Step 3 exam scheduled! How should I study?!

[psychmd118]

Hey everyone,

Little background information about me....I am an IMG, currently in my 3rd year of psychiatry residency training. I took step 3 once, back in March 2016 and didn't pass (188). I am scheduled for my second attempt at this exam and I'm freaking out! I passed all my other USMLEs on the first try....so this is really a scary situation for me. Here were my previous scores: Step 1 - 212, Step 2 CK - 220.

First time I took step 3, I studied for about 2-3 months, but I was always distracted. I used MTB 3, although I didn't add notes into the book as I had done for CK. I had also used UWORLD qbank + CCS, and I was averaging about 56%, which increased to about 64% prior to the test. On my blocks, I was getting scores in the 70s right before my exam! I had skimmed through my step 2 CK notes as well. I took a UWORLD self assessment and scored a 201. I really thought I had it down....

During my test, I was trippin because it was so difficult and I felt like the questions were so random! I didn't feel like UWORLD or any book could have prepared me for the test day. On day 1, there were soo many questions about risk factors for diseases and prognosis of diseases. They don't have much of that in UWORLD! Also, biostats screwed me, and I am not too good with biostats as it is. Day 2 seemed easier for me, because I felt like I didn't guess as much compared to day 1. The CCS cases were alrighttttt, but I knew I hadn't done too well on those. When I got my score report, apparently I had done better on day 1 than on day 2?! This was shocking for me. My CCS was in the middle, so not too good and not too bad.

Studying for this exam for the second time has been so stressful. I have always been one of those people who takes time off from school and rotations to study, so I could study the whole day. At least that's what I did during the first steps. Studying for step 3 during a psychiatry residency is NOT easy. I am at work all day, sit in traffic for an hour and finally arrive home around 5pm, relax for about an hour, and begin studying around 6pm. I like to be in bed by 11pm, so I don't have enough time to study I feel.

I have gone through so many different resources these past few months, because I have no idea what will help me or what I should focus on. I really thought I had everything down during my first attempt. I did kaplan qbank once, and averaged about 65%. I am doing UWORLD for the second time, and my overall correct is 71% and I am in the 84th percentile. I printed out OnlineMedEd notes, because they seem pretty helpful, but I notice some mistakes...I also am using USMLE step 3 Secrets. I have too many resources and no idea what to focus on.

Someone please help! What can I do for biostats besides UWORLD and kaplan? Anything good? Also, would it best to just focus on doing a bunch of different Qbanks? If so, which ones?? I feel like I am remembering some questions from Uworld, since it's my second time doing it. I don't want to make the same mistake twice. Also, what kind of study schedule would be recommended?? Anyways, please give me some advice about what I can do to boost my score, because I feel so lost! And if anyone has good step 3 notes, I'd love it if you could send them along my way! Thanks!

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[LasVagus]

I took the exam two years ago, right after the updates. Your description of your preparation sounds more than sufficient to me. I myself just did the following: 1) All UWORLD Qbank Questions in untimed tutor, 2) wrote down the main teaching point for each question as I went, 3) marked every question I got wrong or accidentally got right (the lucky guesses) and redid them, 4) went through the UWORLD questions a second time, 5) did all CCS cases, and 6) did all CCS cases a second time. This was enough to get me comfortably above the median. I didn't use any other resources. It sounds like you've already done more than this, which makes me think it might be another issue that is holding you back. Did you get good sleep the night before? Did you get psyched out by the seeming randomness of the questions and become too anxious? If you didn't spread the two test days out, would you be better off doing so? Was there any other stress in your life that was distracting you? The scores you describe on the practice exams seem like they should be more than enough to carry the day.

 

[IlDestriero]

So it's not "2 months, 2 weeks, #2 pencil." anymore?


--
Il Destriero

 

[Shikima]

So it's not "2 months, 2 weeks, #2 pencil." anymore?


--
Il Destriero

Unfortunately, no. You're only as good as your internship teaching.

 

[Merovinge]

I took the exam two years ago, right after the updates. Your description of your preparation sounds more than sufficient to me. I myself just did the following: 1) All UWORLD Qbank Questions in untimed tutor, 2) wrote down the main teaching point for each question as I went, 3) marked every question I got wrong or accidentally got right (the lucky guesses) and redid them, 4) went through the UWORLD questions a second time, 5) did all CCS cases, and 6) did all CCS cases a second time. This was enough to get me comfortably above the median. I didn't use any other resources. It sounds like you've already done more than this, which makes me think it might be another issue that is holding you back. Did you get good sleep the night before? Did you get psyched out by the seeming randomness of the questions and become too anxious? If you didn't spread the two test days out, would you be better off doing so? Was there any other stress in your life that was distracting you? The scores you describe on the practice exams seem like they should be more than enough to carry the day.

I agree. If the poster is being honest with him/herself and legit getting those scores (it's so tempting to wiki/google when studying at home) there is probably something else going on (e.g. test anxiety). CSS's I find to be pretty basic because they seem to only draw upon a very small number of problems (maybe 40?) and one can memorize the correct sequencing pretty easily if you have had a decent intern year. These cases will give you a big buffer in doing worse on the epidemiology questions so definitely study them well.

Since they have heavily emphasized biostats it does need to be learned well. If that's still a problem after learning it several times at this point, I would reach out to someone who can cover the basics with you in person, since its unlikely to just magically click the 5th time you try to learn it if the first 4 times went poorly.

You very nearly passed your first time as is, so don't lose faith. If you can get just a few more concepts down and be a bit more comfortable with cases you will be fine this next go around. You have already come so far in your medical career this will only be a tiny speedbump along the way, even if it feels like a mountain right now!

 

[RudinChickpea]

Uworld Qbank and CCS. The rest is really your training. I tried MTB myself, but didn't find it that helpful.

 

[psychmd118]

Thanks so much for all of your replies! I feel that if I knew my biostats, I could possibly have gotten those few extra points to pass the test. Also, since my CCS score the first time around was borderline in the middle, perhaps if I use other resources for CCS apart from just UWORLD and get a high CCS score, it could also boost my score enough to pass. I feel that at this point, I can't learn anything new apart from work on my weak subjects. Like I said, I'm above average on all of my UWORLD scores. Perhaps it was just the randomness of questions on test day that got me? Who knows....

Again, thanks for the replies. If you all have any more advice, please feel free to share with me. Thanks!

 

[pisekar]

Sorry to hear you need to take for the second time. Here is also an IMG and a third year psychiatry resident. I took my exam prior to residency applications. To me, having 65% on USMLEworld or Kaplan Q should be enough to pass multiple question part of the exam. I think, you need to focus on CCS part more. 40% of the score comes from the CCS part. Did you check the cases at the usmle.org? There are 6 different CCS cases there. It is important to have good clinical knowledge to solve those cases, but it is also important to understand how the software works.

For example, if you have a pneumothorax case, you need to diagnose it after seeing initial screen. If vitals are not stable, it means patient is in shock and all you need to do is to check for cardio-lung exam to differentiate which type of shock it is -hypovolemic, cardiogenic or pulmonary etc.. If patient is in shock, jugular veins are distended, and lungs has hyperresonant sounds -> it is pneumothorax. All you need is to order a chest tube and check with x-ray after that. I called them super-emergency cases, there are other scenerios like that, maybe 2-3. If you do any exam in addition to cardio-lung, you will get sub-optimal score. If you order a basic test like CBC or X-ray, you will lose points. In this case, you need to act immediately. When you are at the actual exam, if you order chest tube, patient will get better immediately and case will end.

Second type of cases are emergency cases, like a MI. For this type of cases, you still need to do focus exam, maybe little bit more than CV-lung exam. You can order nitrate, oxygen, aspirin etc as an initial treatment and can order cardiac enzymes, CBC, ECG to clarify your diagnosis. Those type of cases are not super-emergent, but you still need to be focused and need to make a good differential diagnosis, because you are still in the ER.

Last one is outpatient cases, it is easy, you generally do a full exam, order some tests, you can give some medications and then schedule a follow up appointment.


There are some other resources in the internet to study CCS part of the exam. You can search in google, there are some tutor videos which explain software very well.

Good luck!

 

[psychmd118]

Thanks for the feedback! No, I actually didn't have a chance to look at those CCS cases on the website. I feel that I definitely need to improve on the CCS area as well. During the first attempt, all I did was study the UWORLD CCS cases...at first I was super confused, and then I basically tried to memorize the orders for the 44 or so cases. Reason I just memorized was because everyone kept saying that UWORLD CCS is more than enough for step 3. Since everyone was telling me that those cases were enough, I figured that the exam will have a lot that were very similar. However, on the actual exam day, I didn't get a single case that was similar to UWORLD and I was totally lost initially. Even so, I still managed to do okayyy on the CCS portion according to my score report. Like I mentioned above, it was just in the middle area. So definitely will focus on that.

Another point to add is that everyone also told me that just doing UWORLD questions were enough for this test, but I disagree about that. First of all, I feel that I learn well when I read. UWORLD has a lot of information, but can't possibly cover every single thing. I felt as though the multiple choice questions for UWORLD were difficult, but during my second time around I was scoring in the high 60s and 70s on blocks. However, I also did Kaplan Qbank...if a similar question would be presented in a different way with slightly different wording as compared to uworld questions, I felt thrown off and would get the question wrong. Any one else feel this way? I figured maybe that means I have been passively studying all along? Although if someone were to ask me about the management of a patient presenting with certain symptoms, I would be able to answer it. It seems that a slight variation in the way a question is asked just throws me off course. I don't know what this is about. Perhaps not enough practice of questions? I really struggle with the ORDER of which things need to be done in questions that ask "what is the most appropriate step in management?" Ugh....stress.

 

[FlowRate]

Another point to add is that everyone also told me that just doing UWORLD questions were enough for this test, but I disagree about that.

This is what people say who did well on the steps and the shelfs, or who want others to think the same, or who do qbank but review the things they miss in first aid (or whatever).

I, too, need some content review in addition to qbank. QBank is a sampling of everything but, like you pointed out, it doesn't cover everything.

 

[Monocles]

Jumping on the same thread, does anyone know if there are now more basic science questions on step 3 now?

 

[Merovinge]

Thanks for the feedback! No, I actually didn't have a chance to look at those CCS cases on the website. I feel that I definitely need to improve on the CCS area as well. During the first attempt, all I did was study the UWORLD CCS cases...at first I was super confused, and then I basically tried to memorize the orders for the 44 or so cases. Reason I just memorized was because everyone kept saying that UWORLD CCS is more than enough for step 3. Since everyone was telling me that those cases were enough, I figured that the exam will have a lot that were very similar. However, on the actual exam day, I didn't get a single case that was similar to UWORLD and I was totally lost initially. Even so, I still managed to do okayyy on the CCS portion according to my score report. Like I mentioned above, it was just in the middle area. So definitely will focus on that.

Another point to add is that everyone also told me that just doing UWORLD questions were enough for this test, but I disagree about that. First of all, I feel that I learn well when I read. UWORLD has a lot of information, but can't possibly cover every single thing. I felt as though the multiple choice questions for UWORLD were difficult, but during my second time around I was scoring in the high 60s and 70s on blocks. However, I also did Kaplan Qbank...if a similar question would be presented in a different way with slightly different wording as compared to uworld questions, I felt thrown off and would get the question wrong. Any one else feel this way? I figured maybe that means I have been passively studying all along? Although if someone were to ask me about the management of a patient presenting with certain symptoms, I would be able to answer it. It seems that a slight variation in the way a question is asked just throws me off course. I don't know what this is about. Perhaps not enough practice of questions? I really struggle with the ORDER of which things need to be done in questions that ask "what is the most appropriate step in management?" Ugh....stress.

This post does make me concerned that you are using rote memorization to pass these tests. Again you were very close on round 1 so I would not stress out too much, but as much as you can learn underlying principals and apply them it makes the test day much more consistent so that wording changes don't throw you off. You don't need to memorize strict orders for CCS as much as remind yourself of a checklist to do (be it ABC's for trauma, well teenager physicals needing to cover HEADSSS, etc). Similarly orders for tests are really about what is the most essential management, which should be at the heart of your clinical experiences.

 

[mitavanam10]

Hey everyone,

Little background information about me....I am an IMG, currently in my 3rd year of psychiatry residency training. I took step 3 once, back in March 2016 and didn't pass (188). I am scheduled for my second attempt at this exam and I'm freaking out! I passed all my other USMLEs on the first try....so this is really a scary situation for me. Here were my previous scores: Step 1 - 212, Step 2 CK - 220.

First time I took step 3, I studied for about 2-3 months, but I was always distracted. I used MTB 3, although I didn't add notes into the book as I had done for CK. I had also used UWORLD qbank + CCS, and I was averaging about 56%, which increased to about 64% prior to the test. On my blocks, I was getting scores in the 70s right before my exam! I had skimmed through my step 2 CK notes as well. I took a UWORLD self assessment and scored a 201. I really thought I had it down....

During my test, I was trippin because it was so difficult and I felt like the questions were so random! I didn't feel like UWORLD or any book could have prepared me for the test day. On day 1, there were soo many questions about risk factors for diseases and prognosis of diseases. They don't have much of that in UWORLD! Also, biostats screwed me, and I am not too good with biostats as it is. Day 2 seemed easier for me, because I felt like I didn't guess as much compared to day 1. The CCS cases were alrighttttt, but I knew I hadn't done too well on those. When I got my score report, apparently I had done better on day 1 than on day 2?! This was shocking for me. My CCS was in the middle, so not too good and not too bad.

Studying for this exam for the second time has been so stressful. I have always been one of those people who takes time off from school and rotations to study, so I could study the whole day. At least that's what I did during the first steps. Studying for step 3 during a psychiatry residency is NOT easy. I am at work all day, sit in traffic for an hour and finally arrive home around 5pm, relax for about an hour, and begin studying around 6pm. I like to be in bed by 11pm, so I don't have enough time to study I feel.

I have gone through so many different resources these past few months, because I have no idea what will help me or what I should focus on. I really thought I had everything down during my first attempt. I did kaplan qbank once, and averaged about 65%. I am doing UWORLD for the second time, and my overall correct is 71% and I am in the 84th percentile. I printed out OnlineMedEd notes, because they seem pretty helpful, but I notice some mistakes...I also am using USMLE step 3 Secrets. I have too many resources and no idea what to focus on.

Someone please help! What can I do for biostats besides UWORLD and kaplan? Anything good? Also, would it best to just focus on doing a bunch of different Qbanks? If so, which ones?? I feel like I am remembering some questions from Uworld, since it's my second time doing it. I don't want to make the same mistake twice. Also, what kind of study schedule would be recommended?? Anyways, please give me some advice about what I can do to boost my score, because I feel so lost! And if anyone has good step 3 notes, I'd love it if you could send them along my way! Thanks!

How did you do on your exam? Did you pass? Any advice please?

 

[psychmd118]

I passed!!! I am absolutely ecstatic. Thank you all for your advice.

@mitavanam10 - What helped me more than anything was CCS. The multiple choice questions are going to be tough no matter what. I felt as though I guessed on about 50% of questions on every block on both day one AND day two. Keep in mind that most people don't have more than a few weeks to study for step 3 and from what I've heard from others, most everyone feels like the mcq's on day one were very difficult. They said day 2 mcq's would be easier but to be honest, I felt they were just as difficult. I mean, I actually understood what the questions were asking on day 2, but the way they asked and the answer choices that were given were really weird for a lot of the questions. I could narrow most answers down to two answer choices but ultimately had to guess between the two. During my first and second step 3 attempt, I felt as though I second guessed myself so much and often changed my answers, because I thought the answer was too easy and obvious and I would sike myself out. Keep in mind that usmle is not trying to trick you and the simplest answer is likely the right one. I made sure not to change any answers this time around. Anyhow, make sure you know uworld inside and out. I did uworld 3 times and it was a great learning tool. Due to my high level of anxiety, I tried other question banks like the Archer, Kaplan, etc. I found them overwhelming and realized that it was best to stick to 1 question bank. Also, I used MTB 3 and dictated all of my uworld notes into the book. I reviewed it about 2 times in the last couple of weeks before my exam. I also used did uworld ccs twice (the interactive + practice cases). I had the crush ccs book that I would occasionally skim through and compare the management to the way Uworld managed cases, but I didn't actually have sufficient time to read through it thoroughly.

In retrospect, I think the best resources to stick to are Uworld + MTB (if you need to supplement with a book)....if you are more of a first aid person or you like another book, that can be used instead. Just make sure you stick to the least amount of resources possible. I realized that because I was jumping from one source to another during my studying, it made me overthink questions way more than I should've, which probably led to me picking the incorrect answer. Like I mentioned above, most people who study for step 3 do the bare minimum (because they are usually juggling studying with residency, some have families, etc). Therefore, you shouldn't do more than you need to. Focus on your weak subjects. It's impossible to know everything, and no matter how much time you put into studying and how many resources you use to study, on the day of the exam you are still gonna think where the hell did they get these questions?! They are questions that can't be found in any text book or question bank (not all of them, but a lot of them). So you're no different than most people taking this exam who are also not going to know the correct answer. All you can do is make the best educated guess and move on to the next one. There's probably a huge curve on step 3, also. Anyhow, best of luck!

 

[Merovinge]

Congratulations! Now all your future tests with be psych/neuro based and should be a breath of fresh air.

 

[NickNaylor]

I bought Master the Boards and was pretty unimpressed with the text. It seems to be the only relatively well-reviewed text out there, so if you feel like you need a review text, that would be the one.

Step 3 is basically step 2 with a bizarre “clinical case” part of the exam and lots of questions on professionalism and ethics. Thus, for the clinical sciences portion, you could probably just use a step 2 review book and be fine - again, if you feel like you need a review book. After I decided that MTB was garbage, I just ended up focusing on the UWorld qbank. I think I got through about 80% of it before I grew weary of the whole thing. I ended up scoring in the 80th percentile. For comparison, I scored in the 60th-75th percentile for step 1/2.

As long as you did reasonably well on step 2 and put in a modicum of studying for step 3, you will be fine. The exams are very similar, and the same general content is tested. The only major difference is the addition of the professionalism/ethics questions, and quite frankly those really don’t require much studying as they are fairly obvious. The only tricky thing about step 3 is the stupid clinical cases - and not because they’re particularly difficult, but because the interface for them is complete garbage, convoluted, and not easy to use. I would strongly, strongly recommend doing several of the examples in the UWorld qbank if only to get a handle on how to actually take the damn test.

Edit: oops, didn’t closely at the thread and didn’t see that OP had already passed. In that case, congratulations! I’ll just leave this for posterity.

 

[DisorderedDoc417]

Unfortunately, no. You're only as good as your internship teaching.

Disagree — took it prior to taking a single medicine rotation (second month of psych residency), and scored above average. This test is the same as the last two in that prep and past performance dictate future performance. Just be diligent in your approach and take care not to blow it off. Also, check out the step 3 thread!