Hey Guys:

Thanks for reading my Guide on How to Ace the USMLE STEP 3.  I think the common knowledge of STEP 3 being the easiest among the three is exams couldn't be further from the truth.  I will even go one large cynical step further by saying the well-known statement (Step 1, two months, Step 2, 2 weeks, Step 3 a number 2 pencil) was probably made-up by some gunners who wanted to se everyone fail.

My Prep:

I studied from September 2006 to November 6/7 2006 and I got in about 8 weeks.  I sometimes did not study until I got home which on some occasions was after midnight but I made sure to study EVERYDAY!  Even if you only can do a 1/2 hour before falling asleep, make sure your brain see's step 3 text or MCQ's at least once a day.  So if I had time off, I would say that my 8 weeks during my work responsibilities would be equivalent of 5 hard core weeks.

My exam:

I took the exam on a Monday/Tuesday.  This gave me the weekend to clear my mind, do some meditation, relaxation, sauna, jacuzzi and massage (no happy endings!) at the local spa.  I genuinely feel that you should not cram the last few days.  And that the relaxation and a good nights sleep will give you the clarity you need to be able to pull out info from your internal data bank (cortex) smoothly.  On day one, it was just like taking STEP 2 all over again.  About 8 blocks of 42 questions.  Each question stem was considerable shorter on average as compared to step 2.  But they were still treacherous.  It really become a test of stamina toward those last block.  The questions I got were TONS of internal medicine and family medicine.  Most of the patients has multiple comorbidities and were on polypharmacy.  They usually wanted you to tweak meds (beta blocks, ACEI, normalizing INR with coumadin dose) or they wanted you to tell them the BEST test to work up a change in condition.  I would say that most of the questions that I practiced with (USMLEWORLD) did not prepare you for this.  Also, there were lots of peds, vaccinations, and tons of DERM pictures!  Rashes, wounds, and I even had an electron microscopy photo.   Day two started off with about 4 blocks of less MCQ's (about 36) but the questions seemed a little longer and maybe more diagnosis oriented.  Which happens to be my strength but most people describe day 2 MCQ's as slightly more difficult.  After the blocks of MCQ's you are taken to the CCS section.  There are 9 cases.  They are a nice break from the grueling MCQ's and seem to be much easier to manage especially if you have already done your internship (unless you are psych, path, oph).  My CCS cases wre very random.  I am reluctant to do this but I will give you two of my cases (1. AIDS DIARRHEA, 2. HBV/management)  I would say that there is no good review book to prepare you for the CCS cases.  The back of the First Aid has a good section and THE HIDDEN GEM also has a good section but, Crush has nothing!  There is a really easy algorithm on how to approach the CCS cases on THE HIDDEN GEM (thestudyhookup dot com).  Basically before you even click to go to the next case, the algorithm tells you a formula to write down on your erasable market board.  ITS CLUTCH!  Makes the CCS cases easy.  Also, the FSMB disk that they give you really helps out a lot as far as the CCS cases but there are discrepancies ont he real thing.  FOr example, I screwed up my first case because I forgot to advance the clock but the FSMB disc never makes this step necessary.  I would say to all of you  PLEASE PLEASE PLEASE DONT FORGET TO ADVANCE THE CLOCK.  If you dont know what I mean, than do the disc or read the HIDDEN GEM CD file on CCS and you will understand what I mean.  Also I got a lot of questions about ALS for some reason.  There was a lot of neurology too.  Know your Guillane/Barre and neuritis.

Time Management:

I am a fast reader and had no problems with time on STEPS 1 and 2 but I did find myself rushing through the last 5 questions on a few blocks.  As I said above, the questions in my opinion were shorter than step 2 but they are more detailed.  Also, since they almost never ask you for a diagnosis on STEP 3, it tends to be a little more difficult to sort out the answer choices.  Someone told me to take a break btw each and every block.  Even if you dont go out of the room and sign out, just take a deep breath and close your eyes.  This was very helpful to me.  I actually went out to my locker between each block and wrote down my MCQ's that I remembered so that I can add it to my disc.  Anyway, the short break between blocks was very helpful.  Also, have a peice of chocolate (mild stimulant properties, theobromine) between every few blocks!  It helps!  Dont take a lot of caffeine unless that was how your prepared.

What I studied:

I did the FSMB disc about 10 times.  Like I said, it was very good except teh advance the clock feature doesnt seem as important on the practice disc as it is on the actual exam.  I read Crush about 3 times.  I though Crush was very specific for STEP 3 but had a low sensitivity.  What do I mean by that?  Well, you need to know all the material in CRUSH but, there is a lot more info that is not in Crush, that is necessary.  I purchased a CD which I also used to study that had some really useful files for STEP 3.  Since then, I added about 30 more files including my med schools Step 3 recall collection and my personal exam experience as a file.  With my CCS cases.  Its called THE HIDDEN GEM for Step 3.  Of all the review books out there......I would was that Strong Medicine is the best.  After taking the exam I thumbed through the book and there were several items straight out of my exam from Strong Medicine (DiCostanza).

All, I can say, is the opposite of what was told to me.  STUDY HARD!  THis is the hardest of the three exams HANDS DOWN!  Plus, it is the most relevant to real clinical material you will be seeing as a resident and and attending.  Unless of course you are in path, derm, oph, and other limited subspecialties ( I have no idea why path and rads residents need to take step 3 but I would bet that it wont be for much longer).

GOOD LUCK

Email me if anyone has any questions!  thestudyhookup at gmail dot com

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