Usmle Step 3
Step-3 is a computer based 2 day test comprising of 7-8 blocks of MCQs type questions on day-1 and 3-4 blocks on day two morning session. Afternoon session is Computer cases simulation (8-9 cases on computer, where you manage patient in different settings like in real life). Every block has like 30-55 questions depending the time limit which could be from 30 min to one hour. One key concept of the step-3 exam is that you should know that they are gonna ask something from Clinical SCIENCES, like steps of management, diagnosis protocols, level of treatment, a lot of points in ethics and medical communication, a lot of recent research stuff or recent happenings like GULF WAR syndrome. Weird questions which the patient ask during your own clinical practice. They assume that you know the diagnosis and sometime the intial basic level of management when they ask more advanced level of treatment. PLS. scroll down to look for helpful books for step-3 test…
It is a more clinical exam but I would say it is easier than USMLE step-2. There are a couple of reasons for that:
1. In this exam you have an idea that which environment you are working in, because at the start of every section
there is a “heading” which tells you in which environment you are working.
2. The other thing about the exam is that it is totally clinical and relatively few questions are on the basic sciences.
So you know pretty much that the answer for a certain question has to be clinical not basic and you don’t have to
study biochemistry and other basic details.
3. This exam is basically testing your clinical knowledge at different settings like emergency room, rural health
clinic, primary health clinic and other specific areas, so you have an idea about the answer.
For instance if there is question about a certain patient and you are sitting in a rural health clinic then obviously
you are not supposed to tick the answer choices which are like high-tech diagnostic tests (CT, MRI etc..), because
in that clinical setting you don’t have these equipment………
Anyway, step-3 exam is easier and if you are taking it after 01 year of residency then I think you do not need much to study.
Without a residency you should prepare the medical ethics and psychiatry topics very well.
The toll free no. for USMLE step-3 is 1800-USMLEXM (1800-876-5396) or visit the internet at (www.usmle.org), so contact them for your application forms and ask them if you have any specific question.
Step-3 scores are applicable in all state boards and it does not matter whether you pass it in New York or
elsewhere……….
COMPUTER BASED STEP-3, CBT
Dear friends, CBT step-3 is not much different, the exam still has 75% MCQs and 25% computer simulated cases (CCS-primum). Total two days, 1st day all MCQs blocks, 2nd day 1st half is MCQs blocks and rest are CCS clinical cases. MCQs are similar as they were in paper-pencil exam. The simulated cases are not too much different only difference is that it is interactve. Some of the good advices from the residents are:
1. Do these cases exactly the way you are trained in your residency programs, follow the standardized protocols you learn during residency.
2. Apply common sense and general medical knowledge as much as you can if you dont know the right answers.
3. In office settings and if specially the patient is coming for first visit, do the complete physical exam. In ER do the limited focused physical exam.
4. The frequently encountered problem is to forget about the clock forwarding settings, so keep in mind to forward the clock.
Some unusual cases, which need attention for management point of view are Turner’s syndrome, Alzheimer’s, Mental retardation, Congenital syndromes (Down etc..), These were the unusual cases my friends recently got in step-3 and I think they need extra attention.
Please follow the lik below for clinical cases..
Clinical cases on the internet helpful for step-3
Important notes from some of recent Step-3 exam
Exam notes from October 2000-2002, CBT:
quite a number on Gulf war syndrome questions and also brest implants, genetics chart and questions about that remember the old Autosomal dominant and recessive basic stuff. Tons of derma pics, some x-rays, and some ECGs. some questions on drugs like under trial or recently FDA approved like a patient would come in with news about the drug (like raloxifene) and how would you advise the pstient on that drug, things like that sort or the drugs FDA has recently disapproved. a lot of ethics questions and situational communication skills, like what would be the best response to the patient.
for clinical cases a lot of people have said HTN, DM, and most common in OB/Gyn are vaginitis cases on step-3. also follow link on my page for USMLE forums, its helpful. people have discussed their step-3 experiences on that forum.
some other notes about previous exams:
A couple of my friends took the exam, but they were mostly taking it without residency experience. One common thing, which all told me is the over all exam idea about management and treatment stragtegies. Since I have not tken it so I would try to put in my friend’s words.
Step-3 is basically more of management, ethics and problems which a resident deals in his routine clinical life. It could be an abused woman neglected child or could be step wise treatment of cancer pain. this kind of question is not very common in step-2 but in step-3, quite common.
Generally most questions with HTN, Diabetes, Afro-American people, and quite a no. with thyroid and BPH (prostate Hypertrophy).
Aspirin/acetaminophen toxicity, 10-15 questions. General preventive exams at different aged/sex people. Cancer pain management step-wise. geriatric pts. mostly with stroke and parkinson and some with multiple sclerosis.
male CA: lung (stages and treatment), prostate, testes
female: breast, cervix, endometrium
all skin cancers : basal cell, squamous cell, melanoma, skin slides, derma pictures, common diseases.
derma pictures of lyme disease, rocky mountain spotted fever.
ophthalmoscopic slides of HTN, DM.
some questions on glaucoma, and all types of conjunctivitis.
ENT questions mostly ear infections.
pulmonary embolism with DVT, specific tests/treatment.
endocarditis-prophylaxis, HTN in detail, with drugs and interactiona dn HTN with DM (which drug), HTN with asthma, these were very common questions.
pediatrics infections, croup, epiglotitis, bronchiolitis.
headaches types, myesthenia gravis, Carpel tunnel (usually with acromegaly and hypothyroid).
psychiatric patients and thyroid in reference to lithium, PTU drug and side effects. a lot of pharmacology, drung interactions.
DM , treatment, dose maintenance, lipid profiles in disorders and specific drug of choice.
cardiogenic shock, hemothorax, trauma,
blood anemia, neutropenia and infections, thrombocytopenia, HS purpura, sickle cell pain, anemia pictures.
GERD, raised liver enzymes, two spleen cases both traumatic.
lump breast diagnosis and treatment age wise.
SLE, temporal arteritis
dehydration, electrolyte balance, potassium (very important),
kidney, mostly GN, all types and specific points., UTi post coital drugs, long term repeated infections. incontinence in old ladies.
epilepsy, loading dose, drugs and pharmacology.
biostatistics, and very less questions on AIDS (this is unusual).
ENT question with follow up upto one year, like ear fluid and ear ache, RX immediate adn when pt. comes back with same problem after 3 wk, 6 wk, and 12 wks.
myringotomy pts. ..what to advise the parents.
pt, minor age dying from trauma, ethical question on transfusions..
pt. advance directive signed and the person responsible dies before the patient. what to do if pt nees treatment.
removal methods for tatoos.
this was the review from the friends who took the exam, do send comments and notes if you took the exam too…
The books to study for this exam are:
Dear friends, I recently took KAPLAN course for step-3 (MAY 2000). It was a good motivational course. All they told us is to concentrate on exam based study not medical knowledge. So it is an exam of pretty much current knowledge but not like FDA approves something yesterday and its gonna be on exam. So you have to be careful. The books for this exam are not very much defined but the best you can do is practice all MCQs available for step-3 and the books I have mentioned below.
The books like Mosby’s Ace the boards and Washington Manual and Fred Ferri are recommended. You should also consult NIH web site for latest development (HTTP://www.nih.gov). The other thing you can do is just review your basic concepts of Medicine (70-75% exam is gonna be Internal med). Rest the exam would be a lot of ethics, medical communication questions, so be ready for those subjective types of MCQs.
New edition 2000 of Family Practice review by Swanson has arrived . i dont know how good it is but you might wanna check out…It was a good book 3 yrs ago when the author was alive but since then it has not been updated and 33% of information in this book is out dated. So it’s not now the no.1 choice for MCQs practice any more. So it’s upto you if you want to buy this book or not…
4. USMLE step-3 review, Ace the boards, review by Mosby’s for step-3…
ONly MCQs for step-3, good for practice….highly recommended ..
the above two books would be good enough if you have finished one year residency training in USA. I think without residency you should read some more books like mentioned below..
Medical/Clinical Ethics books for STEP-3
1. Clinical ethics : a practical approach to ethical decisions in clinical medicine by Albert R. Jonsen, Mark Siegler, William J. Winslade….. …… Order clinical ethics, Today!
2. Practical ethics for students, interns and residents: a short reference manual by Charles Junkerman, MD and David Schiedermayer, MD. …… Order practical ethics, Today!
Boards and wards for step 2 and step-3….
A lot of other practice question books and review books are now available all at AMAZON.COM for reasonable prices… following is a list of all books with prices…
1. Crush Step 3 by Adam Brochert
2. Swanson’s Family Practice Review by Alfred F. Tallia (Editor), et al (same as i mention ealier)
3. Appleton & Lange’s Outline Review USMLE Step 3 by Joel S. Goldberg (Editor)
4. Review Questions for the USMLE, Step 3 Examination by Arshad Majid (Editor)….
5. Appleton & Lange’s Review for the USMLE Step 3 by Samuel L., Md. Jacobs
6. Blueprints Q&A Step 3 by Michael S. Clement, Gregory A. Maynard (Editor)……..
7. NMS Review for the USMLE Step 3 (Book with CD-ROM) by Mitchell H. Rosner, Andrew E. Lazar
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3. Southland tutorials MCQs for usmle step-3. These are recommended also for practice MCQs, South land series is good but too difficcult.
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. Books for step-3 and to read during residency….
Internal Medicine and Pedi
For antimicrobial therapy, this book is highly recommended.
Sandord Guide To Antimicrobial Therapy, 2000 (pocket edition) by Jay P Sanford .
2. Washington manual of medicine.
Washington Manual ….. ……
3. Fred Ferri Medical series
Practical Guide to the Care of the Medical Patient by Fred Ferri, MD…. …..
For pedi House staff (residents, the book to follow ), is Harriet Lane manual.
Harriet lane manual of pedi…. ….
For surgery House staff (pocket manual of ScHWARTZ)
Highly recommended Mont Reid surgical handbook……
Schwartz surgery manual pocket…. ……
For OB/Gyn House staff (pocket manual of Ob/gyn)
Ob/Gyn and inferility, hand book for clinicians, resident survival guide by GORDON…. …..
Also good series for step-3 and Int med board exams.
Others:
1. Med-study series booklets or MKSAP (it is very good and should be studied for quick review)
Medstudy booklets.
Reasons to do Step-3:There is an
Extra benefit for IMGs/ FMGs, if they pass USMLE step-3 before residency, they would be eligible for
H-1 visa which is much better than the usual J-1 visa for residency.
Most of the states in US requires that you should pass your steps 1, 2 and 3 with in 7 yrs. as a requirement for state medical boards but its my impression that if you dont pass the 3 steps in 7 yrs and they change the system like they did earlier from FMGEMS exams to USMLE then your step-1 and 2 would be disqualified if they bring in some new exams series. and you will have to do the new exam series. So it is better to pass the exams in 7 yrs.
visit for all info on state medical licensure requirementsFederal state medical board
