Hack Your USMLE Step 3 Exam

Hack Your Step 3 ExamOne of the hurdles to becoming a “real doctor” is to pass all three parts to the USMLE or COMLEX Board Exams.  You have already taken Step 1, Step 2 CK and Step 2 CS , and the final hurdle is Step 3.  By this point in your training (assuming that you are a senior medical school student or new resident) you are very familiar with this three part Board Exam process.

2 Months, 2 Weeks, 2 Pencils . . . Really?

There is the old saying of “2 months, 2 weeks, 2 pencils” back we when took the exam on paper … that’s right, the exam use to be on dead trees.  Residents would pass along this “wisdom” in an effort to have Interns not stress out about Step 3.  All you had to bring two #2 pencils to take the exam and with your work as a resident, you would know the answers to the exam.

The problem with this statement is that there will be some residents who fail Step 3.

Why do they fail it?

They don’t study.

Why would you not study for a a high stakes exam that you have to pay to sit for?

What is on the USMLE Step 3 Exam?

Step 3 is a two-day exam which includes both multiple-choice and computer-based case simulations.

Day #1

During the first day, you will take 233 multiple-choice questions which are divided into 6 blocks of 38 to 40 questions.  (You have 60 minutes to complete each block.)  You have about 7 hours to take the exam on the first day.  (Including a built in 45 minute break you can take in-between the blocks and a 5 minutes tutorial.)  If you finish a block early, you can take extra break time.

Day #2

On the second day, you will take 180 multiple-choice questions that are divided into 6 blocks of 30 questions each.  (You have 45 minutes to complete each block)  This is followed by 13 clinical case simulations (CCS) and you are given 10 or 20 minutes of “real time” in which to complete each case.  (A minimum 45 minute break during this day is built in as well.)

When Should You Study for Step 3? 

Do yourself a favor and take Step 3 while you are in your Intern Year.

When you can take the Step 3 Exam during your Intern Year may depend on the state in which you are in residency.  Some states require you to take Step 3 after finishing your Intern Year while others allow you to take Step 3 after graduation from medical school.

While you are learning to do all the normal “doctor stuff” like treat myocardial infarctions, diagnose acute stroke with CT, and management of patients in the ED, use this time to reinforce your studying for Step 3.  The further you go into your clinical anesthesia years, the harder this test becomes, because you become more specialized.

How Much Should You Study for Step 3?

How much studying you should do is up to you.  You will be “studying” as you go through your Intern year just by working as an Intern.  It is still a good idea to sign up for Step 3 at least 6 months into your Intern Year.  (That gives you some time to get the getters out of being an Intern and allows some time to study)

Set up a study schedule that you have time to read and time to do some practice questions to get ready for the exam.

Step 3 is a general medical exam, so there is a broad amount of information contained in the exam.  You can see the content outline here.

You may need to brush up on such as OB, Peds, Surgery, if you don’t have rotations in those areas.

What Should You Use to Study for Step 3?

Study like you studied for Step 2 and you should do well.

If you are a minimalist, then pick a review book and question book or website (see Books and Websites below) and get after it.  Be sure to include a CCS review book so that you know how to manage these types of questions for the exam.  If you are a DO, be sure to brush up on your OMM if you are taking the COMLEX Step 3.  OMM is a high yield area to get some points for the COMLEX, that you don’t want to pass up.

USMLE / COMLEX Step 3 Books

You will want to get a high yield guide to help you focus in and have one or two sources to help get you pointed in the right direction.

Brochert’s Crush Step 3: The Ultimate USMLE Step 3 Review. I used a much older edition of this text and really liked it using to prep for Step 3.  When I looked abc through my second edition of this book, this 4th edition has a lot more to offer.  It has a section on Preventative Medicine and Biostatistics, Pediatrics, Internal Medicine,  OB/GYN, Psych and Ethics, Surgery, Radiology / Laboratory Medicine / Pharmacology, with a final section of Medical Images. It is available in paperback and e-textbook.


Crush Step 3 CCS: The Ultimate USMLE Step 3 CCS Review.   It is essential that you have a Computer-based Case Simulation (CCS) book to help you prep for Step 3.  You have to know how to answer CCS questions.  (This book came out after I took Step 3.  I couldn’t find the book I used on Amazon … it went out of print.)  There are 19 different CCS Cases by chief complaint.  It is available in paperback and Kindle format.



First Aid for the USMLE Step 3 has been a staple for years on the shelves of residents trying to get ready for the Step Exams, including Step 3.  The first chapter walks you through the exam, including the CCS.  Then each chapter is organized into different specialties.  The final chapter gives you some high yield CCS cases to study up on . It is available as paperback and kindle.



Master the Boards USMLE Step 3 is a newer edition to the Step 3 review genre.  It is organized into sections, with Internal Medicine being the largest.  It also incorporates a section on Preventative Medicine and one on Ethics.  I don’t know a whole lot about this brand, because I have not personally used it.  You can find Master the Boards on Amazon as a paperback or for your Kindle.



USMLE Step 3 QBook (USMLE Prep)SIXTH EDITION.  This is one of the better selling question book.  You might choose to skip this and use one of the online QBanks below, but if you are looking for a question book to study with when you don’t have a computer, this is the way to go.  Section one has study and test taking strategies, as well as the organization of the exam.  The other sections are practice questions/answers: Internal Medicine (4 practice test and answers), Neurology (2 practice test and answers), OB/GYN (3 practice test and answers), Pediatrics (4 practice test and answers), Psychiatry (2 practice test and answers), and Surgery (2 practice test and answers).  It is available as paperback.

COMLEX Step 3 Specific Books

OMT Review 3rd Edition – This is the most popular OMT review book on Amazon.  Having a “manip” review book is essential to doing well on COMLEX Step 3.  If you are in a predominately allopathic program, you might start forgetting some of the basic OMT things you knew like the back of your hand.  When I took the Complex Step 3 (I took both the USMLE and COMLEX Step 3) I used the Simmons book which has gone out of print.  When/if he releases it … I will update this article.  I do have his cram pages.  Savarese’s book is available as a paperback.


USMLE / COMLEX Step 3 Websites

Each of these websites offers different types of plans based on the amount of time you want access to their question bank.  Take a look at them and talk with some of the other residents so see how they like them.

Kaplan QBank is one of those companies that have been around for years.

UWorld USMLE QBank  is a relatively new company in the test preparation space.  When I ask residents what they are using to study, UWorld is quite popular.

Looking for other ways to Hack your Anesthesia Intern Year?

Check out our article How to Use Your Intern year to Prepare for Your Anesthesiology Residency. It offers and see other ways lay a good foundation for your anesthesiology training.  Think you are going to be too busy to study during residency?  Check out our article Studying on the Move to help you build up your Anesthesiology Knowledge while working as a resident.