The first day is 7 x 60min blocks x 48 questions. Some will have 1-2 fewer questions to give more time for the "drug ad" item sets.
The second day still has 4 x45 min blocks of 36 questions. Then an additional 9-12 cases.
http://www.usmle.org/pdfs/step-3/2012content_step3.pdf page 2 & 3
I take the test at the end of the month. Does anyone know if this change is a gradual implementation or if all testing centers will have this format of the test? Has anyone had this new format yet?
I took step three this past Friday and Saturday (yesterday and the day before). The change was in full effect on my test. It was quite shocking as I had no idea it was going to happen.
The first day was 7 blocks of sections ranging from 46 to 48 questions each (one hour per section) and there were two drug ads. The second day was four more MCQ sections, each with 36 questions (I think) and you had 45 minutes each section. There was one abstract question (actually 3 questions) on the test.
The big...no, HUGE change was in the CCS section. There were 12 cases. For 10 of the twelve you were given 22 minutes and for the remaining two you had 11 minutes per case. This included the wrap-up time at the end of the case, so the amount of time you had to actually manage each case was shorter. The cases were pretty straight forward, but it didn't seem as if the amount of time needed per case changed based on whether it was a "short" (11 minute) case or "long" one. In other words, the 11 minutes cases didn't seem "simpler."
Although I feel I didn't do anything horrible, as in I got to the root diagnosis and treatment of the cases, I routinely ran out of time and wasn't able to schedule follow-up, or tidy-up things in the end and in order to get all of the miscellaneous teaching/counseling in, there were probably 3-4 where I wasn't able to put in a final diagnosis (not that it matters). I did all the USMLEWorld CSS simulations, and although you wouldn't think it, there was a HUGE difference in the pacing you need to take now. It's now very much a rapid-fire approach in order to get all the diagnostic tests that may possibly be needed for the case in as soon as possible so that you'll actually see the results. If you take a more practical approach, of ruling in/out diseases based on pre-test probability and then testing, you'll run out of time. There were probably two cases where the time ran out before all the test results were back.
In summary, the MCQ section really wasn't all that different. A couple of drug ads and one abstract...no big deal. I personally felt that the CCS had a completely different feel, however. In preparing (using the 25 minute format) there was much more time to think things through and proceed accordingly. Now, it feels as if it is a matter of pouncing on a diagnosis and throwing every test or treatment in as soon as you can. I'll be the first to admit that it might have played out a little differently if I wasn't so surprised, but even being as efficient as possible, there were quite a few cases where getting everything done in the time allotted was difficult. But seriously, doing a history, physical, diagnostic testing, floor orders, treatment, monitoring treatment, ruling out other co-morbid conditions, with education and follow-up in as little as 9 minutes (for the 11 minutes cases) is tough!
