fine. By minimal effort I mean one to two weeks of casual studying from your review source of choice. As with any standardized test, it never hurts to be a really good test taker, too.
 
yaah said:
So who has taken step III? Because of the state I am in I can't register for the test until I have completed 6 months of residency training. Is step III easy? Deceptively hard? I am not really worried too much about passing the thing but what I am worried is that I will start obsessing about studying for it and ignore my residency training for a couple of months.

I hate step 3. A complete waste of time. We should get an exemption.

Here is the "purpose" of step III:
The purpose of Step 3 is to determine if a physician possesses and can apply the medical knowledge and understanding of clinical science considered essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory care settings. The inclusion of Step 3 in the USMLE sequence of licensing examinations ensures that attention is devoted to the importance of assessing the knowledge and skills of physicians who are assuming independent responsibility for providing general medical care to patients.


Now, as a pathology resident, no one is EVER going to allow me to practice patient care and management in an outpatient setting, as far as I know. I would be practicing it as it relates to pathology, but somehow I don't think this is what the above "purpose" is referring to.

As as far as "assuming independent responsibility", isn't that more of a specialty-based issue? As in, I wouldn't assume an OB/GYN resident who passed step III could be a path attending. We have to take board exams within our specialty, and it is these exams that allow us to be accepted into the field and assume responsibility. Step III is crap. If you don't pass the pathology boards no one is going to give you a job, right? So what's the point of step III other than making money and providing lawyers with some massage therapy for their egos? It's not as bad as the Step II CS, but it's bad.

A) dude, only the bottom 5% fail. Plus every attending pathologists before you has taken it and seemed to manage.
B) Gas-passers, Rads, E-med, and hospitalists have to take it and none of them ever work in the outpatient setting.
C) you don't need to be an OB attending to answer basic questions about women's health. As a pathologist you should have a good handle on the pathogenesis, clinical presentation, treatment and complications of treatments for most diseases. That is why you are the "doctor's doctor".

Quit stressing, study for it minimally, and just get it over with.
 
yaah said:
So who has taken step III? Because of the state I am in I can't register for the test until I have completed 6 months of residency training. Is step III easy? Deceptively hard? I am not really worried too much about passing the thing but what I am worried is that I will start obsessing about studying for it and ignore my residency training for a couple of months.

I hate step 3. A complete waste of time. We should get an exemption.

Here is the "purpose" of step III:
The purpose of Step 3 is to determine if a physician possesses and can apply the medical knowledge and understanding of clinical science considered essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory care settings. The inclusion of Step 3 in the USMLE sequence of licensing examinations ensures that attention is devoted to the importance of assessing the knowledge and skills of physicians who are assuming independent responsibility for providing general medical care to patients.


Now, as a pathology resident, no one is EVER going to allow me to practice patient care and management in an outpatient setting, as far as I know. I would be practicing it as it relates to pathology, but somehow I don't think this is what the above "purpose" is referring to.

As as far as "assuming independent responsibility", isn't that more of a specialty-based issue? As in, I wouldn't assume an OB/GYN resident who passed step III could be a path attending. We have to take board exams within our specialty, and it is these exams that allow us to be accepted into the field and assume responsibility. Step III is crap. If you don't pass the pathology boards no one is going to give you a job, right? So what's the point of step III other than making money and providing lawyers with some massage therapy for their egos? It's not as bad as the Step II CS, but it's bad.

1) As Weil-Felix stated, you can take step 3 as soon as you graduate. You just have to register in a state that has no requirements. Personally, I was in a residency program in NY (A state with a minimum 1 year of residency requirement), registered for it through CT, and took it in CA. Is there any reason for one state to have extra requirements when another state has no requirements? No. In the past, you actually had to go to that state to take the test, but now that its all computerized, you can take it at any Prmetric center. I think at some point the medical boards will figure this out and get rid of the state specific nonsense. And yes, once you pass, you pass. its good even in states that wouldnt have allowed you to take it when you did.

2) Remember, when the state medical baord licenses you, they license you to practice medicine and surgery, no matter what your residency training. Thats why you have to take Step 3. This is a good thing. The last thing you want is for state governments to start micromanaging what each specialty can and cant do. Besides, dont you want the power to prescribe medications?

Enjoy!
 
sohsie said:
1Besides, dont you want the power to prescribe medications?

No! It's unnecessary for me - if it is unrelated to my job the only thing I would be doing would be prescribing meds for family and friends, and they should be going to their own doctor, not me.

As far as stressing over it, as I said I am not really stressing over it, nor am I worried that I will fail (and if I should, I can just take it again anyway). It's just a pain in the butt.

About registering through another state - how easy is this? It seems to me there would be some kind of jumping through hoops. Maybe I'll look into it. I just don't want to go through applying and doing everything only to find out "Oh by the way"...
 
One important trick that can help maximize your efforts is to gather case simulations from those that have taken the test recently. Then you can study how to handle the cases in detail. A friend of mine, also a pathology resident, took the exam twice and didn't pass. He then went to some forums on the web and learned some tricks and questions. He easily passed the third time. It's worthwhile trying an "indirect" approach.
 
DiePath said:
One important trick that can help maximize your efforts is to gather case simulations from those that have taken the test recently. Then you can study how to handle the cases in detail. A friend of mine, also a pathology resident, took the exam twice and didn't pass. He then went to some forums on the web and learned some tricks and questions. He easily passed the third time. It's worthwhile trying an "indirect" approach.

There are already forums for the Step 2 BS (*ahem* CS) exam.

Man...I got a string of threads going. I wonder how long this will last. 10 minutes? 5 minutes? 20 minutes?

Deschutes will probably post and break the streak anyway. :laugh:
 
yaah said:
About registering through another state - how easy is this? It seems to me there would be some kind of jumping through hoops. Maybe I'll look into it. I just don't want to go through applying and doing everything only to find out "Oh by the way"...

It's as easy as registering in the state you live in. I did this and had no problems or hoops to jump through whatsoever. Seriously, when you go to the FSMB web site to register, they ask you "What state do you want to register in?" Then you pick one. It's that easy.
 
Weil-Felix said:
It's as easy as registering in the state you live in. I did this and had no problems or hoops to jump through whatsoever. Seriously, when you go to the FSMB web site to register, they ask you "What state do you want to register in?" Then you pick one. It's that easy.

I find this peculiar. Then why bother to have the state registrations at all? And why does each individual state have different requirements?

So, I could register as an Alabamian for this test, and send all my info to Alabama, and take the test in Michigan, despite the fact that I have never even been to Alabama?
 
yaah said:
I find this peculiar. Then why bother to have the state registrations at all? And why does each individual state have different requirements?

So, I could register as an Alabamian for this test, and send all my info to Alabama, and take the test in Michigan, despite the fact that I have never even been to Alabama?

Exactly. Like I said in a previous post, it defies logic, and is probably a remnant of the time when there were state specific tests and/or before the computerization of the test. Most people in the northeast who want to take it early apply through CT. I applied through CT and I had nothing on my application that indicated that I would ever even visit CT. And I took it in SoCal.
 
If you go to this website http://www.fsmb.org/ then click on USMLE - Step 3, it will bring you to a general information page. Click on the "online registration" and it will pull up a chart with all the requirements for each state. There are many states that have no time requirements.

A resident I just interviewed with took Step 3 his 2nd week of residency. Best to do it while Step 2 is still fairly fresh and get it out of the way so it's not hanging over your head.
 
Members don't see this ad :)
2005 said:
A resident I just interviewed with took Step 3 his 2nd week of residency. Best to do it while Step 2 is still fairly fresh and get it out of the way so it's not hanging over your head.
Amen! I would do the same thing. I got all this downtime after interviews so this year would be the best year for me to study and pass step 3. If I could take step 3 before med school graduation, I would totally do that too.
 
AndyMilonakis said:
Amen! I would do the same thing. I got all this downtime after interviews so this year would be the best year for me to study and pass step 3. If I could take step 3 before med school graduation, I would totally do that too.


Me too! If graduation is required, I wonder if we could manage to take it between graduation and residency.
 
jeff2005 said:
Me too! If graduation is required, I wonder if we could manage to take it between graduation and residency.

I took it the 2 days before starting residency. They required me to send in a copy of the med school diploma, so I sent in my exam application the day after my graduation.
 
I found Step III to be more a test of endurance rather than extensive knowledge. Two straight days of testing is a bear! The questions for the most part were things I vaguely remembered from med school and I was usually able to narrow the answers down to 2. The patient scenarios weren't too bad; I think I only killed one patient :). I found Crush Step 3, First Aid for Step 2 and the St. Frances Guide to Inpatient Medicine to be very helpful. The St. Frances Guide has some nice algorithms for treating certain conditions that were quite useful. Make sure and know the common diseases such as CAD, DM, HTN, etc. Many of the questions deal with outpatient scenarios. I would also be familiar with screening schedules and tests. Most of the path residents I know passed on the first try. Despite our permanent hiatus from clinical medicine, you should do alright.
 
Don't stress. I studied questions from the same Family Practice review book I used for Step II, and then read some chapters from the Washington Manual. During the test I had worries that I wasn't doing well (like when they showed what I thought was a normal xray of the leg, but "normal" wasn't one of the choices!), but I passed comfortably.

It really shouldn't affect fellowships, unless the program wants you to be BC in AP,CP.
 
I haven't heard anybody caring about your score on step III. They just care if you pass it.

My ability to read xrays is crap. I look at a lot of them when I have autopsies to try to correlate what I see to what the film looked like. Lung films are so hard to correlate, IMHO.

My big fear is that I will get too many questions on medications. :(
 
yaah said:
My big fear is that I will get too many questions on medications. :(
That is currently haunting my Step 2 prep! I am hoping post-Step 3 I need never think of them again, except in the context of toxicology.
 
sohsie said:
Exactly. Like I said in a previous post, it defies logic, and is probably a remnant of the time when there were state specific tests and/or before the computerization of the test. Most people in the northeast who want to take it early apply through CT. I applied through CT and I had nothing on my application that indicated that I would ever even visit CT. And I took it in SoCal.


I went to the fsmb website to see what all this hype was about...seems legit though, as it shows state by state requirements - with several states ala Nebraska and CT mentioned above that have NONE.

sohsie, just wondering why you didn't just register for Calif. (since you took it there too) instead of CT as it appears that Calif has no requirement either.
 
SLUsagar said:
I went to the fsmb website to see what all this hype was about...seems legit though, as it shows state by state requirements - with several states ala Nebraska and CT mentioned above that have NONE.

sohsie, just wondering why you didn't just register for Calif. (since you took it there too) instead of CT as it appears that Calif has no requirement either.
At the time I registered, I thought I would take it in NJ or NY, before residency started. Also, I didnt 100% believe that I could just take it in any state because it just seemed too ludicrous to me. Unfortunately, I got my ticket too late. Fortunately, I'm sunning in SoCal right now (Well, not right now. Its actually supposed to rain for the next week) I registered in CT because I didnt know who was going to mail me my ticket, so I figured better to register in a state near me to cut down on the mailing time. In retrospect, it didnt really matter where I registered.
 
**** this frigging test. :laugh: I hate it! Taking it on tuesday and wednesday. Now I am at the point where I momentarily get clutched when I realize I have no idea how to treat some diseases or conditions like pH imbalances (how does one alkalinize or acidify the urine without just giving straight bicarbonate or acid IV?) or am I going to remember names of antibiotics when I get to the CCS part and I have to treat Strongyloides and I don't remember the name of the drug. :mad: :mad: Then I realize that it will still only be one question so I will figure out the rest of it. **** these tests and the rationale behind them! :laugh:
 
yaah said:
So who has taken step III? Because of the state I am in I can't register for the test until I have completed 6 months of residency training. Is step III easy? .
I'm confuzzed-arent' you PGY-2 and therefore could have taken Step III last year? Sorry about the ignorance-Steps I-III weren't around when I finished school.
 
I could have, but I didn't. Schedule worked out easier to take it this month so I could study for it.
 
yaah said:
I could have, but I didn't. Schedule worked out easier to take it this month so I could study for it.
Yep...he's gunnin' for 250. Watch out though...geddy's set on rippin' your head off on Step 3. I know he's started studying for it after getting through Rosai for the second time. He knows more surg path than some of the attendings now...I pass by the signout rooms when I go check my mail and I hear even some of the bigwig attendings mutter, "hmm...this is a confusing case...let's see what geddy would say about this."

DAAAAAAAAAAAMN!!!!!! :eek:
 
Yeah no ****. I think it's worse though for the two guys who had already completed day 1, but apparently have to reschedule day 2? I am not sure if they will be forced to take both days again.

They did extend my scheduling permit until december, but their response is still kind of glib and not what I was expecting. They requested I reschedule my test for a time early in my window, so that if another irregularity occurs, I will be able to still fit it within my scheduling window. Hello! This is YOUR fault, you fools! +pissed+ I guess this is the advantage of having NBME, USMLE, FSMB, state medical board, and prometric all involved, because this way no one is really responsible.
 
This is just painful.

And of course have it happen to medical residents who have too limited spare time to lobby for changes!

I always said doctors should be unionized :rolleyes:

You have my signature if you write a letter.
 
We are unionized here.

I'm going to write a few letters. You could be a squeaky wheel before you take your test and call them ahead of time, and ask them if they are sure everything is going to go well. I'm sure they'll love that.
 
Dude, I just read that ****.

That's...just...F*CKED...up...right...there!

First there's the creation of step 2 BS...then they pull this ****.

F*ck! What's next? They're gonna **** in a water fountain and make you eat it?
 
yaah said:
We are unionized here.
Really? And which letters of the alphabet are those?

Btw I'm still looking for the equivalent of the Canadian Medical Protective Agency :)

yaah said:
I'm going to write a few letters.
This is probably my background showing, but have you considered an old-fashioned "Letter to the Editor"?

yaah said:
You could be a squeaky wheel before you take your test and call them ahead of time, and ask them if they are sure everything is going to go well. I'm sure they'll love that.
I can just imagine.

deschutes: "I have heard that it is not unheard of for difficulties with downloading the test to completely disrupt a test-taking session."
Prometric staff Ms. CYA: "Call the NBME".
 
Yaah - that totally sucks what happened today with your step III. I am glad you wrote complaint letters to everybody. I hope things end up working out all right and not too inconveniently.
 
deschutes said:
This is probably my background showing, but have you considered an old-fashioned "Letter to the Editor"?

The editor of what?

Now my dilemma is how much I study again when it comes time for the test AGAIN.
 
I doubt a national newspaper would be concerned. Others would see this as, "Well, they allowed you to reschedule and gave you an extended time period in which you could."

People not in residency don't understand residency. They think it's like other jobs where you can just take a couple of days off, to take a job related test. And their job will pay them for it.
 
yaah said:
I doubt a national newspaper would be concerned.
That's the beauty of the "Letters to the Editor" pages of newspapers - at least, those that I was familiar with. Noisy neighbours - and police not doing a thing about it? Letter. Chopping down trees in a park? Letter.

"I am a young doctor-in-training zillions of dollars in debt who is forced to take time off from working on your sick mom's blood transfusion in an overburdened healthcare system to deal with a mandatory test that xxxxxxxx number of newly-minted doctors have to take every year and has been in place for x number of decades - and THIS happens." That kind of line.

yaah said:
People not in residency don't understand residency. They think it's like other jobs where you can just take a couple of days off, to take a job related test. And their job will pay them for it.
Yes, it will be an interesting challenge.

Read it to your girlfriend (for some reason I am assuming she is not an MD) or someone not medically-related - and if she/they can understand why this is an issue, you might have your break!

If the NBME can run a general-public survey and base the establishment of the Step 2 CS on the results of said survey, I think we need to follow their lead and speak the language with simple "dumbed-down" questions and answers.

I know, I know... it's easy for me to say. I'll think about it too. Who knows, I might need to write a letter of my own :rolleyes:
 
So I'm crawling the FSMB website and it says there that the "registration instructions are valid for applications dated on or before September 1, 2005". Or something to that effect.

Brilliant. It's September 19 today. What happens now? :confused:
 
I think they start a new year of eligibility on sept 1. Big shock that they haven't updated it yet though. BIG shock. :rolleyes: You could always call them and wait on hold for 45 minutes for someone to pick up and tell you that they don't know the answer to your question.

Do I sound bitter?

Anyway, I took step 3 last week. The clinical cases were not so bad, I knew the dx in all of them, but probably goofed on management a couple of times, I don't know. Nothing serious. I figure I messed up on which medications I was supposed to give the diabetic woman having an inferior MI.

The multiple choice were annoying.
 
yaah said:
I think they start a new year of eligibility on sept 1. Big shock that they haven't updated it yet though. BIG shock. :rolleyes:
I figured. I saw that and the shadow of the cloud of foreboding fell over me.

Guess that means I'm not taking it until at least January.

One of the reasons to choose AP/CP - you actually have time on CP rotations to deal with this mad stuff.
 
deschutes said:
I figured. I saw that and the shadow of the cloud of foreboding fell over me.

Guess that means I'm not taking it until at least January.

One of the reasons to choose AP/CP - you actually have time on CP rotations to deal with this mad stuff.

I'm planning on taking this huge, steaming POS exam in January.. I can't wait to spend the holidays relearning things like cardiology and ID. Gah.
 
Aubrey said:
I'm planning on taking this huge, steaming POS exam in January.. I can't wait to spend the holidays relearning things like cardiology and ID. Gah.

If it's anything like my test, don't worry about that. Instead, learn about medical management of back pain, screening for cancer, and childhood asthma. Oh dear heavens, was there a lot of childhood asthma.
 
yaah said:
Oh dear heavens, was there a lot of childhood asthma.
You've just summarized my entire Pediatrics rotation :laugh:
Which is not to say that I know anything about childhood asthma now :laugh:

Anyway I got an email back this morning, it says:

Dear Doctor: (I wonder why they do this and proceed to treat us like ****...)

The 2006 application materials and information should be available on our website, www.fsmb.org in late September. The eligibility period for the Step 3 2006 administration will begin on November 1, 2005.

Sincerely, &etc
 
Aubrey said:
I'm planning on taking this huge, steaming POS exam in January.. I can't wait to spend the holidays relearning things like cardiology and ID. Gah.
Actually this exam is a hot, steaming piece of **** (spell that **** out, don't be a *****).
 
AndyMilonakis said:
Actually this exam is a hot, steaming piece of **** (spell that **** out, don't be a *****).

I'm just trying to cultivate an image of gentility during interview season.. after that I return to my customary sailor-swearing. :laugh:
 
Aubrey said:
I'm just trying to cultivate an image of gentility during interview season.. after that I return to my customary sailor-swearing. :laugh:
Your anonymity is still preserved. Just don't do what I did and tell people where you go to school. You're already kinda f*cked by saying that you're an MSTP (i think). But right now, you're still good. So swear on!
 
Top