USMLE Official USMLE Step 3 Experiences Thread

[Redpancreas]

Score: 243
Study Period: 2 months
Step 2CK: 245
Step 1: 252.
UW Step 3 Average: 69% timed tutor, random. Repeated Peds/OB+GYN/Endo.
UWSA 1 (4 weeks out): 206 (Fun fact: there's an option to score recheck your practice exam. When I clicked it my score went from 196 to 206). I hate practice exams and think I split this one up into two days. I mainly used it for more questions.
Demographics: US MD, 2 years of IM residency experience
Study time: Two month time period, studied 9-5 most days but took maybe 20-30 days off just goofing off or focusing on other things in life.

Resources:
1.) UWorld Step 3 ($300)
2.) UWorld Step 2 CK (Peds/OBGYN mainly but I literally went clicked through other sections the day before my exam)
3.) OnlineMedEd videos for some review
4.) CCScases.com for CCS ($60)
5.) $25 Biostats package.
6.) MedQuest [new] by Conrad Fischer/Niket Sonpal (Video lecture series based off 2020 Master the Boards). Warning $$$ (300).

Study Period:
Out of all the Step exams, this one was the most lonely/isolating one with no real dedicated resources other than UWorld that I'd heard of. I studied January/Feb for most the day. Most PGYs won't be able to do this, but my advice is to not take the exam lightly. It seems like a lot of people seem to fail it or drop scores and I felt the exam was actually quite difficult despite all the sentiment from attendings that it's a breeze or whatever. For those interested in IM fellowship, your score probably doesn't matter BUT score too low and you could get screened out for a competitive fellowship so I wouldn't go in there with a #2 pencil as the saying goes.

I started with UW questions and mixed in some OB/GYN + Peds independent review and things were going slow. One thing that sped me up was I met an IMG on the USMLE Step 3 FB group and we basically started doing UW and CCS together over Zoom and I went at a pace of 80UW+4CCS a day. She was super good with Peds/OB-GYN and had just taken Step 2. We chose to use CCScases.com instead of UW because it gave way more feedback to learn from and gave us an exactly percentage on each case based on a detailed analysis of how we managed the patient and the order we did it in. After we completed this, we kind of split up and went our own way after re-doing some Uworld questions from my weak areas (OB/GYN, Endo, Peds). I ended up not using Anki. TBH near the end I kind of slacked and maybe 10-15 days off the month, I did not really study. I spent most my time redoing a bit of UWorld and watching the Peds, OB/GYN, Endocrine, Hematology, Cardiology, and ID sections of MedQuest (new 2020 resource).

Strategy:
There are 3 unique elements/curveballs to this exam aside from what is in UW Step 3 some don't expect.

1.) Biostats Emphasis (Day 1):
I think what's most in your control on this exam is biostats yet no one wants to spend time on it. I did UW random tutor so I was exposed to biostats consistently throughout and spent more time figuring out why I got these questions wrong. There are a few recurring themes like it a confidence interval cross 1, that's not the answer and to never pick X causes Y as an answer. A week before the exam, I purchased the biostats UW package which also helped a bit to drill down less common concepts like predictive values, NNH/T, and definitions and test taking strategies for biostats. I felt this helped me on the real thing. Definitely memorize the 2x2 table and learn how to manipulate it. As someone pretty good at math, it felt humiliating to memorize a 2x2 table and formulas I could just derive/reason through but you are gonna get questions testing sensitivity/specifity so you may as well get super accustomed to doing these calculations fast instead of wasting minutes trying to reason through stuff.

2.) Basic Science (Day 1)
A lot of IMGs were advising me to read First Aid and I pulled out my old copy but didn't use it too much. I figured I'd either know it or I didn't and spending all day reading First Aid for Step 1 wasn't an active learning strategy and too low yield to be worth my time. I didn't review any of the First Aid Micro/etc. people said to. What helped me in some cases were the MedQuest lectures where Conrad Fischer hits on high yield basic topics simultaneously while covering the higher level stuff like diagnosis & management/etc.

3.) CCS cases (Day 2)
Start prep early. I preferred CCScases.com to UWorld because the CCScases software gave me way more feedback than UWorld and gave me insight as to how one loses points. A lot of people seemed to get bogged down by details like preventative care/vaccines/smoking cessation when in reality that's like maybe 5% of the points based on CCScases. The key thing to CCS I think is your treatment. Per CCScases, it accounted for about half your score. Missing a one key step like prescribing a medication or calling surgery to do something costs you 30-40% of the points Don't worry about dosing as you only need to know routes and for antibiotics, multiple answers are accepted as long as you're covering the right bug. Work-up was second most important. It's important to not only order what's indicated to make a diagnosis but order what's needed to figure out why things happened in the first place or further complications. For example, with AFib (not on my test) it's important to order TSH and BMP even though it doesn't contribute to the diagnosis. As an IM resident, this came naturally but to others it may be a refresher. The diagnosis itself is not actually tested (I did not have to type it in a box even when the case ended like I think they used to have you do). I actually scored near full points on a practice CCScases case where I didn't have an exact diagnosis in my head but had a gist it was some kind of ovarian mass and did the right things to manage it. The best thing to do is to develop your own system for orders and practice this. This is a bit like a video game in that speed/accuracy come with time. Practice a lot of cases. The real test had different order sets than CCScases though and CCS cases were a little too obvious about what the diagnosis was were my only two knocks on them. Definitely download the official USMLE software which has 6 cases to review to get a sense of what the real order sets are like, but unfortunately the real cases are a bit more challenging than those on that software too. On the real deal the cases are a bit difficult because they kind of "evolve" as one diagnosis turns out to be another whereas CCScases the diagnoses were fairly straight forward.

Experience:
I took it on a Wed/Friday. I don't think the time between matters and it's probably more of a mental thing.

Day 1:
Honestly, I really felt good about this day which was eery because everyone said this was the worst day. On my exam, there were probably 7-10 biostats questions PER block on Day 1 ONLY and covered a range of biostats material. A decent amount of it was pretty basic 2x2 table stuff so don't neglect that. There was some basic science material on there. It may have hit on strengths but I felt it was stuff residents should still know like MOAs of drugs, etc. The way basic science was often tested was in the form of a 2-3 order MCQ where they gave you a clinical scenario. You had to get the diagnosis (1) and the treatment (2) and the answer choices would be the mechanism of action of the treatment. I honestly found these to be easier because you can reason through them. Some of the questions were super random but that's with any Step exam. Some of those random ones were actually random factoids I had a gestalt about based off something I remembered way back in the M1/M2 classroom. All the ethics questions were on day 1 for me as well and there were some tough ones. I did run of time on a few blocks with 1-2 questions left that I had to skim/guess on but that's not atypical for me. I came out of day 1 with a 8/10 confidence level.

Day 2:
The Day 2 MCQs absolutely shattered my confidence. My Step 1 score was way better than my Step 2 score so maybe this is different for everyone because it seems like a lot of people are saying these questions are like Step 2CK whereas Day 1 is a microcosm of Step 1. I spent a lot of time with Uworld Step 3 and even CK but it still felt like I was guessing on way too much. The answer choices I was looking for just weren't there and I walked out of the first set of 30 (my exam had 6 sets of 30) and was like holy **** I don't think I was sure of a single answer (slight exaggeration but still that's how it felt). I went 2 blocks at a time from then on and honestly things got a little better but it was still pretty bad overall and had to guess on the last 3-4Q on some blocks (another sign Day 2 was harder) and honestly I just did not know what some questions were trying to test or didn't see an answer I liked. Another thing that messed with my head was there were these two-part questions where answering one locks your answer and most of the time the next question reveals the answer to the previous question in the first sentence (ex. The physician orders [insert answer choice from last question]). I think I was like 7 for 9 on them between both days. There were more pairs than that but others didn't necessarily give away the answer. I couldn't help but take more time on these knowing I would know if I got them wrong in a few seconds so be ready for that mentally. Anyhow, this whole day felt super tough. While I used some clinical reasoning from residency I did not think the questions made as much sense as UWorld Step 3. I just thought questions were more vague...obviously I did well enough so something went right though so don't be super discouraged if this happens to you. When I left the center, no one on Reddit or SDN seemed to share this experience. Finally CCS came along. Note that you get a 45 min cumulative break time on day 2 for MCQs and a separate 45 min break time for CCS. I personally used very minimal break time which I think was a good idea because I think my performance on an exam gets worse the later it gets into the day and I finished at 2pm instead of 4 pm which was optimal. The real CCS cases felt better than the D2 MCQs I just ranted about but just not as slam-dunk diagnosis types as CCScases.com. One case had two separate diseases! I have residency experience and that helped a ton. One case was a pretty realistic scenario I see a lot in the ICU I didn't think CCS would test on. I was perturbed when I had a case I knew exactly how to manage end promptly after my first round of orders when it said the patient was feeling better. There was also a peds case that was a very rare dz i didn't realize until midway through. I also stumbled on cant'-miss diagnoses three times presenting atypically (which is why it's so important to do a fundamental workup on everyone and not anchor on a diagnosis at the beginning). It’s also true that shot gunning takes time because you are shown results for everything you order so you have to know when to shot gun and when not to. Overall, most cases ended early and most got better through patient feedback. I didn't feel the need to take many breaks between CCS. I ended the day 1.5 hrs early (there is separate break timer for MCQ section and CCS). I felt that was a good way to do it.

Results Experience:
Bonus section lol. There's a lot of confusion about this which leads to anxiety. I've combed through tons of reddit/sdn threads including SDNs very own "The Trick Works!" thread and here is what seems to be the case:

1.) Your score report will show up on a Wednesday at 12:00AM EST on Interactive Website. No email will prompt you to look. Log into linked website and click "Print Score Report". It will download a PDF which will be your numerical score, P/F, and some performance graphs you may be interested in. The NBME/FSMB doesn't make this an exact science, but from looking at everyone's experience, the general principle is reporting goes 3 Wednesdays from the 2nd test date if that was a day after Wednesday and 4 Wednesdays from the 2nd test date if that was a day before Wednesday. The exception to this is if you tested in January/February (see point #3).

2.) The Trick: The Sunday before your results come, the "scheduling permit" link disappears from your USMLE Step 3 row on the "Check Exam Status" link of the same website: Interactive Website.
Previously people thought if the link disappeared, then you passed. This seems to be wrong. The "scheduling permit" link still seems to disappear even when people failed the exam recently per many recent reports which I imagine leads to situations of a false sense of hope. What's not clear is whether the "scheduling permit" link not disappearing means you've failed. There is like one person who has said it did not disappear the week they got their score and they said they failed. The thing is in the moment, you don't really know if the permit didn't disappear because you failed or if it's just that you're not getting your results that week (more likely and not many people followed up to give us that info).

3.) Per FSMB "necessary annual modifications to the test item pool will result in a delay in reporting Step 3 scores for examinees who test in early in the year. The target date for reporting scores for most examinees testing in January and February 20XX is Wednesday, March XX, 20XX (AKA: Delayed reporting date). After this, the normal score reporting schedule (see point #1) will resume.

Take Home Points:
1.Emphasize biostats. You don't have to buy another biostats resource or watch biostats specific videos. Just get comfortable doing basic biostats questions and understand key definitions, etc. It's pretty similar to UW. I also recommend the UW extension package for $25.
2. Emphasize CCS. Practice this regularly and don't wait until this last minute. UW is great but I recommend CCScases. I have heard good things about Archer/Crush but haven't used those.
3. MedQuest USMLE Step 3 is an expensive, but valuable resource IMO worth more than OnlineMedEd for Step 3 because it's more comprehensive which I needed for OB/GYN & Peds.
4. The exam's just like the other steps except for exceptions above and 95% pass, but I would not take it too lightly. For those in IM, I would wait until after intern year to take it. Do they use it for fellowship? Probably not...but they may screen out low scores (a cards program I saw said on their website they screen out anyone with <220 on any Step). Remember, there's no rush to take this. I remember trying to take this at the beginning of my intern year duringa pretty poorly assigned vacation and it felt like way too much new information and was unsure what source to learn it (i.e. I just needed more residency time), but now after revisiting it, things just made a whole lot of sense. IMGs may not struggle the same way because many have intern year built into their medical school training. The test tests clinical reasoning you usually gain as an intern. You'll run into questions where your Step 1/2 brain will tell you to do X or Y but your residency experience will tell you to do Z and Zs usually the answer.
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Despite me writing this novel, 95% of US MDs passed Step 3 with an average score of 228 last year per my 2021 score report. Your mentors/attendings will tell you they didn't study and aced the exam or that all you need to do is pass. On here, there seem to be a lot of people failing (probably as a selection bias). The reality's probably closer to the actual data, but do note the exam has a higher passing threshold than Step 1 and a lower average so if you were in the 200-220s on your prior Steps, you probably should invest some time just to be sure you pass. I think 2 weeks of dedicated study in residency or 2 months of interval studying in residency is plenty. In my position though, I was taking it 3.5 years after CK without and plan on pursuing an IM fellowship so I didn't want to take any chances because I know some places screen scores.

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[LongDogLife]

I wanted to share my experience as a way to give something back since I used this thread to gauge my chances of passing.

PGY-4 (Diagnostic Radiology) in a busy/demanding residency program.

Step 1: 230s
Step 2: 250s
Step 3: 230s

Study time: ~ 2mo, mostly inconsistent over the first month averaging 1 hour per day after work and maybe a little more on the weekends. The last 2-3 weeks I studied hard, probably 2-3 hours on weekdays and 8-10 hours on weekends.

Resources: Uworld qbank (66% first pass on timed tutor but left about 300 questions unused, saved flashcards for important charts and concepts that I wanted to review again, added to my written step 2 ck notes along the way for high yield or forgettable topics). Uworld CCS (rapidly went through half to understand the software). Uworld biostats (breezed through for a few hours before test day). Also did some of the CCS cases on the nbme website the night before. Make sure you are comfortable with the CCS software. There are some useful youtube videos going over cases to help you understand. Make sure to watch one or two of those. When driving in the car I would listen to random high yield Step 3 videos on youtube. I never took any of the uworld practice tests or nbme's because I did not think they were worth the time, plus a low score would freak me out and that would not do me any good.

First day was kind of random with a few questions on path/histo, genetics, biochem, etc. Day 1 had quite a bit of stats, but very doable if you prepped. Make sure you know the common equations and know how to apply them (ARR, RR, sens, spec, PPV, NPV, NNT, etc). I could care less about the drug ads as I don't think they are worth spending much time on. I would save those for the end. No stats on day 2. Day 2 was very clinically based similar to step 2CK and the CCS cases were straightforward. Most CCS cases finished early.

Good luck everyone. I hope this helps a few anxious test takers. Prep appropriately and fear not.

 

[Gablesresident]

Thank you for sharing this detailed information, I my self failed once after PGY3 just thinking it was a breeze and experience gets you through, Its certainly not the case. Makes sense though, why not just do NBME questions and learn from them especially when they give you explanations. Uworld didn't help me at all, what probably did is my experiences.

Congrats Dr Singh, just joined this forum. It is an education looking at the responses here. Can you tell me when some recommend the " biostatistics package for $25, what are they talking about..? Is it UW separately or Medquest videos on Biostats ? Thanks, Devendra ( I am based in Trinidad and Tobago and sitting step 3 in August).

 

[LongDogLife]

Congrats Dr Singh, just joined this forum. It is an education looking at the responses here. Can you tell me when some recommend the " biostatistics package for $25, what are they talking about..? Is it UW separately or Medquest videos on Biostats ? Thanks, Devendra ( I am based in Trinidad and Tobago and sitting step 3 in August).

The biostats package is offered by Uworld. It's definitely worth the money even if you only spend half a day working through the questions.

 

[Brill4]

Just posting to provide another data/reference point for the test takers here. It always helped me to get an idea of where I stand because we all know how inaccurate the practice exams can be.


Score: 232

Study Period: 6-8 weeks while on relatively busy ICU and Floor rotations. Usually 2ish hours a day after work.

Step 1: 245-249
Step 2: 250-254


UW Step 3 Average: 65%, untimed, by system. Completed 60% of the Qbank.

UWSA1: 213 (2 weeks before)
USWA2: 217 (5 days before)

Predictmystepscore (dot) com predicted score: 235 +/- 24

About me: PGY-1 Transitional Year Intern, going into Rads starting July.


Other:

Completed maybe 1/4 of the cases on CCS cases website. Case % ranging from 40%-98%. On the real thing none of my patients died, most cases ended early. 1 or 2 patients seemed to not be getting better for a majority of the case until something I ordered triggered for it to end.

For biostats on day 1, the UWorld step 3 biostats section + biostats supplement+ Randy Neil videos on YouTube were enough to prepare me well. I took everyone’s advice seriously and only did Biostats and CCS cases for the last week before the exam.

Took both days back to back. I didn’t care about my score as long as I was passing so I was trying to get it over with. If you need to score well, I would suggest maybe 1-2 days off between day 1 and 2 because it’s pretty exhausting. I don’t think a week between is necessary unless that is the only thing that works with your scheduling.

Everything else I would agree with what most people have said in this thread. My experience is pretty much the same. Glad to be done with the USMLE forever ✌🏽

 

[TheIllusionist]

Final Score: 259 (all categories equal performance, except low performance on cases)- performed same as score predictors

Prior Scores
Prior background test taking context: 99.9th SAT, 97th MCAT
Step 1: 247, (~ 30th percentile student M1 and 65th percentile student M2 on class exams- overperformed my practice exams)
Step 2CK: 261 (shelf scores averaged 95th percentile- felt like underperformed that day relative to practice tests)
In-training exams (medicine resident): 97th, 98th percentiles

UWSA1: 241
USWSA2: 244
U-World Q Bank Percentile (timed random, average 45 seconds a question): 79% correct

It's a bit funny that I did best, percentile wise, on the STEP exam that matters the least. I'm a medicine resident, so the exam was mostly in my wheelhouse. I've studied MKSAP throughout residency. That makes my situation a bit unique. Generally those who do well have a strong background from other exams because U World cannot cover everything. Nonetheless, it is sufficient to pass. I studied U World for 2 hours a day for a month. I also did the biostat supplement. I read through the foundations chapters of First Aid. I put off studying for CCS, until 1 day before my test. That's all I would change. U World didn't give me enough feedback on it. I would have done the CCS cases website. I could have brushed up on pediatrics a tad bit more. Alas, there just was not the motivation to dig into a subject that I knew for sure would not be part of my future practice.

I always suspected that the rate limiter to my performance was memory. I just could not get the material in my head to stick. I did worse early on. However, one thing that has always helped me throughout training is trying to learn mechanisms. Focusing on pathogenesis and getting material to connect in one coherent story is important. Now, this in no way replaces the mighty Anki Deck. Memorizing key facts is still King. But that's a lot easier to do when you can connect the details. It also promotes better long term retention. That's my underlying learning philosophy for medicine.

 

[medunc123]

Just got my score back and wanted to post some thoughts because I noticed there isn't a lot of information on Step 3 compared to the prior 2 exams.

Final score Step 3: 235

Step 1: 260, Step 2: 255

I studied for about a month and a half using UWorld (about 30 questions per day). I ended up getting through 35% of UWorld on random mode with 67% correct. During the week leading up to the exam I practiced about 10 of the clinical case scenarios on UWorld and did the free sample case scenarios on the USMLE website. I ran out of time so I didn't take any practice tests, but I went in with a goal of just passing.

I took the exam towards the end of my intern year. I'm in a relatively busy surgery program so my time for preparation was limited. It had also been over three years since I took Step 2 CK because I took a research year in med school. For people who have a long gap since they last took Step 2, I think it is helpful to take towards the end of intern year just to get back in the groove of clinical medicine. As others have mentioned, a lot of the exam is ethics and biostats so if there's one area to focus on studying, that should be it. I have heard a lot of people say "there's" a lot of biochem" and "it felt like Step 1" but I didn't feel that way at all. Also I was pretty worried about the OB GYN questions because I have zero exposure to that, but most of the questions were geared towards the general practiononer (not nearly as hard as questions on the OB shelf). Hope this helps!

 

[BlessedSerenity89]

Final Score: 214 (all categories equal performance including CCS cases)

I wanted to put this out there for anyone who is not a good test taker like me so I'm always trying to find ppl that have similar avg scores to what I have as a predictor if I would pass.

UWSA1: 188 (2 weeks prior to exam)
UWSA2: 194 (the week of exam)
Final Score 5/25/22 and 5/28/22 test days: 214

I studied for 1 month (Uworld questions was able to get through about 50% of the questions with 65-65% passing rates each block, high yield MTB topics such as ID and OB , Biostats Uworld section, 15 Uworld CCS cases, skimmed Step 3 secrets). I am an FM resident and I think I got lucky because as everyone says the 1st day was hard (lots of biostats and MOA of antibiotics and other Step 1 stuff scattered throughout) but the second day my MCQs were more clinical and easier to get through and my CCS cases were for the most part straightforward and were cases that I see and counsel for in FM often ( 1 case didn't know what it was). Hope this helps for anyone like me who is not a master test taker! Message me if you have any questions!

 

[sebastopublican]

I wanted to share another perspective of someone approaching this exam late in non-IM residency (PGY4 Neurology - my initial plan was to take after intern year and I was cancelled by COVID several times, gave up until I had time beginning of chief year). The outpatient content and a lot of the inpatient IM-subspecialty content felt very remote to me.

Test date: 7/20/22 & 7/21/22 (to those of you stuck with this schedule - it was actually ok to take back-to-back; first day ends early and you can rest that afternoon/evening)

Score (reported 8/3/22): 241 Absolutely pissed that I overshot it - had other things to do with my time! Just wanted to pass.
Step 1: 245 - SIX YEARS PRIOR
Step 2: 239 - FIVE YEARS PRIOR (did not study much at all for Step 2, by that time I knew I was Neuro and we don't care about board scores)

Study Period: 3.5 weeks (1 week lightly on a very busy consult service - got through 150 questions - and really the majority of studying during 2.5 weeks mostly dedicated; did have to do ~36hrs of clinical work per week in those last 2 weeks that screwed up my sleep and consumed a lot of time/energy, so it wasn't all dedicated). You can probably do it safely with 2 weeks dedicated. Also, if I were IM or EM, I would have probably felt safe walking in with zero studying. It's literally a test of their knowledge base with some sprinkles of other specialties.

UW Step 3 Average: 69% first pass, tutor, untimed, by system (and this certainly inflated my % correct). Completed ~85% of the Q bank.

Did not have time to waste on practice exams. I did not want to throw away a day of learning (~7% of my study time!) and/or lose sleep over a bad score. I was going to make the exam attempt either way and knew the odds were in my favor.

Don't get me wrong, I was NOT overconfident at all - many moments of despair, especially early in studying when I was just overwhelmed by all of the content I had never been exposed to (the primary care outpatient management stuff - not even close to my wheelhouse).

A note for fellow Neuro folks already deep in their training: I did not do the ~200 Neurology UW questions - I did a few and it seemed that they were not written by neurologists so the language was a bit off and the presentations were...lacking....the exam will tell you 2 findings and then "normal" otherwise when it would NOT be stone-cold normal in the clinical situation. I could tell I was going to overthink everything and it would just consume time/energy that I did not have in the last few days of prep (e.g., UWorld has a stem with a young cocaine user who develops subtle RUE/RLE weakness without facial involvement, chest pain, nor any cortical signs and you are supposed to think she is having a L hemisphere stroke from an aortic arch dissection...all I can say is that this explains so much about the ED consults). You don't need to study for the Neuro stuff on Step 3, it's either going to be so rudimentary that you can skim and answer instantly, or it will be a poorly written question that you would agonize over because there isn't a clear right answer after going through neurology training - you know too much of the gray areas of these presentations. Makes me wonder about the accuracy of the exam content overall, actually.

In the last 4 days, I did the following (roughly in order):

1. Repeated my UW incorrect Qs for Cards, GI, and ID (no time for other systems) and averaged ~80% on those so felt better that I had at least learned something by studying. This was calming and I recommend if you think you have the energy/time. Reinforced tricky concepts in those systems. I spent an entire day re-reviewing ID and added Step 1 level stuff - whenever there was a bug mentioned in UW, I quickly looked at FA step 1 to review the high yield tidbits on that bug. That was an exhausting day, so don't do this the day before the exam. Tried to iron out my anxiety with the "kid with sore throat" and "kid with rash" presentations that just make adult residents quake in our boots.
2. Reviewed other systems rapidly using FA and the UW Notebook feature I had dumped information/charts/pictures into while I was doing the Q bank. Focused on that last line in the charts for diseases that is usually management next steps or prognosis.
3. Used FA step 1 to try to cram pharmacology (tried to pair that with the system I was reviewing) - especially tried to re-learn tricky poisoning, anesthesia/autonomic nervous system Rx, micro & oncology pharm. The dedicated pharm chapter of FA was great for rapidly reviewing Rx grouped by side effect profile (that is how my brain works). Memorized the common CYP450 metabolites for the umpteenth time in my career. I was not successful in re-learning everything, but enough stuck that it did help on the exam.
4. Practiced 40 biostats questions so the formulae/manipulations were at my fingertips - the calculations on the actual exam were much simpler and faster than UW; I probably did not need to do this and would have been ok just reviewing the formulae the night before.
5. Went through the 6 NBME practice CCS and 10 UW cases - just to learn what they wanted in terms of base orders and the "ideal" order of operations in the sim environment for the emergency/fast paced cases. Read the scoring information closely on the NBME practice cases.
6. Stared at the flowcharts for the cancer screening/abnormal test/nodule workups and also the vaccine schedules off the CDC website.

One trick I wish I had started earlier in studying - since the CCS software has poor searchability for orders, in the last 72 hours of studying I started to have the NBME software (not the UW software) open on a laptop while I was studying and would occasionally check to see how the software had labeled a common test (e.g., depending on your institution, a T-spot may be found by searching TB test, tuberculosis, IGRA or Quantiferon). Essentially, they are asking us to learn a whole new EMR and you are back to square one as an intern who can't find things. Don't worry if you don't have time to do this or don't feel super comfortable with the software going in - the cases on the actual test are going to be straightforward enough that you can get it done regardless.

The experience: walked into Day 1 exhausted, so tired from 2 weeks of cramming and did not sleep well the night before. I walked out of Day 1 thinking "not A+, but probably passed." Mostly first- and second-order Qs -felt like the cognitive load of the questions was low, which makes it ok to do on poor sleep. Residency training helps with your stamina for sure. Immediately looked up 10-15 questions I was agonizing over and found that I guessed wrong on all - just rote stuff I had no chance of knowing OR situations where the data were split on 2 possible choices, which seems ridiculous to put on a board exam. Laughed at that a bit. Rested and lightly reviewed vaccine schedules that evening. Got better sleep that night. Walked out of Day 2 feeling a little worse - cases seemed fine but I was crushed in the MCQs by evidence-based management of outpatient problems that were not in UW. Actually felt despair in one block where I knew only 20% of the answers, the rest were guesses. Clearly still did ok.

Not to cast doubt, but I should mention that overall, I found UW slightly off target in their emphasis - the test is much more about prognosis/counseling for these diseases and the presentations are more straightforward so it is less about being a good diagnostician and more about memorizing the management and natural history of disease. This is buried in the UW explanations but de-emphasized, so you may be feeling good about getting the diagnosis/disease mechanism question correct, but on the actual exam the question will be about what to do when the patient comes back with some sort of treatment side effect or disease sequelae.

Don't panic. Also be kind to yourself if you don't pass - it felt like such a wide/scattered knowledge base that no single study source will provide. You'll probably pass the second time with a different set of questions. I've spoken to people about their experiences and it seems like the test content can vary significantly from one sitting to the next.

If you are taking this late in training, remember: even though you are farther from some basic science concepts, you are faster, have more cognitive stamina, more training in forcing executive function even when exhausted, more ability to compartmentalize patient cases (i.e., can move from one vignette to another without confusing patients), and more of a framework to place patient cases without having to mull over every detail of the case. Also you will likely crush CCS with minimal prep.

 

[apkusmle]

step 1: 261
step 2: 276
step 3: ???

took last week

day 1: biostats, random pathoma style path/histo questions, a couple immunodeficiencies, just very random and hard. Biostats is mostly conceptual with a decent amount of things I have never ever even heard of, like weird biases.

day 2: more like the isoteric NBME factoid type questions. Every other questions is " pick out of 5 risk factors and choose the biggest one." Everything is either know it or don't. Or they ask a pharm question and test a rare side effect you can only identify if you under stand the MOA


CCS is the part giving me concern. I finished within like 2 hours of the possible 3.5 hours, but several of my cases WOULD NOT END. No matter what I did. Identified the infection, got the microbial sensitivities, treated the pain and gave fluids, literally nothing left to do, yet the case would not end. Kinda threw me off and makes me concerned because I didn't study CCS a ton and just got the general feel for how to do it from ccscases, only did like 30. Now I am worried my work flow was off and I missed a major component. I had 4 cases that just wouldn't end no matter what I threw at them although every case said XXX is feeling improved so they all atleast started to improve.

Not really worried I wont pass, just shamelessly want a high score and feel like I crushed this exam other than CCS and since I have enjoyed doing well on NBME exams and want to finish my USMLE series strong.

Just curious about your score. How did you end up performing?

 

[apkusmle]

I am starting my preparation, and based on my lessons from step2; I want to start my preparation with official free questions and nbme 5 to actually know what the exam emphasizes. My question is how similar are the questions in free137, nbme 5, and the actual exam?
Would any recent exam takers guide me?