How to Create the Optimal USMLE Step 3 Study Schedule

USMLE Step 3 is the final step in the process of being licensed to practice medicine. Once you pass this exam, you’ll be eligible to able to practice medicine independently. Although there may still be specialty boards in your future, you could look at Step 3 as the culmination of your hard work to become a doctor.

By the time you get to this point, you have plenty of experience with taking standardized tests. It can even be tempting to skip the process of studying for Step 3. By the time you take this exam, you’ll be in the midst of long nights of clinical practice, and you’ll likely be exhausted. Studying can be a challenge. However, your Step 3 score does matter.

How should you create your USMLE Step 3 study schedule? What does your Step 3 score mean for your future in medicine? Should you even bother to worry about it? To answer these questions, it helps to begin with an overview of the whole USMLE process.

What you need to know about the USMLE

As you may already know, USMLE has three parts, called “steps.” (Because Step 2 itself has two parts, CK and CS, one could actually consider the USMLE to be composed of four parts.)

Step 1

The USMLE Step 1 is often administered after the first two years of medical school, and is a multiple-choice exam that covers the basic sciences. Many medical students consider Step 1 to be the most challenging part of the USMLE, and it requires a diligent study schedule in order to be successful. Your Step 1 score has a significant impact on your residency application. (If you’re looking for help studying for Step 1, we offer some advice here.)

Step 2 CK and CS

Step 2 consists of two separate exams, which are scheduled at different times and different testing centers. Step 2 CK (Clinical Knowledge) is another multiple-choice exam. Step 2 CS uses an entirely different format, with live actors playing “standardized patients.” The student performs simulated patient encounters, and grading is based on the quality of the interactions with the “patient” as well the student’s writeups. A numerical score is used for Step 2 CK, while Step 2 CS is pass/fail.

Generally, both parts of Step 2 are taken during the third or fourth year of medical school. In fact, many medical schools require passing Step 2 in order to graduate, and some residency programs will also require Step 2 CK scores in order to rank an applicant for the Match. This means the test must be taken by around January or early February of the fourth year of med school. (This gives time for the results to be reported, which can take 3-4 weeks.) Many people choose to take Step 2 CK by July or early August of the fourth year, so that results are available when ERAS opens for beginning residency applications in September.

Step 3

The USMLE Step 3 is a very clinically-focused exam, and is usually taken during the intern year (the first year of residency, after medical school graduation). This means that much of the material will be fresh in your mind from your time on the wards; however, it also means that you’ll have to study for the exam while simultaneously completing your highly demanding intern year.

Step 3 is a 2-day exam. The first day is fairly similar to Step 1 and Step 2 CK, and is a 7-hour multiple-choice exam. It consists of 232 items, divided into 6 sections with no more than 40 questions each. You get an hour to finish each block, with a 45-minute lunch break after the third block.

The second day lasts 9 hours and is broken up into two different test formats. The first part is a multiple-choice test of 180 items divided into 6 sections of 30 questions each, with 45 minutes for each section. The second part consists of case simulations (administered through a computer, not using live standardized patients as in Step 2 CS). There are 13 cases, and you get 10 to 20 minutes to answer all of the questions related to each case.

You don’t have to schedule the two days of Step 3 back-to-back. However, you must take Day 1 before Day 2, and the two days cannot be more than two weeks apart from each other. It’s best to schedule your exam near the end of a lighter rotation, or even a period of time off. This will give you time to prepare for the exam.

How much does your score on Step 3 really matter?

Honestly, the answer to this question depends on what your future in medicine looks like. If you’re planning to go straight into practice after your residency ends, then it may not be particularly important how well you score on this exam – as long as you pass it, of course. If you’re thinking of continuing your education after residency, such as by doing a fellowship in a subspecialty, then your particular Step 3 score may become more important, especially if you’ve chosen a more competitive field.

How can you prepare the right USMLE Step 3 study schedule?

By the time you get to Step 3, you’re an experienced test taker. At the same time, studying for this exam is a good idea, particularly if you’re at all considering applying for a fellowship or another program after residency. The material you’ll encounter on the wards during your intern year will very helpful on the exam, but there’s a lot of random chance in which patients you happen to encounter, so relying on your intern year itself to fully prepare you is unwise. It’s best to begin studying about a month before the exam.

Because Step 3 is a clinically-focused exam, you should let this guide your studying. Focus on case studies, to prepare for the case simulations you’ll encounter on Day 2. Even the multiple choice questions will often as you to apply medical concepts to clinical situations, so keep this in mind as you study. AMBOSS and UWorld are both great resources for preparing for the exam. (It’s likely that you used one or both of these as you prepared for previous USMLE steps.) Your Step 3 study schedule should include a block of focused exam prep time each day.

If you’re nervous about the USMLE Step 3, or have not performed as well as you would have liked on previous steps, then having an USMLE Step 3 tutor to help you prepare a study schedule may be helpful. Medlearnity’s highly-experienced tutors would be happy to help you. They’re physicians themselves, so they’ve been through this process and are excellent at guiding others to do their best on the USMLE. You can schedule a free one-hour tutoring session here.