Got my score this past Wednesday 4/11/18, exactly 3 weeks after my second day of testing. Checked this thread compulsively for reassurance and inspiration in the weeks before and after my test, so wanted to follow in the footsteps of those before me and give back by sharing my stats. My story is a bit long-winded, but as long as it helps someone out there, it was well worth the time to write.
Step 1: 217 PASS (minimum 192)
Step 2 CK: 197 FAIL (minimum 209)
Step 2 CK: 208 FAIL (minimum 209)
Step 2 CS: PASS
Step 2 CK: 248 PASS (minimum 209)
Step 3: 207 PASS (minimum 196)
UWSA: 185. Taken on 3/4/18; freaked out and pushed my test back from 3/12 and 3/14 to 3/19 and 3/21. Would've pushed it back farther, too, if my schedule and the powers that be would've permitted it, but was already testing the limits of deadlines set by the military and my residency program.
UWorld: 61% correct, 75% complete, 39th percentile in random untimed tutor mode. Spent 3 weeks working my way through the bank, including 1 week of PTO dedicated entirely to studying. Also did the UWorld Biostats add-on, which was very high-yield and doable. Went over 3/4ths of UWorld interactive cases and all of Crush CCS, which I highly recommend. Took extensive notes on UWorld that I never reviewed, lol. I'm currently an intern in Family Medicine, so that clinical experience definitely helped. However, I did find it challenging to carve time for studying out of my already packed schedule.
Step 3: PASS 207. Taken 2 weeks after UWSA. Based on my score report, I only passed because of CCS. Only about half of my cases ended early, but I still scored in the higher performance range. Agree that CCS must be lenient because I made several mistakes on test day, even on the easy cases. Wasn't sure how to treat one thing and never figured out what exactly was going on in another, but felt the rest of the cases were fairly straightforward stuff that I'd seen before. Day 1 and Day 2 MCQs spanned the borderline zone, with a couple of X’s in both the lower and higher performance areas. Felt pressed for time throughout the entire test and typically had to spend less than one minute on the last 5-10 questions in each block because I didn't budget my time well. Selected an answer choice for all questions, though. Like everyone else, I thought I failed walking out. Feeling like you failed or passed has little bearing on whether you actually failed or passed.
Background: I did not feel prepared enough to take this test when I did, but my hand was forced by deadlines so I took it anyway. I have taken tests when I was not adequately prepared in the past (note two failures on Step 2 CK following a breakup; ability to study effectively was impaired, but I took the tests before I was ready because I was trying to graduate on time). These attempts did not pan out in my favor. Needless to say, finding myself in a similar predicament yet again (sans breakup, haha) gave me a sickening sense of déjà vu. I'm going to be a hypocrite and strongly discourage anyone from taking any USMLE board exam if you aren't passing practice tests by a healthy 20-point margin (except Step 3 UWSA, just pass that sucker if you can) because life is a lot harder with one fail and you risk your entire career as a physician with multiple fails. I've been there. It’s terrible and terrifying. I graduated 3 months late and matched the following cycle to an excellent Family Medicine program, my top choice, but I know of others in similar positions who were not so lucky.
Prep Recommendations: I’m probably not qualified to give advice on studying for Step 3 given that I barely passed, but here I go anyway. Remember, do as I say, not as I do! 😉 I’ll incorporate a few general strategies I used to improve my CK score to add credence to my Step 3 tips. If you performed well on board exams in the past, just do what you always do and you’ll probably be OK. If you’re someone who has struggled with board exams in the past, start prepping early and strive to do the following if time permits:
1) UWorld x2: Just get through it and read explanations on the first pass, then take notes on all wrong answers and marked correct answers you were unsure about on the second pass. Probably not a bad idea to do these in timed tutor on the first pass and non-tutor timed on the second pass. Agree with Sea Otter that questions should be approached as a learning tool. Time management is vital; shoot to spend no more than 90 seconds answering each question. Spend at least 3-5 minutes reviewing each answer; I averaged easily 10+ minutes on each answer, but I actually don't recommend dwelling for too long like I did because you won't make it through the entire bank. Be sure to spend 1 to 3 days reviewing notes prior to the test. Add MTB, Kaplan, etc. if you feel like you need to and have time, but who has time these days? UWorld is more reliable and detailed than either of these sources, so it makes more sense to know UWorld like the back of your hand than to spread yourself thin between several sources. The only time I would recommend using review books as anything more than an occasional reference is if you start studying several months in advance, want to build a strong foundation before embarking on questions, or just prefer the format of a particular book. Other than that, questions are where it's at.
2) UWorld Biostats: This was gold, definitely do it! I completed my first pass in one day by taking notes and Googling YouTube videos on foreign concepts, and I performed VERY well on the second pass after reviewing notes one week later. Would’ve killed Biostats on the actual test if time wasn’t a factor, but alas, time is always a factor.
3) UWorld CCS: Do both interactive and read-out practice cases. If I could do it all again, I would review the read-out practice cases and go through the scoring and time management sections of the interactive cases FIRST to familiarize myself with the orders and general strategy of CCS, THEN test myself by going through the interactive cases and manually inputting orders to compare my work with the rubric. I found the 10-minute cases to be the most challenging because I was strapped for time. UWorld CCS alone is enough to do well on CCS if you utilize it to the fullest extent. I personally found Crush CCS to be extremely helpful and read the whole thing in 2-3 days (an average resident could easily skim through in one day, but I take a bit longer). First 3 chapters are a solid intro to CCS, so this is a good place to start. Best thing I did was come up with personalized mnemonics to help remember what to order for each general complaint/scenario so I wouldn’t forget when under pressure.
4) Free practice CCS cases: I had planned on doing these the day between my first and second day to test myself and make sure I was comfortable with the software, but my laptop literally died in its noble attempt to download the cases. Fortunately for me, the format of UWorld CCS is nearly identical to the actual CCS, so the UWorld software alone was enough to make me comfortable on the real deal. At any rate, I would recommend the free cases even though I didn’t do them. Preparing for CCS is the best way to improve your score in a short period of time; it takes much more time and hard work to produce a comparative score increase with questions alone. Ideally, it’s best to be comfortable with both MCQs (75% of total score) and CCS (25% of total score), but reality is rarely ideal. Consider investing a little more tender love and care into CCS if you’re weak in MCQs and pressed for time. I have heard good things about the Archer videos and CCS cases d0t c0m (if you want practice with a scoring component, which UWorld does not offer), but I personally did not have time to use either of these resources. Might be a good idea for someone taking Step 3 before residency. Definitely don’t blow off CCS. At the very least, familiarize yourself with the software by practicing with the free cases like you would a new EMR.
5) Practice tests: Take either the UWSA or the NBME, or both if you feel so compelled. I can’t speak for the NBME, but the Step 3 UWSA is infamous for underpredicting scores. This is partially due to the fact that CCS is not taken into consideration (this also applies to the NBME). However, I suspect there may be issues with the scoring process of Step 3 UWSA itself. For instance, I read a post where someone scored higher than average on each of the four sections but was given a lower than average predicted score. It might be worth noting that I’ve personally met three other people who failed the UWSA and subsequently passed the Step 3 (one failed UWSA literally the day before his actual test and ended up passing Step 3 with a 210). That said, people who fail practice tests are much less likely to publicly report their scores if they fail the real deal. So take a practice test to gauge where you are and get exposure to more questions, but keep this info in mind when interpreting your score so you don’t lose your mind. You will likely never *feel* ready to take this test, but you can feel good about your odds if you complete UWorld at >60% correct on first pass (if not, a thorough second pass is definitely in order), spend 7+ days getting comfortable with CCS, and score a pass on UWSA.
6) SLEEP: If these tips were in any particular order, sleep would easily be #1. Managed to get 7 hours of sleep before each day of Step 3. Prior to my two fails on Step 2 CK, I got 3 hours and 1.5 hours of sleep, respectively, and was averaging 4-5 hours/night in the weeks prior. Prior to my third attempt, I prioritized sleep in the weeks leading up to the exam and even asked my doctor for a couple of Ambien (which I’d never taken before, so he prescribed #5 tabs so I could test it out the week before) because I was so desperate. Took it the night before my third attempt along with melatonin and Benadryl (didn’t care about the morning drowsiness, just wanted some shut eye) and managed to get 6 hours of sleep. Best thing I ever did. I don’t recommend all of that nonsense for the general population, and in retrospect I probably would’ve benefited from propanolol on the day of rather than sleeping pills, but the bottom line is that a good night’s sleep can be the difference between passing and failing if you’re close to the line. The medical profession seems to categorically undervalue the importance of sleep, and you’re doing yourself a major disservice if you fall victim to this mindset. Don’t skimp on sleep (or food, for that matter), before the test or in life. Your mood, attention span, cognitive abilities, and overall sanity are worth the time investment.
If you failed: It’s okay to feel devastated. Allow yourself time to cry and do whatever else you need to do to process what happened. Try to give yourself the same grace you would extend to a good friend. Failing does NOT mean that you’re somehow unfit to be a doctor. Remember that 2-4% of people who take the USMLE board exams are going to fail no matter what; the committee will continue to bump up the passing score as the average rises to cut out a small percentage of test-takers. A fail usually just means you took the exam before you were ready. Think of it this way: if a group of students were forced to take Step 3 on their first day of medical school, everyone would fail. But take those same individuals 5 years later and 97% of them pass. View yourself on that same continuum and have faith that your trajectory will eventually clear the mark. Choose to adopt a growth mindset and realize that you can expand your medical knowledge if need be to clear this hurdle with adequate preparation. If medical knowledge was not the issue, identify whatever was holding you back and address it head-on. After I failed CK the second time, one of my mentors told me that one day I would look back on this exam as a small hurdle that tripped me up a couple of times. He was right. So remember, your career is NOT over; all this means is that you have to pick yourself up and work harder than everyone else to get to the same place.
