How To Study For Step 3 (Comprehensive Guide + Study Plans)

Below is the step-by-step comprehensive guide on how to study effectively for the Step 3 examination.

They are as follows:

1. USMLE Step 3 Isn’t Like The Others.

Step 3 is different from the other types of USMLE in many ways, which as a result of that, the preparation for the exam requires crucial guidelines different from the methods you can apply while preparing for a Step 1 or 2 examination as well as CK.

Firstly, the exam is divided into two separate days.

The first day consists of your standard multiple choice questions in a timed setting, while the second day is similar but with the addition of clinical cases. 

The cases cover a variety of clinical scenarios from emergency, to acute care, to chronic care.

So, you will need to familiarize yourself with triage as well as treatment. 

Though, Step 3 heavily emphasizes triage,  the delivery care and most importantly, ethics and biostatistics studies.

2. Create A timeline And A Test Date.

The first step in any study plan is to develop a timeline which will help to create boundaries regarding when you plan to take the exam and how much time you will have to prepare.

We must reiterate that leaving an open-ended Step 3 test date is strongly discouraged, as the associated perception that you have an unlimited amount of time to study may lead to inefficiency and procrastination.

Moreover, when you later attempt to book your test date, you may find that the dates previously available are no longer options and you have to defer your exam to later or travel to a distant testing center.

That’s why selecting dates for the exam should be based on consideration of your schedule and when it would be reasonable for you to both prepare for the test and have two days off to take it.

You should be realistic about when you will have time to study. 

So, if you have a series of challenging rotations on which you will be putting in long hours, it’s probably not wise to schedule your exam at the end of said block rather what would be preferable is to identify a period of time when you may be off or have a lighter workload, during which you may have nights or weekends available for studying.

Lastly, one last aspect is how you want to schedule the two days relative to each other. Many people elect to take both parts back to back and finish the exam in two days, while others might prefer to have a break in between the days. 

So, the decision on how to go about it is entirely your personal decision.

Though in my opinion, I will recommend that you take a few days in between to recuperate and prepare a bit more for the clinical cases as they are lengthy and have a difficult user interface which must be something you have not yet encountered in your career.

3. Do Well To Practice Questions And Tests Slips

The most important component of any study plan is to practice test questions. 

Among banks, the best and go-to option is UWorld which, much like it did for Step 1 and Step 2 CK, incorporates the highest-yield concepts into questions with well-written and researched explanations. 

In fact, this is the best place to start your studying, and you should make it a priority to get through a first pass with reasonable efficiency to afford the time to return to these questions and do as much of a second pass as possible. 

One great advantage of the UWorld bank is that it accounts for, and will also test you on, the higher-level ethics and biostatistics questions that you will encounter on the first test day.

So, If you finish UWorld once, or even twice, and have time remaining in your study period, you may look out for more questions. 

I will recommend AMBOSS. It is a newer bank that also offers Step 3-specific questions through which you can work. 

The AMBOSS questions tend to be slightly more challenging, in that they require you to pick up on minute details in longer vignettes in order to arrive at the right answer.

Regarding practice tests, your choices are the same as they were for the previous board exams and specifically the NBMEs and UWorld Self-Assessments. It is worthwhile to at least do the latter and then consider purchasing the former as time permits. 

While these tests will result in a three-digit conversion of your raw score, you should note that they are not full-length and only cover concepts tested in the multiple choice components on the exam days; they do not incorporate the CCS component which you will have to practice separately.

4. Buy A Textbook To Aid Your Step 3 studying.

Regarding textbooks for Step 3, much like Step 2 CK, a single stand-alone textbook does not exist as the go-to resource in the way that First Aid is for Step 1.

To that end, there is no single option that you should feel compelled to use. 

One textbook that is worth looking into is First Aid for the USMLE Step 3. While it’s not realistic or practical to read this or another similar resource from cover to cover, one way that it may be incorporated is by using it as a secondary resource to take a deeper dive into certain topics you self-diagnose as areas of opportunity.

For instance, if you feel like you are consistently getting questions about the indications for different classes of antiarrhythmics wrong and, despite the question explanations, still do not have a clear framework for how to think about these medications, it may be worthwhile to review this section in the textbook you choose. 

What is not necessary or advisable is spending excess time reviewing the entire cardiology chapter to relearn concepts with which you already felt comfortable.

5. Use Computer-Based Case Simulations.

A unique aspect of Step 3 is the Primum® Computer-based Case Simulations (CCS) component of the exam. While the multiple choice components of Step 3 may be very similar to what you experienced in Step 1 and Step 2 CK, this part will be very different. 

The single most important recommendation for approaching these cases is to become familiar with the software and how you will be timed and scored during the exam.

On the day of the exam, you will be presented with thirteen cases which start with a brief patient vignette that will include whether the context is an emergency department or an outpatient clinic and routine vitals signs. It is then your responsibility to perform a physical examination and begin to order diagnostic tests and begin to develop a therapeutic plan.

As you work through these cases, there are two simultaneous clocks running. 

One clock counts down how much real-world time you have remaining in the simulation which generally starts at ten or twenty minutes while the other clock moves forward in simulated time to correspond to the evolution of the condition of a patient.

So If this seems confusing, you should be rest assured that it is not intuitive for most people. 

However, for that reason, it is all the more important to do the practice cases within the UWorld interface to develop dexterity with placing orders in this simulated context and hone your clinical reasoning. 

If you are able to finish these with time and still have enough spare time as well, there are so-called printable cases that walk through additional examples so that you can continue to familiarize yourself with the rubrics with which you will be scored.

The Best Step 3 Review Courses

If you are still wondering how to study for Step 3 efficiently, here are some of the best Step 3 review courses you should try.

  • Kaplan USMLE Step 3 Prep Course

Kaplan USMLE Step 3 prep course is unquestionably one of the best. 

So, If you are going to take the boards and other exams, Kaplan will surely get you covered. 

It has about 900 practice questions that simulate the actual Step 3. It also includes 60 hours of video lectures which you could watch to refresh your fundamental medical knowledge. 

They also provide a tracker so you could check on your progress from time to time. 

However, you just need to set aside a lot of cash $999 for an access period of 3 months which in my opinion, I will say that the course is worth it.

  • BoardVitals USMLE Step 3 Study Materials

A cheaper alternative that you can use is the BoardVitals USMLE Step 3 Study Materials which comprises about 1,200 practice questions which is more than the questions set by the Kaplan course.

For $199, you will be granted access for 6-months to use the materials. 

However, it doesn’t include any video lectures.

So, there will be a need for another reference book as supplementary in case you need additional info for a particular topic. 

It also has a tracker that monitors your progress.

  • Doctors In Training USMLE Step 3 Review Course

With the 500 practice questions and 10-hour video lectures, the Doctors In Training USMLE Step 3 review course could also be an excellent choice to prepare for Step 3. 

With $249, you could have access to the resources for 45 days. That’s quite quick, but it will give you the pressure to push through studying for Step 3 because each day will actually count.


1. Is Step 3 Required For Residency?

No, it’s not. 

You need to be in residency for at least a year until you could take Step 3. 

So, Step 3 won’t matter in your residency applications. 

As long as you pass Step 3, you’re all good. 

However, take note that Step 3 is a mandatory exam so you could finally be a licensed physician. No Step 3, no license. Also, if you are an International Medical Graduate, you will be required to pass USMLE Step 3 to obtain an H1 Visa.

2. Can I Take USMLE Step 3 Before Residency?

Yes, you can. 

There are a lot of resources to help you prepare for Step 3. 

However, waiting to take the USMLE Step 3 until the start of your residency is preferable. 

Delaying it will give you more time to practice your skills which is a great way to learn and apply to crush Step 3. 

You have until your third year of residency to pass the exam. 

3. What Is A Good Score For Step 3?

According to NBME, the median Step 3 score of US medical graduates is 226. 

The 25th percentile is 216, while the 75th percentile is around 236. Starting in 2020, the minimum passing score for Step 3 was raised to 198. 

The passing rate among American/Canadian medical schools is 97% and for non-American schools is 86%. 

4. How Hard Is It To Pass USMLE Step 3?

Step 3 is relatively the easiest compared with the first 2 exams. Still, don’t become complacent because not everyone passes the exam. Nobody passes with just sheer knowledge. You still have to make some efforts to improve your skills, knowledge, and timing in answering time-pressured clinical questions.

5. How Many Times Can You Fail Step 3?

You may take Step 3 a maximum of 3 times within 12 months. In case you still fail on your third attempt, your fourth and subsequent attempts must be done at least 12 months after your 1st attempt and at least 6 months after the third one.

6. What Is Step 3?

Step 3 will test your knowledge and skills in handling various clinical cases independently. You will be assuming a two-day unsupervised responsibility in the provision of medical care. The first day will be the Foundations of Independent Practice (FIP), while the second day is referred to as Advanced Clinical Medicine (ACM).

7. How To Choose The Best Resources For Step 3?

Choosing the resources for studying in Step 3 is crucial as you don’t have the luxury of time to read and finish other books and Qbanks. 

Using too many may just lead you to end up failing to finish the entire resource and miss significant points for the exam. For most, UWorld is enough and the most important resource for Step 3.


Preparing for Step 3 exam is not the same as Step 1 or Step 2 or CK exams; that’s why it requires a specialized approach. 

So, to be able to be successful with Step 3, you will need confidence, dedication, and time even when you create timelines and have gathered enough resources.

With this, we hope that you will conquer this exam and come out with flying colors.

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