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USMLE Step 3 Forum USMLE Step 3 Discussion Forum: Let's talk about anything related to USMLE Step 3 exam


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  #1  
Old 01-31-2016
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Default USMLE Step 3 Experience Jan 2016

Alright people. I just finished step 3 a few hours ago and thought I shared some of my thoughts regarding it.

Background:

IMG - British
Currently PGY 1 in London
Step 1 : Around 250
Step 2: Around 260

Preparation:

6 weeks. Mostly after work however. 1-3 hours ish a day

MTB Step 3 - 1 read through + another read through 9 months ago for finals at medical school

Conrad Fischer's Correlation and Clinical Scenarios (Internal med, peds, ob&gyn, and surgery) - 1 read through

USMLEWorld - about 400ish questions

USMLEWorld Self Assessment Score - 248

USMLEWorld Biostats review - 2 read throughs

USMLEWorld CCS Cases – I did 42, and then read through the remaining 9.

The Exam:

So I took the exam in 2 consecutive days. I did not want to do it this way, however because I have limited holiday time I had to do it 2 days in a row. But honestly, I found it to be alright doing it together. I felt like I was still in the zone when the second day rolled around and everything went by so quickly. Looking back at the exam, I am glad it was scheduled for 2 days in a row.

Day One - ~7 hours long.

6 Blocks one hour blocks of 40 questions + break time.

Biostatistics and Epi

Whooo boy. As a lot of other people have said, its pretty damn heavy on the biostats. About 8-10 questions per block, which makes it about 25% of the questions on day one. On the bright side, they are easy questions and therefore easy points. The majority of the questions were things like sensitivity, specificity, NPV, PPV, confidence intervals, bias, study design and etc. The Drug ad is also easy, but keep in mind these questions will take longer than normal questions so either leave yourself some extra time to do them, or do them at the end. I spent about 3 hours reading up on biostats and I felt comfortable answering the majority of questions on the exam. Read the UWorld Bio stats review, it’s all you need. It only takes about an hour to read through it as well.

Bottom line: Lots of easy biostats questions. USMLEWorld Biostats Review is all you need. Read it.

Basic Sciences

The “Step 1” style questions are actually quite rare. You might have 1 or 2 in the entire block. They are more or less straight forward. I did not purposely study any basic science information. You will not need to review First Aid or anything. Most of the questions were pretty basic/common knowledge or were easily deducible.

Bottom line: Do not worry about this. Do not study basic science crap. You will be fine.

The Rest

The other questions are very Step 2 CK-esque. These are the bread and butter questions, the majority are not hard. I will admit there were some questions that were difficult but in the end it felt very much like Step 2 CK.

Overall Impression

The first day went by very quickly. I did 2 blocks in a row and then took a 15 minute break. So I spent just under 7 hours in the Prometric center. Although this day was only 1 block less than Step 1, it just went by faster for some reason. I felt that it was a reasonable exam, not too hard but not too easy. I also did not have any difficulties finishing within the time limit.

Day 2 - ~ 9 hours long

6 Block of 30 questions, 45 minutes each
13 CCS Cases – six 10 minute cases and seven 20 minute cases.

MCQ Questions

It was a mix of Step 2 CK questions (most likey diagnosis, best initial treatment, most accuate test etc..) and a new type of question not seen in the prior steps. These were questions about prognosis of a certain diseases and questions that required complex decision making. The questions about prognosis were sometimes frustrating because prognosis is not covered in MTB. Nevertheless, the questions were not extremely hard and were normally evident or could at least be inferred. The questions that require more advanced medical decisions were difficult. These questions were definitely frustrating because in real life a specialist would be making these decisions. I found myself have to guess/attempt to deduce a correct answer because it was not always clear.

Bottom line: The Step 2 CK-esque questions were straightforward. The other ones were frustrating at times but could more or less be inferred/deduced, but you will probably have to guess some as well.

Biostats and Basic sciences

There were none of these questions.

Computer-based Case Simulations

Before I begin. If you just read Conrad Fishcers CCS books + do the USMLEWorld Cases, you will be golden.

Also these are my top tips for CCS:

Everyone at the ER gets: CBC, LFT, BMP, ECG, UA, CXR
Everyone who is septic gets: CRP, ESR, IV access, normal saline, lactate, foley, blood culture (+/- urine culture), oxygen, appropriate abx.
Everyone who is hypoxic: oximeter, ABG, oxygen, CXR
Everyone who gets admitted: Bed rest +/- bathroom privileges, pneumatic compression stockings, some sort of diet.
Everyone who is super sick/unstable: BEFORE physical exam order – iv access, normal saline, cardiac monitor, continuous blood pressure, oximeter +/- oxygen

The reason for these general order is because you can bang them out at the beginning of the case and it covers your bases without you having to think about what to do. If the diagnosis is not apparent from the history (but it should be because it is always barn door obvious) then these tests will usually help you come to a DDx.

Also why did I chose pneumatic compression stockings over LMWH? Because there are less contraindications to the PCS than there are to LMWH and therefore it is just easier to use those rather than having to assess risk of LMWH.

My thoughts

Very similar to the USMLEWorld Cases. They were straight forward and about half of my cases on the day were covered by UWorld. The other half were also very straight forward. I only got one case where I was not too sure on the treatment and therefore I treated the patient very conservatively. In the end she got better and it turns out that my conservative treatment was an acceptable treatment. However, my diagnostic sequencing was definitely wrong. The rest of the cases went well for me. I was surprised at how basic some of the cases were. For example, I had a case where the patient obviously had a gynecological cancer. It was a 20 minute cases, so I thought I had to diagnose the cancer, and then get the patient to the hospital and then organize the surgery. Once I diagnosed and staged the cancer, I sent the patient to the hospital to have it resected. But before I could make the patient ready for surgery, the case ended. I still had about 10 minutes to go as well.

All my cases ended early, and by a lot sometimes. When a case ends early, the extra time gets added to your break time. When I went into CCS, I had 20 minutes of break time remaining. By the end of CCS (I took three 5-10 mins breaks in CCS as well) I had an hour of extra break time. For example, I had a case where the patient had a very common infection that is normally empirically treated. I started the patient on antibiotics (which they were not allergic too), and took a culture. I sent the patient home with instructions to come back in a week. As soon as I sent the patient home, the case ended. That was a 10 minute case and I finished it in 3 minutes.

Bottom line: CCS is straight forward. Do the USMLEWorld Cases and read Conrad fishcers CCS books and you will be absolutely fine. I think CCS is the easiest part of the exam. Definitely have some sort of template for certain patients (like I listed above), it helps with speed and ensures you cover your bases and helps diagnosis issues.


Step 3 overall impressions


Definitely an exam which you need to revise for at least a month if you have to work as well. And at least 2 weeks if you are just purely studying. Its difficult at times and then dead easy at other times. My top tips are as follows

1.) Definitely recommend doing it 2 days in a row. Helps with the anxiety as well.
2.) Do your biostats review (USMLEWorld Biostats is all you need)
3.) You need MTB
4.) USMLEWorld CCS Cases are pure gold
5.) Basic sciences? What basic sciences? It is almost nonexistent in the exam. Don’t worry about it.
6.) Be ready for some inferring/deducing/guessing on the more difficult questions
7.) On CCS have a template for your patients (as I listed above)


(Hopefully I pass now...)


Good luck everyone!
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  #2  
Old 02-03-2016
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Default advice on prep material

Thanks for the informative post.
Which of your review sources were more helpful?
You mentioned MTB 3 is a must, how about the others?
Did you find Conrad Fischer's Correlation and Clinical Scenarios essential?
Any experience with Kaplan lectures or lecture notes?
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  #3  
Old 02-05-2016
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Thanks for your experience!

Why do you need MTB?

I am also curious about what the clinical case scenario book is about and how different it is from uworld's ccs teaching protocol?
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  #4  
Old 02-07-2016
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Default

MTB is a must because it has everything you need to know. I would say roughly 90% of the tested material on step 3 is in MTB. So if you know it well, you are pretty much good to go.

The Conrad Fischer books:

Internal medicine is the best. If you are only going to read one, read the IM one.

OB Gyn and Paeds are alright.

The Surgical one is horrendous compared to the others.. BUT it is still worth reading.

So we are all so used to writing exams in the same MCQ style. The CCS is a completely different beast. There are so many things that you will forget to "order" because in real life they either get done automatically, or a nurse does it etc.

The books are good because they will show you the common things that you will forget.

My advice is to definitely read the IM one. It is the most informative and has the most useful information. The Paeds, OBGYN, and surgical one are less informative but they will tell you specific tests/protocols/procedures that are not covered in the IM book.

USMLEWorld CCS. The cases are great practice. I also highly recommend you done them after you read the books. The issue with the UWorld CCS cases are they do not explain exactly why you are ordering a test/drug. The CCS Books go over each order and explain why you need them and why you need to do them now.



Quote:
Thanks for the informative post.
Which of your review sources were more helpful?
You mentioned MTB 3 is a must, how about the others?
Did you find Conrad Fischer's Correlation and Clinical Scenarios essential?
Any experience with Kaplan lectures or lecture notes?
All of the resources i mentioned in the first post were very helpful. The most helpful is MTB and USMLEworld CCS.

Kaplan lectures and lecture notes. I had them. Did not find them useful. The notes are difficult to read (just massive walls of text).
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  #5  
Old 02-08-2016
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Do you have any experience with First Aid? I feel it's better (and more up-to-date) than MTB. To be honest, I didn't find MTB for Step 2 CK that useful when I took that exam.
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  #6  
Old 02-09-2016
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Quote:
Originally Posted by PeterPan View Post
Do you have any experience with First Aid? I feel it's better (and more up-to-date) than MTB. To be honest, I didn't find MTB for Step 2 CK that useful when I took that exam.
Never seen FA Step 3. I enjoyed the format of MTB Step 2 CK so I naturally went for MTB Step 3. I liked the casual/witty nature of the book.

MTB was publish 10 months before FA so I guess FA would be more up to date. But I cannot comment on that as I have never read FA.
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  #7  
Old 02-16-2016
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Default uw for ccs?

Hi
for ccs in uworld, while practising, the cases dont end while i do all steps given in the explanation. my ques is, if i do only wat is given in uw ccs explanation under scoring n timing, is it fine? i dont hv clinical experience and i am essentially learning from ccs.
is uw enuf for ccs?
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  #8  
Old 03-01-2016
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Any update on your score? was it a number you were expecting?
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  #9  
Old 03-28-2016
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Default QBank

Thanks for sharing your experience. Did u try the other QBanks like Kaplan besides UWorld?
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  #10  
Old 04-05-2016
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Default great review

very good mate. appreciate the detailed info. best of luck
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