Dr. Zoofi's comprehensive guide to scoring 255 in USMLE Step 3

Step-by-Step Guide to Prepare for USMLE Step 3

Firstly, take a deep breath. This exam is not as hard as Step 1 and Step 2, mostly because everyone’s comparatively a little underprepared and the curve of the exam is more forgiving. Nonetheless, you still need to do your best, as you did in every other exam.

Exam Pattern Overview

The exam is divided into two days:

Day 1: Foundations of Independent Practice (FIP)

- Duration: 7 hours (with 45 minutes break time)

- Content:

  - Basic medical and scientific principles

  - Biostatistics and epidemiology

  - Diagnosis and initial management of common conditions

  - Patient safety and quality improvement

- Structure: 6 blocks of MCQs (1 hour each)

Guide to Biostatistics:

- Resources: UWorld questions + Dr. Randy Neil videos. 

 - Here are the Dr. Randy Neil Biostatistics Videos on YouTube (https://www.youtube.com/results?search_query=Dr.+Randy+Neil+biostatistics).

Guide to Acing MCQs:

- Key Resource: UWORLD! UWORLD! UWORLD!

- If you need the PDF of the notes I prepared, feel free to write to us. *Contact Us*

Day 2: Advanced Clinical Medicine (ACM)

- Duration: 9 hours (with 45 minutes break time)

- Content:

  - More complex clinical scenarios

  - Diagnosis and management of chronic and acute conditions

  - Computer-based case simulations (CCS)

- Structure: 6 blocks of MCQs + CCS cases

Guide to CCS Cases:

- Tips and Techniques: CCS cases are heavily emphasized. Here are some key strategies:

1. Prioritize High-Yield Cases:

   - If you are short on time, prioritize what's more important. I focused on the 50 most high-yield cases from the CCS Cases website https://ccscases.com.

   B. Stabilizing Orders (VOMICA)

   - Vitals

   - Oxygen/oximetry

   - Morphine/metoclopramide/magnesium

   - IV fluids

   - Cardiac monitoring

   - Accu-check (glucose check)

   - Acetaminophen

   - ABG

   C. ICU Orders

   - Elevate head end of the bed

   - DVT prophylaxis

   - Stress ulcer prophylaxis

   - Activity (bed rest, ambulate in room)

   - Output monitoring

   - Diet (NPO, type of diet, or NG tube if disoriented)

   - Suction airway if comatose or disoriented

   D. Pre-operative Orders

   - NPO, normal saline

   - Informed consent

   - Cefazolin (or another antibiotic like Ampicillin + Sulbactam)

   - PT/PTT

   - Name of surgery

   - Cross-matching of blood

   E. End of Visit Requirements (IT SCARS)

   - Influenza vaccine/illicit substances counseling

   - Tetanus

   - Seatbelt

   - Counsel patient & family/compliance with medication

   - Alcohol

   - Reassure

   - Smoking cessation

  Tip: At the beginning of the case, write the age/gender & appropriate screening exams next to it.

Tips for Exam Day Anxiety

1. Preparation: 

   - Ensure you’ve covered all the key topics and practiced with UWorld and CCS cases.

   - Organize all necessary documents the night before the exam. (Print out of the scheduling permit and ID proof)

2. Sleep:

   - Get a good night’s sleep before both days of the exam. How much a well-rested mind can help in tackling questions is underrated.

3. Exam Day Strategy:

   - Arrive at the test center early to avoid any last-minute stress. Try to locate the test center a day before.

   - Use the 45-minute break time effectively. Take short breaks between blocks to stay fresh. I would put my head down and close my eyes for 3-4 minutes after each block. I usually would move out of the exam hall after every 2 blocks. By going through the exam tutorial from the USMLE website, you can add 15 minutes to your break time.

   - Stay hydrated and bring snacks to maintain your energy levels. Have a nutritious breakfast to keep your energy levels stable. Have a mix of protein and carbohydrates to prevent a glucose crash. I ate an egg sandwich and a banana for breakfast. I also chewed on bits of dark chocolate, protein bars, and sipped coffee during the breaks to keep energy levels stable. If you drink coffee daily, don’t skip it on the exam day. Lastly, don’t forget to remain hydrated.

4. Mental Focus:

   - Practice deep breathing techniques to stay calm.

   - Focus on one question at a time, and don’t dwell on difficult questions for too long. You can come back to those questions later at the end of the block.

   - Remind yourself that it’s okay to feel nervous; everyone else is likely feeling the same way.

Remember, you've got this! Stay calm, stay focused, and give it your best shot. Good luck!

Feeling overwhelmed about the exam or short on time? We're here to help! Just let us know how we can support you by reaching out to us. We've got your back!

Warm Regards 

Dr. Zoofi Shan 🦋