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Jul 2, 2020
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Hey everyone. I received my Step 3 score this morning (test date June 8-9), and needless to say, I was shocked. In the months leading up to my test, I struggled to find blog posts that detailed the test experience and provided sense of score prediction, so I figured I'd post here.

I'm currently a PGY2 in dermatology (Step 1 260, Step 2 267), but I prepared for Step 3 during my internal medicine preliminary year. I downloaded UWORLD for Step 3 during my first month of intern year, but I didn't even open the software until ~2 months in. I felt like I needed the first month or so to get used to the flow of things at the hospital. Once I felt comfortable-ish in my role as an intern, I started slowly going through UWORLD at a rate of ~ 10-15 questions per day on most days of the week. I used untimed tutor mode, and I would only do one subject at a time. After doing the questions, I reviewed the explanations in UWORLD and generated flashcards in Anki. For every disease in UWORLD, I tried to make sure I knew the cause/pathophysiology, risk factors, presenting symptoms, diagnostic algorithm, treatment algorithm, and major complications/prognosis. Admittedly, I was pretty lax when it came to risk factors and prognosis since I felt like it would be nearly impossible to know that information for every pathology. It took me most of the year to finish UWORLD at this slow pace, but I never felt overwhelmed, since I was doing it in such small chunks. A lot of this knowledge was reinforced when I applied it to my internal medicine patients at work, but I honestly feel like UWORLD/Anki helped me take care of patients more than patient care helped me learn the material in UWORLD. My UWORLD average was ~ 85% after the first pass. Once I finished the UWORLD QBank (early April), I started reviewing the CCS cases. I watched the tutorial videos on the USMLE website to get a feel for what CCS looked like, and I went right to the interactive cases to practice. I did 2-3 cases a day until I got through all 50ish of them, and I took notes of procedural things I kept getting wrong as well as knowledge gaps that came up. I skimmed the 40ish non-interactive cases, but I didn't spend much time on them since I felt that they didn't really help me with the skills needed for CCS. Of note, a lot of the workup and management suggestions in UWORLD cases seemed a bit excessive in my opinion. Once I had finished the cases, I had about 1 month left before my exam (this was thanks to COVID, which caused my test to be pushed back twice). I used this month to reset the UWORLD QBank and go through it again. I only got through about 50% of the QBank on the second pass but I did it on timed and random. During the week prior to my exam, I took the two UWORLD self assessments and scored 259 and 256 respectively.

I took the test on two back-to-back days and it felt pretty brutal. Day one has 6 blocks of 38-40 questions, and there were lots of ethics, biostats, drug ad, and basic science questions. Nothing outside of what I would have studied for step 1, but it was a bit jarring to see some of that stuff come back. I had more than enough time to finish the blocks but not enough time to check all of my answers. I felt that day one was more difficult than day 2, since many of the questions were vague (particularly the ethics/professionalism questions). Day 2 started with 6 blocks of 30 questions, and more than 95% of them were "know it or you don't" type questions. Lots of prognosis and risk factor questions but most of them were for common diseases. Unlike day 1, I was >90% sure of most of the questions on each block of day 2; I'd say maybe 5-8 questions per block were asking things I was unsure of or had never heard of. CCS was incredibly similar to UWORLD. 13 cases, 7 were 20 minute and 6 were 10 minute. The short cases were certainly more stressful since there is a couple-second delay every time you order something in the software. Overall, none of the scenarios were out of the realm of reasonable...there was a good mixture of medicine, surgery, psychiatry, OBGYN, and pediatrics, and all of the diagnoses and management algorithms were featured either in the UWORLD QBank or CCS cases. In all cases, I received some sort of positive feedback from the patient before the case ended (and all of my 20 min cases ended early). After the test, I felt as if a car had just run over me, but I was confident that I had passed. Having said that, I didn't know whether I'd be getting a 230 or a 260...there were several questions (at least 20) that I knew for sure I had gotten wrong and there were many more that I was unsure about. When I opened my score report and saw 271, I couldn't believe it and rechecked a few times just to make sure I wasn't hallucinating.

Overall, although I had a really strong basis in medicine/basic science going into intern year, I really believe that UWORLD and Anki made my score possible. Additionally, taking it slow and preparing for the test over the course of a year instead of trying to get through all of UWORLD in a few weeks allowed me to retain the information better. Studying this way also made my intern year less painful, as I was more able to generate plans without having to consult uptodate. I hope this helps somebody!

Some advice for CCS cases:
-If patient is unstable or sick, start with IV access, normal saline, cardiac monitoring, BP monitoring, pulse oximetry q1, oxygen therapy, and vital signs q1 (plus or minus EKG/troponin, blood glucose, neuro checks, and central line depending on the specifics) prior to a targeted physical exam.
-If you're admitting the patient to the hospital, remember to place an activity order, diet order, DVT prophylaxis order, vital signs q8, and routine labs (i.e. BMP and CBC q24).
-If you're sending the patient to surgery, remember to consult the appropriate surgical service (what you write in the consult doesn't matter), make the patient NPO, get type and screen and coags, administer antibiotics (cefazolin or ceftriaxone/flagyl if in the setting of abdominal pathology), and place a Foley and order urine output checks q8.
-Counsel appropriately during the final 2 minutes (no need to randomly tell everyone not to smoke and to wear a seat belt...just do whatever makes sense with the case).
 
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Congratulations! Not shocking given your testing history but a 271 on step 3 is extremely high. Most people drop on step 3 even with 260s on step 1 and 2.

I’m a bit surprised you devoted so much effort to step 3 given your testing history and specialty. Many people with that kind of background barely study. In any case, I am sure it will be helpful with medical derm. Congrats again!
 
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Jul 2, 2020
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Thanks for the kind words. Honestly my personality is such that if there’s a test, I’m going to prepare for it. Having said that, I think the way I studied made my intern year go more smoothly. UWORLD has such a wealth of information (particularly in IM) that I was able to apply directly to my job. This probably isn’t the case for other specialties given the medicine focus of Step 3, but for me the effort I put in to studying made my day-to-day experience at work much better.
 
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Jul 2, 2020
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I took it in early June on a Monday/Tuesday. The score came out 3 Wednesdays later (i.e. 15 days) and it was released at midnight going into Wednesday.
 
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Langerhans of Islets

2+ Year Member
May 13, 2018
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Hey everyone. I received my Step 3 score this morning (test date June 8-9), and needless to say, I was shocked. In the months leading up to my test, I struggled to find blog posts that detailed the test experience and provided sense of score prediction, so I figured I'd post here.

I'm currently a PGY2 in dermatology (Step 1 260, Step 2 267), but I prepared for Step 3 during my internal medicine preliminary year. I downloaded UWORLD for Step 3 during my first month of intern year, but I didn't even open the software until ~2 months in. I felt like I needed the first month or so to get used to the flow of things at the hospital. Once I felt comfortable-ish in my role as an intern, I started slowly going through UWORLD at a rate of ~ 10-15 questions per day on most days of the week. I used untimed tutor mode, and I would only do one subject at a time. After doing the questions, I reviewed the explanations in UWORLD and generated flashcards in Anki. For every disease in UWORLD, I tried to make sure I knew the cause/pathophysiology, risk factors, presenting symptoms, diagnostic algorithm, treatment algorithm, and major complications/prognosis. Admittedly, I was pretty lax when it came to risk factors and prognosis since I felt like it would be nearly impossible to know that information for every pathology. It took me most of the year to finish UWORLD at this slow pace, but I never felt overwhelmed, since I was doing it in such small chunks. A lot of this knowledge was reinforced when I applied it to my internal medicine patients at work, but I honestly feel like UWORLD/Anki helped me take care of patients more than patient care helped me learn the material in UWORLD. My UWORLD average was ~ 85% after the first pass. Once I finished the UWORLD QBank (early April), I started reviewing the CCS cases. I watched the tutorial videos on the USMLE website to get a feel for what CCS looked like, and I went right to the interactive cases to practice. I did 2-3 cases a day until I got through all 50ish of them, and I took notes of procedural things I kept getting wrong as well as knowledge gaps that came up. I skimmed the 40ish non-interactive cases, but I didn't spend much time on them since I felt that they didn't really help me with the skills needed for CCS. Of note, a lot of the workup and management suggestions in UWORLD cases seemed a bit excessive in my opinion. Once I had finished the cases, I had about 1 month left before my exam (this was thanks to COVID, which caused my test to be pushed back twice). I used this month to reset the UWORLD QBank and go through it again. I only got through about 50% of the QBank on the second pass but I did it on timed and random. During the week prior to my exam, I took the two UWORLD self assessments and scored 259 and 256 respectively.

I took the test on two back-to-back days and it felt pretty brutal. Day one has 6 blocks of 38-40 questions, and there were lots of ethics, biostats, drug ad, and basic science questions. Nothing outside of what I would have studied for step 1, but it was a bit jarring to see some of that stuff come back. I had more than enough time to finish the blocks but not enough time to check all of my answers. I felt that day one was more difficult than day 2, since many of the questions were vague (particularly the ethics/professionalism questions). Day 2 started with 6 blocks of 30 questions, and more than 95% of them were "know it or you don't" type questions. Lots of prognosis and risk factor questions but most of them were for common diseases. Unlike day 1, I was >90% sure of most of the questions on each block of day 2; I'd say maybe 5-8 questions per block were asking things I was unsure of or had never heard of. CCS was incredibly similar to UWORLD. 13 cases, 7 were 20 minute and 6 were 10 minute. The short cases were certainly more stressful since there is a couple-second delay every time you order something in the software. Overall, none of the scenarios were out of the realm of reasonable...there was a good mixture of medicine, surgery, psychiatry, OBGYN, and pediatrics, and all of the diagnoses and management algorithms were featured either in the UWORLD QBank or CCS cases. In all cases, I received some sort of positive feedback from the patient before the case ended (and all of my 20 min cases ended early). After the test, I felt as if a car had just run over me, but I was confident that I had passed. Having said that, I didn't know whether I'd be getting a 230 or a 260...there were several questions (at least 20) that I knew for sure I had gotten wrong and there were many more that I was unsure about. When I opened my score report and saw 271, I couldn't believe it and rechecked a few times just to make sure I wasn't hallucinating.

Overall, although I had a really strong basis in medicine/basic science going into intern year, I really believe that UWORLD and Anki made my score possible. Additionally, taking it slow and preparing for the test over the course of a year instead of trying to get through all of UWORLD in a few weeks allowed me to retain the information better. Studying this way also made my intern year less painful, as I was more able to generate plans without having to consult uptodate. I hope this helps somebody!

Some advice for CCS cases:
-If patient is unstable or sick, start with IV access, normal saline, cardiac monitoring, BP monitoring, pulse oximetry q1, oxygen therapy, and vital signs q1 (plus or minus EKG/troponin, blood glucose, neuro checks, and central line depending on the specifics) prior to a targeted physical exam.
-If you're admitting the patient to the hospital, remember to place an activity order, diet order, DVT prophylaxis order, vital signs q8, and routine labs (i.e. BMP and CBC q24).
-If you're sending the patient to surgery, remember to consult the appropriate surgical service (what you write in the consult doesn't matter), make the patient NPO, get type and screen and coags, administer antibiotics (cefazolin or ceftriaxone/flagyl if in the setting of abdominal pathology), and place a Foley and order urine output checks q8.
-Counsel appropriately during the final 2 minutes (no need to randomly tell everyone not to smoke and to wear a seat belt...just do whatever makes sense with the case).
Congrats on your great score and thanks for the write-up! Were the questions from microbiology more clinical or more detailed about the organism and stuff (capsulated/catalse/coagulase/number of strands etc)?
 
Jul 2, 2020
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Congrats on your great score and thanks for the write-up! Were the questions from microbiology more clinical or more detailed about the organism and stuff (capsulated/catalse/coagulase/number of strands etc)?

Overwhelmingly, the questions were clinical rather than basic science-y. There was one question that asked about a very specific feature of a microbe, and I had to guess (and got it wrong lol), but the VAST majority of the micro questions related to "most likely organism"/diagnosis/management.
 

Langerhans of Islets

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May 13, 2018
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Overwhelmingly, the questions were clinical rather than basic science-y. There was one question that asked about a very specific feature of a microbe, and I had to guess (and got it wrong lol), but the VAST majority of the micro questions related to "most likely organism"/diagnosis/management.
Great, thank you for answering!
 
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