Preparing for the USMLE Step 3 Exam Before Your Residency


Last week on the blog, we went over they key questions you need to ask yourself when deciding whether or not to take the USMLE Step 3 before you apply to a US medical residency program. Unlike the USMLE Step 1, Step 2 CK, and Step 2 CS (which we have also been discussing in recent weeks), the USMLE Step 3 is not required for ECFMG certification or for success in the residency application process. However, as mentioned in the previous blog post, you may consider it as an option, depending on your circumstances.

If you have made the decision to take the USMLE Step 3 before applying for your residency, there is nothing more important than ensuring that you are well-prepared to ace the exam on test day. There are several key reasons why:

  • If you fail the exam, the attempt appears on your transcript, which may cause concern for admissions officials when they review your application.
  • Some post-residency fellowship programs consider your USMLE Step 3 score as one of the factors in the admissions process.
  • If you are taking the exam in order to qualify for an H1-B Visa sponsorship, you need a passing mark.

Given these high stakes, it is essential to make sure you are ready before you take the USMLE Step 3. Read on to learn more about the basics of the exam and what you should do to get ready.

The Basics of the USMLE Step 3

The USMLE Step 3 is the last test in the sequence of exams that you need to pass to gain a license to practice medicine in the United States. It is a two-day exam that is designed to determine if you have the biomedical knowledge and clinical skills you need for success as a physician. The test includes both multiple-choice questions and computer-based case simulations.

On day 1, you take the USMLE Step 3 Foundations of Independent Practice (FIP) exam. This part of Step 3 lasts for seven hours and consists entirely multiple-choice questions. It is divided into six 60-minute blocks (38-40 questions per block), with short breaks in between blocks.

Much of the content on the exam is presented as patient case studies, but some of the items also ask you to interpret medical research abstracts or pharmaceutical advertisements. Some of the topics that are covered include:

  • Applications of basic biomedical science
  • Understanding of biostatistics, epidemiology, and population health
  • Communication abilities and interpersonal skills
  • Medical ethics
  • Systems-based practice
  • Patient safety
  • Knowledge of history and physical examination
  • Interpretation of diagnostic studies

On day 2, you take the USMLE Step 3 Advanced Clinical Medicine (ACM) exam. This part of Step 3 lasts for nine hours and consists of a mix of multiple choice questions and computer-based case simulations. It starts with six 45-minute blocks of multiple-choice questions (30 questions per block), followed by 13 case simulations (each of which lasts between 10 and 20 minutes).

On the computer-based case simulations, you will be evaluated on your performance in two settings: an office / health center and an emergency department / inpatient facility. For the multiple-choice questions, there are some areas of content overlap between the FIP and the ACM, but the main difference is that the ACM focuses much more heavily on diagnosis and management. You can expect to be tested on:

  • Prognosis and patient outcome
  • Health screenings
  • Health maintenance strategies
  • Therapeutics
  • Decision-making in the clinical setting
  • Knowledge of history and physical examination
  • Interpretation of diagnostic studies

Getting Ready for the USMLE Step 3 Before Your Residency Program

In order to do well on the USMLE Step 3 before starting your residency program, there are two main things you need to do:

  • Ensure that you have comprehensive understanding of the content of the exam.
  • Familiarize yourself with the format and the question types.

The USMLE website offers a comprehensive overview of the USMLE Step 3, as well as practice questions for the computer-based simulations. You can also find a variety of other study aids on the internet. Most of the content should be familiar from medical school and any clinical experience that you may have had — like a student elective or a graduate externship experience — but it is extremely important to familiarize with the test specifications so that you will be ready to apply your knowledge!

Even after you start studying, you should remember that you can always decide to wait to take the USMLE Step 3 until after you start your residency program. After all, in most programs, you have until your third year to pass the exam. If you start studying and realize that you do not have enough time to study for the exam and prepare a stellar US medical residency application, it’s probably better to wait. And you won’t really have wasted time, because any studying you did do will only benefit you when you take the USMLE Step 3 as a medical resident!

Need more help with the US medical residency application and preparation process? Contact FMG Portal today!